Gallbladder Cancer

Overview

Gallbladder cancer is a rare type of cancer that develops when malignant (cancer) cells originate in the gallbladder's tissues. The gallbladder is a pear-shaped organ in the upper belly that sits just under the liver. It holds bile, a digestive fluid produced by the liver. Bile is secreted from the gallbladder by the common bile duct, which connects the gallbladder and liver to the first part of the small intestine when food is broken down in the stomach and intestines.

Types

Based on the origin, gallbladder cancers are categorised into two types:
 
About 90% of gallbladder cancers are found to be adenocarcinomas. The cancerous growth in this type begins in the gland-like cells present in the inner lining of the gallbladder. Adenocarcinomas are further classified into subtypes – non papillary adenocarcinoma, papillary adenocarcinoma and mucinous adenocarcinoma.
 
Other types of gallbladder cancers are adenosquamous carcinoma, squamous cell carcinoma, carcinosarcoma, etc. These are both rare and aggressive than adenocarcinomas.

Symptoms

The symptoms of gallbladder cancer can be confusing. If the following symptoms are observed for more than two weeks, it is important to see a physician:
 

• Steady pain on the right side (upper) of the abdomen
• Fatigue
• Loss of appetite
• Unintentional weight loss
• Enlarged gallbladder
• Vomiting due to obstruction
• Jaundice 
• A swollen abdomen

 
Early signs and symptoms of gallbladder cancer are similar to gallbladder inflammation caused by gallstones. Symptoms of biliary and gastric blockage may develop later.

Causes

The exact causes of gallbladder cancer are still not known. Nevertheless, the researchers have identified a few factors that increase one’s risk of developing gallbladder cancer:

• Gender: Women are more likely than men to develop gallbladder cancer.
• Cholecystitis: Cholecystitis is an inflammation of the gallbladder that leads to gallbladder stones. This is by far the most common predisposing factor for gallbladder cancer.
• Positive Family History for Gallstones and Gallbladder Cancer: People who have a family history of gallstones are twice as likely to get gallbladder cancer.
• Tobacco Use and Chemical Exposure: Tobacco and several industrial chemicals cause damage to the DNA structure, lead to genetic abnormalities and thereby, increase the risk of gallbladder and other cancers. Gallbladder cancer is more common in people who work in the metal or rubber industries.
• Porcelain Gallbladder: This is a condition in which calcium deposits form on the inside of the gallbladder's walls, hardening them. Those with a porcelain gallbladder have an increased risk of gallbladder cancer.
• Improper Functioning of Pancreas and Bile Ducts: Problems associated with pancreas and bile ducts may increase one’s risk of gallbladder cancer. 
• Obesity: Being overweight or obese increases the chances of gallstones and cholecystitis, which can lead to gallbladder cancer.
• Diet: A high-carbohydrate, low-fibre diet has been linked with an increased risk of gallbladder cancer.
• Diabetes: Diabetes has been linked to an increased risk of this disease
• Hormone Replacement Therapy: Women who are exposed to more of the hormone estrogen may have a higher risk of gallbladder cancer.

Diagnosis

There are multiple tests recommended by doctors for the detection and diagnosis of gallbladder cancer. The results from these tests are further used to create personalised treatment plans for patients.
 
First and foremost, the doctor may conduct a physical examination, during which he/she may look for signs of gallbladder cancer. The doctor may particularly look for lumps, tenderness and fluid build-up in the abdomen region. He/she may also look for signs of jaundice. The lymph nodes nearby are also checked for swelling. If gallbladder cancer is suspected, the following tests may be recommended:
 
a. Blood Tests: To determine the amount of bilirubin in the blood, blood tests may be performed. Bilirubin levels in the blood can be raised by problems with the gallbladder, bile ducts, or liver. Albumin, liver enzymes (alkaline phosphatase, AST, ALT, and GGT) tests, as well as other blood tests, may be performed. These tests are frequently referred to as liver function tests. They aid in the diagnosis of disorders of the liver, bile ducts and gallbladder.
 
b. Tumour Markers: Gallbladder cancer patients may have elevated levels of the markers CEA and CA 19-9 in their blood. These indicators are usually seen in significant concentrations in the blood only when cancer has progressed to an advanced stage. While these biomarkers aren't specific to gallbladder cancer, they can be helpful after an individual has been diagnosed with the disease. These indicators can be tracked over time to study how the patient's body is responding to the treatment.
 
c. Imaging Tests: Various imaging tests, such as ultrasound scan, CT scan, MRI scan, etc., are recommended to study the internal structure of the organ and check for the presence of abnormal masses. Apart from supporting accurate diagnosis, these tests also help in disease staging, treatment planning, therapy monitoring and restaging. In the case of gallbladder cancer, a special imaging test is recommended to thoroughly examine the gallbladder region.
 

