Gallbladder Wall Thickening: Can it be cancer?

As a Gastrointestinal oncologist, one of my goals is to help people understand concerns that arise during routine health check-ups or investigations. One of the frequent findings in abdominal ultrasound or CT scan is a thickening of the gallbladder wall. Let’s understand this condition better.

What is the gallbladder?

The gallbladder is a pear-shaped organ underneath your liver and behind the lower ribs in the right upper abdomen. It stores bile, concentrates it and releases it when we eat. Bile is a digestive juice produced by the liver. The gallbladder is connected to the liver and intestine through a thin tube called the common bile duct (CBD). The CBD carries bile from the liver and gallbladder to the intestine.

What Does Gallbladder Wall Thickening Mean?

The gallbladder has a thin wall. When the gallbladder wall is thicker than normal (3 mm) on imaging scans, we consider it abnormal. It is a common problem and can result from many conditions. It can also sometimes be a sign of gallbladder cancer.

What Causes Gallbladder Wall Thickening?

Several conditions cause the thickening of the gallbladder wall. Most of them are inflammatory and benign, but we need to keep the possibility of cancer in mind.

Common causes of gallbladder wall thickening include:

Cholecystitis (inflammation of the gallbladder): This is one of the most common causes of gallbladder wall thickening. Stones in the gallbladder usually cause this condition. It can present as an acute emergency or chronic pain.

Xanthogranulomatous cholecystitis: It is a variant of cholecystitis that often mimics gallbladder cancer.

Adenomyomatosis:  There is a growth of the inner lining that invaginates into the crevices of a thickened muscularis forming so-called Rokitansky-Aschoff sinuses. Cholesterol crystals precipitate in bile trapped in the Rokitansky-Aschoff sinuses.

Gallbladder polyps: Polyps are an abnormal growth of cells and tissues. They look like small, flat bumps or tiny mushroom-like stalks on the inner lining of the gallbladder wall, projecting into the gallbladder lumen. Gallbladder polyps are relatively common. They are reportedly present in 5% of the population. Most of the gallbladder polyps are benign (non-cancerous). Some larger polyps could be malignant (cancerous) or have the potential to become malignant.

Hepatitis, cirrhosis, heart failure, renal failure, sepsis and pancreatitis: These medical conditions also cause thickening of the gallbladder wall.

Gallbladder cancer: Gallbladder cancer begins in the inner layers of the gallbladder. It gradually grows beyond the gallbladder wall and spreads. India has the highest rate of occurrence of this disease in the world and women are three times more likely to develop gallbladder cancer compared to men.

Is Gallbladder Wall Thickening a Sign of Cancer?

As mentioned in the previous paragraph, there are several causes of gallbladder wall thickening, and one of them is gallbladder cancer. In most cases, gallbladder wall thickening is due to non-cancerous causes. It is important to carefully assess each case and actively search for signs of cancer, as early diagnosis and proper treatment are crucial for a successful outcome if cancer is present.

What Should You Do If You Have Gallbladder Wall Thickening?

If you have been diagnosed with gallbladder wall thickening, there is no need to panic. It is important to consult with a specialist who will conduct tests to determine the cause of the thickening and provide appropriate treatment.

Diagnosis of gallbladder wall thickening

Diagnosis means identifying a disease. The following tests will help us make the diagnosis of gallbladder wall thickening and find the cause of it.

Physical history and examination: Understanding symptoms and checking for signs by a physician are the basics of arriving at a diagnosis. There are certain signs such as fever and short durations of illness which favour a noncancerous diagnosis while lack of appetite, weight loss and jaundice signals cancer. but these signs are only suggestive and not definitive.   

Blood tests: Complete blood count measures the distinct cells in the blood. Besides, liver and kidney function tests assess the function of these organs. We also do tumour markers such as CA 19.9 which helps us make the diagnosis.

Ultrasound (USG): An ultrasound scan uses high-frequency sound waves to create an image of the inside of the body. This is a basic test to see the liver, gallbladder and bile ducts. Most gallbladder wall thickening is identified on USG.

Computed tomography (CT) scan: CT Scanner acquires images of the inside of our body with the help of x-ray beams. These images are then computer-processed, giving an accurate representation. Contrast injected into the blood enhances these images.

Magnetic resonance imaging (MRI): Instead of X-rays, it uses radio waves and strong magnetic fields.

Positron emission tomography (PET) scan: Cancer cells take up a larger amount of glucose. Here injected radioactive glucose (18F-fluorodeoxyglucose; FDG) binds to the tumour, and the patient is scanned. The images are computer-processed and combined with CT images, giving us a CT image with bright-coloured tumours. It can be sometimes useful in differentiating benign from malignant thickening and in staging the disease when cancer is suspected.

Biopsy or FNAC: Biopsy means sampling a small piece of the tumour and examining it under a microscope. It is usually not done due to the possibility of it being falsely negative is significant, making it unreliable.  

Despite advancements in technology and testing, distinguishing non-cancerous gallbladder wall thickening from cancerous thickening can be challenging at times.

Treatment of gallbladder wall thickening

The treatment for gallbladder wall thickening depends on its cause. If it's due to medical reasons, we need to treat the underlying medical condition. Small polyps and adenomyomatosis can be monitored through regular follow-up. Inflammatory conditions such as cholecystitis and suspected cancer will require surgical treatment.

Surgery for gallbladder wall thickening

The type of surgery for gallbladder wall thickening depends on the risk of cancer. Gallbladder removal surgery is called a cholecystectomy.

There are three types of cholecystectomies these patients will undergo depending on the possibility of cancer being present.

Simple cholecystectomy

In this procedure, only the gallbladder is removed. The plane of dissection is between the gallbladder and the liver. This is done when the chances of the thickening being cancerous are minimal.

Radical (extended) cholecystectomy

This is the standard surgical procedure for gallbladder cancer. This procedure is done when we think that the thickening is cancerous. It involves removing the gallbladder, along with its liver bed to the healthy tissue procedure.

Anticipatory extended cholecystectomy:

When the chance of thickening being cancer is uncertain, the gallbladder is removed along with the liver bed. The removed tissue is then sent for a frozen section where a pathologist will examine it for the presence of cancer. If cancer is detected, adjacent lymph nodes are also cleared.

The possibility of thickening in the gallbladder wall being cancer exists on a spectrum from non-cancerous to cancerous. Surgical procedures are chosen based on probability, balancing the risks of undertreatment and overtreatment.

There are two ways surgeons do these surgeries

1. Open Surgery: This involves making a single long incision over the abdomen to perform the surgery.

2. Minimally Invasive Surgery: This includes laparoscopic or robotic procedures, which use tiny incisions and special long thin surgical tools for the surgery. This approach results in faster recovery and reduced pain compared to open surgery. However, it requires expertise, so it's important to ensure that your surgeon is skilled and experienced in these techniques.

Laparoscopic surgery for gallbladder wall thickening

In laparoscopic surgery, the surgeon stands beside the patient and manually manoeuvres the instruments.

Robotic surgery for gallbladder wall thickening

Here a robotic interface is introduced between the patient and surgeon. the surgeon sits at a console, and robotic arms equipped with surgical instruments mirror his hand movements. It combines the skill and expertise of a surgeon with the vision, precision, and flexibility of robotic technology.  

Take-Home Message

Gallbladder wall thickening is a common finding, and the majority of them are due to non-cancerous conditions. However, there is a possibility of cancer, and it’s important that proper diagnostic workup and treatment planning is done.

Early detection and appropriate treatment can save lives.
Stay Alert! Stay Healthy!
Wish you a speedy recovery!