Have you heard of a small sac-like organ located on the right side of your abdomen, just below your liver? We call it the gallbladder. It stores a liquid called 'bile' produced by the liver. This bile helps us digest the fatty foods we eat. So, sometimes cancer cells start growing inside this small organ. That's what we call gallbladder cancer.
What is Gallbladder Cancer?
Simply put, gallbladder cancer is when healthy cells in the gallbladder become cancerous and grow out of control. This cancer usually starts in the innermost layer of cells in the gallbladder. We call it the `(mucosal layer)`. Then, little by little, it starts to spread outward.
The biggest problem with this is that it doesn't show any symptoms in the early stages . Most of the time, it's discovered by accident. Imagine, doctors only discover this cancer when they're having surgery to remove the gallbladder for another reason.
But there is good news. If this cancer is found in its early stages, that is, if it has not spread beyond the gallbladder, there is a much higher chance of complete surgical removal and a full recovery . However, in many people, the cancer has already spread beyond the gallbladder by the time it is diagnosed. At that point, treatment becomes a little more difficult.
How common is this disease?
Although we lack specific data on this in Sri Lanka, this is a very rare cancer in countries like America. However, it is relatively common in Asian countries like India, Japan, Korea, and some countries in South America. The reason for this is seen as the increased incidence of gallstones among people in those countries. Because gallstones are a major risk factor for this cancer.
What are the symptoms of gallbladder cancer?
As I said before, the main reason why this cancer is difficult to diagnose is that it doesn't show any symptoms in the early stages. Even when the symptoms do appear, they are very similar to the symptoms of gallstones. So people think, "Oh, these must be stones."
But if you have the symptoms below, it is very important to take care of it.
| Symptom | Description |
|---|---|
| Upper abdominal pain | A strange pain in the right side of the abdomen, under the ribs. |
| Yellowing of the skin and eyes (Jaundice) | We call this jaundice. The skin and whites of the eyes turn yellow. This can happen when the bile ducts are blocked. |
| Stomach cramps | When you touch your abdomen, it may feel like a lump that catches in your hand. |
| Weight loss for no reason | If you suddenly lose weight for no reason and without controlling your diet, you should be concerned. |
| Nausea and vomiting | There may be persistent nausea and vomiting. |
| Bloating | Feeling full even after eating a little, feeling like your stomach is full of gas. |
| Fever | A fever that lasts for a long time and has no known cause. |
The important thing is that not everyone with these symptoms has gallbladder cancer. However, if these symptoms persist, it is wise to see a doctor immediately for a checkup .
Why does this cancer develop? What are the risk factors?
Scientists still don't know exactly how a healthy cell becomes a cancer cell. But they have found several things that increase the chance of developing this cancer. We call these risk factors.
This cancer is caused by changes (mutations) in genes. But these are not genetic changes inherited from parents. They are changes that occur during life.
Who is at higher risk?
- For women: Women are at higher risk of developing this cancer than men.
- For people over 65 years of age: The risk increases with age. The average age of diagnosis is around 72 years.
- For those with gallstones: This is the main risk factor. A small number of people with gallstones can develop this cancer.
- For those with gallbladder polyps: Small growths that form on the wall of the gallbladder can turn into cancer.
- Chronic cholecystitis: The risk is higher if the gallbladder has been inflamed for a long time.
- Obesity: Excess body weight is also a risk factor.
- Typhoid disease: Typhoid disease caused by the bacteria `Salmonella typhi` is also a chronic condition and is a risk.
- Porcelain gallbladder: A condition in which calcium deposits build up in the walls of the gallbladder, making them as hard as porcelain bricks. This also increases the risk of cancer.
- Choledochal cysts: Cyst-like conditions that occur in the bile ducts.
In addition, smoking and exposure to certain chemicals used in the rubber and textile industries are believed to increase the risk.
How to diagnose this disease?
As I said before, it can be difficult to diagnose because there are no symptoms. When you go to see a doctor, he will ask you about your symptoms, your family medical history, and examine you. Then, if cancer is suspected, he will order several tests.
1. Blood tests (Lab tests)
Some things in the blood can be measured to get a clue about cancer.
- Liver function test: This measures the levels of enzymes released by the liver. These levels may change if the cancer has affected the liver.
