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Gallbladder cancer in the UK and the NHS
Around 1,300 people a year are diagnosed with gallbladder cancer in the UK, most of them women and most over 75. Half are diagnosed as emergencies. This page follows the NHS route from suspicion to treatment, names the specialist hepatobiliary centres, lists what the NHS funds today with the NICE and SMC decisions behind it, the genomic tests to ask for, the trials open in the UK, and where England, Scotland, Wales and Northern Ireland differ.
Your pathway in the NHS
How the cancer usually comes to light, then the national standards that time each step. The standards are England's unless the four-nations section says otherwise.
Found by chance
Many gallbladder cancers are found when the gallbladder is removed for stones and the pathologist finds a tumour, or on a scan done for another reason. The pathology report's T stage then decides whether a second, wider operation is offered; that decision belongs to a specialist HPB team, not the local surgical unit.
Sources: NHS England service specification 2260: HPB, primary liver, secondary liver, perihilar biliary tract and gallbladder cancers (September 2024) (2024-09); British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma (Gut 2023;73:16-46) (2023-12-07)
Urgent suspected cancer referral
17% (England, 2019)NICE NG12 tells GPs to consider an urgent direct-access ultrasound scan for gall bladder cancer in people with an upper abdominal mass consistent with an enlarged gall bladder (recommendation 1.2.10), and to refer anyone aged 40 and over with jaundice on a suspected cancer pathway (1.2.4). In England 17 percent of gallbladder cancers diagnosed in 2019 came through an urgent suspected cancer referral.
Sources: NICE NG12: suspected cancer, recommendations by site (gall bladder cancer 1.2.10; jaundice 1.2.4) (2015); Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Emergency presentation
50% (England, 2019)Half of gallbladder cancers in England (2019) were diagnosed after an emergency presentation, typically jaundice, pain or a blocked bile duct needing a stent. The emergency team should hand the case to the specialist HPB MDT before any treatment decision.
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24); NHS England service specification 2260: HPB, primary liver, secondary liver, perihilar biliary tract and gallbladder cancers (September 2024) (2024-09)
- 1Day 0: referralUrgent suspected cancer referral or direct-access scan
The clock starts when the GP refers on the suspected cancer pathway, a screening or other route flags cancer, or (in Wales) at the point of suspicion. From 1 October 2023 England no longer measures the old two-week wait to first appointment; the 28-day Faster Diagnosis Standard replaced it.
Sources: NICE NG12: suspected cancer, recommendations by site (gall bladder cancer 1.2.10; jaundice 1.2.4) (2015); NHS England: changes to cancer waiting times standards from 1 October 2023 (2023-10-01)
- 228 days: diagnosis or all-clearFaster Diagnosis Standard: told you have cancer, or that you do not, within 28 daysTarget 75%, rising to 80% by March 2026
NHS England's Faster Diagnosis Standard applies to urgent suspected cancer, breast symptomatic and screening referrals. For HPB cancers NHS England's timed pathway asks teams to complete the diagnostic process within 21 days where possible, because these cancers are aggressive.
Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (2023-10-01); NHS England: 2025/26 priorities and operational planning guidance (2025-01); NHS England: implementing a timed HPB cancer diagnostic pathway
- 3Specialist HPB MDTEvery case discussed at the weekly specialist multidisciplinary team meeting
The specialist HPB MDT (Level 3 in NHS England's model) takes every treatment decision for gallbladder cancer, including incidental cancers found after cholecystectomy and recurrences, with surgery and oncology present. It must preserve tissue for molecular profiling and consider trial recruitment for every patient.
Sources: NHS England service specification 2260: HPB, primary liver, secondary liver, perihilar biliary tract and gallbladder cancers (September 2024) (2024-09)
- 431 days: decision to first treatmentTreatment starts within 31 days of the decision to treatTarget 96%
Applies to first and subsequent treatments: surgery, chemotherapy with immunotherapy, radiotherapy or a stent as definitive palliation.
Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (2023-10-01)
- 562 days: referral to first treatmentFirst treatment within 62 days of the urgent referralTarget 85% (planning target 75% by March 2026)
The headline standard for the whole route. Monthly trust-level performance is published by NHS England; HPB pathways often run long because tissue diagnosis needs an endoscopy or biopsy and surgery needs fitness assessment.
Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (2023-10-01); NHS England: 2025/26 priorities and operational planning guidance (2025-01); NHS England: cancer waiting times statistics
- 6TreatmentSurgery at the HPB centre; drug treatment locally under the centre's MDT
Curative surgery (re-resection of the liver bed and lymph nodes after an incidental finding, or a planned radical cholecystectomy) is done only at the specialist centre. Chemotherapy and immunotherapy may be given at a local cancer unit, but the specialist MDT keeps the decision and receives the outcome.
Sources: NHS England service specification 2260: HPB, primary liver, secondary liver, perihilar biliary tract and gallbladder cancers (September 2024) (2024-09)
- 7Molecular profilingNational Genomic Test Directory tests through the Genomic Laboratory Hub
At diagnosis of advanced disease the team should request the biliary panel (FGFR2 and NTRK fusions, IDH1, mismatch repair or MSI) and HER2 testing, so that a second-line option is known before it is needed.
Sources: NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24); NHS England: National Genomic Test Directory
Where you would be treated
24 centre entries across 4 nations, with what each offers for this cancer. The service model note below says what happens only at a specialist centre and what can be given closer to home under its MDT.
