Treatment of Stage IV Gallbladder Cancer
Gallbladder cancer as the name suggests, begins in the gallbladder, an organ that stores a substance called bile. To read about gallbladder and gallbladder cancer, click here
How is gallbladder cancer staged?
Staging of gallbladder cancer helps the doctors figure out the on how much the cancer has spread in the body and determine its best treatment. Staging also helps calculate survival statistics too. The lower the number of the stage, the less is the cancer has spread, with early stages being 1 and the most advanced stage being 4. The staging system and the other factors taken into consideration to determine the stage of gallbladder cancer are as follows:
Cancer types that form tumours are staged using TNM system and the same method is used for gallbladder cancer too, TNM stands for stands for tumour, node and metastasis.
Tumour(T) generally is used to categorize the size of the primary tumour but in this case, it used to reflect the extent to which the cancer has spread to the walls of the gallbladder. The gallbladder has several layers listed below in the order of innermost to the outermost layers:
- The epithelium, a thin layer of cells that lines the interior wall of the gallbladder.
- The lamina propria, a layer of loose connective tissues.
- The muscularis, a layer of muscular tissue that helps the gallbladder contract to push the bile into the bile duct.
- The perimuscular, a layer lining the muscularis made up of fibrous tissue.
- The serosa which forms the outer covering of gallbladder and comes from the peritoneum (lining of the abdominal cavity).
The node describes whether the cancer has spread to the nearby lymph nodes or not. N0 represents no spreading of the cancer to the lymph nodes, N1 represents the spreading of cancer to nearby lymph nodes and N2 stands for spreading to distant lymph nodes.
This gives information about the cancer spreading to other parts of the body, M0 represents no metastasis while M1 stands for metastasized tumours.
Read more about the staging of gallbladder cancer here.
Stage IV gallbladder cancer:
Stage IV is the most advanced stage of gallbladder cancer and the following are the sub stages:
Stage IVA: The tumour has grown into one of the main blood vessels connected to the liver or has grown into two or more structures outside the liver, it may or may not have spread to nearby lymph nodes but has not spread to distant organs and the staging is (T4, N0 or N1, M0)
Stage IVB: The cancer may or may not have spread out of the gallbladder but has affected four or more lymph nodes but has not spread to distant organs and the staging is (any T, N2, M0) or the cancer may or may not have spread beyond the gallbladder or to the lymph nodes but has spread to distant organs and the staging is (any T, any N, M1).
How is stage IV gallbladder cancer treated?
Stage IV gallbladder cancer has a poor prognosis and the cancer cannot be cured at this stage and the treatment aims at relieving the patient’s symptoms and making them as comfortable as possible.
This aims not at treating the cancer but to relieve the patient of the problems caused by the disease and 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 uses drugs to kill cancer cells throughout the body and is used in treating gallbladder cancer if there is a chance of recurrence or the cancer has spread too much and is generally recommended after surgery to destroy remaining cancer cells in this cancer type. Read more about use of chemotherapy in gallbladder cancer treatment here.
Radiotherapy involves killing cancer cells using high intensity radiation and is also used if the tumours are to be targeted unlike chemotherapy which kills cancer cells in all body parts, however due the risk associated with radiation, it is used only in case the cancer has spread or can recur. It can be used to remove tumours that cause problems and ellevate the symptoms. Read more about use of radiotherapy in gallbladder cancer treatment here.