Gallbladder Cancer

What is gallbladder cancer?

Gallbladder cancer as the name suggests, begins in the gallbladder, an organ that stores a substance called bile. Depending on the tissue or organ where the cancer begins, there are around 200 types of cancers and these are called primary cancers. Some cancers have a high likelihood of spreading from one tissue to another and this is called metastasis.

The gallbladder:

The gallbladder is a pear shaped hollow organ on the right side of the abdomen, located under the liver and it is a part of the human biliary system. It is a muscular sac with an approximate capacity of 50 ml in adult humans. Gallstones, gallbladder attack, gallbladder disease are some of the problems associated with gallbladder.

Functioning:

The gallbladder stores and concentrates the bile coming from the liver in between the meals. The liver produces a yellow brown digestive enzyme called bile which flows directly into the small intestine during the meals and is stored in the gallbladder in between the meals. The gallbladder thus serves as a reservoir for bile and its absorbent lining concentrates the bile, which is responsible for the digestion and absorption of fats and fat soluble vitamins.

What are the risk factors of gallbladder cancer?

When the exact causes of a disease are not known, certain factors that are involved with it are noted and these are called the risk factors. The risk factors are the conditions that suggest higher probabilities for developing a certain disease, in this case gallbladder cancers. Some risk factors for gallbladder cancer are as follows, to read more:

  • Gallbladder cancer is rarely found in people younger than 50 years and is generally common in patients older than 70 years and the risk increases with age.
  • 7 out of every 10 cases of gallbladder cancer are women and they are more likely to develop this cancer than men.
  • The existence of gallstones or inflammation of the gallbladder known as cholecystitis is a major risk factor of gallbladder cancer.
  • People whose predecessors have gallstones are more prone to develop gallbladder cancer.
  • Smoking and exposure to chemicals like nitrosamines cause mutations in DNA which can cause this cancer.
  • Porcelain gallbladder, the depositing of calcium on the inner walls of the gallbladder can lead to gallbladder cancer.
  • The inflammation of the bile duct also increases the risk of gallbladder cancer.
  • Abnormal attachment between the bile duct and the pancreas and the outgrowths in the bile duct raise the risk of patients developing gallbladder cancer.
  • Overweight or obesity leads to hormonal changes in the body that caused repeated cholecystitis, which increases the risk of developing gallbladder cancer.
  • Hormone transfusion or replacements raise the risk of the person developing gallbladder cancer. Women who are exposed to high levels of oestrogen during these therapies are more inclined to develop the cancer.

Signs and symptoms of gallbladder cancer:

Gallbladder cancer doesn’t often show signs or symptoms in the early stages because it is located deep inside the body so diagnosing it in the early stages is very difficult.

Early detection:

Gallbladder cancer is hard to find in its early stages, the organ is located deep in the body and tumours cannot be seen or felt during routine examinations. Gallbladder cancer has no reliable screening tests to detect the cancer early and so these are usually detected after the tumour has grown enough to show symptoms.

Symptoms:

Following are the most common symptoms that patients with gallbladder cancer might experience:

  • People with gallbladder might experience severe pain in the abdomen, particularly in the right side upper part.
  • Vomitings might sometimes be a symptom for gallbladder cancer.
  • Jaundice could be one of the main symptoms for the advanced stages, caused due to the tumours growing beyond the gallbladder and creating blockage in the bile duct.
  • When the cancer spreads to other parts of the body, it can be felt in the form of lumps, especially in the right side of the abdomen.
  • Other common symptoms include loss of appetite, weight loss, itchy skin, fever, dark urine, greasy or light-colored stools.

To read more about the signs, symptoms and the early detection of gallbladder cancer, read more here

How is gallbladder cancer diagnosed?

Gallbladder cancer is not usually diagnosed in the early stages and is usually detected after the symptoms show. The doctors then run a series of tests to determine and confirm if the patient has gallbladder cancer, read about the detailed diagnosis of gallbladder cancer here, the following are the common diagnostic tests:

Medical history and physical exam:

If the doctor suspects the patient to have gallbladder cancer, a complete medical history is taken to check for risk factors and symptoms that can point out to the cancer.

Liver function tests:

Lab tests maybe done to find out the levels of bilirubin, albumin, liver enzymes such as alkaline phosphatase, AST, ALT and GGT and certain other substances in the blood and these are collectively called liver function tests and they can help diagnose liver, bile duct or gallbladder disease.