England
- HPB and liver surgery
- Sheila Sherlock Liver Centre
- ABC and SAFIR-ABC10 trial site
- HPB surgery
- Liver transplantation
- Specialist HPB MDT
- HPB surgery
- Liver unit
- Biliary trials
- Medical pancreato-biliary service and surgical outpatients (HPB surgery moved to the Royal Free)
- SAFIR-ABC10 UK sponsor
- Zanidatamab early access study
- HPB surgery
- Liver transplantation
- Biliary trials
- HPB surgery
- Liver unit and transplantation
- Biliary trials
- HPB and transplant surgery
- ATTR-01 trial site
- HPB surgery
- Liver transplantation
- HPB surgery
- Oncology and the ABC trials at The Christie
- HPB and liver surgery for Merseyside, Cheshire, North Wales and the Isle of Man
- Oncology at Clatterbridge
- HPB surgery
- BILCAP lead centre
- HPB surgery
- ATTR-01 and biliary microbiome study site
- HPB surgery for Nottingham, Mansfield, Lincolnshire and Derby
- HPB surgery
- BILCAP site
- HPB surgery (Northern General and Royal Hallamshire)
- Oncology at Weston Park
- HPB surgery
- Oncology at the Bristol Haematology and Oncology Centre
- HPB surgery for Devon, Cornwall and the Isles of Scilly
Other English HPB specialist centres
Hull University Teaching Hospitals (Castle Hill); University Hospitals of North Midlands (Royal Stoke); University Hospitals Coventry and Warwickshire; Royal Surrey County Hospital; East Lancashire Hospitals (Royal Blackburn); Barts Health; The Royal Marsden
England
- Trusts the National Pancreatic Cancer Audit lists as HPB specialist centres; ask which one your Cancer Alliance refers gallbladder cancer to
Scotland
- HPB surgery for the West of Scotland
- Oncology at the Beatson
- HPB surgery for South East Scotland
- Liver transplantation
- Oncology at the Western General
Aberdeen Royal Infirmary, Ninewells Hospital Dundee and Raigmore Hospital Inverness
NHS Grampian, NHS Tayside, NHS Highland
North of Scotland
- Surgical centres for NHS Scotland North, serving Grampian, Tayside, Highland, Orkney, Shetland and the Western Isles
Service pageListed by Pancreatic Cancer UK
Wales
- HPB surgery for South Wales
- Oncology at Singleton and Velindre
- Liver surgery
- Oncology at Velindre
Northern Ireland
- Northern Ireland's HPB surgical service
- Systemic treatment at the Northern Ireland Cancer Centre
The service model
In England, surgery for gallbladder cancer is a specialised service commissioned by NHS England under service specification 2260 (September 2024). A specialist HPB cancer service must serve a catchment of at least two million people and perform at least 150 liver operations a year for cancer (75 of them major), hold a weekly specialist MDT with surgery and oncology present, take every treatment decision including for incidental cancers found at cholecystectomy, preserve tissue for molecular profiling and build trial recruitment into its work. Local hospitals (Levels 1 and 2) do the first scans and give palliative care under the centre's guidance. The English trust list comes from the National Pancreatic Cancer Audit's HPB specialist centre table, which also covers pancreatic and periampullary cancer; gallbladder surgery sits with the same HPB teams in most trusts, so confirm with your Cancer Alliance which centre takes your referral. Scotland, Wales and Northern Ireland run their own networks (listed above from Pancreatic Cancer UK and AMMF). The Getting It Right First Time programme has no gallbladder or hepatobiliary workstream: its specialty list runs from pancreatic cancer to lower gastrointestinal cancer with nothing for the liver or bile ducts, so its pancreatic cancer national report (November 2025), which carries a Liverpool case study on centralising HPB oncology, is the nearest GIRFT review of these services.
Sources: NHS England service specification 2260: HPB, primary liver, secondary liver, perihilar biliary tract and gallbladder cancers (September 2024) (2024-09); NHS England: service specification, HPB liver, biliary tract and gallbladder cancers (2024-09); National Pancreatic Cancer Audit 2025, methodology supplement, Table 7: trust codes for HPB specialist centres (2025-11); Pancreatic Cancer UK: your local specialist centre (covers pancreatic, liver, gallbladder and bile duct cancers) (2025-11); AMMF: UK centres with cholangiocarcinoma expertise (2023-03); GIRFT: pancreatic cancer national specialty report (November 2025); no gallbladder report exists (2025-11)
What the NHS funds today
By line of treatment: England's NICE decision (which binds Wales and is adopted in Northern Ireland) and Scotland's SMC decision, each with its reference and date. Generic medicines were never appraised and are funded through national chemotherapy protocols.
