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Gallbladder Cancer
Gallbladder cancer is an abnormal growth of cells that begins in the gallbladder.
The gallbladder is a small, pear-shaped organ on the right side of the abdomen, just beneath the liver. The gallbladder stores bile, a digestive fluid produced by the liver.
Gallbladder cancer is not very common. When gallbladder cancer is discovered at its earliest stages, the chance for a cure is very good. But most gallbladder cancers are discovered at a late stage, when the prognosis is often very poor.
India is a high incidence area for gallbladder cancer (GBC) and contributes to about 10% of the global GBC burden. Within India, the incidence is high in North, North-East, Central and Eastern India, and less common in South and West India. The incidence has been on a steady rise in both genders. The presentation is often with advanced disease and carries dismal prognosis.
Symptoms
Signs and Symptoms of Gallbladder cancer may include:
- Abdominal pain, particularly in the upper right portion of the abdomen
- Bloating of the abdomen
- Unexplained Loss of weight
- Yellowing of the skin and of the eyes (jaundice)
Causes
It’s not clear what causes gallbladder cancer.
Gallbladder cancer arises when a healthy gallbladder cells develop changes called as mutations in their DNA. As a result the cells continue to grow out of control. These cells then form a tumor that can grow beyond the gallbladder and spread to other areas of the body.
Most gallbladder cancer begins in the glandular cells that line the inner surface of the gallbladder and is an adenocarcinoma.
Risk factors
Factors that can increase the risk of gallbladder cancer include:
- Gender. Gallbladder cancer is more common in women.
- Age. GBC in India usually affects younger patients in the 5th and 6th decade in contrast to the west. Gallstones are present in 80% of the Indian patients with GBC .
- Other gallbladder diseases and conditions. Other gallbladder conditions that can increase the risk of gallbladder cancer include polyps, chronic inflammation and infection. Additional co-factors such as older age, lower socio-economic status, exposure to pollutants, heavy metals, chemicals, adulterated mustard oil and smoking in patients with gallstones have been identified which promote carcinogenesis.
- Environmental risk factors such as soil and water contamination by industrial wastes, agricultural effluents and human sewage have been identified as putative risk factors.
- Inflammation of the bile ducts. Primary sclerosing cholangitis, which causes inflammation of the ducts that drain bile from the gallbladder and liver, increases the risk of gallbladder cancer.
Diagnosis
- Blood tests. Blood tests to evaluate the liver function
- Imaging tests that can create pictures of the gallbladder include ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI).
Determining the extent of gallbladder cancer
Once gallbladder cancer is confirmed, the extent (stage) of the cancer has to be determined. The stage of the gallbladder cancer determines the prognosis and the treatment options.
Tests and procedures used to stage gallbladder cancer include:
- Exploratory surgery. The doctor may recommend surgery to look inside the abdomen for signs that gallbladder cancer has spread.
With laparoscopy, the surgeon makes a small incision in the abdomen and inserts a tiny camera. The camera allows the surgeon to examine organs surrounding the gallbladder for signs that the cancer has spread.
- Tests to examine the bile ducts. Procedures to inject dye into the bile ducts. This is followed by an imaging test that records where the dye goes. These tests can show blockages in the bile ducts. These tests may include magnetic resonance cholangiography and endoscopic retrograde cholangiopancreatography (ERCP).
- Additional imaging tests. Most people with gallbladder cancer will undergo a series of scans to help determine whether the cancer has spread or remains localized. Your doctor uses information from these procedures to assign your cancer a stage. The stages of gallbladder cancer range from 0 to IV. The earliest stages indicate a cancer that’s confined to the gallbladder. Later stages indicate more-advanced cancer that has grown to involve nearby organs or has spread to other areas of the body.
Treatment Option Overview
- There are different types of treatment for patients with gallbladder cancer.
- Three types of standard treatment are used:
- Surgery
- Radiation therapy
- Chemotherapy
- New types of treatment are being tested in clinical trials.
- Radiation sensitizers
- Targeted therapy
- Immunotherapy
- Treatment for gallbladder cancer may cause side effects.
- Patients may want to think about taking part in a clinical trial.
- Patients can enter clinical trials before, during, or after starting their cancer treatment.
- Follow-up tests may be needed.