Gallbladder Cancer

Gallbladder cancer is a relatively uncommon disease that occurs when the cells of gallbladder grow uncontrollably, often due to chronic inflammation. The gallbladder is a small, pear-shaped organ that lies on the right side of your abdomen, just under your liver. It stores bile, which is a digestive fluid secreted by your liver, and is needed to breakdown fats. If gallbladder cancer is detected in its early stages, the chance of having it cured is high. However, most gallbladder cancers are discovered very late, and in these cases the prognosis is poor. As it does not cause any specific signs and symptoms in its early stages, gallbladder cancer is often difficult to diagnose. Also, the hidden nature of the gallbladder makes it easy for gallbladder cancer to grow without being detected.

Gallbladder cancer is not usually detected at its initial stages. This may be due to the fact that the gallbladder is located deep down inside the body. The noticeable gallbladder symptoms are as follows:

• Jaundice - Yellowish discoloration of the skin and eyes
• Pain in the abdomen, particularly in the upper right portion of the abdomen 
• Abdominal bloating 
• Abdominal lumps
• Nausea and vomiting
• Itchiness 
• Fever 
• Loss of appetite
• Unexpected loss of weight  

All the above are the signs of gallbladder disease or gallbladder problems. In case you begin to notice one or more of these gallbladder symptoms, talk to your medical specialist immediately.

If you feel gallbladder pain, or pressure in the upper right side of your abdomen, it could indicate that you have gallbladder stones. 

The exact cause of gallbladder cancer is unclear. However, recent studies have revealed that gallbladder cancer often develops as a result of mutations in the DNA of gallbladder cells. Due to this, the cells begin to grow nonstop, without dying when required to. The accumulating cells end up forming a tumor mass, which can even grow past the gallbladder and spread to other body parts.

The majority of gallbladder cancer starts in the glandular cells that are found in the lining of the inner surface of the gallbladder, referred to as adenocarcinoma.

Tests and procedures used to diagnose gallbladder cancer include:

• Physical examination: The body of the patient will be examined to observe general health signs. This includes checking for signs and symptoms of diseases like lumps or any other things that may seem unusual. The doctor may also take a look at the health habits of the patient as well as past illnesses and treatments.

• Liver function tests: This is a procedure whereby the blood sample of the patient is checked so as to measure the quantity of specific substances and constituents the liver releases into the blood. An unusual abundance may be a sign of liver disease caused as a result of gallbladder cancer.

• Carcinoembryonic Antigen (CEA) assay: This is a test performed to measure the level of CEA available in the blood. Cancer cells and normal cells are responsible for releasing CEA into the bloodstream. A higher than expected amount of CEA can be related to gallbladder cancer.

• CA 19-9 assay: This is a test performed to measure the amount of CA 19-9 in the blood. Cancer cells and normal cells are responsible for releasing CA 19-9 into the bloodstream. A higher than expected amount can be related to gallbladder disease.

• Blood chemistry studies: In this procedure, a blood sample will be checked, measuring the quantity of specific substances which are released by organs and tissues into the blood. In case the measured amount is higher or lower than normal, this can be a sign of malfunctioning in the organ producing the substance.

• CT scan (CAT scan): This is a procedure which takes a number of comprehensive pictures of the internal part of the body. This often includes taking a scan of the abdomen, chest and pelvis. They are often taken from varying angles to have a better view. The pictures are created using a computer connected to an imaging machine. For a CT scan with contrast, a dye is either swallowed or injected into a blood vein. This helps in showing the tissues or organs more clearly. This procedure is often referred to as computerized tomography, computed tomography, or computerized axial tomography scan.

• Ultrasound exam: This is a procedure whereby high-energy sound waves are bounced off internal organs or tissues. Echoes will be made in the process. The echoes create various pictures of the internal tissues of the body. They are often referred to as a sonogram. An abdominal ultrasound is performed during the diagnosis of gallbladder cancer.

• Percutaneous Transhepatic Cholangiography (PTC): This is a procedure used to x-ray both the liver as well as the bile ducts. For a PTC, a thin or slender needle will be inserted through the skin beneath the ribs and into the liver. An x-ray is taken, but before that, a dye will be injected into the liver or bile ducts. In case a blockage is observed, a thin, flexible tube known as a stent may be left in the liver. This helps in draining the bile into the small intestine or waste can be collected outside the body using a bag.

• Chest x-ray: An x-ray will be performed on the bones and organs inside the chest. This involves sending an energy beam through the body and onto film. Through this, a picture of the internal areas of the body will be seen.

• Laparoscopy: This involves a surgical procedure taking a look at the internal organs close to the abdomen, in order to check for signs of gallbladder cancer. Small cuts will be made in the abdominal wall. A laparoscope, a thin, slender, lighted tube, will then be inserted into any of the cuts (incisions). The laparoscopy makes it possible to detect if cancer remains within the gallbladder only, or if other body areas have been affected. Hence, gallbladder surgery can be performed to check the spread of the gallbladder disease.