Tumour marker tests:

A blood sample is taken and is tested for biomarkers that can be elevated in the presence of a particular type of cancer and this procedure is called tumour marker test. People with gallbladder cancer may have high levels of markers called CEA and CA 19-9, though these are not unique to gallbladder cancer and are high only in the advanced stages.

Imaging tests:

Imaging tests use X rays, magnetic resonance or sound waves to produce the image of the affected areas in the patient’s body and the following are the reasons why imaging tests help in diagnosing gallbladder cancer:

  • Finding suspicious areas to test for the presence of cancer
  • Helping determine the location of tumours for sampling and biopsies
  • Determining the spread of cancer
  • Checking the patient’s response to treatment
  • Checking for signs of recurrence

Ultrasound, MRI, CT scan, cholangiography and angiography are the imaging tests usually used to diagnose gallbladder cancer.

Cholangiography:

This is an imaging test to check if the bile ducts are blocked, narrowed or dilated and it is used to plan for surgeries to treat gallbladder cancer. Magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) are the types of cholangiograms available as per the requirement of the patient.

Angiography:

Angiogram is an X ray used to look at the blood vessels of the patient. A thin plastic tube is inserted into the artery and a small amount of contrast dye is injected to outline the blood vessels. This can show the tumours or blockages in the blood vessels that can be noted if the cancer has spread beyond the gallbladder into the surrounding blood vessels.

Laparoscopy:

Laparoscope is a thin tube with a light and a video camera than is inserted into the patient’s abdomen through a small incision, to look at the gallbladder, the liver and nearby organs and if needed a biopsy can be done too to confirm cancer. Laparoscopy can help determine the stage and extent of gallbladder cancer too.

Biopsy:

Biopsy for involves the removal of cells from the suspicious areas and examining them under a microscope and is not the prefered method of diagnosis for gallbladder cancer. This is because in case of gallbladder cancer, it can cause the cancer to spread and even if required, surgical biopsy is the prefered option, it means examination of cells removed through or post surgery.

How is gallbladder cancer staged?

Staging of gallbladder cancer helps the doctors figure out how much the cancer has spread in the pancreas and determine its best treatment. Staging also helps calculate survival statistics. The lower the number of the stage, the less is the cancer has spread, with early stages being 0 called carcinoma in situ, followed by stage 1 and the most advanced stage being stage 4. The following are the factors taken into consideration for staging of gallbladder cancer:

TNM method:

Cancer types that form tumours are staged using TNM system and the same method is used for gallbladder cancer too. The extent of the primary tumour (T), the presence of cancerous lymph nodes (N) and how far the gallbladder cancer has spread to a different part of the body (M) can be described using the TNM system.

Grade:

The grade describes how closely the cancer cells resemble the normal cells of the gallbladder when seen under a microscope. The scaling is from 1 to 3 in grading gallbladder cancer.

Extent of resection:

Resection means removal of the cancer tumour through surgery, and based on the extent of resection the gallbladder cancers can be classified as:

Resectable: Those that the doctors believe can be completely removed by surgery

Unresectable: Those that have spread too far or in a location that cannot be operated on through surgery.

For more on staging of gallbladder cancer or its stages, read more here

How is gallbladder cancer treated?

The course of treatment of the patient depends on the stage of gallbladder cancer, the extent to which the cancer has spread and the patient’s response to treatment. The best treatment for this cancer is surgery, read more about surgery for gallbladder cancer here. The following are the treatment options generally used for gallbladder cancer:

Cholecystectomy:

Cholecystectomy is a common procedure used to surgically remove the gallbladder and there are two main ways to remove it. Laparoscopic cholecystectomy involves making small cuts or incisions in the abdomen and using fine surgical instruments to remove the gallbladder pieces while open cholecystectomy involves a single large incision to access and remove the organ.

Extended cholecystectomy:

In case there is a risk of the cancer coming back after a simple cholecystectomy, extended or radical cholecystectomy will be done and this prefered more often a simple cholecystectomy. This involves removal of the gallbladder, an inch or more of the liver tissue next to the gallbladder and all the lymph nodes in the region, depending on the spread of the cancer and the patient’s health, more organs or parts may be removed too.

