GALLBLADDER CANCER

GALLBLADDER CANCER

Definition

Gallbladder cancer is cancer that begins in the gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder stores bile, a digestive fluid produced by your liver. Gallbladder cancer is uncommon. 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. Gallbladder cancer is difficult to diagnose because it often causes no specific signs or symptoms. Also, the relatively hidden nature of the gallbladder makes it easier for gallbladder cancer to grow without being detected.

Symptoms

Gallbladder cancer signs and symptoms may include:

• Abdominal pain, particularly in the upper right portion of the abdomen

• Abdominal bloating

• Itchiness

• Fever

• Loss of appetite

• Losing weight without trying

• Nausea

• Yellowing of the skin and whites of the eyes (jaundice)

Causes

It's not clear what causes gallbladder cancer.

Doctors know that gallbladder cancer forms when healthy gallbladder cells develop changes (mutations) in their DNA. These mutations cause cells to grow out of control and to continue living when other cells would normally die. The accumulating cells 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. Gallbladder cancer that begins in this type of cell is called adenocarcinoma. This term refers to the way the cancer cells appear when examined under a microscope.

Risk factors

Factors that can increase the risk of gallbladder cancer include:

• Your sex. Gallbladder cancer is more common in women.

• Your age. Your risk of gallbladder cancer increases as you age.

• Your weight. People who are obese are at higher risk for developing gallbladder cancer.

• A history of gallstones. Gallbladder cancer is most common in people who have had gallstones in the past. Still, gallbladder cancer is very rare in these people.

• Other gallbladder diseases and conditions. Other gallbladder conditions that can increase the risk of gallbladder cancer include porcelain gallbladder, choledochal cyst and chronic gallbladder infection.

Diagnosing gallbladder cancer

Tests and procedures used to diagnose gallbladder cancer include:

• Blood tests. Blood tests to evaluate your liver function may help your doctor determine what's causing your signs and symptoms.

• Procedures to create images of the gallbladder. 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 your doctor diagnoses your gallbladder cancer, he or she works to find the extent (stage) of your cancer. Your gallbladder cancer's stage helps determine your prognosis and your treatment options.

Tests and procedures used to stage gallbladder cancer include:

• Exploratory surgery. Your doctor may recommend surgery to look inside your abdomen for signs that gallbladder cancer has spread.

In a procedure called laparoscopy, the surgeon makes a small incision in your abdomen and inserts a tiny camera. The camera allows the surgeon to examine organs surrounding your gallbladder for signs that the cancer has spread.

• Tests to examine the bile ducts. Your doctor may recommend 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 endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiography and percutaneous transhepatic cholangiography.

• 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. Which scans should be performed vary depending on your circumstances. Common scans include CT of the chest and abdomen, ultrasonography and MRI of the liver and positron emission tomography.

Stages of gallbladder cancer

The stages of gallbladder cancer are:

• Stage I. At this stage, gallbladder cancer is confined to the inner layers of the gallbladder.

• Stage II. This stage of 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 has grown to invade one or more nearby organs, such as the liver, small intestine or stomach. The gallbladder cancer may have spread to nearby lymph nodes.

• Stage IV. The latest stage of gallbladder cancer includes large tumors that involve multiple nearby organs and tumors of any size that have spread to distant areas of the body.

Treatments and drugs

What gallbladder cancer treatment options are available to you depend on 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 isn't possible, other therapies may help control the spread of the disease and keep you as comfortable as possible.

Surgery for early-stage gallbladder cancer

Surgery may be an option if you have an early-stage gallbladder cancer. Options include:

• Surgery to remove the gallbladder. Early gallbladder cancer that is confined to the gallbladder is treated with an operation to remove the gallbladder (cholecystectomy).

• Surgery to remove the gallbladder and a portion of the liver. Gallbladder cancer that extends beyond the gallbladder and into the liver is sometimes treated with surgery to remove the gallbladder, as well as portions of the liver and bile ducts that surround the gallbladder.

It's not clear whether additional treatments after successful surgery can increase the chances that your gallbladder cancer won't return. Some studies have found this to be the case, so in some instances, your doctor may recommend chemotherapy, radiation therapy or a combination of both after surgery.

Discuss the potential benefits and risks of additional treatment with your doctor to determine what's right for you.

Treatments for late-stage gallbladder cancer

Surgery can't cure gallbladder cancer that has spread to other areas of the body. Instead, doctors use treatments that may relieve signs and symptoms of cancer and make you as comfortable as possible.

Options may include:

• Chemotherapy. Chemotherapy is a drug treatment that uses chemicals to kill cancer cells.

• Radiation therapy. Radiation uses high-powered beams of energy, such as X-rays, to kill cancer cells.

• Clinical trials. Clinical trials use experimental or new medications to treat gallbladder cancer. Talk to your doctor to see whether you're eligible to participate in a clinical trial.

Procedures to relieve blocked bile ducts

Advanced gallbladder cancer can cause blockages in the bile ducts, causing further complications. Procedures to relieve blockages may help. For instance, surgeons can place a hollow metal tube (stent) in a duct to hold it open or surgically reroute bile ducts around the blockage (biliary bypass).

Source: http://www.mayoclinic.org/diseases-conditions/gallbladder-cancer/basics/treatment/con-20023909