| Line | Treatment | England (NICE) | Scotland (SMC) | Wales and Northern Ireland |
|---|---|---|---|---|
| After surgery (adjuvant) | Capecitabine for six months (BILCAP) BILCAP was a UK trial; capecitabine is the only adjuvant treatment with a randomised trial behind it. | NHS England Routinely available: a generic medicine never appraised by NICE, given under national SACT protocols; the BSG guideline recommends it | SMC Not appraised (generic); used under regional protocols | Wales: As England. NI: As England. |
| Advanced, first line | Gemcitabine and cisplatin with durvalumab (TOPAZ-1) | NICE TA9442024-01-10 Recommended within its marketing authorisation, with a commercial arrangement; on the Cancer Drugs Fund list as routine commissioning (Section B, Blueteq form DUR2, funded from 9 April 2024), not managed access | SMC SMC25822023-11-13 Accepted for use within NHSScotland (end of life and orphan equivalent process) | Wales: Follows NICE TA944. NI: Follows NICE TA944. |
| Advanced, first line (alternative) | Gemcitabine and cisplatin with pembrolizumab (KEYNOTE-966) Durvalumab is the funded immunotherapy partner across the UK. | NICE TA9662024-04-24 Not available: appraisal terminated because Merck Sharp and Dohme made no evidence submission | Wales: Not available (no NICE recommendation). NI: Not available. | |
| Advanced, second line (no target) | FOLFOX (oxaliplatin, fluorouracil, folinic acid) after gemcitabine-cisplatin (ABC-06) | NHS England Routinely available: generic medicines under national SACT protocols; the ABC-06 trial was UK-run | SMC Not appraised (generics); used under regional protocols | Wales: As England. NI: As England. |
| Second line, FGFR2 fusion or rearrangement | Pemigatinib The licence and the NICE wording say cholangiocarcinoma; FGFR2 fusions are found mainly in intrahepatic cholangiocarcinoma and are uncommon in gallbladder cancer. Ask the MDT how a gallbladder tumour with an FGFR2 fusion would be handled. | NICE TA7222021-08-25 Recommended within its marketing authorisation for cholangiocarcinoma after systemic therapy, with a commercial arrangement; CDF list Section B (routine commissioning, form PEMIG1, funded from 24 September 2021) | Wales: Follows NICE TA722. NI: Follows NICE TA722. | |
| Second line, FGFR2 fusion or rearrangement (alternative) | Futibatinib | NICE TA10052024-09-11 Recommended for previously treated advanced cholangiocarcinoma with an FGFR2 fusion or rearrangement, with a commercial arrangement; CDF list Section B (routine commissioning, form FUT1, funded from 12 December 2024) | Wales: Follows NICE TA1005. NI: Follows NICE TA1005. | |
| Second line, IDH1 R132 mutation | Ivosidenib IDH1 mutations are also concentrated in intrahepatic cholangiocarcinoma. | NICE TA9482024-01-31 Recommended for advanced cholangiocarcinoma with an IDH1 R132 mutation after one or more systemic treatments, with a commercial arrangement; CDF list Section B (routine commissioning, form IVO1, funded from 30 April 2024) | Wales: Follows NICE TA948. NI: Follows NICE TA948. | |
| Second line, HER2-positive (IHC 3+) | Zanidatamab (HERIZON-BTC-01) The most relevant targeted option for gallbladder cancer, where HER2 over-expression is commoner than in the bile ducts. Needs HER2 immunohistochemistry on the tumour. Not yet on the CDF list version read (1.365, June 2025, which predates TA1153); check the current list for its Blueteq form. | NICE TA11532026-05-07 Recommended for HER2-positive (IHC 3+) unresectable or metastatic biliary tract cancer after at least one line of systemic treatment, with a commercial arrangement | SMC Under consideration: full submission listed, publication date to be confirmed | Wales: Follows NICE TA1153. NI: Follows NICE TA1153. |
| Any line, MSI-high or mismatch repair deficient | Pembrolizumab alone after prior therapy | NICE TA9142023-09-20 Recommended for unresectable or metastatic biliary cancer with high MSI or MMR deficiency that has progressed after at least one prior therapy; CDF list Section B (routine commissioning, forms PEMB27 and PEMB28 for biliary tract cancer, funded from 19 December 2023; not funded at ECOG performance status 2) | SMC SMC25892024-01-15 Accepted for use within NHSScotland for MSI-H or dMMR biliary cancer after at least one prior therapy | Wales: Follows NICE TA914. NI: Follows NICE TA914. |
| Any line, NTRK fusion | Entrectinib or larotrectinib (tumour-agnostic) NTRK fusions are rare in any biliary cancer; the test is bundled with the FGFR2 panel. | NICE TA630 and TA644 · CDF2020 Recommended through the Cancer Drugs Fund for NTRK fusion-positive solid tumours when there are no satisfactory treatment options (larotrectinib TA630, entrectinib TA644); CDF list Section A (managed access): larotrectinib form LAR1a from 21 April 2020, entrectinib form ENT1a from 25 June 2020 | SMC Larotrectinib accepted; check the SMC for entrectinib | Wales: Follows NICE. NI: Follows NICE. |
NICE has published six technology appraisals on biliary tract cancer medicines and terminated one; the topic page lists them all. A NICE recommendation binds NHS England and NHS Wales to fund the medicine within 90 days for the appraised indication; Northern Ireland adopts NICE appraisals through its Department of Health; Scotland decides separately through the Scottish Medicines Consortium. Several of the licences say cholangiocarcinoma rather than gallbladder cancer, so eligibility for a gallbladder tumour with the same mutation is a question for the MDT. The National Cancer Drugs Fund list records which medicines sit in managed access (Section A) and which NHS England funds routinely (Section B), each with the Blueteq form a clinician completes. Version 1.365 (6 June 2025) was read in full: every biliary medicine NICE has recommended sits in Section B, and only the tumour-agnostic NTRK inhibitors remain in the Fund itself. The list page returned a bot challenge (HTTP 202) and the current version (1.406, 6 August 2026, according to the third-party Chemotherapy Updates tracker) has an address that could not be guessed (HTTP 404), so zanidatamab's entry should be checked on the page.
Sources: NICE: all guidance on biliary tract cancers (2026-09-24); NHS England: national Cancer Drugs Fund list; NHS England: National Cancer Drugs Fund list, version 1.365 (6 June 2025), the latest version whose PDF could be downloaded (2025-06-06); Scottish Medicines Consortium: medicines advice, cholangiocarcinoma (2026-09-24)
The NHS position of every approved product is on the NHS coverage page; the same decisions by country are on funding verdicts by country.
