Gallbladder Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses strong medicines to kill cancer cells. The medicines attack and kill cells that grow quickly, like cancer cells. But some normal cells also grow quickly. Because of this, chemotherapy can harm those cells, too. This can cause side effects.

When might chemotherapy be used to treat gallbladder cancer?

Chemotherapy can help some people with gallbladder cancer. It is not yet clear how useful chemo is in treating gallbladder cancer. There are ongoing clinical trials of chemo for gallbladder cancer, as well as chemoradiation. This combines chemo and radiation therapy. Surgery is the first-line treatment when a cure is considered possible. Chemo may be used: 

• After surgery (often along with radiation therapy) to kill any cancer cells that may be left, and help lower your risk that the cancer will come back

• To help shrink tumors to relieve symptoms, if you're too sick to have surgery or the cancer has spread

• As part of treatment for cancer that has spread, or if not all of it can be removed

How is chemotherapy given for gallbladder cancer?

Chemo medicines may be put right into your blood (into a vein) or given as pills. They then enter the bloodstream and reach all areas of your body. This is called systemic treatment.

People who can't have their gallbladder cancer removed by surgery may have chemotherapy that's given right into the main artery going into the liver (hepatic artery). This is called hepatic artery infusion (HAI). Injecting the chemo here sends more medicine right to the tumor. The liver then removes most of the remaining chemo before it can reach the rest of the body. This can lessen the side effects.

Sometimes when gallbladder cancer can't be removed, HAI can help the person live longer or more comfortably. But more research is needed.

What are the medicines used to treat gallbladder cancer?

The chemo medicines used most often for gallbladder cancer include:

• Gemcitabine

• Cisplatin

• 5-fluorouracil

• Capecitabine

• Oxaliplatin

In many cases, 2 of these are combined as 1 treatment. This can help the chemotherapy work better.

Possible side effects

Chemotherapy is designed to attack and kill cells that divide quickly, including cancer cells. Chemo can also affect normal cells that divide quickly. These include hair and skin cells, and bone marrow cells where new blood cells are made. The side effects of chemo are different for everyone. They depend on:

• The dose and type of chemo you're taking

• How often you get chemo

• How long your treatment lasts

• Your age, overall health, and other factors

Side effects can include:

• Hair loss

• Mouth and throat sores

• Rash on the hands and feet

• Rash anywhere on your skin

• Appetite loss

• Nausea and vomiting

• Diarrhea

• Increased chance of infections from low levels of white blood cells

• Easy bruising or bleeding from low levels of blood platelets

• Tiredness from low levels of red blood cells

These side effects usually go away over time after treatment ends. There are often ways to lessen these side effects. For example, medicines can help prevent or reduce nausea and vomiting. Be sure to ask your healthcare provider what can be done to help reduce side effects.

Some medicines can have their own unique side effects. For instance, cisplatin and oxaliplatin can damage nerves. This can cause numbness, tingling, weakness, and sensitivity to cold or heat, especially in the hands and feet. This is called peripheral neuropathy. It slowly goes away in most people after treatment stops. But for some people, the effects can last a long time.

Tell your healthcare team about any side effects you have. Most side effects can be treated. In some cases, the dose of chemo may need to be adjusted. Or treatment may need to be delayed or stopped to keep side effects from getting worse.

Working with your healthcare provider

It's important to know which chemotherapy medicines you're taking. Write down the names of your chemo medicines. Ask your healthcare team how they work and what side effects they might have.

Talk with your healthcare providers about what signs to look for and when to call them. For example, chemo can make you more likely to get infections. Make sure you know how to contact your healthcare provider, including evenings, holidays, and weekends.

It may be helpful to keep a journal of your side effects. Write down physical, thinking, and emotional changes you notice. A written list will make it easier for you to remember things when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage side effects.