Have you ever thought that even the smallest organ in our body, which we sometimes don't pay much attention to, can develop a very serious disease? That's how it is with the gallbladder. This condition called gallbladder cancer can develop. Although this is a bit rare, it is very important to be aware of it. So, today we will talk about gallbladder cancer simply, in a way that you can understand.
What is Gallbladder Cancer?
Simply put, gallbladder cancer is when the cells in your gallbladder start to grow abnormally and rapidly, out of control. These cells are what we call malignant cells.
Now you have a question, what is this gallbladder and what does it do? The gallbladder is a small organ that is located on the right side of our abdomen, under the liver, and is shaped like a small pear. Its main function is to collect and store the bile, a liquid produced by the liver, and to help us digest the fatty foods we eat. It is like a water tank.
This cancer usually starts in the thin layer inside the gallbladder. Doctors call this the `mucosal layer` . Over time, these cancer cells can spread through the gallbladder walls and out.
The sad thing is, this cancer often doesn't show any symptoms in its early stages. Therefore, it is sometimes discovered accidentally after surgery to remove the gallbladder for another reason.
However, if detected early and completely removed with surgery, this cancer has a very high chance of being cured. However, by the time most people are diagnosed, the cancer has already spread beyond the gallbladder. At that point, treatment becomes a bit more challenging.
How common is this cancer?
Compared to countries like the United States, it is a little difficult to find accurate statistics about this cancer in Sri Lanka. However, in some countries of the world, for example, in countries like India, Japan, and Korea, it is seen a little more. This may be because the formation of gallstones and other conditions that increase the risk of this cancer are more common in those countries.
What are the symptoms? Is it difficult to detect in advance?
As we mentioned earlier, gallbladder cancer rarely shows symptoms in its early stages. Even when symptoms do appear, they are often similar to those caused by gallstones or bile duct blockage, so they can be easily confused.
The main symptoms that can be seen are:
- Severe pain in the upper right part of the abdomen .
- Yellowing of the skin and the whites of the eyes. This is called jaundice .
- Feeling like a lump in the stomach.
- Losing weight for no reason.
- Nausea and vomiting.
- Feeling like your stomach is full (bloating).
- Frequent fever.
If you have one or more of these symptoms, it doesn't always mean you have cancer. However, if these symptoms persist, it's best to see a doctor for advice.
Why does this kind of cancer develop?
Gallbladder cancer develops when healthy cells become cancer cells and start to grow out of control. This happens when changes, called `mutations` , occur in the genetic material in our cells. These genetic mutations develop over time, not from our parents.
Scientists still don't know exactly why healthy cells suddenly turn into cancer cells. However, they have identified some risk factors that increase the risk of developing this cancer.
What are the risk factors?
There are several groups and conditions that put you at higher risk of developing this cancer:
- Women are at greater risk than men.
- People over the age of 65 are at higher risk. (The average age at diagnosis is around 72.)
- In the United States, it has been found to occur more frequently in people of American Indian, Alaskan Native, and Mexican-American ethnicities.
Other risk factors:
- The presence or past history of gallstones .
- Having gallbladder polyps ( small tumor-like growths).
- Chronic inflammation of the gallbladder (cholecystitis) .
- Prolonged infection with the bacteria Salmonella typhi, which causes typhoid fever.
- Calcium deposits in the walls of the gallbladder (this is called `porcelain gallbladder` ).
- Long-term inflammation of the bile ducts ( primary sclerosing cholangitis ).
- The formation of cysts in the main bile duct ( choledochal cysts ).
- Obesity .
In addition, smoking and exposure to certain chemicals used in textile and rubber manufacturing are also thought to increase the risk.
How do you recognize this?
As we discussed earlier, gallbladder cancer is often diagnosed late because its early symptoms are mild and its symptoms are similar to other diseases. Sometimes it is discovered incidentally, either because of gallstones or during surgery to remove the gallbladder.
If your doctor suspects that you have gallbladder cancer, he or she will examine you, ask about your medical history, and then order some tests.