• Cholangiography: This test allows the clinician to thoroughly examine the bile ducts. It can be done with an MRI machine (Magnetic Resonance Cholangiopancreatography), an endoscope (Endoscopic Retrograde Cholangiopancreatography), or through a needle inserted through the abdominal skin (Percutaneous Transhepatic Cholangiography).

d. Biopsy: During a biopsy, cells or tissues from the suspected area are removed so that a pathologist can examine them under a microscope for signs of gallbladder cancer. Even after the tumour has been removed, a biopsy may be performed. If the tumour cannot be removed surgically, the biopsy sample may be collected using a thin needle for further examination.

Treatment

There are multiple treatment options available for the treatment and management of gallbladder cancer. Following are the commonly recommended treatment methods:
 
a. Surgery: A cholecystectomy or surgery to remove the gallbladder and some of the surrounding tissues. Nearby lymph nodes may be removed as well. Gallbladder surgery is occasionally guided via a laparoscope. A video camera is attached to the laparoscope, which is introduced through an incision in the abdomen. Surgical instruments are introduced through the pores made. Because there's a chance gallbladder cancer cells will spread to these openings, the tissue around them may be removed as well.
 
The following types of palliative surgery may help reduce symptoms if cancer has spread and cannot be removed:

• Surgical biliary bypass: A biliary bypass may be performed if the tumour is blocking the small intestine and bile is accumulating in the gallbladder. The gallbladder or bile duct will be cut and stitched to the small intestine to construct a new conduit around the obstructed location during this procedure.

• Endoscopic stent placement: If the tumour is blocking the bile duct, surgery to place a stent (a thin, flexible tube) to drain bile that has accumulated in the area may be required. The stent can be inserted around the blocked area to internally drain the bile into the small intestine or can be inserted through a catheter that drains to the outside of the body.

• Percutaneous Transhepatic Biliary Drainage: When endoscopic stent implantation is not possible due to a blockage, surgery to drain bile is performed. To find the blockage, an x-ray of the liver and bile ducts is taken. Ultrasound images may be used to guide the insertion of a stent in the liver, which drains bile into the small intestine or a pouch outside the body. This surgery may be recommended to alleviate jaundice before surgery.

b. Radiation therapy: Radiation therapy is a cancer treatment that destroys cancer cells using high-energy x-rays or other types of radiation. Radiation therapy can either be delivered externally or internally. External radiation therapy delivers radiation to the tumour from a radiation source outside the body. Internal radiation therapy involves injecting a radioactive substance into or near the tumour through seeds, wires, needles or catheters. Radiation therapy may also be recommended to ease pain in advanced stages of the disease.
 
c. Chemotherapy: Chemotherapy is a cancer treatment that employs potent drugs to inhibit cancer cells from growing by either killing them or keeping them from dividing. Chemotherapy enters the bloodstream and can reach cancer cells all over the body when taken by mouth or injected into a vein. It is usually given to gallbladder cancer patients after surgery (adjuvant therapy). Chemotherapy may be administered alone to help reduce signs and symptoms caused by cancer, and to increase survival to some extent in patients with advanced-stage gallbladder cancer.

Frequently Asked Questions

1. Are gallbladder cancers treatable?
 
If detected in the early stages, gallbladder cancers can be treated with positive clinical outcomes and higher survival rates. Thanks to the advancements in the field of cancer care, today, our specialists can treat advanced-stage gallbladder cancers as well.
 
However, early diagnosis makes the treatment simpler, and patients can recover at a relatively faster rate. Therefore, it is important to be mindful of any abdominal issues and other symptoms that last for more than two weeks.
 
2. Is gallbladder cancer difficult to diagnose?
 
Yes, gallbladder cancers are relatively difficult to diagnose for the following reasons:

• In the early stages of gallbladder cancer, there are no indications or symptoms.
• As the disease progresses, the symptoms are similar to those of many other conditions.
• Behind the liver, the gallbladder is hidden.

 
3. Does gallbladder cancer cause pain?
 
Yes, gallbladder cancer causes persistent abdominal pain that may intensify as the illness progresses, but there are treatments available to help manage the pain.
 
4. Do gallbladder stones cause gallbladder cancer?
 
No, gallbladder stones do not cause gallbladder cancers. However, their presence can increase one’s risk of developing gallbladder cancer.
 
5. Can I prevent gallbladder cancer?
 
Although you cannot prevent gallbladder cancer completely, there are a few things that you can do to reduce your risk of developing this disease. Maintaining healthy body weight, having nutritional and balanced meals, staying physically active, quitting tobacco and reducing alcohol intake are a few preventive measures that may help you reduce your gallbladder cancer risk.