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Gall Bladder Cancer

  The gallbladder is an organ which stores bile (a fluid made by the liver which helps in digesting fat). The gallbladder releases bile through a common bile duct tube, and these ducts connect the gallbladder and liver to the small intestine. Any abnormal and uncontrolled cell growth may lead to gallbladder cancer.

What are the symptoms of gallbladder cancer?

Gallbladder cancer may not show early signs and symptoms. Symptoms include

  • Yellowing of the skin and whites of the eyes (Jaundice)
  • Pain above the stomach
  • Fever
  • Nausea and vomiting
  • Bloating
  • Lumps in the abdomen

 

 

What causes gallbladder cancer and who is at risk?

The exact cause which leads to gallbladder cancer is unknown. However, certain risk factors will increase the chances of cancer.

  • Gallstones: People with a history of gallbladder stones have the risk of developing gallbladder cancer.
  • Gallbladder polyps: Gallbladder polyps are a growth that sometimes develops when small gallstones get embedded in the gallbladder wall. Doctors often suggest gallbladder removal for people who have polyps larger than 1 cm because these are more likely to be cancerous.
  • Age: Mostly, gallbladder cancer is diagnosed in people older than 70.
  • Gender: Chances of developing gallbladder cancer is more common in women as compared to men.
  • Smoking: Smoking tobacco increases the risk of gallbladder cancer.
  • Family history: People who have any close family member with gallbladder cancer are at high risk.

 

How is gallbladder cancer diagnosed?

Gallbladder cancer is challenging to diagnose in the early stages as the patient does not present with symptoms. When you visit the doctor with symptoms, he will examine you to identify the problem.

 

  • Physical examination: The doctor will take your health history, including eating habits, etc. He will do a physical check-up and feel your belly to look for any abnormality.
  • Endoscopic retrograde cholangiopancreatography (ERCP): This procedure is used to x-ray the ducts (tubes), which take bile from the liver to the gallbladder and from there to the small intestine. This procedure helps in finding the spread of gallbladder cancer.
  • Laproscopy: It is a surgical procedure to look inside the organs to check for signs of disease. Minor cuts are made in the stomach wall, and a thin, lighted tube (laproscope) is inserted into one of the incisions. This procedure helps see any abnormality, and sometimes some tissue samples are also taken from the gallbladder to check for cancer.
  • Percutaneous cholangiography: In this procedure, a thin needle is inserted via the skin into the gallbladder area during this procedure. A dye is injected so that a clear image will show up on x-rays. The doctor may see if there is a tumor in the gallbladder.
  • Blood tests: The doctor may suggest you to go for a blood test to look for abnormal bilirubin levels and other substances. Bilirubin levels are high in people with gallbladder cancer due to blockage of the common bile duct by a tumor.

 

 

What are the next steps after confirmation of cancer?

After confirmation of cancer, your doctor may ask you to go for additional tests to determine the spread of cancer to the lymph nodes or other areas of your body. These tests also help in determining the grade of cancer. These tests may include:

 

  • Abdominal ultrasound: This procedure, with the help of sound waves, creates a picture of the internal organs in the abdomen to look for any signs of the spread of cancer.
  • Computerized tomography (CT scan): This test uses a unique dye medium that helps with a clear image of the body parts from different angles. It can help in seeing detailed images of soft tissue and blood vessels. CT scan is used to measure the tumor size and helps look for the spread of the tumor to different body organs.
  • Magnetic resonance imaging (MRI): An MRI utilises magnetic fields to produce detailed body images. It helps in measuring the size of the tumor and also to look for the spread of cancer.
  • Positron emission tomography (PET) or PET-CT scan: A PET scan uses a small amount of radioactive sugar substance injected into the patient's body. This sugar substance is then used by cells, and a scanner then detects this substance to make images of the organs inside the body.

 

 

What are the stages of gallbladder cancer?

 

  • Stage 0: At this stage, a group of abnormal cells present may turn into cancer.
  • Stage I: Cancer is present only in the gallbladder and has not spread.
  • Stage II: Cancer has extended to the perimuscular connective tissue but has not spread elsewhere.
  • Stage IIIA: Cancer has spread beyond the gallbladder. It has not spread to nearby arteries or veins, any lymph nodes, or other parts of the body.
  • Stage IIIB: Cancer can be of any size and has spread to nearby lymph nodes but has not spread to nearby arteries and/or veins, or other parts of the body.
  • Stage IVA: Cancer has spread to nearby veins, arteries, and/or nearby lymph nodes, but it has not spread to other body parts.
  • Stage IVB: Cancer cells has spread to other parts of the body or any tumor with distant lymph node spread, though it has not spread to distant organs.

 

How is gallbladder cancer treated?

Treatment of gallbladder cancer depends on various factors like the stage of the cancer, the patient's age, and his overall health. A combination of treatments like radiation therapy, chemotherapy, surgery, etc is planned for patients which are best suited for them.