• Biopsy: Biopsy remains the most effective testing method for any form of gallbladder pain, gallbladder attack, and gallbladder disease. In a biopsy, cells or tissue will be removed. After removal, a pathologist views it using a microscope, to check for cancer or other abnormalities. The biopsy can also be done after gallbladder surgery has been performed to remove the tumor. In case the pathologists are unable to remove the tumor by gallbladder surgery, a biopsy may be done by making use of a fine needle. With this, the cells can be removed from the tumor.

Diagnosing gallbladder cancer is usually difficult. This may be due to the fact that no particular signs and symptoms are noticeable at the initial states. Also, the gallbladder is relatively hidden, making the growth of gallbladder cancer possible without being detected. Various tests and examinations will be performed on the gallbladder and nearby organs so as to detect, diagnose and know the stage of the gallbladder cancer.

Furthermore, doctors carry out numerous tests to diagnose the gallbladder cancer. Through these tests, they will be able to detect the case that cancer has spread to other organs or parts of the body. This is known as metastasis. Some tests are also done to determine the most effective treatments for the disease.

You may initially consult your family doctor or a general practitioner when you have symptoms that worry you. If your doctor suspects gallbladder disease, you may be referred to one of these specialists: 

• A doctor who specializes in treating digestive conditions (gastroenterologist)
• A surgeon who operates on the liver or gallbladder
• A doctor who specializes in treating cancer (oncologist)

As appointments may be brief, it is often a good idea to be well-prepared. Here is some information to help you get ready for your appointment. 

What you can do?

1. At the time you make the appointment, always ask if there is anything you need to do in advance, such as restrict your diet. Be aware of any pre-appointment restrictions.

2. Make a list of the following information: 

• Your symptoms, including those that may seem unrelated to the reason for your appointment
• Key personal information, including major stresses or recent life changes
• All medications, as well as vitamins or herbal supplements, that you take regularly 

3. Consider taking a family member or your friend along. Sometimes, it may become difficult to remember all the information that is provided during an appointment. Someone who accompanies you might remember something that you missed or forgot. 

4. Write down questions to ask your doctor. Prepare a list of questions you need to ask your doctor from the most important to least important. For gallbladder cancer, some basic questions you may ask your doctor include: 

• What is the stage of my gallbladder cancer?
• Can you explain the pathology report to me? 
• Can I keep a copy of my pathology report?
• Will I require more tests?
• What are the treatment options available for my gallbladder cancer? 
• What are the benefits and risks of each of these options?
• Which treatment would you recommend for my condition?

What to expect from your doctor?

   Your doctor may ask you a number of questions, which include:

• When were your symptoms noticed first? 
• Have your symptoms been continuous or occasional?
• How severe are your symptoms? 
• Is there anything that seems to improve or worsen your symptoms? 

The most appropriate treatment option for gallbladder cancer is chosen by the doctor while considering the stage of your cancer, your overall health and your preferences. The initial goal of treatment is to remove the gallbladder cancer, but when that is not feasible, other therapies that control the spread of cancer and keep you as comfortable as possible are given. 

Some of the factors responsible for the treatment options and recovery time include:

• The stage at which the gallbladder cancer was detected
• If cancer can be totally removed by gallbladder surgery.
• How the cancer cell appears after examination under a microscope.
• If the gallbladder cancer is recently diagnosed or recurrent.
• Age and overall health of the patient.

As mentioned earlier, gallbladder disease can be cured provided it was detected early enough, before spreading to other body parts. At this point, it can be removed by performing gallbladder surgery.

In case the gallbladder cancer has spread to other parts of the body, painkilling treatment can be used to improve the quality of life of the patient. This helps to reduce the gallbladder pain and other complications of the gallbladder disease. The patient can also volunteer for clinical trials to improve treatment.

Surgical removal of the gallbladder

Surgery remains the best option in the case that gallbladder cancer was detected at an early stage. This can also be referred to as a cholecystectomy. Gallbladder cancer at the early stages, in which cancer remains confined to the gallbladder alone, can be treated by performing an operation to remove the gallbladder.

Surgical removal of the gallbladder and a portion of the liver

Gallbladder cancer which has already extended past the gallbladder and spread to the liver can be treated with surgery removing the gallbladder as well as removing affected portions of the liver. If surrounding bile ducts have been affected with cancer, they can be removed too.

Radiation therapy, chemotherapy, or a combination of the two may be recommended by your doctor after surgery.

Try as much as possible to discuss the long-term risks and benefits of any additional treatment before settling for a suitable option.

