Bile Duct &
Gallbladder Cancer

Hoag Family Cancer Institute offers exceptional medical and surgical treatment for bile duct cancer. Our subspecialized team of medical oncologists and surgeons employ groundbreaking research and the latest diagnostics and therapies to give you the very best odds at beating cancer.

If you are experiencing any symptoms that might suggest bile duct cancer, your doctor will talk to you about your symptoms, likely followed by a thorough physical exam and bloodwork. Depending on the outcome of those tests, your doctor may refer you to a specialist for other tests that may include:

• Checking for high levels of carbohydrate antigen CA 19-9 in your blood, which can sometimes suggest the presence of bile duct cancer.

• Endoscopic Retrograde Cholangiopancreatography (ERCP): In this test, the doctor passes a long, flexible tube with a camera at the end through your mouth, through the stomach and into the bile ducts to visually examine them.

• Liver function tests

• Imaging tests that may include CT, PET or MRI scans.

• Surgical biopsy

The Hoag Family Cancer Institute offers world-class programs to treat cancer of all types, including bile duct cancer, with multidisciplinary teams, state-of-the-art facilities and technology and the latest in cancer therapies.

Treatment options for bile duct cancer depend on many factors, including how advanced the cancer is when detected, your age and any other health issues you may have. Treatments for bile duct cancer vary from patient to patient, but may include:

• Surgery

• Biliary drainage

• Liver transplant

• Immunotherapy, which primes your immune system to fight the cancer

• Chemotherapy

• Radiation therapy

  • Hoag radiation oncologists and medical physicists work together with the Hoag team of bile duct cancer experts to develop an individualized treatment plan using the latest radiation therapy techniques

  • Image-Guided Intensity-Modulated Radiation Therapy (IG-IMRT)

  • Stereotactic Body Radiation Therapy (SBRT).

• Precision Medicine, in which Hoag physicians test the DNA of patients’ tumors, then develop treatments tailored specifically to the mutations that caused the cancer. This allows physicians to treat the cancer very precisely. Hoag is a national leader in the use of precision medicine in several types of cancer, including bile duct cancer.

Facing surgery can be a frightening prospect, but it is a vital component in the successful treatment of many cancers. The Hoag Family Cancer Institute’s medical team includes experienced, fellowship-trained cancer surgeons who utilize the latest techniques and technology in the surgical management of many different cancers, including bile duct cancer.

Hoag’s non-surgical options, including chemotherapy and radiation therapies, are world-class as well. Hoag was recently named a Radiopharmaceutical Therapy Center of Excellence (RTCoE) by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), a distinction held by only 17 centers in the U.S. including Stanford Health Care, Harvard Medical School and the University of California — San Francisco.

Hoag Family Cancer Institute’s Radiation Oncology Program offers personalized services to treat cancers. Explore advanced treatment technologies for cancer treatment available at Hoag.

Hoag is committed to leading the way in state-of-the-art technologies and advanced treatment options. Part of this commitment includes clinical research with the goal of helping patients live longer, healthier lives. Through carefully planned clinical trials, researchers evaluate the safety and effectiveness of new ways to diagnose, treat and prevent diseases or conditions. Treatments studied in clinical trials might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. View clinical trials for biliary-gallbladder cancer here.

Hoag Family Cancer Institute offers exceptional medical and surgical treatment for gallbladder cancer. Our subspecialized team of medical oncologists and surgeons employ groundbreaking research and the latest diagnostics and therapies to give you the very best odds at beating cancer.

Currently, there are no blood tests or other non-invasive techniques that can definitively screen for gallbladder cancer. Because the disease usually presents no symptoms, gallbladder cancer is often found during unrelated abdominal surgery, gallstone-related surgery to remove the gallbladder, or after the cancer has spread and started to impact other organs.

After discussing your symptoms, your physician will likely give you a thorough physical exam and may order blood tests. While not able to show the presence of gallbladder cancer, these blood tests can show elevated levels of albumin, bilirubin, liver enzymes and other substances that may indicate problems in your gallbladder, bile ducts or liver.

Your blood will also likely be checked carefully for what’s called tumor markers, which are substances made by cancer cells.

Depending on the outcome of those blood tests, your physician may order imaging tests to get a look inside your body. These may include:

• Abdominal ultrasound, which utilizes sound waves to create images of the organs and other structures inside the abdomen using a radio wave source outside the body.

• Endoscopic or laparoscopic ultrasound, in which an ultrasound generating device on a long, flexible cable is inserted down the throat or through small incisions made in the abdomen so the ultrasound device can be positioned closer to the gallbladder

• Computed tomography (CT) scan

• Magnetic resonance imaging (MRI) scan

• Cholangiography, which is an imaging technique that looks directly at the bile ducts

• Biopsy, in which a small sample of tissue or bile fluid is painlessly removed so that it can be tested for the presence of cancer

Accurate diagnosis is a priority at Hoag. A more accurate diagnosis leads to better outcomes and fuller recoveries for patients. Among the advanced techniques Hoag uses to diagnose gallbladder cancer: Volume Rendering Computed Tomography, which creates highly accurate 3-D scans of the abdomen, allowing physicians to properly stage the cancer and determine whether surgery is a good option. Hoag is one of only a few centers in Southern California that have this advanced imaging technology.

If your doctor determines you have gallbladder cancer, the next step is to determine whether the cancer is limited to the gallbladder or has spread to other organs and structures inside the body. How much the cancer has spread will help determine a treatment path and priorities.

