# Gallbladder adenocarcinoma

Source: https://onco.cc/cancers/gallbladder-adenocarcinoma/  
OnCo record `gallbladder-adenocarcinoma` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adenocarcinoma is the usual form of gallbladder cancer, about nine in ten cases, starting in the mucus-making gland cells of the lining. Everything on the main gallbladder cancer page (causes, staging, surgery, chemotherapy with immunotherapy) is written about this type unless it says otherwise.

## Summary

Adenocarcinoma of the gallbladder arises from the glandular epithelium of the mucosa, usually on a background of chronic cholecystitis and gallstones, and in the WHO classification (5th edition, 2019) is subdivided by pattern: the common biliary (pancreatobiliary) type, intestinal type, gastric foveolar, mucinous, signet-ring, clear cell, hepatoid and other rare patterns (Nagtegaal 2020; Roa 2022). Cancer Research UK uses a simpler split into non-papillary, papillary and mucinous adenocarcinoma. In the largest pathology series conventional pancreatobiliary-type adenocarcinomas had a female to male ratio of 3.9 and a mean size of 2.9 cm (Dursun 2012, in which they were the comparator for mucinous carcinoma). Grade (1 well, 2 moderate, 3 poorly differentiated), depth of invasion (T category), the T2a or T2b side, lymphovascular and perineural invasion, node number and the cystic duct margin are the pathological findings that drive treatment (CRUK stages and grades; Shindoh 2015; Aloia 2015).

Because adenocarcinoma is the type every guideline and trial assumes, its management is the main page's: simple cholecystectomy suffices for Tis and T1a, radical cholecystectomy from T1b, adjuvant capecitabine after resection (BILCAP), and gemcitabine and cisplatin with durvalumab or pembrolizumab for advanced disease (TOPAZ-1, KEYNOTE-966), with HER2-directed therapy for the HER2-positive subset. The mucinous, papillary, adenosquamous and neuroendocrine pages describe how the rarer types differ.

## Fields

- Kind: Cancer
- Last checked: 2026-09-24
- Also known as: Adenocarcinoma of the gallbladder; Non-papillary adenocarcinoma of the gallbladder; Pancreatobiliary-type gallbladder adenocarcinoma
- Tags: gallbladder; biliary; subtype-page
- Group: gastrointestinal
- Burden: About 90 percent of gallbladder cancers (Cancer Research UK); 96.7 percent of gallbladder neoplasms recorded in the US National Cancer Database in 2011 to 2020 were adenocarcinomas when compared with neuroendocrine carcinomas (Louis 2025).
- Subtypes: Biliary (pancreatobiliary) type gallbladder adenocarcinoma, the commonest; Intestinal-type gallbladder adenocarcinoma; Mucinous gallbladder adenocarcinoma (own page); Papillary gallbladder carcinoma (own page); Signet-ring, clear cell and hepatoid variants (rare)
- Biomarkers: Grade 1 to 3; T category and T2a or T2b side; Node number (N1 one to three, N2 four or more); Cystic duct margin; HER2, mismatch repair, BRAF V600E and NTRK (frequencies on the main gallbladder cancer page)

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/gallbladder-adenocarcinoma/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/gallbladder-adenocarcinoma/#overview
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/gallbladder-adenocarcinoma/#what-it-is [5 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/gallbladder-adenocarcinoma/#finding-it [5 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/gallbladder-adenocarcinoma/#treating-it [2 settings, 1 decision with options]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/gallbladder-adenocarcinoma/#evidence [3 trials]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/gallbladder-adenocarcinoma/#science [3 targets]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/gallbladder-adenocarcinoma/where-you-are/
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/gallbladder-adenocarcinoma/#living-with-it [11 questions, 5 red cards]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/gallbladder-adenocarcinoma/coming/ [5 medicines]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/gallbladder-adenocarcinoma/data/ [27 connected records]

