Introduction
Carcinoma of the gallbladder is an uncommon gastrointestinal malignancy that has a very poor prognosis. Carcinoma of the gallbladder ranks fifth in incidence of gastrointestinal carcinomas. Carcinoma of the gallbladder is a disease of elderly women, with a female to male ratio of about 3.2 to 1.
What causes Gallbladder cancer?
Although the etiology of gallbladder carcinoma is unknown, several epidemiologic risk factors have been proposed. Of these, cholelithiasis has been most frequently implicated as a possible risk factor.

What are the symptoms of Gallbladder cancer?
In its early stages, carcinoma of the gallbladder is usually asymptomatic. The lack of specific signs or symptoms prevents detection of this cancer at an early and resectable stage. Moreover, when symptoms do occur, they usually resemble those of benign gallbladder disease.
Common symptoms include abdominal pain, nausea, vomiting, weight loss, and anorexia. A changing pattern of the character of the pain is usually described. Physical findings may include tenderness or a mass in the right upper abdominal quadrant, jaundice, cachexia, fever, and ascites.

How Gallbladder cancer is diagnosed?
Laboratory findings in patients with gallbladder carcinoma are nonspecific. Liver function abnormality is the most common lab finding in these patients. Serum alkaline phosphatase, direct bilirubin, and serum aspartate aminotransferase levels are elevated in 50% or more of cases. Elevated carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) may be found.

Ultrasonography is abnormal in 98% of patients (with findings including cholelithiasis, a thickened gallbladder, a mass in the gallbladder, or some combination).

Computed tomography (CT) scanning and magnetic resonance imaging (MRI) are useful in evaluating the extent of invasion and resectability of gall bladder tumors. 

Positron emission tomography (PET) scanning is not used routinely in the preoperative staging or postoperative surveillance of the disease.

Diagnostic Procedures

What is the treatment for Gallbladder cancer?

Surgical Therapy
Operative resection offers the only chance for long-term survival. 
 Patients with localized gall bladder cancer are evaluated for surgical resection. Surgery is contraindicated in the presence of distant metastases. If the tumor was diagnosed incidentally in a surgical specimen, re-resection is indicated for T1b or deeper lesions.

Malignant lesions are commonly staged laparoscopically in order to exclude the presence of undetected intra-abdominal metastases prior to curative laparotomy. Staging laparoscopy is also shown to be effective when the cancer was diagnosed following laparoscopic cholecystectomy.

T1a gall bladder cancer can be treated with simple cholecystectomy.

Patients with T1b or deeper gall bladder cancer are treated with hepatic resection and lymph node dissection that includes the portal, gastrohepatic ligament, and retroduodenal nodes. Resection of liver segments IVb and V are frequently adequate to achieve negative margins. In some cases, extended liver resection and/or bile duct resection may be necessary to achieve negative margins.

Chemothrapy
Chemotherapy dose not help significantly to the patients with gallbladder cancer. However, chemotherapy is used in the adjuvant and palliative treatment of gallbladder cancer in selected cases.

Endoscopic Retrograde Cholangio Pancreatography (ERCP) stenting
It a palliative procedure used to alleviate bile duct obstruction which helps to relive the jaundice.

Percutaneous Transhepatic Biliary Drainage (PTBD)
Like ERCP it also alleviates the bile duct obstruction. It is used alternative to ERCP or when ERCP fails.