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Gallbladder Cancer

Clinical Description: Gallbladder Cancer

Gallbladder cancer is a very rare but usually lethal malignancy, accounting for only 5,000 cases per year in the United States. If discovered early in its course there is a good chance for a cure, but due to lack of symptoms, most patients present with advanced disease, and at this stage, the prognosis is poor. 


Symptoms of Gallbladder Cancer
Some of the symptoms of gallbladder cancer include: fever, pain in the right upper portion of the abdomen, nausea, loss of appetite, weight loss, jaundice (yellowing of the skin and eyes) and bloating. Older persons with a history of gallstones or other gallbladder diseases, along with women and Native Americans are all at increased risk of the disease.


How Gallbladder Cancer is Diagnosed
Initially, an abdominal ultrasound may be done to evaluate some the symptoms. A computed tomography (CT) scan will also be helpful in identifying the location of the tumor and the extent of disease. Another imaging modality is an endoscopic ultrasound which can also help visualize the extent of local spread to lymphatics and can be used to obtain a biopsy. Blood work to evaluate liver function as well as markers that can be elevated in gallbladder cancer, called carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) will help in the assessment and monitoring of the disease. A procedure to look at the bile ducts may be recommended to give the doctor more detailed information. This procedure is called an endoscopic retrograde cholangiopancreatography (ERCP). In this procedure, a small tube is inserted through the mouth, passed through the esophagus and stomach and then dye is injected into the bile ducts to look for obstructions. These obstructions can then be opened with the use of a stent (small tube) relieving pressure off of the ducts and liver and improving some of the symptoms, like jaundice, itching, and sometimes pain. With this method, it may also be possible to obtain a tissue sample for diagnosis. It is also possible to obtain a diagnosis by obtaining a biopsy surgically. 


Stages of gallbladder cancer include:

• Stage I: cancer is confined to the inner layers of the gallbladder.
• Stage II: : cancer has grown to invade the outer layer of the gallbladder and may protrude into nearby organs, such as the liver, stomach, intestines or pancreas or involve nearby lymph nodes
• Stage III: cancer has grown to invade more than one of the nearby organs, or it may invade the portal vein or hepatic artery.
• Stage IV: includes tumors of any size that have spread to distant areas of the body.

Treatment Options for Gallbladder Cancer at Tufts Medical Center

For early stage disease, surgery can be curative. Surgery involves removing the gallbladder and sometimes part of the liver and surrounding lymph nodes, if the cancer is more extensive. Following surgery, a combination of chemotherapy or chemotherapy and radiotherapy can be useful to prevent recurrence in some cases.

With more advanced disease, surgery is not indicated. If the cancer has spread outside the gallbladder, chemotherapy and/or radiation therapy can be used to control the growth and symptoms of the disease. Occasionally a stent would be placed in the bile ducts to help with jaundice. The goal of these therapies is to control symptoms and maintain or improve the quality of life.
 


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Doctors + Care Team

Roger Graham, MD

Roger Graham, MD

Title(s): Chief, Division of General Surgery; Chief, Surgical Oncology; Director, Breast Health Center; Surgeon; Associate Professor, Tufts University School of Medicine
Department(s): Surgery, General Surgery, Surgical Oncology
Appt. Phone: 617-636-8270
Fax #: 617-636-9095

General surgery, surgical oncology, thyroid surgery, breast cancer

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Joel V. Weinstock, MD
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Joel V. Weinstock, MD

Title(s): Chief, Division of Gastroenterology/Hepatology; Professor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-4505

Gastroenterology, inflammatory bowel diseases, mucosal immunity, general gastroenterology, GI bleeding, endoscopy

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Andrew G. Plaut, MD
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Andrew G. Plaut, MD

Title(s): Gastroenterologist; Professor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-4207

Gastroenterology, digestive diseases, gastrointestinal infections and parasitic disease, inflammatory bowel disease, diagnostic evaluation of unexplained pain or diarrhea

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Barbara J. Weinstein, MD

Barbara J. Weinstein, MD

Title(s): Staff Pathologist; Assistant Professor, Tufts University School of Medicine
Department(s): Pathology and Laboratory Medicine
Appt. Phone: 617-636-5829
Fax #: 617-636-8302

General surgical pathology, cytopathology, gastrointestinal pathology

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E. Kent Yucel, MD

E. Kent Yucel, MD

Title(s): Radiologist-in-Chief; Ettinger–Dreyfus Chair and Professor of Radiology, Tufts University School of Medicine
Department(s): Radiology, CardioVascular Center
Appt. Phone: 617-636-0040
Fax #: 617-636-0041

Interventional radiology, general radiology

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Gary M. Strauss, MD, MPH

Gary M. Strauss, MD, MPH

Title(s): Medical Director, Lung Cancer Program; Professor, Tufts University School of Medicine
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-6227
Fax #: 617-636-8538

