Gallbladder Cancer

Gallbladder Cancer

Gallbladder cancer is the cancer that originates from the malignant cells of the gallbladder, a small pear-shaped organ that is located in the upper abdomen under the liver. The outside of the gallbladder constitutes four layers of tissue:

  • The outer layer or serosal layer
  • Inner layer or mucosal layer
  • The muscle layer
  • The connective tissue layer

Cancer of the gallbladder originates from the mucosal layer and then spreads outwards. It is often discovered coincidentally after a gallbladder surgery. Sometimes it is not diagnosed until it has progressed to a later stage.

Gallbladder cancer can spread to other body parts by:

  • Lymph system: The cancer progresses through lymph nodes to other parts of the body.
  • Tissue: The cancer spreads to the surrounding tissues.
  • Blood: The cancer spreads via the blood vessels to other body parts.

Cancers that spread to other parts of the body are named after the organ where they originate. If you have liver cancer that originated from the gallbladder, it is called metastatic gallbladder cancer.

One of the biggest concerns doctors face with cancers is whether those have spread to other body parts beyond their original location. Your doctor will assign a number to the diagnosis to determine the extent of spread. The process is known as staging. Higher the number, the more the extent of spread throughout the body. Following are the stages of gallbladder cancer:

  • Stage 0
    It is when the gallbladder cancer is confined to the inner or the mucosal layer.
  • Stage 1
    The gallbladder cancer has metastasized to the muscular layer.
  • Stage 2
    The cancer has extended beyond the muscular layer and reached the connective tissue layer.
  • Stage 3
    The cancer has reached to the liver or its surrounding organs and possibly the lymph nodes.
  • Stage 4
    The cancer has spread to more than three nearby lymph nodes, to the organs that are located at a distance from the gallbladder, and to the nearby vessels.
  • Stage 5
    The cancer has spread to more than three nearby lymph nodes, to organs located at a distance from the gallbladder, and to the nearby vessels.

Females are more susceptible to developing gallbladder cancer than males. Certain ethnic groups like Asian Americans, American Indians, and Alaskan natives are also at a higher risk. Following are some more conditions which make you more susceptible to developing gallbladder cancer:

  • Exposure to chemicals used in the rubber and textile industries.
  • Smoking.
  • Having common bile duct cysts.
  • Having primary sclerosing cholangitis.
  • Obesity.
  • Age above 65. The average age of diagnosing gallbladder cancer is 72 years.
  • Salmonella infection.
  • Having gallbladder inflammation, polyps, or infections.
  • Consumption of unhealthy diet.
  • Getting gallstones does not mean that you may get gallbladder cancer but your risk for the same increases.

The exact cause of gallbladder cancer is not known.

Because of a lack of obvious symptoms, gallbladder cancer is difficult to diagnose. Even when the patient is symptomatic, the symptoms mimic those of other similar conditions. Additionally, the location of gallbladder makes it more challenging to locate the cancer. Following are some common symptoms of a gallbladder cancer:

  • Pain above the stomach area
  • Fever
  • Bloating
  • Nausea and vomiting
  • Abdominal lumps

Because the early-stage gallbladder cancer is usually asymptomatic and even if the symptoms exist, those mimic other conditions, gallbladder cancer is generally diagnosed late. It is usually discovered because your gallbladder needs to be removed or it is discovered late.

If your doctor thinks you might have gallbladder cancer, they will fully evaluate you and enquire about your medical history. They will then suggest some investigations including:

Laboratory tests

  • Blood chemistries
    Quantifies the amount of specific substances in the blood, including those that may point towards a cancer.
  • Liver function test
    Quantifies the amount of certain substances produced by the liver, which may indicate that the liver has been involved by gallbladder cancer.
  • Carcinoembryonic antigen (CEA) assay
    Quantifies the CEA levels.
  • CA 19-9 assay
    Quantifies the amount of the tumour marker CA 19-9 in the blood. This tumour marker is produced both by cancerous and healthy cells. High levels of CA 19-9 points towards pancreatic or gallbladder cancer.

Imaging tests

  • Abdominal ultrasound
    During this test, ultrasound waves are used to produce detailed images of the internal organs of the abdomen.
  • CT (or CAT) scan
    It is a form of X-ray through which detailed pictures of the internal organs are taken.

Chest X-ray

  • MRI (magnetic resonance imaging)
    During this procedure, images of the internal structures of the body are taken using radio waves, a magnet, and a computer.
  • Endoscopic retrograde cholangiopancreatography (ERCP)
    It is a form of X-ray that takes images of the bile ducts. These ducts can be narrowed due to gallbladder cancer.

Endoscopic ultrasound.

Other investigations

  • Biopsy
    During this test, cells or tissues suspicious of malignancy are removed and then examined under a microscope.
  • Laparoscopy
    It is a surgical procedure during which a thin, lighted tube called a laparoscope is introduced into the abdomen via a small incision to visualise the inside of the body.

To treat gallbladder cancer successfully, it needs to be discovered before it has metastasised to other organs. The treatment is influenced by the stage of the cancer. Stage 1 or localised stage may be treated with:

  • Surgery
    Cholecystectomy is the surgical removal of the gallbladder and the nearby affected tissues. The lymph nodes around the gallbladder and part of the liver may also be removed.
  • Radiation
    During this therapy, high levels of radiation are used to damage the cancer cells or arrest their multiplication, while minimizing the damage to healthy cells. A machine is used outside the body to direct the radiation to the tumour. Side effects like nausea and vomiting, skin problems, liver damage, tiredness, and diarrhoea may be experienced after radiation treatment.
  • Chemotherapy
    It is the use of drugs to damage the cancer cells or to arrest their multiplication. Chemotherapy drugs may either be taken orally or injected. The side effects of chemotherapy include easy bruising, tiredness, infections, easy bleeding, loss of hair, appetite loss, mouth sores, nausea and vomiting, and diarrhoea.

There is no prevention for gallbladder cancer. The best you can do is to avoid the risk factors responsible for developing gallbladder cancer. You can also try maintaining a healthy weight by eating a healthy diet and performing regular exercise. However, there is no guarantee that cancer can be totally prevented by following these measures.

Even though gallbladder cancer is a rare disease, it can be quite serious. If you think you are experiencing symptoms of gallbladder cancer, you must visit a healthcare provider as soon as possible. If you are located in Indore, you can visit Kokilaben Dhirubhai Ambani Hospital, Indore and get an appointment with an expert doctor who will guide you to the next step. While the symptoms of other cancers might be obvious since their early stages, gallbladder cancer may not be obvious until it has already reached an advanced stage. Getting treatment as soon as possible is vital to ensuring a better outcome and preventing life-threatening complications.