Palliative surgery:

This aims not at treating the cancer but to relieve the patient of the problems caused by the disease and is generally used in late stages of gallbladder cancer, to read about stage IV of gallbladder cancer here. The following are some of the procedures that can be used as palliative care:

  • Biliary stent or a catheter: Due to blockage caused by cancer, if bile cannot move from the gallbladder or the liver into the small intestine, the buildup of bile can cause jaundice. A stent or a catheter may be placed through the blockage to allow the movement of bile.
  • Biliary bypass: Depending on where the tumour is, a bypass can be creating through surgery to remove the blockage to allow bile to drain from the liver and the gallbladder. A bypass lasts longer than a stent or a catheter but the patient has to be healthy enough to withstand the procedure.
  • Alcohol injection: The doctors may deaden the nerves that carry pain signals from the gallbladder and the intestinal area to the brain by giving alcohol injections, this can be done during a surgery or as a separate procedure through CT scan.

Chemotherapy:

This treatment is used in treating metastasized gallbladder cancer which cannot be removed by surgery alone. Chemotherapy uses drugs which are given orally or intravenously to kill the cancer cells. These drugs are often given in combination with other drugs or treatments. Chemotherapy alone does not show good results in treating in gallbladder cancer though and is usually given along with other treatment options. Know more about chemotherapy for gallbladder cancer here

Radiotherapy:

This treatment uses high beams of x-rays to kill the malignant cells. The radiation is aimed at the cancer cells to kill them and restrict their growth. Radiation therapy is also used to shrink tumours. The success rate of radiation is comparatively good in treating gallbladder cancer. Higher and precise dosage of radiation will increase the effectiveness of the treatment, but the dose should be slowly increased under steady monitoring due to potential side effects. Read more about radiotherapy for gallbladder cancer here

Survival and stages of gallbladder cancer:

The survival rate usually refers to the five year survival rate that shows how many patients out of 100 live beyond five years after first being diagnosed by a specific cancer. It is an indicator to understand the outlook of the patient based on the type and stage of cancer.

Gallbladder cancer has a survival rate of 19%. Only 1 out of every 5 patients who have gallbladder are diagnosed early because this cancer often doesn’t show up in general screening tests and also, it does not show any symptoms until advanced stages. The 5 year survival rates of different stages of gallbladder cancer are:

Stage I:

In this stage, the cancer is still confined to the gallbladder only. Hence, on diagnosing the cancer, the survival rate of stage I gallbladder cancer is 50% to 80%. Read about the treatment of stage I gallbladder cancer here

Stage II:

If the cancer has spread to the nearby lymph nodes of the gallbladder, combination of treatments along with extensive surgery are recommended to eliminate cancer. The survival rate of gallbladder cancer of this stage is approximately 24%. Read about the treatment of stage II gallbladder cancer here

Stage III:

Metastasized cancer comes under stage III gallbladder cancer and cannot be removed by treatments. The survival rate of cancer at this stage is below 10%. Read about stage III of gallbladder cancer and its treatment here

Stage IV:

Stage IV of cancer is when the cancer has spread to other organs like liver, lungs through the main blood vessels and lymph nodes. No treatment can completely eliminate this stage of cancer but only relieve the patients from the pain and the symptoms caused by the disease. The survival rate of stage IV gallbladder cancer is around 5%. Read about stage IV of gallbladder cancer and its treatment methods here

Follow up with gallbladder cancer:

The patient have to monitor his/her health regularly, even after active treatment for gallbladder cancer. The following is the follow up care for gallbladder cancer:

  • Developing a follow up plan
  • Regular monitoring of blood cell count and hormone levels
  • Maintain a healthy diet
  • Watching for recurrence of cancer
  • Managing long term side effects through tests and monitoring
  • Keeping personal health record

After care:

The follow up plan also includes a proper after care for the patient to follow:

  • Regular check-ups with the doctor
  • Have small healthy meals six to eight times a day
  • Stay hydrated
  • Not work too hard
  • Keep skin moisturized
  • Take nourishment supplements
  • Take anti sickness medication to prevent reduce weakness
  • Consult a doctor on any reactions
  • Avoid spicy food
  • Do not overload the liver
  • Self hygiene is very important especially when the patient is given biliary bypass

To read further about the follow up and treatment outcomes of gallbladder cancer, click here

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