## Standard of care

- Resectable disease: Simple cholecystectomy for Tis and T1a; radical cholecystectomy with liver bed and portal lymphadenectomy from T1b; adjuvant capecitabine (BILCAP). ([Simple cholecystectomy](https://onco.cc/terms/simple-cholecystectomy/), [Radical (extended) cholecystectomy](https://onco.cc/terms/radical-cholecystectomy/), [Capecitabine](https://onco.cc/drugs/capecitabine/), [BILCAP](https://onco.cc/trials/bilcap/))
- Advanced disease: Gemcitabine and cisplatin with durvalumab or pembrolizumab; zanidatamab for HER2-positive disease after chemotherapy. ([Gemcitabine + cisplatin](https://onco.cc/drugs/gemcitabine-cisplatin/), [Durvalumab](https://onco.cc/drugs/durvalumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Zanidatamab](https://onco.cc/drugs/zanidatamab/))

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Gallbladder_cancer
- CRUK: types of gallbladder cancer: https://www.cancerresearchuk.org/about-cancer/gallbladder-cancer/types
- Nagtegaal, Histopathology 2020: the 2019 WHO classification of tumours of the digestive system: https://doi.org/10.1111/his.13975
- Roa, Nature Reviews Disease Primers 2022: gallbladder cancer: https://doi.org/10.1038/s41572-022-00398-y
- Dursun, Arch Pathol Lab Med 2012: mucinous carcinomas of the gallbladder, 15 of 606 carcinomas: https://doi.org/10.5858/arpa.2011-0447-oa
- Louis, Cancer Causes Control 2025: gallbladder adenocarcinoma and neuroendocrine carcinoma in the National Cancer Database: https://doi.org/10.1007/s10552-025-01967-8
- CRUK: stages and grades of gallbladder cancer: https://www.cancerresearchuk.org/about-cancer/gallbladder-cancer/stages-and-grades

## Connected records

- cancers: [Adenosquamous and squamous carcinoma of the gallbladder](https://onco.cc/cancers/gallbladder-adenosquamous-squamous-carcinoma/), [Biliary tract cancer (cholangiocarcinoma)](https://onco.cc/cancers/cholangiocarcinoma/), [Carcinoma in situ and dysplasia of the gallbladder](https://onco.cc/cancers/gallbladder-carcinoma-in-situ-and-dysplasia/), [Gallbladder cancer](https://onco.cc/cancers/gallbladder/), [Incidental gallbladder cancer (found after cholecystectomy)](https://onco.cc/cancers/incidental-gallbladder-cancer/), [Mucinous carcinoma of the gallbladder](https://onco.cc/cancers/gallbladder-mucinous-carcinoma/), [Neuroendocrine carcinoma of the gallbladder](https://onco.cc/cancers/gallbladder-neuroendocrine-carcinoma/), [Papillary carcinoma of the gallbladder](https://onco.cc/cancers/gallbladder-papillary-carcinoma/)
- targets: [HER2](https://onco.cc/targets/her2/)
- drugs: [Capecitabine](https://onco.cc/drugs/capecitabine/), [Durvalumab](https://onco.cc/drugs/durvalumab/), [Gemcitabine + cisplatin](https://onco.cc/drugs/gemcitabine-cisplatin/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Zanidatamab](https://onco.cc/drugs/zanidatamab/)
- terms: [Cystic duct margin](https://onco.cc/terms/cystic-duct-margin/), [Grade](https://onco.cc/terms/tumour-grade/), [Radical (extended) cholecystectomy](https://onco.cc/terms/radical-cholecystectomy/), [Segment IVb and V liver resection (versus wedge resection)](https://onco.cc/terms/segment-ivb-v-resection/), [Simple cholecystectomy](https://onco.cc/terms/simple-cholecystectomy/), [T2a versus T2b gallbladder cancer (peritoneal side versus hepatic side)](https://onco.cc/terms/t2a-versus-t2b/)
- trials: [BILCAP](https://onco.cc/trials/bilcap/), [KEYNOTE-966](https://onco.cc/trials/keynote-966/), [TOPAZ-1](https://onco.cc/trials/topaz-1/)

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JSON: https://onco.cc/api/v1/entities/gallbladder-adenocarcinoma.json