Treatment depends on the stage of cancer and the overall health of the patient. Treatment options include:

Surgery

Early-stage gallbladder cancer may be treated with cholecystectomy (gallbladder removal), often including nearby tissues and lymph nodes.

If the cancer is advanced and inoperable, palliative surgery or procedures may be performed to relieve symptoms. Such options include:

• Biliary bypass: Reroutes bile flow around a blockage to relieve jaundice and abdominal discomfort.
• Endoscopic stent placement: A plastic or metal stent is inserted into the bile duct to keep it open, allowing bile to drain into the intestine
• Percutaneous biliary drainage: A procedure where a tube is inserted through the skin into the liver to drain bile when endoscopic stenting is not feasible, allowing bile to drain into an external bag. Subsequent stenting may be able to be performed if the drainage can be internalised.

Radiation therapy

External beam radiation therapy uses high-energy rays to target cancer cells and shrink tumours, either as a primary treatment or after surgery to reduce recurrence risk if resection margins are involved.

Chemotherapy

Systemic chemotherapy, using drugs such as Gemcitabine and Cisplatin, or 5-Fluorouracil based chemotherapy, is administered orally or intravenously to slow cancer progression and shrink tumours, particularly when surgery is not an option.

Targeted therapy

This approach uses drugs that targets specific genetic mutations in cancer cells. For example, ivosidenib targets IDH1 mutations, while infigratinib and pemigatinib target FGFR2 fusions. These are typically used in patients with advanced or inoperable disease who test positive for these mutations on next generation sequencing.

Immunotherapy

Immune checkpoint inhibitors such as pembrolizumab (PD-1) and durvalumab (PD-L1) help the immune system recognise and attack cancer cells. These may be considered for advanced-stage or recurrent gallbladder cancer that no longer responds to standard treatments, or in patients with certain mutations or deficient mismatch repair proteins.