Tests you can ask for
National Genomic Test Directory entries with their codes, what a result opens, and how the request is made. Ask at diagnosis of advanced disease, not at progression.
| Target | Code | Test | What a positive result opens | How to get it |
|---|---|---|---|---|
| FGFR2 fusion or rearrangement | M220.1 | Multi-target NGS panel for structural variants (NTRK1, NTRK2, NTRK3, FGFR2) on formalin-fixed tumour | Pemigatinib (TA722, SMC2399) or futibatinib (TA1005, SMC2661) after first-line treatment | Your oncologist or the MDT requests it through the regional Genomic Laboratory Hub using the Test Directory code; an existing biopsy or surgical specimen is usually enough. Sources: NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24); NHS England: National Genomic Test Directory |
| NTRK1, NTRK2, NTRK3 fusions | M220.1 | Same structural-variant panel as FGFR2 | Entrectinib or larotrectinib (TA644, TA630, Cancer Drugs Fund) | Comes with the FGFR2 request; no separate sample. Sources: NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24) |
| IDH1 R132 mutation | M220.6 | Multi-target NGS panel for small variants including IDH1 | Ivosidenib (TA948, SMC2664) after one or more systemic treatments | Requested alongside M220.1; the GeNotes page notes the result can also aid diagnosis. Sources: NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24) |
| Mismatch repair deficiency or MSI-high | M220.5 | Microsatellite instability testing (or mismatch repair immunohistochemistry in pathology) | Pembrolizumab alone (TA914, SMC2589); a positive result also prompts a Lynch syndrome conversation | Mismatch repair IHC is done by the pathology lab; MSI testing (M220.5) where IHC is not done. Sources: NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24) |
| HER2 (ERBB2) over-expression | pathology | HER2 immunohistochemistry, with in-situ hybridisation for equivocal results, on the tumour block | Zanidatamab for IHC 3+ disease after one line (TA1153) | Not a Test Directory code: ask the MDT to request HER2 IHC from histopathology, as for breast or stomach cancer. NICE TA1153 (May 2026) makes this the test most likely to change a gallbladder cancer plan. Sources: NICE TA1153: zanidatamab (2026-05-07) |
| Whole genome sequencing | M232 | Whole genome sequencing of tumour and blood for any solid tumour once standard-of-care testing and treatment are exhausted | Trial matching, for example SAFIR-ABC10, and rare targets | Needs fresh-frozen tumour and a blood sample, so it is best planned before surgery or biopsy; a record of discussion form is required. Sources: NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24) |
| DPYD variants (before capecitabine or fluorouracil) | M220.3 | Germline DPYD hotspot test on a blood sample | Dose adjustment or avoidance of fluoropyrimidines (capecitabine after surgery, FOLFOX second line) to prevent severe toxicity | Requested before the first dose; no record of discussion form needed. Sources: NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24) |
In England the National Genomic Test Directory sets which tests the NHS funds and the seven Genomic Laboratory Hubs run them; the codes above are those GeNotes lists for cholangiocarcinoma, reviewed 24 February 2025. Scotland requests through its four regional laboratories and the Scottish Genomic Test Directory; Wales through the All Wales Medical Genomics Service; Northern Ireland through the Regional Molecular Diagnostics Service in Belfast. Turnaround times are set by each Genomic Laboratory Hub, and only two publish them: North Thames gives a national target of 42 days for core and cancer NGS panels against a current 56 to 64 days (correct as of 1 September 2025), and East Genomics publishes the national target range of 3 to 84 days by test category without current figures. Central and South's solid tumour page carries no turnaround statement, the South West hub's site is being decommissioned, and the North West, North East and Yorkshire and South East hub addresses did not resolve on the check date. Ask the MDT what the local turnaround is before a treatment decision waits on a result.
Sources: NHS England: National Genomic Test Directory; NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24); GeNotes: genomic testing in the devolved nations (reviewed 6 August 2026) (2026-08-06); North Thames Genomic Medicine Service: our turn-around times (correct as of 1 September 2025) (2025-09-01); East Genomics: service turnaround times (target range by category, no current figures) (2026-09-24)
Match a report to targets and drugs on the biomarker matrix.
Trials open in the UK
Registered trials with UK sites, from the ISRCTN registry and the sponsors' pages, with the setting each is for. Eligibility is decided by the trial team.
UCL and UCLH (UK arm of a Unicancer trial)Open (UK arm opened January 2025)
SAFIR-ABC10: first-line gemcitabine-cisplatin-durvalumab then therapy matched to the tumour's genomic profile
Advanced cholangiocarcinoma or gallbladder cancer, first line
University College London Hospitals (UK lead)CRUK and UCL Cancer Trials Centre network
Patients are profiled and offered one of seven targeted therapies matched to the result; about 800 participants worldwide.