What tests are performed?
These tests may include blood tests, various scans, and even minor surgeries.
- Blood tests (Lab tests):
- Liver function test: This measures the levels of certain substances released by the liver. This can give some idea of whether gallbladder cancer has affected the liver.
- CEA (Carcinoembryonic antigen) test: CEA is a tumor marker released by both healthy and cancer cells. Elevated levels of this can be a sign of gallbladder cancer.
- CA 19-9 test: This is also a tumor marker. Elevated levels of this can be a sign of gallbladder or pancreatic cancer.
- Imaging tests: These can help doctors see if the cancer is present and if it has spread.
- Abdominal ultrasound: This uses sound waves to take pictures of the abdominal organs. If this shows something like a gallbladder tumor, you may be asked to have a CT scan or MRI scan.
- CT scan (computed tomography scan): A type of X-ray is used to take detailed pictures of internal organs.
- MRI scan (magnetic resonance imaging): Uses a magnet, radio waves, and a computer to take pictures of the inside of the body.
- Endoscopic ultrasound: Pictures of the digestive tract are taken using a tube-like instrument called an endoscope.
- ERCP (Endoscopic retrograde cholangiopancreatography): A procedure that takes X-ray pictures of the bile ducts. Gallbladder cancer can cause these ducts to become narrowed.
- Minor surgeries:
- Biopsy: This involves taking a small sample of suspicious tissue and examining it under a microscope to see if there are any cancer cells. A biopsy is the only way to definitively confirm gallbladder cancer.
- Laparoscopy: In this procedure, a thin tube with a camera (called a laparoscope) is inserted into the abdomen through a small incision to examine the gallbladder and surrounding tissues. This helps determine how far the cancer has spread.
What are the stages of cancer?
Cancer staging is a way for your doctor to determine whether the cancer has spread (metastasized) beyond where it first started. Depending on how far the cancer has spread, your doctor will give your cancer a number (from zero to four). Higher numbers mean that the cancer has spread to more areas of your body.
Here are the stages of gallbladder cancer:
- Stage 0 (Stage 0 - `carcinoma in situ`): Abnormal, potentially cancerous cells are found in the innermost layer (mucosa) of the gallbladder.
- Stage 1: Cancer cells are in the lining of the gallbladder and may have spread to the muscle layer of the gallbladder.
- Stage 2: The cancer has spread beyond the muscle layer and into the connective tissue layers of the gallbladder.
- Stage 3: The cancer has spread to the liver or other nearby organs, or to the outermost layer (serosal layer) of the gallbladder. It may also have spread to the lymph nodes.
- Stage 4: The cancer has spread to more than three nearby lymph nodes, blood vessels, and/or organs distant from the gallbladder.
Doctors call stage 1 gallbladder cancer "local." This means the cancer has not spread outside the gallbladder. Stage 1 cancers are more likely to be cured. Stages 2, 3, and 4 are more challenging to treat.
How does this cancer spread?
Gallbladder cancer starts in the inner layer of the gallbladder and spreads to the outer layers. Over time, it can spread to nearby lymph nodes, the liver, and other organs, such as the bile ducts. Metastatic gallbladder cancer can spread through the lymphatic system, the bloodstream, or to distant organs in the body.
What are the treatments?
The stage of the cancer determines the treatment methods and goals of treatment. In early-stage cancer, the main goal is to completely remove the cancer and stop it from coming back. If the cancer has spread, the goal of treatment is to prolong life and control symptoms.
Treatment of early-stage cancers
Early-stage gallbladder cancer, which can be removed with surgery, has the best treatment outcomes.
- Surgery: A surgeon (surgical oncologist) will remove your gallbladder and the affected tissue around it. This is called a cholecystectomy . Sometimes only the gallbladder is removed (simple cholecystectomy), but sometimes lymph nodes that contain cancer cells or part of the liver, such as the gallbladder, may also be removed (extended cholecystectomy).