  • Surgery: Surgery for cancer depends upon the size and the location of the tumor. There are various surgical procedures done depending upon the stage of the cancer. Surgery may not be a suitable option for patients with advanced-stage cancer. Some of the common surgeries for gallbladder cancer are:
  • Cholecystectomy: This procedure involves the removal of the gallbladder.
  • Radical gallbladder resection: In this procedure, there is the removal of the gallbladder along with a wedge-shaped section of the liver (near gallbladder), the common bile duct, part or all of the ligaments between the intestine and liver, and the lymph nodes around the pancreas and nearby blood vessels.
  • Radiation therapy: Radiation therapy utilises high-energy x-rays or various other types of radiation to kill cancer cells. Radiation therapy can be used in a targeted area or whole body; the doctor carefully directs the energy to the affected area that focuses on killing the cancer cells. Though this treatment is not always used for gallbladder cancer.
  • Chemotherapy: Chemotherapy uses drugs that stop the cancer cells from multiplying, either by killing the cancer cells or by inhibiting them from multiplying. These drugs are administered through the vein or can be given in the form of pills. Oxaliplatin and Gemcitabine are some common drugs used to treat gallbladder cancers.
  • Targeted therapy: This treatment uses drugs and other substances that identify and attack the cancer cells. As this treatment focuses on cancer cells, it is less harmful in comparison to radiation and chemotherapy.

 

What to expect after surgery?

 

After open surgery, the stay in the hospital will be around 3-5 weeks, and it may take about 6-8 weeks to return to normal activities. This is the time where your body is in the recovery phase. You may experience some complications like pain and discomfort around the incision that pain medications will manage, and it will gradually heal.

Once discharged from the hospital, the pain will be managed by the oral medications prescribed by your doctor. Your doctor will call you for regular postoperative evaluations. In case you face any problem after surgery, please get in touch with your doctor immediately.

 

 

What is the survival rate of gallbladder cancer?

The survival rate of the patient depends on the factors like type and stage of gallbladder cancer.

  • 5-year survival rate for patients with localized (cancer is limited to the area where it has started) cancer is 65%.
  • 5-year survival rate for patients with regional (cancer has spread to the nearby lymph nodes) cancer is 28%.
  • 5-year survival rate for patients with distant (cancer has moved farther, such as liver, brain, etc.) cancer is 2%.

 

How to keep a check on reoccurrence?

Almost one-third of patients experienced a recurrence after gallbladder cancer surgery. It is advisable to be vigilant with the follow-up protocol, and in case of any problem you experience, inform your doctor immediately. The doctor will perform a physical exam and recommend you to go for tests to learn as much as possible about the recurrence. After the testing is done, your doctor may plan the best treatment option available that might include previous treatment as well.

 

Prevention tips

Prevention of gallbladder cancer is not possible. However, by making some lifestyle modification, you can lower the risk.

  • Try to maintain ideal body weight.
  • Keep yourself involved in physical activities like yoga, gym, etc and limit the time you spend sitting or lying down
  • Follow a healthy diet plan which includes plenty of green vegetables, fruits, and whole grains, and limits or avoids processed and red meats, sugary drinks, and highly processed foods.
  • Limit alcohol consumption as much as possible.

 

 

 

 

 

 

 

 

 

Symptoms

The signs and symptoms of Gallbladder cancer may include:

  • Abdominal pain, specifically in the upper right portion of the abdomen
  • Abdominal bloating
  • Fever
  • Losing weight without trying
  • Nausea
  • Jaundice

Diagnosis

To diagnose gallbladder, tests, and procedures include:

  • Blood tests: The doctor may recommend Liver function tests which may help your doctor show how well your liver, gallbladder, and bile ducts are working and give clues about what's causing your symptoms.
  • Procedures to generate images of the gallbladder: Imaging tests will be used by the doctor to create pictures of the gallbladder by using ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI).
  • Exploratory surgery: Your doctor may recommend surgery to look inside your abdomen for determining how far the gallbladder cancer has spread.
  • Laparoscopy: In a procedure called laparoscopy, a tiny camera is inserted inside through a small incision in your abdomen to examine organs surrounding your gallbladder for signs that cancer has spread.
  • Tests to examine the bile ducts: To examine the blockages in your bile ducts or liver, the doctor will suggest an X-ray taken after a dye is injected. The dye will result in presenting detailed images. These tests may involve magnetic resonance cholangiography, endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography.
  • Additional imaging tests: Other scans and tests will also be suggested by the doctor to help determine whether cancer has spread or remains localized. The scans will be performed depending on the circumstances, and these include, CT scan of chest and abdomen, ultrasonography, and an MRI of the liver.

Treatment

The doctor may recommend gallbladder cancer treatment options depending on the stage of your cancer, your overall health, and your preferences. The goal of any treatment will be to remove the gallbladder cancer. But, if that is not, then other therapies will be implemented to help combat the spread of the disease and keep you as comfortable as possible.

  • Surgery for Stomach Cancer: The surgeon will remove the gallbladder and a portion of the liver to eliminate cancerous cells. Every so often, surgery is also performed to remove portions of the liver and bile ducts that surround the gallbladder.
  • Radiation treatments: A powerful beam of energy, such as X-rays is used to target and eliminate cancerous cells before and after surgery. Radiation therapy can be used before surgery to limit a tumour so that it's more deftly removed.
  • Chemotherapy: Chemotherapy is implemented to kill cancer cells and limit the growth of cancer cells that may have spread beyond the gallbladder.
  • Targeted Therapy: These drugs primarily affect cancer cells and not active cells. These drugs block the abnormalities causing cancer cells to die.

Preventing gallbladder cancer

Some tips for a healthy lifestyle may include:

  • Maintaining a healthy weight.
  • Eating a healthy diet.
  • Exercising.

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