‘Gallstones’: How High Is the Risk of Cancer? Check the Triggering Factors to Watch Out For. Gallstones are a common health problem among Thai people, and many people have gallstones without knowing it and without any symptoms.
However, if left unchecked or untreated, they may increase the risk of severe inflammation. Understanding and monitoring the condition from its causes and symptoms to screening methods and treatment will help us take proper and timely care of ourselves.
Getting to Know Gallstones What Are They and What Causes Them?
The gallbladder is a small, sac-shaped organ beneath the liver. It stores bile produced by the liver, which is used to digest fat in the small intestine. Gallstones are hard masses formed by the precipitation of substances in bile, particularly cholesterol and bilirubin. They range in size from as small as grains of sand to as large as a golf ball.
The main causes of gallstones include
- Bile contains too much cholesterol, which precipitates and forms gallstones.
- Bile contains excessive bilirubin, which is found in people with conditions involving chronic red blood cell destruction, such as thalassemia, certain types of anemia, and liver disease.
- Poor gallbladder contraction causes bile to remain in the gallbladder and precipitate.
- Genetics, diet, being overweight, increasing age—gallstones are commonly found after age 40—rapid weight loss, consuming a high-fat and high-calorie but low-fiber diet, diabetes, and certain medications such as some lipid-lowering drugs.
How Dangerous Are Gallstones? Do They Increase the Risk of Cancer?
Most people—70–80%—who have gallstones do not experience symptoms. The risk of developing symptoms or suddenly developing a severe infection is approximately 1–2% per year. This risk increases to 10–30% once symptoms develop, when a gallstone repeatedly obstructs the gallbladder neck. Symptoms may be as mild as abdominal discomfort, abdominal fullness, or excessive gas around the area above the navel, the epigastrium, or beneath the right rib cage, usually occurring after meals.
The risk of developing cholecystitis, bile duct obstruction by a gallstone, cholangitis, and pancreatitis also increases. These conditions may cause sudden severe pain, serious infection, jaundice, and fever with chills. The risk of gallbladder cancer is increased with stones larger than 3 cm, whereas small stones do not increase the risk of cancer.
Risk Factors for Gallbladder Cancer
In addition to gallstones, other factors can increase the risk of gallbladder cancer, including:
- Large gallstones Having stones larger than 3 cm increases the risk more than having small stones.
- Chronic cholecystitis Repeated inflammation causes deterioration of the gallbladder wall and chronic ulceration.
- Calcium deposits in the gallbladder “Porcelain gallbladder,” in which the gallbladder wall becomes hardened with calcium.
- Gallbladder polyps Gallbladder polyps larger than 1 cm carry a high risk of becoming cancerous.
- Female sex Age over 50. Gallbladder cancer occurs 2–3 times more often in women than in men.
- Family history Having a family member with gallbladder cancer.
- Certain biliary tract diseases, such as Primary Sclerosing Cholangitis, and choledochal cysts, increase the chance of developing gallbladder cancer.
What Are the Symptoms of Gallstones? Which Symptoms Require Caution?
Gallstones are divided into 2 groups according to symptoms: asymptomatic or silent stones, which account for up to 80%, and symptomatic stones, which require treatment.
- Pain in the right upper abdomen or the middle of the abdomen, usually after meals, especially fatty or fried foods.
- Nausea, vomiting, abdominal fullness, and bloating, especially after eating high-fat foods.
- Pain radiating to the right shoulder or upper back, which may result from nerve stimulation.
- Fever and chills together with severe abdominal pain, which may indicate acute cholecystitis.
- Yellowing of the skin and eyes (jaundice), a warning sign requiring immediate medical attention, indicating that the bile duct may be obstructed.
- Sudden, severe, persistent abdominal pain may indicate an emergency caused by gallbladder rupture or severe inflammation.
- Unexplained weight loss together with chronic nausea may be a sign of cancer.
- Some symptoms resemble those of gastritis, so the condition is often mistaken for a stomach disorder. Many people take medication and receive treatment for gastritis without improvement; gallstones should then be considered.
Symptoms Requiring Immediate Medical Attention
- Yellowing of the skin and eyes.
- Severe, intolerable abdominal pain.
- High fever accompanied by abdominal pain.
- Pale stools or unusually dark urine.
Diagnosis and Screening for the Risk of Gallstones
Detecting gallstones or abnormalities early can greatly reduce the risk of complications and cancer. The recommended screening method is an upper abdominal ultrasound, which is an accurate, painless preliminary screening test suitable for everyone, particularly those with the risk factors or symptoms mentioned above.
Upper Abdominal Ultrasound (Ultrasound Upper Abdomen)
This is a simple, painless examination involving no radiation, with accuracy of up to 95% for detecting gallstones. It can detect very small stones, as well as polyps, inflammation, and abnormalities of the liver and pancreas. The examination takes only 15–30 minutes. Fasting from food and water for at least 4–6 hours before the examination is recommended for the clearest results.
Other examination methods are also available, and the doctor will recommend them as appropriate, such as:
- CT scan or MRI of the abdomen when additional information is needed or cancer, a mass, or a polyp is suspected, to assess the spread and size of the mass.
- Blood tests (Liver Function Test) to assess liver and bile values, as well as tumor markers such as CA 19-9, as part of the diagnosis.
- ERCP or MRCP to examine the bile ducts, particularly when stones in the bile duct or bile duct obstruction are suspected.
Who Should Have an Upper Abdominal Ultrasound in Particular?
- Women aged 40 and older.
- People who are overweight.
- People with a family history of gallstones or gallbladder cancer.
- People who frequently experience abdominal pain.