- Radiation therapy: In this, a machine outside the body (EBRT - external beam radiation therapy) directs radiation beams to the cancer site. This radiation kills cancer cells or slows the growth of the tumor. This is done in a way that minimizes damage to healthy cells. This treatment can be given to kill any cancer cells that may be left after surgery. Radiation therapy can also help relieve symptoms.
- Chemotherapy: This uses drugs to kill cancer cells or stop them from multiplying. Like radiation therapy, chemotherapy helps kill any remaining cancer cells after surgery. Sometimes, your doctor may recommend chemotherapy along with radiation therapy.
Treatment for inoperable, recurrent, or metastatic cancers
Cancers that cannot be removed with surgery (`unresectable`), that have come back after treatment (`recurrent`), or that have spread to other parts of the body (`metastatic`) are difficult to completely cure. Although treatments such as radiation therapy and `chemotherapy` cannot completely eliminate the cancer, they can help reduce your symptoms and prolong your life. Also, if the cancer is blocking your food pipe, surgery can be done to relieve those symptoms.
In these cases, you may also have the opportunity to participate in a clinical trial . Clinical trials are studies that test new treatments and new approaches to existing treatments. Some of the treatments currently being tested in clinical trials for gallbladder cancer include:
- Targeted therapy: Treatment that targets only cancer cells that have certain genetic mutations.
- Immunotherapy: Treatments that strengthen your own immune system to help it recognize and destroy cancer cells.
- Radiosensitizers: Treatments that make cancer cells more sensitive to radiation therapy.
Ask your doctor if you are eligible for a clinical trial.
Are there any side effects of the treatment?
As with any surgery, there are risks of infection, complications from anesthesia, and blood clots. You should discuss all of these with your doctor before starting treatment.
It is also important to be aware of the possible side effects of chemotherapy and radiation therapy. Not everyone experiences side effects in the same way. However, your doctor can explain to you what side effects are likely to occur depending on your treatment plan.
Is there a way to prevent this?
There is no surefire way to completely prevent gallbladder cancer. However, you can try to reduce the risk factors we discussed earlier as much as possible. For example, you can talk to your doctor and maintain a healthy weight that suits you. However, even doing so cannot guarantee 100% that you will not develop cancer.
How is the possibility of recovery?
Gallbladder cancer is usually diagnosed after the disease has spread, so the prognosis is poor. Only about 20% of gallbladder cancers are diagnosed at an early stage. The five-year survival rate for people whose cancer has spread to other parts of the body (metastasized) is as low as 2%. However, when the cancer is localized to the gallbladder, that is, in the early stage, the five-year survival rate increases to 66%.
That means, if detected early, there is great hope for recovery!
What can you do when living with cancer?
Finding out you have gallbladder cancer can be hard to deal with. But it's important to understand your diagnosis, the pros and cons of your treatment options, and your recovery plan. Your cancer care team is the best place to explain all of this to you.
Connecting with professionals who provide palliative care can also help you manage your symptoms. Palliative care is a service that focuses on your comfort and needs, regardless of your condition. Ask your doctor if you need palliative care.
What should you ask the doctor?
When you go to see your doctor, make a list of questions you have about gallbladder cancer. For example, you might ask questions like:
- What tests should I do to know the exact stage of my cancer?
- What stage is my gallbladder cancer?
- What treatment method is best for me?
- What are the benefits and possible risks of these treatments?
- What resources are available to support me during this time?
Take-Home Message
Gallbladder cancer is a rare but very serious condition. If you think you may have symptoms of gallbladder cancer, see a doctor as soon as possible. Keep in mind that while other types of cancer may show symptoms early on, gallbladder cancer may not show obvious symptoms until it is late in the disease. Therefore, it is very important to seek treatment early.
If detected early, this disease is highly curable. Therefore, do not ignore any symptoms. Take care of your body and seek medical advice when necessary.
` Gallbladder cancer, gallbladder cancer, cancer symptoms, gallbladder, bile, cancer stages, cancer treatment, CEA, CA 19-9
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