Gallbladder Cancer

WHAT IS GALLBLADDER CANCER?

Gallbladder cancer is a disease in which malignant (cancer) cells form in the tissues of the gallbladder.

The gallbladder is a pear-shaped organ that lies just under the liver in the upper abdomen. The gallbladder stores bile, a fluid made by the liver to digest fat. When food is being broken down in the stomach and intestines, bile is released from the gallbladder through a tube called the common bile duct, which connects the gallbladder and liver to the first part of the small intestine.

The wall of the gallbladder has 3 main layers of tissue:mucosal (innermost) layer, muscularis (middle, muscle) layer and serosal (outer) layer. Between these layers is supporting connective tissue.

Gallbladdercancer is a rare disease in which malignant (cancer) cells are found in the tissues of the gallbladder, and starts in the innermost layer and spreads through the outer layers as it grows.

Being female or having gallstones can affect the risk of developing gallbladder cancer.



HOW TO DETECT GALLBLADDER CANCER?

Possible signs of gallbladder cancer include jaundice, pain, and fever.

These and other symptoms may be caused by gallbladder cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

Jaundice (yellowing of the skin and whites of the eyes).
Pain above the stomach.
Fever.
Nausea and vomiting.
Bloating.
Lumps in the abdomen.
Tests that examine the gallbladder and nearby organs are used to detect (find), diagnose, and stage gallbladder cancer.

Tests and procedures to detect, diagnose, and stage gallbladder cancer are usually done at the same time. The following tests and procedures may be used:

Ultrasound/CT scan/MRI: An abdominal picture may suggest

gallbladder cancer.

Liver function tests: A higher than normal amount of a substance can be a sign of liver disease that may be caused by gallbladder cancer.

Carcinoembryonic antigen (CEA) assay: CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of gallbladder cancer or other conditions.

CA 19-9 assay: CA 19-9 is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of gallbladder cancer or other conditions.

ERCP (endoscopic retrograde cholangiopancreatography): Sometimes gallbladder cancer causes bile ducts to narrow and block or slow the flow of bile, causing jaundice. ERCP may discover this abnormality.

Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. The biopsy may be done after surgery to remove the tumor. If the tumor clearly cannot be removed by surgery, the biopsy may be done using a fine needle to remove cells from the tumor.

Laparoscopy: The laparoscopy helps to determine if the cancer is within the gallbladder only or has spread to nearby tissues and if it can be removed by surgery.



HOW TO TREATE GALLBLADDER CANCER?

Traditional treatment

Surgery

Surgery is aimed to remove the gallbladder and some of the tissues around, including nearby lymph nodes. Sometimes the surgery is performed under guidance of a laparoscope.

If the cancer has spread and cannot be removed, the following types of palliative surgery may relieve symptoms:

Surgical biliary bypass: During this operation, the gallbladder or bile duct will be cut and sewn to the small intestine to create a new pathway around the blocked area.
Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin, flexible tube) to drain bile that has built up in the area.
Percutaneous transhepatic biliary drainage: An x-ray of the liver and bile ducts is done to locate the blockage. Images made by ultrasound are used to guide placement of a stent, which is left in the liver to drain bile into the small intestine or a collection bag outside the body.
Radiation therapy

There are two types of radiation therapy:

External radiation therapy uses a machine outside the body to send radiation toward the cancer.
Internal radiation therapy uses a radioactive substance (iodine-125) sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
Chemotherapy

Chemotherapy includes systemic chemotherapy and regional chemotherapy, the latter is often performed with percutaneous transarterial (hepatic artery) infusion.

Treatment Options for Gallbladder Cancer

Localized Gallbladder Cancer

Treatment of localized gallbladder cancer may include the following:

Surgical resection.
Radiation therapy with or without chemotherapy.
Unresectable Gallbladder Cancer

Treatment may include the following:

Surgery is aimed to relieve symptoms caused by blocked bile ducts.
Radiation therapy with the placement of stents.
Chemotherapy.
Recurrent Gallbladder Cancer

Treatment is dependent upon cancer involvement.



HOW TO ESTIMATE THE PROGNOSIS OF GALLBLADDER CANCER?

The following factors affect the prognosis:

The stage of the cancer (whether the cancer has spread from the gallbladder to other places in the body).
Whether the cancer can be completely removed by surgery.
The type of gallbladder cancer (how the cancer cell looks under a microscope).
Whether the cancer has just been diagnosed or has recurred (come back).
Gallbladder cancer can be cured only if it is found before it has spread, when it can be removed by surgery. If the cancer has spread, palliative treatment can improve the patient's quality of life by controlling the symptoms and complications of this disease.