- People with diabetes, high cholesterol, or liver disease.
How Are Gallstones Treated?
The main treatment currently is surgical removal of the gallbladder (Cholecystectomy), which is safe and provides the best long-term results. There are 2 surgical methods:
- Laparoscopic surgery (Laparoscopic Cholecystectomy)
This is the standard method commonly used by doctors today. Three to four small incisions are made in the abdomen, and a camera and instruments are inserted to remove the gallbladder. The advantages include smaller wounds, less pain, faster recovery, a hospital stay of only 1–2 days, and a return to normal activities within 1–2 weeks.
- Open surgery (Open Cholecystectomy)
This is used when laparoscopic surgery cannot be performed, such as in cases of severe cholecystitis, adhesions, or other complications. The surgical incision is larger and recovery takes longer (3–6 weeks).
With current medical technology and knowledge, gallbladder removal in cases without inflammation is highly safe, with a complication risk of 1–2%. However, if surgery is delayed until an emergency caused by inflammation occurs, the risk of complications increases, potentially reaching 10–30%, depending on the severity, and recovery will take longer.
Self-Care Guidelines After Gallbladder Surgery
After gallbladder removal, the body can still digest food normally because the gallbladder only serves as a reservoir for bile. Bile will continue to flow directly from the liver to the small intestine as before. However, the following recommendations should be followed:
- During the first 1–2 weeks, eat low-fat, easily digestible foods such as rice porridge, blanched vegetables, and fish.
- Avoid very fatty, fried, or spicy foods until the body has adapted, which generally takes about 4–6 weeks.
- Avoid lifting heavy objects and strenuous exercise during recovery.
- Keep the surgical wound clean and watch for abnormal symptoms such as redness, swelling, or pus.
- Attend all scheduled follow-up appointments with the doctor.
- If diarrhea, yellowing of the skin or eyes, fever, or abdominal pain after meals occurs, inform the doctor.
What Should Be Done If ‘Gallbladder Cancer’ Develops?
Gallbladder cancer is often discovered incidentally at an early stage during surgery or an ultrasound examination. Treatment depends on the stage of the disease. The doctor will order a CT scan or MRI to assess the stage.
- Stage 1: The cancer is confined to the gallbladder wall. Gallbladder removal can result in a complete cure.
- Stage 2: The cancer has spread to surrounding tissue. Surgery to remove the gallbladder and nearby tissue, along with lymph node dissection and chemotherapy.
- Stage 3: The cancer has spread to the lymph nodes or adjacent organs. Neoadjuvant chemotherapy before surgery, combined with extensive surgery, is used to control the disease and reduce recurrence.
- Stage 4: The cancer has spread to distant organs, such as the lungs, areas of the liver distant from the mass, or the bones. Treatment consists of chemotherapy and immunotherapy to relieve symptoms and improve quality of life.
The information shows that early detection is extremely important. Early-stage gallbladder cancer often has no symptoms, but when detected at stages 1–2, the 5-year survival rate is as high as 80–90%, whereas at stage 4 it falls to less than 5%. Annual abdominal ultrasound examinations can significantly reduce the risk of death.
How Can Gallbladder Cancer Be Prevented?
Modifying behaviors and having regular health checkups can help reduce the risk.
- Maintain a normal weight and avoid losing weight too quickly.
- Eat high-fiber foods, including vegetables, fruits, and whole grains, and reduce saturated fat and sugar.
- Avoid alcohol consumption and smoking.
- Have an annual health checkup, including an upper abdominal ultrasound, especially if you have risk factors.
- If gallstones, polyps, or a mass in the gallbladder are detected, follow up regularly with a doctor and do not leave them untreated.
FAQ: Answers to Questions About Gallstones
Q: What foods should be avoided with gallstones?
A: Avoid high-fat foods such as fried foods, pork belly, cream, butter, and palm oil, as well as very spicy foods, alcohol, and soft drinks. These foods stimulate strong gallbladder contractions, worsen pain, and may cause a stone to move and obstruct the bile duct.
Q: Can gallstones go away on their own?
A: Gallstones cannot go away on their own and tend to increase in number over time. However, even some small stones may move out of the gallbladder and obstruct the bile duct, causing severe pain, yellowing of the skin and eyes, fever and chills from cholangitis, or acute pancreatitis.
Q: How do gallstone symptoms vs. acid reflux differ?
A: Although many people may confuse the symptoms of gallstones with acid reflux, the 2 conditions have several important differences.
- Gallstones commonly cause pain in the right upper abdomen, the epigastrium, or the upper middle abdomen, usually after eating. The pain may occur at night and feel like fullness, bloating, or severe pain. It may radiate to the right shoulder or the middle of the back. It is not typically a burning pain in the chest and does not occur on the left side.
- Acid reflux (GERD) causes a burning sensation in the chest, a sour or bitter taste in the mouth, and frequent burping. Symptoms worsen when lying flat or bending over and do not cause right-sided pain.
Summary: Gallstones
Gallstones are a common condition, but many people overlook them because they have no symptoms in the early stages or mistake them for stomach problems. Gallstones can also cause acute, preventable emergencies such as cholecystitis, cholangitis, and pancreatitis. The risk of gallbladder cancer may appear low, but if risk factors accumulate—such as large gallstones, chronic inflammation, or polyps—the risk increases significantly.
The best approach is early detection and early treatment through an annual upper abdominal ultrasound, especially if you have risk factors, together with adjusting your eating habits and exercising. If gallstones are found, continue to follow up with a doctor and do not leave them untreated, because taking care of yourself today is an investment in long-term good health.