• Chemotherapy: Chemotherapy includes using specific drugs which are able to eliminate the cancer cells. A chemotherapy treatment basically comprises of a certain amount of treatment cycles which the patient is subjected to over a period of time. The drugs usually used include gemcitabine (Gemzar), cisplatin (Platinol), as well as fluorouracil (5-FU).

• Radiation therapy: In radiation therapy, high-powered beams of energy like x-rays are used to destroy these cancerous cells.  

Gallbladder surgery recovery time depends on the type of surgery you had. You might undergo open surgery or a laparoscopy. 

After open surgery, in which a large incision is made and the surgeon removes the gallbladder, you will likely stay in the hospital for two or three days. After returning home, it can take up to six weeks to fully heal.

After laparoscopic surgery, in which small incisions are made and surgical tools are used to remove the gallbladder, you may be able to leave the hospital the same day. In certain cases, your doctor might want you to spend the night in the hospital. It only takes about a week to heal from this type of surgery. 

The growth and development of gallbladder cancer cells occurs in stages.

The stages of gallbladder cancer are: 

•     Stage I: At this stage, gallbladder cancer is confined only to the inner layers of the gallbladder. This is the initial stage. 
•     Stage II: At this stage the gallbladder cancer has grown to invade the outer layer of the gallbladder and may extend beyond the gallbladder. 
•     Stage III: At this stage, gallbladder cancer invades one or more nearby organs such as the liver, small intestine or stomach. It may also spread to neighboring lymph nodes. 
•     Stage IV: The latest stage of gallbladder cancer includes large tumors that may affect multiple, nearby organs and tumors of any size that have spread to distant areas of the body.

Advanced stages of gallbladder cancer can result in blocked bile ducts, causing further complications. Blocked bile ducts can occur due to gallstones as well, and a blocked bile duct can lead to a gallbladder attack.

Surgical procedures to relieve blockages may help. For instance, surgeons will place a hollow metal tube (stent) inside a duct to hold it open or surgically reroute bile ducts around the blockage (biliary bypass).

The function of the gallbladder is to store bile. Bile is a fluid produced by the liver used in the digestion of fat. Once food in the intestines and stomach is being broken down, the gallbladder releases bile through a tube known as the common bile duct. This connects the liver and gallbladder to the small intestine. 

The gallbladder is an organ in the body in the shape of a pear. It is located right beneath the liver towards the upper region of the abdomen. It is located on your right side, beneath your ribs. 

The following risk factors can increase a person's chances of developing gallbladder cancer:

• A history of gallstones: Gallstones are commonest risk factors for developing gallbladder cancer.  Almost 75-90% of people with gallbladder cancer have a history of gallstones. However, lesser than 1% of people with gallstones may develop gallbladder cancer.
• Other gallbladder diseases and conditions: Other gallbladder conditions that increase your risk of developing gallbladder cancer include porcelain gallbladder, gallbladder ployps, choledochal cyst, and chronic gallbladder infection.
• Age: The risk of gallbladder cancer increases with advancing age. Most people with gallbladder cancer are above 70 years of age.
• Gender: Gallbladder cancer are twice more common in women than men.
• Being obese: People who are overweight are at an increased risk of developing gallbladder cancer. 
• Ethnic background: Mexican Americans and Native Americans are more likely to develop gallbladder cancer.
• Smoking: Use of tobacco enhances your risk of gallbladder cancer.
• Family history: A family history of gallbladder cancer may slightly increase your risk of developing gallbladder cancer.

Lifestyle modifications are necessary in order to cope with gallbladder cancer.

Being aware of the fact that you have a life-threatening illness can be devastating. Trying to cope with the diagnosis of gallbladder cancer can be very stressful as this condition often carries a very poor prognosis.

Here are some ideas to help you cope with gallbladder cancer:

• Ask your doctor questions about gallbladder cancer: Write down if you have any questions about your cancer, and ask these at your next appointment. Also ask your doctor about trustworthy sources that can get you more information. Awareness about gallbladder cancer and your treatment options makes you more comfortable in making decisions regarding your care. 

• Stay connected with your friends and family: Your diagnosis can be stressful for your friends and family too. Try to keep them involved in your life. Think of tasks you may assign them, such as caring for your home if you have to stay in the hospital, or just being with you when you want to talk. You may find some comfort while being in the support of a caring group of your friends and family. 
• Find someone you can talk to who has experience with people facing a life-threatening illness. Consult a counselor, medical social worker, clergy member or a support group for people with cancer. 
• Write down your medical wishes: Take steps to see that your wishes are known to others. Ask your doctor about advance directives, which allow you to indicate what type of treatment you would want in the event you are unable to communicate your wishes. Also ask regarding nomination of a medical power of attorney, which is someone you designate to make your choices if you are unable to communicate.