Synopsis
Distinguish common benign polypoid findings from lesions needing surveillance or hepatopancreatobiliary review, and recognise incidental or symptomatic gallbladder cancer without disrupting oncological planning.
- Most small gallbladder polypoid lesions are benign cholesterol deposits, but size, sessile morphology, focal wall thickening, interval growth and patient risk factors influence malignancy concern.
- Ultrasound reports should document maximum diameter, attachment, mobility, acoustic shadowing, adjacent wall and comparison with prior imaging; stones move and shadow, whereas a true polyp remains attached.
- Do not memorise one universal operation or surveillance threshold: apply the current network radiology and HPB policy, because measurement variability and accepted algorithms can change.
- Primary sclerosing cholangitis, increasing age, a sessile lesion or associated focal wall thickening can lower the threshold for specialist discussion; decisions still require individual surgical fitness and preference.
- Gallbladder cancer is often clinically silent or found unexpectedly after cholecystectomy; later disease may cause persistent right-upper-quadrant pain, weight loss, jaundice, anorexia or an abdominal mass.
- A suspicious mass or concerning polyp needs contrast cross-sectional staging and specialist HPB MDT review, not casual transperitoneal biopsy or routine simple cholecystectomy without an oncological plan.
- Fever and jaundice may reflect cholangitis caused by malignant obstruction and require emergency antibiotics and biliary drainage independently of the cancer timetable.
- Histology after every cholecystectomy must be reviewed and acted upon; an incidental tumour can require completion staging and additional liver or nodal surgery at a specialist centre.
Key red flags
Unexpected adenocarcinoma in a cholecystectomy specimen requires staging, pathology review and specialist MDT discussion before assuming the original operation was sufficient.
Rigors, fever, hypotension or confusion with tumour-related jaundice is an emergency cholangitis presentation requiring resuscitation and drainage alongside oncological care.
Investigation priorities
Characterise lesion size, morphology, mobility, shadowing, wall change, gallstones and biliary dilatation with prior-image comparison.
Management branches
Ultrasound reports a polypoid gallbladder lesion without a definite invasive mass.
- Verify the image quality, maximum size, sessile or pedunculated morphology, focal wall thickening and comparison with every prior scan.
- Record primary sclerosing cholangitis, age, symptoms, gallstones, comorbidity and whether the person could benefit from future surgery.
- Apply the current local radiology-HPB algorithm to choose discharge, interval ultrasound or surgical consultation, documenting the version used.
- Escalate discordant measurements, convincing growth or suspicious morphology for specialist imaging rather than repeatedly resetting surveillance.
Routine pathology unexpectedly identifies gallbladder carcinoma in a removed specimen.
- Notify and support the patient promptly, ensure expert pathology review and retrieve the operative record, specimen handling and any bile-spillage details.
- Obtain complete staging imaging through the HPB cancer service and avoid assuming that a negative preoperative ultrasound excludes residual disease.
- Let the specialist MDT decide whether observation, completion liver and lymph-node surgery, systemic treatment or another strategy is appropriate.
Key medicines
Analgesic ladder for cancer-related painSelect regular non-opioid and, when needed, opioid regimens from the current BNF with individual titration and breakthrough provision.Review renal and hepatic function, constipation, nausea, sedation and driving; new escalating pain also warrants anatomical reassessment rather than dose escalation alone.
Antibiotics for tumour-associated cholangitisGive the local emergency biliary-infection regimen at current BNF doses and arrange urgent drainage when malignant obstruction is infected.Do not confuse antimicrobial response with cancer treatment or durable duct patency; adjust for cultures, allergy, renal function and prior stents.