Gall bladder cancer is the abnormal growth of cells occurring in the Gall bladder. It is a pear-shaped organ present below the liver and its function is associated with the storage of bile. The gall bladder cancer is a rare type of cancer worldwide but its incidence is high in India, especially in northern and northeastern states.
Gall bladder cancer causes
GB cancer can be attributed with variety of reasons with inflammation due to presence of gall stones being the most common reason.
Gallstones, particularly larger or calcified stones, cause chronic inflammation and irritation of the gallbladder lining, potentially leading to cancerous changes over time.
Age also plays a role, as gallbladder cancer is more common in older adults, with the risk increasing with age.
Women are at a higher risk compared to men, possibly due to hormonal influences or higher rates of gallstone formation in women.
Ethnicity is another factor, with Native Americans, Hispanics, and individuals from South Asian countries having a higher incidence of gallbladder cancer.
Obesity contributes to the risk as well, as excess body fat can alter bile composition and increase the likelihood of gallstone formation.
Chronic inflammation of the gallbladder, such as in cases of chronic gallbladder infections or inflammation (cholecystitis), is also associated with an elevated risk of developing gallbladder cancer.
Certain conditions like porcelain gallbladder, characterized by calcification and hardening of the gallbladder wall, are linked to an increased risk.
Additionally, occupational exposures to environmental toxins or chemicals in industries like rubber manufacturing, textile production, or metal processing may elevate the risk of gallbladder cancer.
Gall bladder Cancer Symptoms
Gall bladder cancer is generally diagnosed in very late stages because the tumor rarely present symptoms in early stages and when symptoms are present they usually mimic symptoms associated with benign diseases such as gall stones.
Presence of Symptoms usually indicate advanced disease. various symptoms include:
Abdominal Pain: Persistent and unexplained abdominal pain, particularly in the upper right quadrant or mid-abdomen, is a common symptom of gallbladder cancer. The pain may worsen after meals or radiate to the back or shoulder blades.
Jaundice: Yellowing of the skin and whites of the eyes (jaundice) can occur when gallbladder cancer blocks the bile ducts, leading to a buildup of bilirubin in the bloodstream. This can cause dark urine, pale stools, and itching.
Unexplained Weight Loss: Significant and unexplained weight loss without changes in diet or activity level may occur in individuals with gallbladder cancer. Cancer-related metabolic changes and decreased appetite can contribute to weight loss.
Abdominal Mass or Lump: In some cases, a palpable mass or lump may be felt in the abdomen due to the presence of a tumor in the gallbladder or surrounding structures.
Nausea and Vomiting: Persistent nausea, vomiting, and digestive discomfort, especially after meals, can be symptoms of gallbladder cancer. These symptoms may be accompanied by a feeling of fullness even after eating small amounts.
Changes in Appetite: Loss of appetite or early satiety (feeling full quickly) can occur as a result of gallbladder cancer, leading to unintended weight loss over time.
Fever and Chills: In advanced stages or if the cancer causes complications such as infections, fever, chills, and general malaise may develop.
Enlarged Liver: In some cases, gallbladder cancer may cause the liver to enlarge (hepatomegaly), which can be detected during a physical examination.
Gall bladder Diagnosis and Treatment
For making diagnosis of Gall bladder cancer, thorough history and medical examination is done before investigations are done. A very high suspicion for GB cancer is kept if the above symptoms are noticed in patient with known gall stones.
investigations used for diagnostic and staging purpose are as follows
Imaging Tests: Imaging studies are crucial for evaluating the gallbladder and surrounding structures. Tests such as ultrasound, CT (computed tomography) scans, MRI (magnetic resonance imaging), and PET (positron emission tomography) scans can help visualize tumors, assess tumor size, location, and potential spread to nearby organs or lymph nodes.
Blood Tests: Blood tests may be conducted to assess liver function, detect markers such as elevated bilirubin levels (indicative of jaundice), and evaluate overall health status.
Biopsy: A definitive diagnosis of gallbladder cancer requires a biopsy, where a small tissue sample is obtained for laboratory analysis. Biopsies can be performed during surgery (surgical biopsy) or using minimally invasive techniques such as fine-needle aspiration guided by imaging (CT or ultrasound).
Histopathological Examination: The biopsy tissue is examined under a microscope by a pathologist to confirm the presence of cancer cells, determine the cancer type (e.g., adenocarcinoma), grade (degree of abnormality), and stage (extent of spread).
Staging Tests: Once gallbladder cancer is confirmed, additional tests such as endoscopic retrograde cholangiopancreatography (ERCP), laparoscopy, or exploratory surgery may be performed to stage the cancer accurately. Staging helps determine if the cancer is localized or has spread to nearby tissues, lymph nodes, or distant organs.
Treatment depends on the stage at which cancer is diagnosed and overall health of the patient. Surgery is mainstay of treatment in early stages with Chemotherapy and targeted therapies used in more advanced stages. Treatment options also depend on whether the cancer can be completely removed by surgery or whether the cancer has just been diagnosed or has recurred (come back).
Surgery include removal of the gallbladder (cholecystectomy) with or without a part of adjacent liver is the primary treatment for early-stage gallbladder cancer. In some cases, nearby lymph nodes and surrounding tissues may also be removed to ensure complete cancer removal. Surgical options may include laparoscopic or open surgery, depending on the cancer’s extent and the patient’s overall health.
palliative surgery options in case of advanced stages with jaundice include biliary bypass, Endoscopic stent placement or Percutaneous transhepatic biliary drainage (PTBD)
Chemotherapy uses powerful drugs to kill cancer cells or slow their growth and It may be used before surgery (neoadjuvant chemotherapy) to shrink tumors, after surgery (adjuvant chemotherapy) to destroy any remaining cancer cells, or as palliative treatment for advanced-stage cancer to relieve symptoms and improve quality of life.
Radiation therapy uses high-energy beams to target and kill cancer cells. It may be used after surgery (adjuvant radiation therapy) to reduce the risk of cancer recurrence or as palliative treatment to shrink tumors and alleviate symptoms such as pain or jaundice.
Targeted therapy drugs specifically target and attack cancer cells while minimizing damage to healthy cells. These drugs may be used in combination with chemotherapy or as standalone treatments, especially for advanced-stage gallbladder cancer with specific genetic mutations or biomarkers.
Immunotherapy works by stimulating the immune system to recognize and attack cancer cells. While not yet widely used for gallbladder cancer, ongoing research and clinical trials are exploring immunotherapy’s potential benefits in treating this disease.
Gall bladder cancer Survival rates
As gall bladder cancer are often diagnosed in very late stages when the disease has already spread to liver, involved biliary ducts or has spread to other organs, its survival rates are very poor at this stage.
Early Stage (Stage I and II): When gallbladder cancer is localized to the gallbladder or nearby tissues without spreading extensively, the five-year survival rate is relatively higher, ranging from 50% to 70%. Surgical removal of the tumor, often combined with chemotherapy or radiation therapy, can offer better chances of long-term survival.
Advanced Stage (Stage III and IV): In cases where gallbladder cancer has spread to distant organs or lymph nodes, the five-year survival rate decreases significantly, ranging from 5% to 30%. Treatment at this stage focuses on palliative care, symptom management, and improving quality of life rather than curative intent.
Multidisciplinary teams comprised of surgical oncologist, medical oncologist, radiation oncologist, radiologists, gastroenterologists and other specialists provide comprehensive care to optimize treatment outcomes.
Early detection by regular screening, understanding the symptoms and prompt medical action can help improve overall patient survival outcomes in this disease.