Registry or sponsor page →ISRCTN13555554Recruiting to 30 September 2026 (observational)
Real-world outcomes of HER2-positive biliary tract cancer treated with zanidatamab through an early access programme
HER2-positive biliary tract cancer, previously treated
University College London Hospitals NHS Foundation Trust
Registry or sponsor page →ISRCTN11210442Recruitment listed to 31 December 2025; check status
Oral and gut microbiome and outcomes of chemotherapy with immunotherapy in biliary tract cancer
Biliary tract adenocarcinoma including gallbladder, on gemcitabine-cisplatin with immunotherapy
The ChristieImperial College HealthcareCambridge University HospitalsRoyal Free LondonOxford University HospitalsUniversity Hospitals BirminghamClatterbridgeNottingham University HospitalsVelindreUCLH
Registry or sponsor page →ISRCTN38972074Recruiting to November 2029
ATTR-01 phase 1-2 master protocol in selected epithelial solid tumours, including cholangiocarcinoma
Advanced solid tumours including cholangiocarcinoma
St James's University Hospital, LeedsChurchill Hospital, OxfordVelindre Cancer CentreBeatson West of Scotland Cancer Centre
Early-phase; eligibility is by tumour type and prior treatment.
Registry or sponsor page →ISRCTN is the UK registry; searches for gallbladder, biliary tract cancer and cholangiocarcinoma were run through its public API on the check date. Trials registered only on ClinicalTrials.gov with UK sites appear on the trial records linked from the cancer page. The NIHR's Be Part of Research site lets you search by condition and postcode and register interest; it could not be read automatically here, so open it directly.
Sources: ISRCTN registry search: gallbladder; NIHR Be Part of Research: gallbladder cancer
The UK trial legacy
ABC-02 (2010): the UK trial that set the world's first-line standard
Run through the National Cancer Research Network and led from Manchester and London, ABC-02 randomised 410 people with advanced biliary tract cancer, including gallbladder cancer, to gemcitabine alone or gemcitabine with cisplatin. The combination lengthened survival and became the first-line standard everywhere; TOPAZ-1 and KEYNOTE-966 later added immunotherapy on top of it rather than replacing it.
Sources: Valle et al, Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer (ABC-02), NEJM 2010 (2010-04-08); ISRCTN82956140: ABC-02
BILCAP (2019): six months of capecitabine after surgery
Led from Southampton, BILCAP randomised 447 people who had had their biliary cancer removed to capecitabine tablets for six months or observation. Median survival was longer with capecitabine in the pre-specified analysis, and the trial made adjuvant capecitabine the standard offered after gallbladder cancer surgery in the UK and in international guidelines. The UK HPB Research Collaborative Group's CAPBIL study (2026) is the real-world check: it pooled 516 gallbladder cancer operations from 24 UK centres between 2014 and 2022 and found no survival benefit from adjuvant therapy once patients were propensity-matched, while its companion paper on 285 incidental cancers found that those who completed adjuvant chemotherapy lived longer. How far BILCAP's result carries to gallbladder cancer in particular is therefore an open question for ACTICCA-1 and ARTEMIDE-Biliary01 to settle.
Sources: Primrose et al, Capecitabine compared with observation in resected biliary tract cancer (BILCAP), Lancet Oncology 2019 (2019-05); ISRCTN72785446: BILCAP; McClements et al, surgical outcomes in gallbladder cancer: evidence from the UK nationwide CAPBIL study, HPB 2026 (2026-06-22); McClements et al, management of incidental gallbladder cancer in the nationwide CAPBIL study, British Journal of Surgery 2026 (2026-08-01)
ABC-06 (2021): proof that second-line chemotherapy helps
ABC-06 was the first randomised trial of second-line treatment in biliary cancer. It compared FOLFOX plus active symptom control with active symptom control alone after gemcitabine-cisplatin, and showed a modest but real survival gain, which is why FOLFOX is the NHS's default second-line chemotherapy when no targetable change is found.
Sources: Lamarca et al, second-line FOLFOX chemotherapy versus active symptom control for advanced biliary tract cancer (ABC-06), Lancet Oncology 2021 (2021-05)
UK data
Each figure with its nation, period and the page it was read from. Survival figures are population averages and sit behind the usual disclosure.
New cases a year
1,288
UK · 2019, 2021-2022 average
Around 900 in women and 380 in men; less than 1 percent of all cancers.
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Deaths a year
810
UK · 2022-2024 average
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Diagnosed at 75 or over
54%
UK · 2019, 2021-2022
Rates peak at ages 85 to 89 (13 percent of cases).
Sources: Cancer Research UK: gallbladder cancer incidence (2026-09-24)
Change in incidence rate since the early 1990s
+79%
UK · to 2019, 2021-2022
Up by a third in the last decade; projected to rise a further 43 percent by 2038-2040, to about 3,100 cases a year.
Sources: Cancer Research UK: gallbladder cancer incidence (2026-09-24)
Diagnosed after an emergency presentation
50%
England · 2019
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Diagnosed through an urgent suspected cancer referral
17%
England · 2019
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Diagnosed at an early stage (I or II)
24%
Northern Ireland · 2015-2019 average, cases with a known stage
About 15 cases a year. The registries' own stage tables for Northern Ireland (2019-2023) and Wales (2020-2022) are below; NDRS blocks automated reading, so no England stage split is quoted.
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Treated with surgery in the first course
21%
England · 2022
22 percent had systemic anti-cancer therapy and 2 percent radiotherapy.
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Five-year survival
Show survival figures (2)
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 11.8% five-year survival (England, diagnosed 2016-2020).
- 18.2 percent for people aged 15 to 54 against 6.7 percent for those aged 75 to 99. Population averages, not a personal prognosis.
England · diagnosed 2016-2020
Sources: Cancer Research UK: gallbladder cancer survival (2026-09-24)
Ten-year survival
Show survival figures (1)
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 15% ten-year survival (England, diagnosed 2009-2013).
