Symptoms of Gallbladder Cancer
Gallbladder cancer typically presents with symptoms that mimic benign biliary disease—most commonly right upper quadrant pain resembling biliary colic or chronic cholecystitis—which is why the majority of cases are diagnosed at advanced stages or discovered incidentally during cholecystectomy. 1
Why Early Detection Is Difficult
- Early-stage gallbladder cancer is asymptomatic, making preoperative diagnosis extremely challenging even with modern imaging techniques 2, 3, 4
- The aggressive nature of the tumor allows rapid spread, contributing to late-stage diagnosis 1
- Clinical presentation overlaps significantly with benign gallbladder disease, particularly symptomatic cholelithiasis and chronic cholecystitis 1, 5
- Most diagnoses (incidental findings) occur during or after cholecystectomy performed for presumed benign disease 1, 3, 4
Common Presenting Symptoms
Localized Symptoms
- Right upper quadrant pain is the most common presenting symptom, especially in advanced cases where disease has spread beyond the gallbladder 6
- Symptoms indistinguishable from biliary colic or chronic cholecystitis (intermittent RUQ pain, often postprandial) 1
Obstructive Symptoms (Advanced Disease)
- Jaundice occurs in approximately 50% of gallbladder cancer cases (compared to 84-90% in cholangiocarcinoma), indicating biliary obstruction from tumor invasion 6, 7
- Pale or clay-colored stools result from inability of bile pigments to reach the intestinal lumen 7
- Dark urine occurs because conjugated bilirubin accumulates in bloodstream and is excreted by kidneys 7
- Pruritus (intense itching) is caused by bile salt deposition in the skin 7
Systemic Manifestations (Advanced Disease)
- Weight loss, malaise, and fatigue are typical systemic manifestations of advanced malignancy 1, 6, 7
- Night sweats may accompany other constitutional symptoms 6
Less Common Presentations
- Suspicious mass detected on ultrasound performed for other indications 1
- Fever is uncommon unless cholangitis develops as a complication, typically after biliary drainage attempts 1, 6, 7
Clinical Pitfalls to Avoid
- The absence of fever in a patient with jaundice and RUQ pain should raise suspicion for malignancy rather than infectious/inflammatory causes 6, 7
- Painless progressive jaundice with pale stools and dark urine, without fever, is the classic presentation of malignant biliary obstruction including gallbladder cancer 7
- Gallbladder wall thickening without pericholecystic fluid in an older patient with elevated alkaline phosphatase should raise concern for gallbladder cancer rather than cholecystitis 8
- Do not assume benign disease based on typical "cholecystitis" symptoms alone—maintain high index of suspicion, particularly in older patients 1, 8
Laboratory Abnormalities That May Accompany Symptoms
- Obstructive pattern of liver function tests: elevated alkaline phosphatase (most specific), bilirubin, and gamma-glutamyl transpeptidase 1, 6, 7
- Aminotransferases (AST/ALT) are markedly higher in gallbladder carcinoma compared to uncomplicated cholecystitis, particularly in older adults 6
- Prolonged prothrombin time/INR may develop from vitamin K malabsorption due to chronic biliary obstruction 1, 6, 7
- Low albumin and hemoglobin reflect advanced disease with systemic effects 6
- Reduced fat-soluble vitamins (A, D, E, K) occur with prolonged obstruction 1, 6, 7