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Overview
Gallbladder cancer occurs when growth of abnormal cells arise in the gallbladder. The gallbladder is located on the right side of the abdomen, underneath the liver. The function of the gallbladder is to store bile and digestive fluid that is released by the liver. Early detection and diagnosis of gallbladder cancer can increase the outcome of the treatment, but early-stage of gallbladder cancer are usually asymptomatic and could be difficult to detect.
Symptoms
- Upper right abdominal pain
- Abdominal bloating
- Unintentional weight loss
- Jaundice (yellow discoloration of the eyes and skin)
Causes
Gallbladder cancer occurs when there is a change of DNA in the gallbladder. DNA in cells alters the cell’s behavior. Therefore, the cell mutation in the gallbladder causes uncontrolled duplication, resulting in forming a mass of cells also known as a tumor. This tumor then begins to invade and destroy the healthy tissues. These cells have the tendency to metastasize (spread to other parts of the body).
Gallbladder cancer mostly starts growing in the glandular cells that are aligned with the inner part of the gallbladder. When gallbladder cancer occurs in glandular cell, the disease is called adenocarcinoma.
Risk factors
- Sex: Women are more prone to have the disease than men.
- Age: The higher the age, the greater the risk of having gallbladder cancer.
- Having history of gallstones: When patients have gallstones, the risk of getting gallbladder cancer increases. Large gallstones tend to result in higher risks of acquiring the disease.
- Other gallbladder diseases and conditions: Other diseases and conditions that are associated with gallbladder cancer are polyps, chronic inflammation and infection. These are also the risk factors.
- Bile ducts inflammation: Primary sclerosing cholangitis leads to an inflammation of the ducts that carry bile from the gallbladder and liver. This condition puts patient in an increased risk of having gallbladder cancer.
Diagnosis
- Blood tests are done to evaluate the liver function. This will facilitate the doctor in ruling out the cause of the symptoms.
- Imaging tests such as ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI) will display pictures of the gallbladder.
If gallbladder cancer has been diagnosed, the stage of the cancer needs to be evaluated because the stage will determine the prognosis and the appropriate treatment options for the patient.
The followings are the procedures that are used to identify the stage of gallbladder cancer:
- Exploratory surgery is a recommended procedure that inspects the internal part of the abdomen for any signs that may signify that gallbladder cancer has spread. In a laparoscopic procedure, a tiny camera will be inserted in the abdomen through small incision, to examine the organs near gallbladder.
- Bile ducts examination is done by injecting dye into the bile ducts. Then images of where the dye goes will be recorded to visualize any blockages or narrowing in the bile ducts. Magnetic resonance cholangiography and endoscopic retrograde cholangiopancreatography (ERCP) may involve in this procedure.
- Other imaging tests. A series of scans to identify whether the cancer has metastasized or remained only within the gallbladder. CT and MRI scans of the abdomen and chest are commonly done.
The data collected from the tests above will help evaluate the stage of the cancer. Roman numerals from 0 to IV are indications of gallbladder cancer stage. The lowest stage is when the cancer is only at the lining of the inside of the gallbladder. In stage IV or advanced stage, the cancer has spread or metastasized to other parts of the body.
Treatment
The stage of the cancer, the health condition and patients’ preference are factors that will determine the treatment options for gallbladder cancer. The primary objective of treatment is to completely remove gallbladder cancer and prevention of the disease from spreading.
Surgery
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- Surgical removal of the gallbladder: Also known as a cholecystectomy. When gallbladder cancer is still in the early-stage and cancer is within the gallbladder only, the disease can be treated with cholecystectomy, a surgery to remove the gallbladder.
- Surgical removal of gallbladder and a part of the liver: Gallbladder cancer that has spread to the liver, the gallbladder including a part of the liver and bile ducts that surround the organ may need to be removed.
In cases where the cancer in the gallbladder is very small and can be entirely removed by a surgery, additional treatments may not be required. If the cancer cells are present after the operation, chemotherapy or other treatments will then be considered.
Chemotherapy
Chemotherapy uses medicines to kill cancer cells. Chemotherapy can be given both intravenously or orally. It is often suggested as a treatment option when there is a chance that gallbladder cancer still remain after the surgery.
Radiation therapy
Radiation therapy is the use of powerful beams of energy, such as X-rays and protons, in order to destroy cancer cells. The energy beams are given from a machine that surrounds the body while the patient is lying on a table.
A combination of radiation therapy and chemotherapy could be used if gallbladder cancers have not been entirely removed after the operation. Radiation therapy helps manage gallbladder cancer that is resulting in painful condition if surgery is not a choice for treatment.
Targeted drug therapy
Targeted drug treatments attack certain specific receptors that are found in the cancer cells. The cancer cells die when targeted drugs block those receptors. This treatment tends to be an option for patients with later stage of gallbladder cancer.
The cancer cells in the gallbladder will be tested before determining which targeted drugs are most suitable for the patient.
Immunotherapy
Immunotherapy is the use of drug to help the immune system fight against cancer. As cancer cells create proteins, it makes it difficult for immune system to attack cancer cells. As a result, cells in the immune system cannot recognize that cancer cells are harmful. Immunotherapy becomes effective by interfering that natural process. Immunotherapy is often a treatment option for advanced gallbladder cancer.
