Gallbladder Cancer

Gallbladder Cancer

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Gallbladder cancer is an uncommon cancer. In Malaysia, it accounts for approximately 0.8% of new cancer cases reported between the year 2007-2011 (Malaysian Cancer Registry).

Types of gallbladder cancer

  • Adenocarcinomas: Cancer that begins in the gland-like cells that line organs of the digestive tract.
  • Papillary adenocarcinoma: a special subtype of adenocarcinoma that much less likely to spread to nearby lymph nodes or other organs like the liver.

Other less common types of gallbladder cancers are:

  • Adenosquamous carcinomas
  • Squamous cell carcinomas
  • Small cell carcinomas
  • Sarcomas

Symptoms 

In the early stages, gallbladder cancer does not cause symptoms until later in the course of the disease. Common symptoms of gallbladder cancer include:

  • Abdominal pain
  • Nausea and vomiting
  • Jaundice (yellowing of the skin and whites of eyes)
  • Lumps on the side of the belly or the abdomen
  • Unexplained weight loss

Other less common symptoms include:

  • Itchy skin
  • Dark urine
  • Light coloured or greasy stools

Risk Factors 

There are several risk factors that make a person more prone to developing gallbladder cancer and most of which are related to chronic inflammation in the gallbladder. Knowing the risk factor that causes cancer can help one be more informed on their lifestyle choices affecting their health.

The most common risk factors are:

  • Gallstones – These hard, rock-like deposits sometimes form from cholesterol and other substances found in the bile.
  • Porcelain gallbladder – This is a condition where calcium deposits cover the wall of the gallbladder.
  • Choledochal cysts: Bile-filled cysts may develop along the common bile duct that leads from the gallbladder and liver to the small intestine.
  • Gallbladder polyps: These are abnormal growths that form on the gallbladder.

Staging of Gallbladder Cancer

Stage 0: The cancer is small and found in the innermost (epithelial) layer of the gallbladder.

Stage I: Still localized within the gallbladder, the tumour has begun to penetrate into the second and third layers of the gallbladder (the lamina propria and the muscle layer).

Stage II: The cancer is still localized within the gallbladder but has now penetrated the deeper layer of perimuscular fibrous tissue.

Stage III: This stage is divided into two subcategories:

  • Cancer has extended through the outermost layer of the gallbladder (the serosa) and may have extended into the liver or another nearby structure.
  • Cancer cells have spread to nearby lymph nodes, but the tumour has not spread into the blood vessels leading to the liver, or more than one nearby organ other than the liver.

Stage IV: This stage is divided into two subcategories:

  • Cancer has spread into the blood vessels leading to the liver and has extended to a nearby organ other than the liver. Cancer cells may have reached nearby lymph nodes, but they have not reached distant organs.
  • Cancers at this stage are the most advanced. Cancer cells have either spread to lymph nodes farther away from the gallbladder, or they have spread to distant organs.

Diagnosis

In some cases, gallbladder cancers are found after the gallbladder had been removed to treat gallstones or chronic inflammation. When presented with symptoms, a physical examination will be done and mainly focused on checking for any lumps on the abdomen, tenderness or buildup of fluid.

  • Ultrasound– This procedure is often performed with an ultrasound transducer on the skin over the abdomen. An ultrasound technician, called a sonographer, will apply a special lubricating jelly to your skin. This prevents friction so they can rub the ultrasound transducer on your skin. The jelly also helps transmit the sound waves.
  • Endoscopic Ultrasound – For these techniques, the ultrasound device is attached to a tube, and inserted through the mouth or through a small surgical incision.
  • MRI – MRI is designed to examine the soft tissues within the body and is often used to diagnose gallbladder cancer.

Treatment

  • Surgery – It may be performed to completely remove the tumour if the cancer is still localized, or to relieve symptoms or pain if the cancer is more widespread.
  • Chemotherapy – Chemotherapy may be prescribed in addition to surgery to help prevent recurrence of gallbladder cancer.
  • Radiotherapy – Radiotherapy for gallbladder cancer may be used to shrink the size of a tumour or to help kill cancer cells that may be left after surgery.
  • A combination of these options.

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