Gallbladder Cancer Treatment in India
Gallbladder cancer is a rare disease in which malignant (cancer) cells are found in the tissues of the gallbladder. The gallbladder is a pear-shaped organ that lies just under the liver in the upper abdomen. The gallbladder stores bile, a fluidmade by the liver to digest fat. When food is being broken down in the stomach and intestines, bile is released from the gallbladder through a tube called the common bile duct, which connects the gallbladder and liver to the first part of thesmall intestine.
Types of Gallbladder Cancer
The two types of gallbladder cancer that occur most frequently are:
- Adenocarcinoma is the most common type of gallbladder cancer, and accounts for 90 percent of cases. Adenocarcinomas are a specific type of cancer that begin in the gland-like cells that line organs of the digestive tract.
- Papillary adenocarcinoma is a special subtype of adenocarcinoma that has a better prognosis, or outlook, compared with other types of gallbladder cancers. It is much less likely to spread to nearby lymph nodes or other organs like the liver.
Other much less common types of gallbladder cancers are adenosquamous carcinomas, squamous cell carcinomas, small cell carcinomas and sarcomas.
Causes of Gallbladder Cancer
- Gender: Gallbladder cancer occurs twice as frequently in women as in men, and this may be related to the increased frequency of gallstones and chronic inflammation.
- Age: Gallbladder cancer occurs mainly in individuals over the age of 65, and the average age at diagnosis is 73.
- Obesity: Being overweight or obese is a risk factor for gallbladder cancer, and may be related to the increased risk for developing gallstones.
- Family history: Although the genetic cause is unknown, the risk of gallbladder cancer seems to increase in families with a history of the disease.
- Chemical exposure: Some studies have shown that exposure to certain industrial chemicals, particularly those used in the rubber and textile industries, may be linked to an increased risk of gallbladder cancer.
- Gallstones: The leading gallbladder cancer risk factor is the presence of gallstones, which are found in over 75 percent of patients with gallbladder cancer.
- Porcelain gallbladder: This is a condition where calcium deposits cover the wall of the gallbladder, and some but not all studies have suggested a link between this condition and the development of gallbladder cancer. There may be a link between chronic inflammation and the calcification of the gallbladder.
- Choledochal cysts: Bile-filled cysts may develop along the common bile duct that leads from the gallbladder and liver to the small intestine. Sometimes the lining of the cysts may develop pre-cancerous cells, increasing the risk of cancer.
- Bile duct abnormalities: Other conditions that cause the bile duct to backup or result in inflammation of the gallbladder may also be potential risk factors.
- Gallbladder polyps: These are abnormal growths that form on the gallbladder. They may be caused by cholesterol deposits or by inflammation. Larger polyps (bigger than a centimeter) have a greater chance of being cancerous, and doctors often recommend removing the gallbladder when larger polyps are found.
- Typhoid: Individuals with a chronic salmonella infection, which is the bacterium that causes typhoid, may be at increased risk for gallbladder cancer,
Sysmtons of Gallbladder Cancer
- Jaundice (yellowing of the skin and whites of the eyes).
- Pain above the stomach.
- Nausea and vomiting.
- Lumps in the abdomen.
Stages of Gallbladder Cancer
Stage 0: Tis, N0, M0: There is a small cancer only in the epithelial layer of the gallbladder (Tis). It has not spread outside the gallbladder.
Stage I: T1 (a or b), N0, M0: The tumor has grown into the lamina propria (T1a) or the muscle layer (T1b). It has not spread outside the gallbladder.
Stage II: T2, N0, M0: The tumor has grown into the perimuscular fibrous tissue (T2). It has not spread outside the gallbladder.
Stage IIIA: T3, N0, M0: The tumor extends through the serosa (outer layer of the gallbladder) and/or directly grows into the liver and/or one other nearby structure (T3). It has not spread to nearby lymph nodes (N0) or to tissues or organs far away from the gallbladder (M0).
Stage IIIB: T1 to T3, N1, M0: The tumor has not grown into the main blood vessels leading into the liver or reached more than one nearby organ other than the liver (T1 to T3), but it has reached nearby lymph nodes (N1). It has not spread to tissues or organs far away from the gallbladder (M0).
Stage IVA: T4, N0 or N1, M0: The tumor has grown into the main blood vessels leading into the liver or has reached more than one nearby organ other than the liver (T4). It may or may not have spread to nearby lymph nodes (N0 or N1). It has not spread to tissues or organs far away from the gallbladder (M0).