England · diagnosed 2009-2013
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Preventable cases
20%
UK · current estimate
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Incidence by ethnic group
Higher in Asian and Black groups than White
England · 2013-2017
Sources: Cancer Research UK: gallbladder cancer incidence (2026-09-24)
New cases, gallbladder (C23)
76
Wales · 2022
22 men and 54 women; 63 a year on average over 2018-2022 (66, 50, 63, 62, 76), summed from the WCISU counts by four-digit ICD-10 code, age band and sex.
Sources: Public Health Wales, WCISU: cancer incidence in Wales 2002-2022, data tables (counts by ICD-10 code, xlsx) (2026-02)
Deaths, gallbladder (C23)
53
Wales · 2025 (year of registration)
13 men and 40 women; 52 in each of 2023 and 2024 and 47 a year on average over 2021-2025, summed from the WCISU counts by ICD-10 code.
Sources: Public Health Wales, WCISU: cancer mortality in Wales 2002-2025, data tables (counts by ICD-10 code, xlsx) (2026-03)
Stage at diagnosis, gallbladder (C23)
I 2%, II 4%, III 9%, IV 64%, unknown 21%
Wales · 2020-2022 (201 cases)
Of the 159 cases with a known stage, 8 percent were stage I or II and 81 percent stage IV. Wales does publish stage for gallbladder cancer; an earlier version of this page said it did not.
Sources: Public Health Wales, WCISU: cancer incidence in Wales 2011-2022, stage data table (xlsx) (2026-02)
New cases, gallbladder and biliary tract (C23-C24)
123
Northern Ireland · 2023
574 cases in 2019-2023, 115 a year, 335 of them in women; median age 76; European age-standardised rate 6.7 per 100,000. The registry groups the gallbladder with the extrahepatic bile ducts.
Sources: Northern Ireland Cancer Registry: gallbladder and biliary tract cancer data tables, 1993-2023 (xlsx, Tables 1, 4, 9, 11, 12 and 17) (2026-09-24)
Deaths, gallbladder and biliary tract (C23-C24)
37
Northern Ireland · 2023
199 deaths in 2019-2023, 40 a year; median age at death 79.
Sources: Northern Ireland Cancer Registry: gallbladder and biliary tract cancer data tables, 1993-2023 (xlsx, Tables 1, 4, 9, 11, 12 and 17) (2026-09-24)
Stage at diagnosis (C23-C24)
I 5%, II 7%, III 19%, IV 35%, unknown 34%
Northern Ireland · 2019-2023 (574 cases)
Of cases with a known stage: I 8 percent, II 11 percent, III 28 percent, IV 53 percent (TNM 8 from 2018).
Sources: Northern Ireland Cancer Registry: gallbladder and biliary tract cancer data tables, 1993-2023 (xlsx, Tables 1, 4, 9, 11, 12 and 17) (2026-09-24)
Five-year net survival (C23-C24)
Show survival figures (2)
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 18.2% five-year net survival (c23-c24) (Northern Ireland, diagnosed 2014-2018).
- One-year 40.7 percent. Stage I or II 45.7 percent at five years against 8.9 percent for stage III or IV. Population averages, not a personal prognosis.
Northern Ireland · diagnosed 2014-2018
Sources: Northern Ireland Cancer Registry: gallbladder and biliary tract cancer data tables, 1993-2023 (xlsx, Tables 1, 4, 9, 11, 12 and 17) (2026-09-24)
Incidence and mortality, gallbladder (C23)
Not published as a separate site
Scotland · to 2024
Public Health Scotland's open data CSVs and its incidence and mortality Table 1 spreadsheets carry liver and intrahepatic bile ducts (C22) and pancreas (C25) but no C23 or C24 site, so no Scottish count exists to quote; the UK total from Cancer Research UK includes Scotland.
Sources: Public Health Scotland: cancer incidence in Scotland to December 2024 (Table 1 spreadsheet checked for a C23 site) (2026-08-18)
Incidental gallbladder cancers going on to liver resection
67.7%
UK (24 HPB centres) · 2014-2022
193 of 285 patients in CAPBIL; 97.9 percent of those resections took liver segments 4b and 5. Five-year disease-free survival 41.5 percent and overall survival 45.1 percent for the whole cohort.
Sources: McClements et al, management of incidental gallbladder cancer in the nationwide CAPBIL study, British Journal of Surgery 2026 (2026-08-01)
Gallbladder cancer operations pooled by the UK HPB Research Collaborative
516
UK (24 HPB centres) · 2014-2022
Median follow-up 25 months; T3 to T4 stage and nodal disease predicted worse survival; no survival benefit from adjuvant therapy after propensity matching.
Sources: McClements et al, surgical outcomes in gallbladder cancer: evidence from the UK nationwide CAPBIL study, HPB 2026 (2026-06-22)
Support in the UK
Charities focused on this cancer, the general cancer charities, and the official schemes that help with costs. Each link goes to the organisation's own page.