- Tumor marker tests: Blood tests called CEA and CA 19-9 look at the levels of substances released by cancer cells. If these are elevated, it raises suspicion of cancer.
2. Imaging tests
These tests take pictures of the organs inside the body to see if there is cancer and how far it has spread.
- Abdominal ultrasound: This is the simplest test to do first. It takes pictures of the abdominal organs. If something like a tumor is seen, you will be referred for further testing.
- CT scan (Computed tomography): This uses X-rays to take cross-sectional images of the body. This can show a lot of detail.
- MRI scan (Magnetic resonance imaging): Uses a magnetic field to take detailed pictures of the inside of the body.
- ERCP (Endoscopic retrograde cholangiopancreatography): An endoscope (a thin tube with a camera) is inserted through the mouth, a dye is injected into the bile ducts, and X-ray images are taken. This can be used to see if the ducts have become narrowed due to cancer.
3. Surgeries
- Biopsy: This is the only way to be 100% sure that cancer is present. This involves taking a small piece of tissue from the suspicious lump and examining it under a microscope.
- Laparoscopy: A small incision is made in the abdomen and a thin tube with a camera is inserted, allowing the doctor to directly view the gallbladder and surrounding tissue. This helps assess how far the cancer has spread.
Cancer Stages and Treatment
Once doctors diagnose cancer, they find out how far it has spread in the body. We call this cancer staging. Treatment is determined based on this stage.
- Stage 0: The abnormal cells that could become cancerous are only in the innermost layer of the gallbladder.
- Stage 1: The cancer is in the inner layer of the gallbladder, and may have spread to the muscle layer.
- Stage 2: The cancer has spread beyond the muscle layer.
- Stage 3: The cancer has spread to the outermost layer of the gallbladder and to nearby organs, such as the liver, or to lymph nodes.
- Stage 4: The cancer has spread to distant organs, blood vessels, and multiple lymph nodes.
Stage 1 cancer is called ``local''. This means that the cancer is confined to the gallbladder. At this stage, a complete cure can be achieved with surgery. Treatment becomes more challenging in stages 2, 3, and 4.
What are the treatments?
Treatment options depend on many factors, such as the stage of the cancer and your overall health.
Treatment for early stage cancer
If cancer is detected early, the main goal is to completely remove the cancer with surgery and prevent it from coming back.
- Surgery: A cancer surgeon performs a cholecystectomy to remove the gallbladder. Sometimes, not only the gallbladder but also the surrounding lymph nodes and a small part of the liver may need to be removed.
- Radiation therapy: High-energy rays are given to destroy any cancer cells that may remain after surgery.
- Chemotherapy: Drugs that kill cancer cells or stop their growth are given. This may be given after surgery or with radiation therapy.
Treatment for advanced cancer
The goal of treatment for unresectable or recurrent cancer is to control symptoms and prolong survival, rather than to cure the disease.
Radiation and chemotherapy are also used here. In addition, you may have the opportunity to participate in clinical trials of new treatments.
- Targeted therapy: Medications are given that target specific genetic changes in cancer cells.
- Immunotherapy: Stimulates the body's own immune system to identify and destroy cancer cells.
Are there any side effects of the treatment?
Yes. Like any treatment, there can be side effects. Surgery carries risks such as complications from anesthesia, infection, and blood clots. Chemotherapy and radiation treatments can cause side effects such as hair loss, nausea, and fatigue. But these are all different for each person. It is important to talk openly with your doctor about the treatments you are receiving and their side effects to gain a good understanding.
Can this disease be cured?
It can be cured. But it requires detecting the cancer at a very early stage and removing it with surgery before it spreads to other organs. The longer it is left untreated, the less likely it is to be cured. That's why we say to be aware of the symptoms.
Take-Home Message
- Gallbladder cancer is a silent disease that does not show any symptoms in the early stages.
- If you continue to have symptoms like pain in the right side of your abdomen, jaundice, and unexplained weight loss, don't ignore them.
- Gallstones are a major risk factor for this cancer.
- If cancer is detected early, the chances of a complete cure with surgery are very high.
- If you have any doubts or symptoms, don't be afraid or delay in seeing a qualified doctor for advice. That's the best thing you can do.
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