The first 60 days: Carcinoma in situ and dysplasia of the gallbladder

What happens now

Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.

Biomarkers your report may list

Grade of dysplasia (low or high)Absence of invasion through the basement membrane (Tis) versus lamina propria invasion (T1a)Cystic duct margin status Rokitansky-Aschoff sinus involvement Pyloric and intestinal metaplasia in the background mucosa

Ask which of these were tested and what the results were; see the report reader for what each value means.

Weeks 1 to 3

Who is on your team

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These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.

A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.

Weeks 2 to 6

Decisions coming up

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Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.

1.Tis or dysplasia with a clear cystic duct margin
No further surgery; follow-up because occasional late recurrences reflect a field effect.
Simple cholecystectomy Cystic duct margin
2.Positive cystic duct margin or Rokitansky-Aschoff sinus involvement
Consider bile duct margin re-excision or further surgery at a hepatobiliary centre.
Cystic duct margin Rokitansky-Aschoff sinus Radical (extended) cholecystectomy
3.Gallbladder polyp in primary sclerosing cholangitis
Cholecystectomy advised for polyps of any size by international guidelines; a 2020 cohort supports short-interval imaging first when no high-risk feature is present.
Gallbladder polyp (polypoid lesion)Simple cholecystectomy

Every visit

Questions to ask at each visit

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Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.

Newly diagnosed

What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
Which biomarkers have been tested on my tumour (for example Grade of dysplasia, Absence of invasion through the basement membraneversus lamina propria invasion, Cystic duct margin status, Rokitansky-Aschoff sinus involvement, Pyloric and intestinal metaplasia in the background mucosa), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Low-grade biliary intraepithelial neoplasiaof the gallbladder, High-grade biliary intraepithelial neoplasia, carcinoma in situ of the gallbladder, Carcinoma in situ extending into Rokitansky-Aschoff sinuses.
Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.

Tis or dysplasia with a clear cystic duct margin

For my situation (tis or dysplasia with a clear cystic duct margin), which of the standard options do you recommend and why?Guideline options include: No further surgery; follow-up because occasional late recurrences reflect a field effect.

Positive cystic duct margin or Rokitansky-Aschoff sinus involvement

For my situation (positive cystic duct margin or rokitansky-aschoff sinus involvement), which of the standard options do you recommend and why?Guideline options include: Consider bile duct margin re-excision or further surgery at a hepatobiliary centre.

Gallbladder polyp in primary sclerosing cholangitis

For my situation (gallbladder polyp in primary sclerosing cholangitis), which of the standard options do you recommend and why?Guideline options include: Cholecystectomy advised for polyps of any size by international guidelines; a 2020 cohort supports short-interval imaging first when no high-risk feature is present.

Any stage

Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.

From day one

Help that costs nothing

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Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.

Any time

What to read next

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Words this page and the cancer page use

Gallbladder polyp (polypoid lesion): A small growth on the inside wall of the gallbladder, usually spotted by chance on an ultrasound scan.
Rokitansky-Aschoff sinus: Tiny pouches where the gallbladder lining pushes down into the muscle wall, common in gallbladders damaged by stones and inflammation.
Dysplasia (pre-cancerous change): Abnormal-looking cells in a surface lining that are not yet cancer but are on the way.
Cystic duct margin: The cut end of the short duct that joined the gallbladder to the main bile duct, examined by the pathologist after a gallbladder is removed.
Simple cholecystectomy: The standard operation to remove the gallbladder, almost always by keyhole surgery for gallstones.
Radical (extended) cholecystectomy: The cancer operation for gallbladder cancer: the gallbladder (if still present) is removed together with a rim of the liver it sits against and the lymph nodes along the bile duct and liver blood vessels.
Carcinoma in situ (CIS): Cancer cells that fill the lining layer where they started but have not broken through the basement membrane into the tissue beneath.

Every term links to the glossary.