Stage IVB: Either of the following is true:
Any T, N2, M0: The main tumor may or may not have grown outside the gallbladder. It has spread to lymph nodes further away from the gallbladder (N2). It has not spread to tissues or organs far away from the gallbladder (M0).
Any T, any N, M1: The main tumor might or might not have grown outside the gallbladder. It might or might not have spread to lymph nodes. The tumor has spread to tissues or organs far away from the gallbladder (M1).
Diagnosis of Gallbladder Cancer
Your specialist will arrange blood tests called liver function tests. This series of tests shows if the liver and gallbladder are working normally. Included is a test for a chemical called bilirubin
Your doctor may use this type of scan to look at your gallbladder. Ultrasound can pick up about 1 in 2 gallbladder cancers. This scan uses sound waves to create pictures of your body.
A CT is a computerised scan using X-rays. Your specialist may suggest you have a CT scan of your tummy (abdomen). CT scans of the gallbladder can pick up a growth inside the gallbladder, or one that is growing outside the gallbladde
X-ray of the gallbladder using an endoscope (ERCP)
ERCP stands for endoscopic retrograde cholangiopancreatography. You swallow a long, flexible tube so your doctor can look at the inside of your small bowel (duodenum) and take biopsies of anything that looks abnormal.
Type of MRI scan of the gallbladder, pancreas and bile ducts (MRCP)
MRCP is short for magnetic resonance cholangiopancreatography. It’s a type of MRI scan. It uses radio signals to give detailed pictures of your pancreas, gallbladder and bile ducts
Biopsy and fine needle aspiration (FNA)
A biopsy means removing a sample of tissue and looking at it under a microscope. This is the only certain way to tell whether a growth is a cancer or not
Treatment of Gallbladder Cancer
The main types of treatments for gallbladder cancer include:
There are 2 general types of surgery for cancer of the gallbladder:
- Potentially curative surgery
Potentially curative surgery is done when imaging tests or the results of earlier surgeries show there is a good chance that the surgeon can remove all of the cancer
- Palliative surgery
Palliative surgery is done to relieve pain or prevent complications, such as blockage of the bile ducts, if the tumor is too widespread to be removed completely. Palliative surgery is not expected to cure the cancer, but it can sometimes help relieve symptoms and/or prolong a person’s life. Palliative surgery is described in more detail in “Palliative therapy for gallbladder cancer.”
Radiation therapy uses high-energy rays (such as x-rays) or atomic particles to destroy cancer cells. There are different kinds of radiation therapy.For gallbladder cancer, a machine is used to create a beam of x-rays or particles that are aimed at the cancer. This is known as external beam radiation therapy (EBRT).
Chemotherapy (chemo) is treatment with anti-cancer drugs that are usually given into a vein or taken by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancers that have spread beyond where they started. Chemo can help some people with gallbladder cancer, but so far its effects against this type of cancer has been found to be limited. .For resectable gallbladder cancers, chemo may be used after surgery
Palliative therapy is treatment given to help control or reduce symptoms caused by advanced cancer. It does not try to cure the cancer. If the cancer has spread too far to be removed completely by surgery, doctors may advise palliative operations, radiation, chemotherapy, or other treatments to help make you feel better or to help prevent possible complications from the cancer. Because gallbladder cancers tend to advance quickly, doctors try to use palliative therapies that are less likely to affect a person’s quality of life, when possible. f
Biliary stent or biliary cathete
cancer is blocking a duct that carries bile from the gallbladder or liver to the small intestine, it can lead to jaundice and other problems. The doctor may insert a small tube (either a stent or a catheter) into the bile duct or the gallbladder to help the bile drain out. during surgery.
- A stent is a small metal or plastic tube that keeps the duct open to allow the bile to drain into the small intestine.
- A catheter is a thin, flexible tube that drains into a bag outside the body through a small hole in the skin of the abdomen. The bag can be emptied when needed. If you have a catheter, your doctor or nurse will teach you how to care for it.
These procedures are often done to help relieve or prevent symptoms from more advanced cancers
Photodynamic Therapy : A laser and a light sensitive medicine are used in this therapy for destroying the cancer cells. The different gallbladder symptoms can also be relieved by the means of this therapy. The injection of the medicine is done into a vein that will travel through the body which is then taken up by the cells. A laser is then passed over the cells for activating the drug that will eventually kill all the cancer cells.