Gall Bladder Cancer

Q 1 what is gall bladder cancer? 

Gall bladder cancer develops in the gall bladder. The gallbladder is a small pear-shaped sac that lies under the liver. Its main function is to stores and concentrates the bile, and delivers bile to the intestine as required. Bile is a yellowish-green liquid produced by the liver that helps in the digestion of fats.

Q 2 what are the causes of gall bladder cancer?

  • Older age – it is more common in people over the age of 60
  • Gallbladder cancer occurs twice as frequently in women as in men
  • Preexisting gallbladder conditions such as large gallstones, polyps in the gallbladder or a condition called porcelain gallbladder
  • History of gallstones appears to be one of the strongest risk factors for the development of gall bladder cancer. The risk is higher with larger gallstones (especially patients with stones larger than 3 cm) and duration of gall stones. 
  • Chronic infection with Salmonella typhi
  • Smokers
  • Those who are obese or overweight.

Q 3 what are the types of gall bladder cancer? 

  • Adenocarcinoma   This is the most common type of gallbladder cancer
  • Squamous cell cancer 
  • Adenosquamous cancer
  • Small cell cancer
  • Neuroendocrine tumor
  • Lymphoma and melanoma

Q 4 what are the symptoms of gall bladder cancer? 

  • Gall bladder cancer may be diagnosed before the operation, at the time of surgical exploration for abdominal symptoms attributable to another disease process, or after the operation upon examination of the gallbladder specimen, typically removed for gall stone disease. 
  • Among symptomatic patients, the most common complaint is pain, followed by anorexia, nausea, or vomiting. 
  • Advanced cancer may present with 
  • dark yellow urine or pale-colored stool (usually with jaundice)
  • itchy skin
  • weight loss and loss of appetite 

A word of caution 

All of these symptoms can also be caused by conditions that are not cancer. Kindly consult your doctor first. 

Q 5 How gall bladder cancer is diagnosed? 

  • Ultrasound is the first investigation done for abdominal pain or discomfort
  • CT scan or MRI/MRCP done for patients who have concerning findings on ultrasound 
  • CT scan is also recommended for patients who are found to have a gall bladder cancer following simple cholecystectomy.
  • Positron emission tomography (PET) scan: To know the distant spread of disease  
  • Blood tests – to assess the state of liver, kidneys and bone marrow
  • Blood tumor markers such as CEA and CA 19.9 

Q 6 What is the role of a biopsy in carcinoma of the gall bladder? 

If cancer is suspected in gall bladder on imaging like CT scan and it is found not to spread to the surrounding structure, then a biopsy is never done and the surgeon directly proceeds for surgery. 

A biopsy is only done in advanced cases where the operation is not possible. 

Q 7 What is gall bladder cancer staging? 

Staging is a measurement of how far cancer has spread.

After all the tests have been completed and the results are known, it should be possible to predict what stage the cancer is. The higher the stage, further cancer has spread

  • Stage I Cancer is limited to gall bladder 
  • Stage II Cancer has spread beyond the gall bladder into a surrounding structure like liver or small intestine or lymph nodes 
  • In stage III, cancer has spread to the main blood vessel in the liver or to nearby multiple organs 
  • In stage IV, cancer has spread to lymph nodes and/or to organs far away from the gallbladder.

A word of caution 

The above staging is a simplified version for your basic understanding. The reader is advised to follow the TNM staging system developed by the American Joint Committee on Cancer (AJCC) in which 

  • T stands for the size and location of the primary tumor
  • N stands for nodes. It tells whether cancer has spread to the nearby lymph nodes
  • M stands for metastasis. It tells whether cancer has spread to distant parts of the body.

Q 8 How gall bladder cancer is treated? 

Gall bladder cancer is curable if diagnosed at an early stage. Surgery is the only curative option. 

When deciding treatment options for a particular patient, the doctor will consider the following factors and will decide individual treatment plan:

  • The size of the cancer
  • The stage of the cancer
  • The location of the cancer
  • Your overall health and ability to recover from surgery, radiation therapy or chemotherapy
  • Your personal preferences

Following are the general guidelines but treatment may vary from patient to patient:  

  • Early-stage diseases: Surgery (Radical cholecystectomy: includes removal of gall bladder with liver tissue with surrounding lymph nodes) followed by chemotherapy 
  • Locally advanced or node-positive diseases:  A trial of 3 cycles of chemotherapy given. If a good response to chemotherapy then surgery can be done.  
  • Options for advanced disease (Unresectable, Recurrent, or Metastatic) include: 
  • A biopsy is done for confirmation of cancer 
  • Inserting a hollow tube (stent) into the bile duct to stop it becoming blocked – this can help relieve symptoms such as jaundice
  • Chemotherapy – Given to slow cancer progression and relieve symptoms. 
  • Radiotherapy – to relieve symptoms and improve the quality of life.