Gall bladder cancer (GBC) is a rare malignancy with an estimated 9,760 new cases during 2009 in the United States. It is the most common cancer of the biliary tract, although it is no longer considered to be a type of cholangiocarcinoma. The outcome of those with GBC has been reported to be dismal, but with the current aggressive approach, there have been significant improvements in the 5-year survival rates, especially in the early stages. GBC is rare, yet the most common cancer of the biliary tree. GBC is most commonly diagnosed incidentally during laparoscopic cholecystectomy. Large gallstones are a risk factor. Old age and male gender are often associated with more aggressive disease and poor outcomes. A suspicious or frankly malignant lesion of the gallbladder is not biopsied. If GBC is strongly suspected or confirmed, it is recommended to proceed with an open approach, rather than laparoscopic. Port site metastases can occur in ~ 20% and hence port-sites should be excised. Avoid bile spillage and gallbladder perforation during cholecystectomy for oncological reasons. Simple cholecystectomy is curative treatment for T1a lesions. It is recommended to perform extended cholecystectomy for T1b lesions. There is no hard evidence to guide adjuvant therapy. The survival rates of GBC have improved over the years with better hepatic resections and a more aggressive approach.