- Information on biliary cancers, treatments, molecular profiling and trials
- List of UK centres with expertise
- Patient discussion groups and webinars
- Research grants and an annual conference
Charity
- Support line and online community
- Macmillan nurses in many HPB teams
- Grants and benefits advice
Charity
- Drop-in centres beside major cancer hospitals
- Benefits advice, psychological support and courses, free
Charity
- Nurse helpline and Cancer Chat forum
- Plain-English information on gallbladder cancer
- The UK statistics quoted on this page
Free NHS prescriptions in England (medical exemption certificate)
Cost and benefit- Anyone undergoing treatment for cancer, the effects of cancer or the effects of cancer treatment is entitled to a five-year medical exemption certificate covering every NHS prescription; ask your GP or hospital doctor for the application form
- Ten years where a listed long-term condition is also present; free without a certificate from age 60
Prescriptions in Scotland, Wales and Northern Ireland
Cost and benefit- Scotland: prescriptions are free for everyone; a GP-signed EC92A medical exemption form is only needed to have a prescription dispensed free in England
- Wales: free for anyone registered with a Welsh GP and dispensed in Wales; Welsh residents with an English GP get an entitlement card, and a WP92A medical exemption certificate for cancer covers dispensing anywhere in the UK
- Northern Ireland: all prescriptions dispensed in Northern Ireland are free for everyone, with nothing to apply for
Special rules for end of life (SR1)
Cost and benefit- If a doctor, consultant or specialist nurse says you may have 12 months or less to live, claims for PIP, Universal Credit, ESA, Attendance Allowance and DLA for children are fast-tracked, paid at the higher rate and need no medical assessment; the clinician completes an SR1 form, which replaced the DS1500
- Nothing is lost if you live longer than expected; GOV.UK notes different rules apply in Scotland, and nidirect carries Northern Ireland's version
Healthcare Travel Costs Scheme
Cost and benefit- Help with fares to hospital for people on qualifying benefits or low income; matters when the HPB centre is far from home
Personal Independence Payment
Cost and benefit- Non-means-tested payment for people under State Pension age whose illness or treatment affects daily living or mobility; special rules give a fast decision for terminal illness (SR1 form)
- Scotland has Adult Disability Payment instead
Attendance Allowance
Cost and benefit- For people over State Pension age who need help with personal care; special rules for terminal illness
Macmillan Grants
Cost and benefit- One-off payments for costs such as heating, travel or clothing; a nurse or social worker applies with you
More schemes by country on Assistance; costs of care on Costs.
Across the four nations
Where England, Scotland, Wales and Northern Ireland run different rules for the same step.
| Topic | England | Scotland | Wales | Northern Ireland |
|---|---|---|---|---|
| Waiting-time standards Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (2023-10-01); NHS England: 2025/26 priorities and operational planning guidance (2025-01); Public Health Scotland: cancer waiting times, 1 January to 31 March 2026 (2026); Welsh Government: suspected cancer pathway quality report; NHS Wales Performance and Improvement: Suspected Cancer Pathway; Department of Health (Northern Ireland): cancer waiting times; Department of Health (Northern Ireland): cancer waiting time statistics, January to March 2026 (2026) | 28-day Faster Diagnosis Standard (75%, 80% by March 2026); 31 days from decision to treat (96%); 62 days from referral to first treatment (85%, planning target 75% by March 2026). | 62 days from urgent suspicion of cancer referral to first treatment and 31 days from decision to treat, both set at 95%; 72.2% met the 62-day standard in January to March 2026. | Single Suspected Cancer Pathway: 62 days from the point of suspicion to first definitive treatment, target 75% (the clock starts at suspicion, not referral). | 31 days from decision to treat (98%) and 62 days from urgent GP referral (95%); performance is published quarterly by the Department of Health. |
| Who decides drug funding Sources: NICE: all guidance on biliary tract cancers (2026-09-24); Scottish Medicines Consortium: medicines advice, cholangiocarcinoma (2026-09-24) | NICE technology appraisals; the Cancer Drugs Fund for managed access; NHS England commissions. | Scottish Medicines Consortium; five biliary medicines are accepted (pemigatinib, durvalumab, ivosidenib, futibatinib, pembrolizumab for MSI-high), pembrolizumab with chemotherapy was not recommended after a non-submission (SMC2683), and zanidatamab is pending. | Follows NICE appraisals; the All Wales Medicines Strategy Group appraises medicines NICE has not. | The Department of Health endorses NICE appraisals for the HSC. |
| Genomic testing route Sources: NHS England: National Genomic Test Directory; GeNotes: genomic testing in the devolved nations (reviewed 6 August 2026) (2026-08-06) | National Genomic Test Directory, seven Genomic Laboratory Hubs (codes M220.1, M220.5, M220.6, M232). | Scottish Genomic Test Directory; four regional laboratories in Aberdeen, Dundee, Edinburgh and Glasgow. | All Wales Medical Genomics Service. | Northern Ireland Regional Molecular Diagnostics Service, Belfast. |
| Where surgery happens Sources: NHS England service specification 2260: HPB, primary liver, secondary liver, perihilar biliary tract and gallbladder cancers (September 2024) (2024-09); Pancreatic Cancer UK: your local specialist centre (covers pancreatic, liver, gallbladder and bile duct cancers) (2025-11) | Specialised HPB cancer centres commissioned by NHS England under specification 2260 (catchment of at least two million; 150 liver operations a year). | Regional networks: Glasgow Royal Infirmary (West), Royal Infirmary of Edinburgh (South East), Aberdeen, Dundee and Inverness (North). | Morriston Hospital, Swansea for South Wales; North Wales patients go to Liverpool; some mid-Wales patients to Stoke-on-Trent. | One HPB service in the Belfast Trust. |
