Clinical Appearance:

Since there are no specific symptoms of carcinoma of the gallbladder, the cancer is usually diagnosed when it has already progressed to an advanced state. Patients may complain of abdominal pain or distention, weight loss, nausea, or anorexia. Jaundice is the first symptom in some patients. This occurs when the tumor directly or indirectly causes an obstruction in the normal flow of bile from the liver to the small intestine. Bilirubin, a component of bile, builds up within the liver and is absorbed into the bloodstream in excess amounts. This can be detected in a blood test, but it can also manifest as yellowish discoloring of the skin and eyes. The patient may also experience pruritis, or generalized itching, due to the deposition of bile components in the skin. Occasionally an abdominal mass in the upper right or central region of the abdomen can be felt on physical examination.

Jaundice is the most common symptom of carcinoma of the bile duct, resulting from blockage of the bile duct with tumor. The excess bile components in the bloodstream can cause pruritis and dark coloration of the urine. Normally, a portion of the bile is excreted in stool; bile actually gives stool its brown color. But when the biliary tract is obstructed by tumor, the stools may appear pale. Abdominal pain, fatigue, weight loss, and anorexia are less common symptoms. Occasionally, if obstruction of the biliary tract causes the gallbladder to swell enormously, the gallbladder may be felt during a physical examination. Sometimes the biliary tract can become infected, but this is normally a rare consequence of invasive tests. Infection causes fever, chills, and pain in the right upper portion of the abdomen.

Cancer Staging:
       Carcinoma of the gallbladder and bile duct are staged according to the tumor-node-metastasis (TNM) system of the American Joint Commission on Cancer (AJCC). This staging scheme assesses the invasiveness of the tumor, the involvement of nearby lymph nodes, and the extent of distant spread. A higher stage signifies worse prognosis.

Stage I tumors of the gallbladder are confined to the inner layers of the bile duct itself. Stage II tumors extend to the outer layers. Stage III tumors have spread to nearby lymph nodes or a directly adjacent organ. Stage IV tumors have invaded deeply into the liver or have spread to multiple adjacent organs. Involvement of distant organs or lymph nodes is also included in Stage IV.

The staging of carcinoma of the bile duct is similar to that of the gallbladder. Stage I tumors are confined to the inner layers of the bile duct itself. Stage II tumors extend to the outer layers. Stage III tumors have spread to nearby lymph nodes. Stage IV tumors have invaded other organs in the abdomen or distant lymph nodes.