What Is Gallbladder Cancer?
Gallbladder cancer is a serious and complex disease. It is:
- The third most common cancer among women (especially those over the age of 50).
- The fifth most common cancer of the digestive tract (gastrointestinal tract).
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Causes and Risk Factors
The exact cause of gallbladder cancer is not always known. Important risk factors include:
- Gallstones: Gallstones are present in 70% to 80% of cases; while it is not definitively known whether the stones themselves cause cancer, individuals with gallstones face a 38 times higher risk of cancer compared to those without them.
- Gallbladder polyps, particularly larger polyps. Polyps measuring more than 1 cm may increase the risk of cancer by 23%.
- Porcelain gallbladder (calcification of the gallbladder) has a 22% chance of causing cancer.
- Chronic cholecystitis (long-term inflammation of the gallbladder).
- Smoking.
- Alcohol use.
- Diets high in unhealthy fats and calories.
- Excess body weight (obesity).
Symptoms of Gallbladder Cancer
Gallbladder cancer may have no symptoms in its early stages.
Possible symptoms include:
- Symptoms similar to those caused by gallstones.
- Gallbladder infection (cholecystitis).
- Abdominal pain.
- Loss of appetite.
- Vomiting.
- A mass or lump in the abdomen.
- Jaundice.
- Fever.
- Itching of the skin.
The symptoms may vary depending on how far the cancer has spread. Gallbladder cancer has about 5 stages and symptoms will differ depending on which stage the patient currently is in.
Diagnosis of Gallbladder Cancer
- Ultrasound: An ultrasound may show gallstones, mass, and thickening of the gallbladder wall.
- A contrast-enhanced CT scan can help identify a gallbladder mass, whether it has spread into the liver and the involvement of nearby lymph nodes.
- Tumor Markers (CA 19-9).
- Liver function tests.
- MRCP.
- Often, cancer is detected in the gallbladder biopsy following gallbladder surgery (cholecystectomy).
- FNAC or biopsy is not always performed before surgery, particularly when there is concern that a needle procedure could affect the surgical plan or potentially spread tumor cells. It may be used in selected situations when tissue confirmation is needed.
Treatment of Gallbladder Cancer
Treatment depends on the stage and location of the cancer.
- Surgical Removal (Hepatic Bisegmentectomy): treatment may involve removing the gallbladder along with part of the nearby liver (segment IVB and V).
- Fascia, fat, and lymph nodes of the hepatoduodenal ligament must be removed.
- If this appropriate surgery is performed at an early stage, the probability of 5-year survival exceeds 90%.
- If the bile duct is involved, biliary reconstruction is required.
- If the digestive tract is involved, gastrojejunostomy is required.
- If the bile duct is encased or obstructed, a stent must be placed in the bile duct via ERCP to relieve jaundice.
- Chemotherapy yields very limited results in advanced stages of gallbladder cancer.
Prevention of Gallbladder Cancer
- Do not ignore symptomatic or complicated gallstones for a long time.
- Seek medical evaluation for porcelain gallbladder, significant gallbladder polyps, or marked gallbladder-wall thickening.
- Treat long-standing gallbladder inflammation appropriately.
- Avoid smoking.
- Avoid excessive alcohol use.
- Follow a balanced diet and avoid excessive intake of high-fat and high-calorie foods.
Conclusion
- Take appropriate steps to reduce the risk factors for gallbladder cancer.
- Detecting gallbladder cancer at an early stage and providing appropriate treatment can greatly improve the chance of long-term survival.