Lung cancer, melanoma, breast cancer, genitourinary cancer, solid tumors

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Harmony Allison, MD
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Harmony Allison, MD

Title(s): Gastroenterologist; Clinical and Research Instructor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-1480

Gastrointestinal motility, inflammatory bowel disease, general GI and endoscopy, diarrhea, constipation, celiac sprue and limited LFT abnormalities

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Hoon Ji, MD, PhD

Hoon Ji, MD, PhD

Title(s): Chief of Body MRI; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology
Appt. Phone: 617-636-4916
Fax #: 617-636-2578

Body MRI, general radiology

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Judith F. Katz, MD

Judith F. Katz, MD

Title(s): Chief of Ultrasound; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology
Appt. Phone: 617-636-7818
Fax #: 617-636-1499

Ultrasound, nuclear medicine, body CT, mammography, general radiology

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Kathleen Viveiros, MD
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Kathleen Viveiros, MD

Title(s): Director, Gastroenterology/Hepatology Fellowship Program
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-4207

Hepatology, pre- and postliver transplant, hepatitis, chronic liver disease, general gastroenterology

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Kathryn Huber, MD, PhD

Kathryn Huber, MD, PhD

Title(s): Radiation Oncologist; Assistant Professor, Tufts University School of Medicine
Department(s): Radiation Oncology
Appt. Phone: 617-636-6161
Fax #: 617-636-6131

Radiotherapy for cancers of the lung and gastrointestinal tract

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Kevin Daly, MD

Kevin Daly, MD

Title(s): Interventional Radiologist, Cardiovascular and Interventional Radiology; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology, CardioVascular Center
Appt. Phone: 617-636-3004
Fax #: 617-636-1149

Diagnostic and interventional radiology, general radiology

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Laurence H. Brinckerhoff, MD

Laurence H. Brinckerhoff, MD

Title(s): Surgeon; Associate Professor, Tufts University School of Medicine
Department(s): Surgery, General Surgery, Thoracic Surgery
Appt. Phone: 617-636-5589
Fax #: 617-636-9095

Thoracic surgical oncology, minimally invasive surgery, clinical trials, tumor immunology

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Lori B. Olans, MD, MPH
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Lori B. Olans, MD, MPH

Title(s): Gastroenterologist; Assistant Professor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-8615

General gastroenterology

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Martin D. Goodman, MD

Martin D. Goodman, MD

Title(s): Surgeon; Director, Peritoneal Surface Malignancy Program; Assistant Professor, Tufts University School of Medicine
Department(s): Surgery, General Surgery, Surgical Oncology
Appt. Phone: 617-636-9248
Fax #: 617-636-9095

General surgery, advanced abdominal tumors, peritoneal surface malignancies, hepatobiliary/pancreatic/colorectal minimally invasive surgical oncology

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Moises Guelrud, MD
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Moises Guelrud, MD

Title(s): Gastroenterologist; Professor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-4505

Gastroenterology, sphincter of Oddi manometry in children and adults, ERCP (diagnosis and therapeutic) in children and adults, ECRP (diagnosis and therapeutic) in children and adults, endoscopic diagnosis and treatment of Barrett's esophagus, magnification endoscopy and chromoendoscopy, pancreatic diseases

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Nayer Nikpoor, MD

Nayer Nikpoor, MD

Title(s): Chief of Nuclear Medicine; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology
Appt. Phone: 617-636-6342
Fax #: 617-636-9109

Nuclear medicine

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Neil J. Halin, DO, FSIR

Neil J. Halin, DO, FSIR

Title(s): Chief, Cardiovascular and Interventional Radiology; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology, CardioVascular Center
Appt. Phone: 617-636-3004
Fax #: 617-636-1449

Peripheral vascular disease, biliary and urinary obstruction, thrombo-embolic disease, vascular disease, general radiology

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Robert Martell, MD, PhD

Robert Martell, MD, PhD

Title(s): Medical Oncologist; Associate Professor, Tufts University School of Medicine
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-6227
Fax #: 617-636-8538

Phase I clinical trials, GI oncology, breast cancer, head and neck malignancies, liver tumors

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Wasif M. Saif, MD

Wasif M. Saif, MD

Title(s): Director, GI Oncology Program; Leader, Experimental Therapeutics; Professor, Tufts University School of Medicine
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-6227
Fax #: 617-636-8538

Chemistry and pharmacology of folate antagonist, experimental therapeutics, clinical trial design (Phase I and II), cancers treated include pancreas, gall bladder, cholangiocarcinoma (bile duct), anal, colon (including Rectum), neuroendocrine (carcinoid), psedomyxoma peritonei, esophagus, gastroesophageal (including Stomach), liver, unknown primary, GIST, adrenal, peritoneum, phase I clinical studies of novel cancer drugs and/or combinations

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