Gallbladder carcinoma (Gallbladder carcinoma) is a rare cancer. The global incidence is about less than 5 cases per 100,000 population but is more common in populations in northern India, South America, and Japan.
Major risk factors include
- Gallstones (Gallstone) because they cause chronic inflammation of the gallbladder wall
- Porcelain gallbladder (calcification of the gallbladder wall)
- Gallbladder adenomatous polyp
- Smoking
- Infection with certain bacteria, such as Typhoid
- Chronic inflammation of the bile ducts (Primary sclerosing cholangitis)
- Mutated gene abnormalities
- Anomalous pancreaticobiliary junction (abnormal anatomy of the bile duct and pancreatic duct)
Symptoms of gallbladder cancer
Gallbladder cancer is a disease that often does not show symptoms in the early stages, similar to many other cancers, causing many patients to be unaware until the disease has progressed. When symptoms begin, it usually indicates that the cancer is at an advanced stage.
Common symptoms that patients usually present with include
- Abdominal pain, especially in the right rib area
- Loss of appetite, feeling full easily
- Unexplained weight loss
- Jaundice, yellowing of the skin and eyes due to bile duct obstruction
- Palpable mass in the abdomen near the right rib area
In some cases, patients may present with acute symptoms such as cholecystitis or cholangitis, which upon further examination are found to have hidden gallbladder cancer. Additionally, a significant number of gallbladder cancers are incidentally detected from biopsy after gallbladder surgery for other reasons, such as gallstones or gallbladder polyps, even though the patients had no prior suspicious symptoms. Therefore, if there are abnormal symptoms in the abdominal area or a history of gallbladder disease, detailed examination should be done to increase the chance of early detection.
Additional diagnostic tests
- Doctors may start with an ultrasound. If a mass is found in the gallbladder, the doctor will consider sending the patient for a CT scan of the abdomen or an MRI of the abdomen to help confirm the nature and stage of the disease, which affects treatment planning.
- Generally, biopsy for diagnosis before treatment is not recommended if imaging suggests cancer and surgery is considered feasible, because gallbladder biopsy increases the risk of cancer spreading to the peritoneal lining.
Treatment
- Depends on the stage of the disease from imaging and whether surgery is possible
- Currently, surgery (Extended cholecystectomy) is the only treatment with a chance of cure. If surgery is feasible, the doctor will remove the gallbladder along with the liver tissue adjacent to the gallbladder (Liver resection) and dissect nearby lymph nodes (Lymphadenectomy). If cancer has spread to the bile duct, bile duct resection (Bile duct resection) and biliary-enteric bypass will also be performed.
- If the tumor is very large and involves adjacent organs, commonly the stomach, duodenum, or pancreatic head, the doctor may consider resecting the proximal intestine along with the pancreatic head (Hepato-pancreatoduodenectomy). This indicates a poor prognosis. Surgery carries high risks and complications and should only be performed in medical centers with highly specialized expertise and readiness.
- Chemotherapy, Radiotherapy, and Targeted therapy
Chemotherapy or radiotherapy depends on the stage of the disease, chemotherapy regimen, and treatment goals, such as adjuvant chemotherapy after surgery, palliative chemotherapy for inoperable cases. Neoadjuvant chemotherapy and targeted therapy are still under study, and doctors will consider each patient individually.
Prognosis
Gallbladder cancer has a poor prognosis because most patients with symptoms are already at an advanced stage with metastasis to other organs. The mortality rate is high. The 5-year survival rate is less than 30% if cancer has spread to adjacent organs or lymph nodes, and less than 5% if it has spread to distant organs.
However, if detected at an early stage without metastasis and surgery is possible, the 5-year survival rate can be as high as 70%. These patients often have no symptoms or are incidentally found during abdominal ultrasound or gallbladder surgery for other reasons.
Prevention and screening for gallbladder cancer
- Tumor markers in the blood, such as CEA, CA 19-9, may be elevated in gallbladder cancer but not always, and can give false positive or false negative results.
- Since gallbladder cancer is associated with gallstones, factors causing gallstones such as obesity can be prevented by weight control and regular exercise. However, not all gallstones require surgery to prevent gallbladder cancer. Surgery is recommended if the patient has abdominal pain from gallstones, cholecystitis, or if the gallstones are very large (>2-3 cm).
- Regarding gallbladder polyps, most are cholesterol polyps which do not carry a risk of gallbladder cancer. Surgery is considered only if the polyp is larger than 1 cm, which increases the risk of adenomatous polyps that can become gallbladder cancer.
- It can be seen that prevention of gallbladder cancer includes not smoking, controlling weight, and exercising regularly to reduce the risk of gallstones. Although there is currently no standard screening test for gallbladder cancer, abdominal ultrasound to check for gallstones or polyps is a low-risk, painless test that can be done routinely and is considered an indirect preventive measure.
