Cancer of the gallbladder is more common in women than men. It is the third common cancer in women and fifth common cancer of gastrointestinal tract. Gall stone is present in the gallbladder in about 70 % to 80% of cases. Most of the time gall bladder cancer is asymptomatic and grows silently. That’s why detected in late and in complicated stage. Sometimes it is detected after removal of gall bladder (cholecystectomy) for gall stone or infection.
The symptoms of gallbladder cancer may be obscured by symptoms of gall stone or cholecystitis. Abdominal discomfort, dyspepsia, feeling of abdominal mass and jaundice may be the presenting symptoms.
Abdominal ultrasound is the most important initial diagnostic tool, which may show soft tissue mass in the gall bladder. CT scan with contrast film shows contrast enhancement of the gallbladder mass. Tumor marker like CA.19-9 may be increased.
Certain conditions of gall bladder needs careful evaluation: they are porcelain gallbladder (calcification of gallbladder wall), large polyp (s), soft tissue mass in the gall bladder and unusually thick wall gallbladder.
Gallbladder cancer spread through stages. (one through five).
If it could be diagnosed in the early stage, then radical surgery is the definitive treatment strategy. It involves removal (resection) of segment IVB &V of liver along with cancerous gallbladder enemas, the result is excellent with five-year survival rate can be more than 90%. The outlook is poor if the cancer is found in late stage with a 5-year survival rate close to 3%.
In the advanced stage palliative stenting (endoprosthesis) of bile duct by endoscopic means to relive jaundice is the option. However, if endoscopic procedure is not feasible due to blockage and narrowing of duodenal channel, then palliative bypass surgery as hepatico-jejunostmy and gastrojejunostomy may needed to relieve biliary and duodenal blockage. Chemotherapy have limited role. Therefore, attention should be paid for early detection and treatment.
What are the Causes of Gallbladder Cancer:
It is still not completely clear the real cause(s) of gallbladder cancer, but the following factors are believed to increase the risk of developing it:
* The female patient over 50 years , with long course of chronic cholecystitis
* Cholecystolithiasis (gallbladder stones). The risk of developing gallbladder cancer for patients with cholecystolithiasis is 38 times higher than that of people without gallbladder stones.
* Calcification of gallbladder wall. It is more common in women over the age of 65. It is the final stage of chronic cholecystitis and its cancerization rate reaches as high as 22%.
* The patient whose gallbladder polyps are 10 mm or larger thus the cancerization rate can reach as high as 23%.
* The incidence rate of gallbladder cancer may higher among people who like eating pickled products, bean curd preserved, fried foods, and chili. Besides, unhealthy habits such as smoking, alcohol drinking and high fat and high calorie diets may play a role in promoting the development of gallbladder cancer.
* Women with early menarche age, late menopausal age, with many times of child-bearing have higher risk of developing gallbladder cancer, which may be related to the change of the level of endogenous estrogen, progesterone in their body.
* Obesity in youth and weight more than their normal peers by 20%-30% can increase the risk of developing gallbladder cancer.
Diagnosis of Gallbladder Cancer :
1. Ultrasonography: it can be done to show the size of gallbladder lesions, observing whether there are obvious lymph node metastases and liver involvement.
2. CT scan: after ultrasound examination, the patient who is highly suspected with gallbladder cancer need to do an enhanced CT examination, which can display whether the tumor invades liver or spread to the related lymph nodes.
3. MRI: it can be used to judge whether there are liver involvement or MRCP can be considered to be done when patients appear obstructive jaundice.
4. PET-CT: it can give a qualitative diagnosis for the occupying lesion of gallbladder and it helps to determine whether there are lesions existing outside the gallbladder.
5. Laboratory examination: to check whether serum tumor marker (CA 19-9) have increased.
The most common and effective treatment is surgical removal of cancerous gallbladder en mass with part of liver ( Hepatic bisegmentectomy, segment IVB & V).
Post cholecystectomy carcinoma gall bladder Liver resection (Bisegmentectomy)
When it is done as early as possible, patients have the best chance of long term survival and even cure .If gall bladder cancer is diagnosed after cholecystectomy (incidental cancer), reoperation to remove part of liver is required.
If surgery is not possible, endoscopic stenting of the biliary tree can reduce jaundice
Gall bladder cancer when obstructed the bile duct , if stenting is not possible then anastomosis of bile duct with intestine ( hepatico jejunostomy) and if duodenum is blocked ,then gastrojejunostomy may be done to relieve biliary and gastric outlet obstruction.
Chemotheraphy have limited role.