How should I approach the management of a patient diagnosed with early-stage gallbladder cancer in primary care?

In primary care, the management of a patient diagnosed with early-stage gallbladder cancer should focus on prompt referral to specialist care for comprehensive staging and multidisciplinary team (MDT) assessment, as definitive treatment is surgical and requires specialist input. Early-stage gallbladder cancer often necessitates surgical resection, typically cholecystectomy with or without extended resection depending on staging, which cannot be performed in primary care. Therefore, the key role in primary care is to ensure timely recognition, support, and coordination of care.

Initial steps in primary care include:

• Confirming diagnosis and ensuring the patient understands their condition and the need for specialist referral.
• Referring urgently to a hepatobiliary or surgical oncology MDT for staging investigations such as contrast-enhanced CT or MRI to assess local invasion and metastases.
• Providing supportive care including symptom management (e.g., pain control) and psychological support, as gallbladder cancer can have significant impact on quality of life.
• Monitoring for complications such as biliary obstruction or infection, and liaising with secondary care if these arise.

While gallstone disease management guidelines recommend laparoscopic cholecystectomy for symptomatic gallstones, gallbladder cancer requires more extensive surgical planning and oncological assessment beyond primary care capabilities ¹. Literature highlights that peritoneal relapse is common in gallbladder cancer, underscoring the importance of specialist staging and treatment planning to optimize outcomes (Maplanka, 2014).

In summary, primary care's role is to facilitate early diagnosis confirmation, urgent referral to specialist MDTs for staging and treatment planning, provide supportive care, and coordinate ongoing management in partnership with secondary care ¹ (Maplanka, 2014).