The gall bladder stores bile, a produced of the liver that aids in the digestion of fat-containing foods. It is a non-essential organ and can be removed without significant consequences. Gall bladder cancer, also called carcinoma of the gall bladder, is extremely rare affecting only 7,100 people in the United States per year. Unless it is very small and found when the gall bladder is removed for other reasons, the treatment now available is not particularly effective.
Because it is so uncommon and because its symptoms mirror those of far more common ailments, cancer of the gall bladder is usually not found until it is at an advanced stage and cannot be surgically removed. In the advanced stages, pain relief and the restoration of normal bile flow from the liver into the intestines are the principal goals of therapy.
How It Spreads ?
Gall bladder cancer tends to spread to nearby organs and tissues such as the liver or small intestine. It also spreads through the lymph system to lymph nodes in the region of the liver (porta hepatis). Ultimately, other lymph nodes and organs can become involved.
What Causes It ?
No one factor has been clearly shown to cause gall bladder cancer. Although it occurs most often in people with porcelain gall bladders where repeated inflammation from passing gallstones leads to hardening (calcification) of the gall bladder, it is extremely rare even in such patients. Since the gallbladder isn't essential, people with a calcified gall bladder may consider having it removed as a preventative measure.
Common Signs and SymptomsUnfortunately, there are no specific, surefire symptoms that suggest a diagnosis of gallbladder cancer. Usually, patients present with problems resulting from blockage of the bile ducts, such as jaundice, loss of appetite and weight loss. There may be a mass and/or pain in the abdomen, especially on the right under the ribcage. However, people often have no symptoms, or their symptoms closely mimic those of gallstones. The most common way gallbladder tumors are diagnosed is incidentally, during surgery performed to remove the gallbladder (cholecystectomy) for some other reason. About 1-2% cholecystectomies reveal a cancer of the gallbladder.
On patient examination, a healthcare provider (HCP) may detect jaundice of skin or the whites of the eyes, a mass in the right upper abdominal quadrant or around the belly button (periumbilical).
How is gallbladder cancer staged?
The American Joint Committee on Cancer uses the TNM system to stage gallbladder cancer as follows: (Adapted from AJCC 6 th edition, 2002)
Primary tumor (T)
- TX - Primary tumor cannot be assessed
- T0 - No evidence of primary tumor
- Tis - Carcinoma in situ
- T1 - Tumor invades mucosa or muscle layer
- T2 - Tumor invades perimuscular connective tissue
- T3 - Tumor invades/perforates the serosa and/or directly invades the liver and/or one other adjacent organ or structure
- T4 - Tumor invades main portal vein or hepatic artery or >2 adjacent organs
Regional lymph node (N)
- NX - Regional lymph nodes cannot be assessed
- N0 - No metastases in regional lymph nodes
- N1 – Regional lymph node metastases
- MX - Presence of metastases cannot be assessed
- M0 - No distant metastases
- M1 - Distant metastases
How is gallbladder cancer treated?
As with many tumor types, management is often a multidisciplinary approach involving a variety of treatments.
For early stage disease (Stage I), surgery alone can be considered. In patients who have a gallbladder cancer found during a cholecystectomy, reexcision is recommended if the disease is stage II or higher. In stage I disease, the need for reexcision is more controversial. Total surgical removal of all known tumor is the only truly “curative” treatment. Unfortunately, only about 25% of patients with gallbladder cancer are able to undergo definitive surgery. Furthermore, such a procedure is typically quite extensive, and involves removal of the gallbladder, regional lymph nodes, and a portion of liver if there is concern of invasion.
As you might expect, such a surgery carries a high risk of serious operative injury. Even when surgery is possible, the surgeon is usually unable to take very large resection margins around the tumor, meaning that cancer cells may exist at, or very close to, the tissue edges where the surgeon cut. Even with improving surgical techniques, the risk of recurrence is high. In such cases, external beam radiation therapy can be used in hopes of eradicating any microscopic cancer remaining in the surgical area and surrounding at-risk regions
As a preventive means, a healthy diet routine focused at maintaining a proper bowel, kidney and liver functions would help in keeping the gallbladder free of diseases. Vegetarianism has been recommended as the best method for overall prevention of gallbladder cancer. Inculcating healthy food habits and sticking to a moderate life has proved beneficial in countering all kinds of illness or disease.
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