| Cancer statistics Sources: NDRS: Cancer Registration Statistics, England 2023; Cancer Research UK: gallbladder cancer statistics (2026-09-24); Public Health Scotland: cancer incidence in Scotland to December 2024 (Table 1 spreadsheet checked for a C23 site) (2026-08-18); Public Health Scotland: cancer mortality in Scotland, annual update to 2024 (Table 1 spreadsheet checked for a C23 site) (2026-07-14); Public Health Scotland open data: annual cancer incidence CSV (sites carried: liver C22 and pancreas C25; no gallbladder C23) (2026-09-24); Public Health Wales, WCISU: cancer incidence in Wales 2002-2022, data tables (counts by ICD-10 code, xlsx) (2026-02); Northern Ireland Cancer Registry: gallbladder cancer and other biliary cancer (ICD-10 C23-C24), official statistics 1993-2023 (2026-09-24) | National Disease Registration Service (NDRS): Cancer Registration Statistics, England, with counts by stage; its pages and downloads returned 403 to OnCo. | Public Health Scotland: gallbladder cancer is not a separately published site (its open data and Table 1 spreadsheets carry C22 and C25 only). | Welsh Cancer Intelligence and Surveillance Unit (Public Health Wales): counts by ICD-10 code and a stage table that includes gallbladder cancer (C23), as spreadsheets. | Northern Ireland Cancer Registry (Queen's University Belfast): gallbladder and biliary tract (C23-C24) tables with stage and survival, as a spreadsheet and factsheet. |
| Prescription charges Sources: NHS Business Services Authority: medical exemption certificates (five years for cancer, the effects of cancer or its treatment) (2026-09-24); NHS inform: prescription charges and exemptions (prescriptions in Scotland are free) (2026-01-07); Welsh Government: free prescriptions (2020-09-18); nidirect: help with health costs (all prescriptions dispensed in Northern Ireland are free of charge) (2026-09-24) | £9.90 an item unless exempt; anyone being treated for cancer or its effects gets a five-year medical exemption certificate, and everyone over 60 is exempt. | Free for everyone; no certificate needed (an EC92A form only for dispensing in England). | Free for everyone registered with a Welsh GP and dispensed in Wales; a WP92A medical exemption certificate covers cancer patients dispensing elsewhere in the UK. | Free for everyone; nothing to apply for. |
| Benefits under the special rules for end of life Sources: GOV.UK: get benefits if you're nearing the end of life (special rules) (2026-09-24); DWP: the Special Rules, how the benefit system supports people nearing the end of life (SR1 form, for clinicians) (2026-09-24); nidirect: benefits if you are nearing the end of life (2026-09-24); GOV.UK: Personal Independence Payment; GOV.UK: Attendance Allowance | PIP (under State Pension age) or Attendance Allowance (over it) fast-tracked at the higher rate, no assessment, when a clinician says 12 months or less; SR1 form. | Adult Disability Payment through Social Security Scotland instead of PIP; GOV.UK notes different special rules apply in Scotland. | As England (DWP). | The same 12-month test through the Department for Communities; if you live longer the benefit continues, with a review after three years. |
What could not be sourced
Named gaps, so a missing figure is never mistaken for a zero.
- NDRS Cancer Registration Statistics, England 2023: the publication page, its cancer-incidence-by-stage page and the files.digital.nhs.uk download host all returned HTTP 403 on 24 September 2026, with a browser user agent and with plain curl, so no England-only count for ICD-10 C23 in 2023 and no England stage split are quoted. The UK figures come from Cancer Research UK, which builds on the four registries; Wales and Northern Ireland stage splits are quoted from their registries above.
- Scotland publishes no gallbladder (C23) or extrahepatic bile duct (C24) site: the Public Health Scotland open data incidence and mortality CSVs (HTTP 200) and the incidence, mortality and staging Table 1 and Table 9 spreadsheets (HTTP 200) list liver and intrahepatic bile ducts (C22) and pancreas (C25) only.
- The Cancer Drugs Fund list page returned a bot challenge (HTTP 202) and the current PDF (version 1.406, 6 August 2026) could not be found at any guessable address (HTTP 404); version 1.365 (6 June 2025) was downloaded and read, so zanidatamab (NICE TA1153, May 2026) has no CDF entry quoted here.
- Genomic Laboratory Hub turnaround times: only North Thames and East Genomics publish them (quoted above). Central and South's solid tumour page (HTTP 200) has no turnaround statement; the South West hub's site (HTTP 200) says it is being decommissioned and its test pages return 404; the North West, North East and Yorkshire and South East hub hostnames did not resolve.
- GIRFT's site returned HTTP 403 to scripts; read through a fetch tool, its specialty list has no gallbladder, biliary or hepatobiliary workstream, and its pancreatic cancer national report (November 2025, hosted on the FutureNHS platform behind a login) is the nearest HPB review.
- Hassan Malik has no consultant page on the Liverpool University Hospitals site (the trust search returned no profile, HTTP 200; the old liverpoolft.nhs.uk service pages return 404); his record rests on the University of Liverpool staff page and an HCA Healthcare UK profile.
- The nidirect prescriptions article itself does not state the charge position; the statement that all prescriptions dispensed in Northern Ireland are free is taken from nidirect's help-with-health-costs page.
- Be Part of Research is rendered in the browser and could not be searched automatically; ISRCTN was searched through its API.
- The Scottish Medicines Consortium has not yet published on zanidatamab; the submission is listed as under consideration.
- NHS England's cancer waiting times pages block automated reading (HTTP 202); the standards are quoted from NHS England's published explanations found through search.
How to read this page. Every figure and decision links to the page it was read from (104 sources, checked 2026-09-24); the drug and trial pills open OnCo records with their own sources. Standards and funding change: confirm with your team and the linked pages. Machine-readable copy at /api/v1/cancers/gallbladder/uk.json. OnCo is orientation, not medical advice.