Diagnosis is key to your treatment and recovery, and no hospital in California is more committed to accuracy in diagnosis than Hoag. At Hoag Family Cancer Institute, our gallbladder cancer team includes medical oncologists, radiation oncologists, advanced endoscopists and surgeons, all work together to provide the right treatment for you. Learn more about Hoag’s specialized gallbladder cancer team.

At Hoag Family Cancer Institute, our multidisciplinary team offers globally-recognized options for those facing this challenging disease, with treatments tailored to meet each patient’s specific needs.

At Hoag, surgical options for gallbladder cancer may include:

• Laparoscopy, which involves inserting a long, flexible camera through incisions in the abdomen to look for evidence of cancer that wasn’t revealed in previous scans, to plan for upcoming surgeries or to determine whether a patient’s cancer is resectable, meaning that it can be removed completely, or unresectable, which means it is too far advanced for surgery.

• Simple cholecystectomy, which is an operation to fully remove the gallbladder. People can live long lives without their gallbladder and removal of the gallbladder is common in the treatment of conditions like gallstones. This procedure can either be performed “open” through an surgical incision in the abdomen, or laparoscopically, utilizing thin video devices and surgical tools inserted through very small incisions in the abdomen. However, in the case of known gallbladder cancer, a more extensive operation is usually performed, known as…

• Extended (or radical) cholecystectomy, in which surgeons remove at least the gallbladder, liver tissue near the gallbladder and all nearby lymph nodes. Depending on how advanced the cancer is, the surgeon may also remove a larger portion of the liver, the common bile duct, the ligament that connects the liver and intestines, the pancreas, part of the small intestine or other organs that have been invaded by cancer cells.

According to the American Cancer Society, gallbladder cancer is rare, but only a small percentage of gallbladder cancers are considered curable when discovered. That said, there are widely-differing opinions on how advanced gallbladder cancer can be before surgery is no longer a good option.

For that reason, the ACS suggests getting a second opinion, particularly from a major, highly-experienced cancer center like Hoag Family Cancer Institute. Facing a gallbladder cancer diagnosis in Orange County? Then get a second opinion that could save your life. Trust Hoag.

The Hoag team performs more complex gallbladder cancer surgeries than any other surgical program in Southern California. We utilize state-of-the-art, robotically-assisted and minimally-invasive procedures that may not be available elsewhere. Being a high-volume gallbladder cancer surgical program enables the gastrointestinal experts at Hoag to achieve a technical skill level many other centers just can’t match.

At Hoag, we often combine techniques to address complex conditions like gallbladder cancer from all sides. In addition to surgery, non-surgical options for gallbladder cancer at Hoag may include:

• Radiation therapy, which may be recommended either before or after surgery, often in combination with chemotherapy. Hoag is one of only two hospitals in California with the ViewRay MRIdian™ linear accelerator, the most advanced radiation treatment available in the United States for cancers of the abdomen. By utilizing MRI imaging with a linear accelerator, Hoag clinicians can obtain real-time, high resolution images of tumors and surrounding soft tissues. This allows for precise application of radiation during treatment, even if the tumor shifts due to breathing or other factors. That level of precision allows Hoag clinicians to deliver a higher, potentially more effective, radiation dose to the tumor with minimal impact on healthy surrounding tissue.

• Hoag Radiation Oncology also offers other state of the art technologies such as Tomotherapy HD to provide for the most accurate image guided radiotherapy systems today. Explore more about Hoag’s state-of-the-art equipment here.

• Chemotherapy uses drug therapy to help destroy cancer cells. Chemotherapy is often combined with radiation therapy to treat cancer that has spread beyond the esophagus to nearby organs. Chemotherapy and radiation may be used after surgery to reduce the risk that gallbladder cancer may recur. In individuals with advanced gallbladder cancer, chemotherapy may be used alone or it may be combined with targeted drug therapy.

• Targeted therapy and precision medicine, utilizes DNA testing of patients tumors, to help select and formulate drugs that attack specific abnormalities within cancer cells. For example, the targeted drug erlotinib (Tarceva) blocks chemicals that signal cancer cells to grow and divide. This drug is usually combined with chemotherapy for use in people with advanced gallbladder cancer.

Hoag is committed to leading the way in state-of-the-art technologies and advanced treatment options. Part of this commitment includes clinical research with the goal of helping patients live longer, healthier lives. Through carefully planned clinical trials, researchers evaluate the safety and effectiveness of new ways to diagnose, treat and prevent diseases or conditions. Treatments studied in clinical trials might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. View clinical trials for gallbladder cancer here.

Hoag’s Precision Medicine Program combines genomics and genetics to diagnose, treat, and prevent diseases. Using the latest advances in genomic technologies, targeted therapies and research, our precision medicine program brings together a multidisciplinary team, including a robust genetic counseling group of experts, to provide patients with the latest in innovation and technology.

Meet the Precision Medicine Team.

Being diagnosed with cancer can feel overwhelming at times. Many patients and their families need help with coping and can benefit from supportive counseling. Oncology Clinical Social Workers are available to provide emotional and practical support during all stages of cancer including diagnosis, treatment and post-treatment survivorship.

Find out more and meet our team.

Hoag Family Cancer Institute dietitians work closely with patients’ physicians, nurses, therapists, and social workers to ensure complete care.

Find out more and meet our team.