Gallbladder Cancer

What is Gallbladder Cancer?

Gallbladder cancer is a rare type of cancer where malignant cells form in the gallbladder tissues, a small, pear-shaped organ beneath your liver on the right side of your abdomen.

Impact of Gallbladder Cancer on Anatomy and Health

Gallbladder cancer can impact your anatomy and health in several ways:

• Disruption of Normal Bile Flow: The gallbladder's main function is to store bile produced by the liver and release it into the small intestine to aid in digestion, particularly of fats. Cancerous tumours in the gallbladder can obstruct this normal flow, leading to digestive problems and other complications like gallstones and cholecystitis (gallbladder inflammation).
• Spread to Other Organs: Like other cancers, gallbladder cancer can metastasise or spread to other body parts, including the liver, lymph nodes, and other organs in the abdomen. This can lead to further health complications and affect the functioning of these organs.
• General Health Effects: Like all forms of cancer, gallbladder cancer can cause general symptoms that impact overall health, such as fatigue, weight loss, and loss of appetite. These symptoms can interfere with the quality of life and overall well-being.
• Possible Surgical Removal: In many cases, treatment for gallbladder cancer may involve surgical removal of the gallbladder (cholecystectomy). The body can function without a gallbladder, but some people might need to adjust their diet or take medication to compensate for changes in bile flow.
• Treatment Side Effects: Other treatments, such as radiation and chemotherapy, can also have significant side effects that affect overall health, including fatigue, nausea, and an increased risk of infection due to a weakened immune system.

Risk Factors for Gallbladder Cancer

Several factors may increase your risk of gallbladder cancer:

• Age: Gallbladder cancer incidence increases with age. Most people diagnosed with gallbladder cancer are over the age of 70.
• Gender: Gallbladder cancer is more common in women. This may be partly because gallstones, a risk factor for gallbladder cancer, are also more common in women.
• Gallstones and Inflammation: Most people diagnosed with gallbladder cancer also have gallstones. Long-term inflammation of the gallbladder, often associated with gallstones, increases the risk of gallbladder cancer.
• Obesity: Being overweight increases the risk of gallstones and gallbladder cancer.
• Family History: A family history of gallbladder cancer increases the risk.
• Native American Ancestry: People of Native American descent have higher rates of gallbladder cancer.
• Certain Health Conditions: Conditions that increase bile in the gallbladder, like primary sclerosing cholangitis or abnormal bile ducts, can increase the risk.

Causes of Gallbladder Cancer

The exact cause of gallbladder cancer is not known. However, this cancer forms when a cell in the gallbladder develops mutations in its DNA. The mutations cause the cell to grow and divide rapidly. The accumulating abnormal cells form a tumour that can grow beyond the gallbladder and spread to other body areas.

Symptoms of Gallbladder Cancer

Gallbladder cancer is often discovered late because it tends not to cause specific symptoms until it's advanced. However, potential signs and symptoms include:

• Abdominal pain: Particularly in the upper right portion of your abdomen.
• Jaundice: Yellowing of the skin and the whites of your eyes.
• Fever.
• Nausea and vomiting.
• Bloating.
• Loss of appetite.
• Unexplained weight loss.

Types of Gallbladder Cancer

The types of gallbladder cancer are determined by the type of cells that initiate the cancer, and they include:

• Adenocarcinoma: This is the most common type of gallbladder cancer. It begins in the glandular cells that line the inner surface of the gallbladder. Adenocarcinoma of the gallbladder is further divided into several subtypes, including papillary adenocarcinoma, which tends to have a better prognosis than other types.
• Squamous Cell Carcinoma: These cancers start in the squamous cells that line the gallbladder. They are less common than adenocarcinomas.
• Adenosquamous Carcinomas: These cancers have adenocarcinoma and squamous cell carcinoma features. They tend to grow and spread quickly.
• Small Cell Carcinomas (Neuroendocrine Carcinomas): These are fast-growing cancers that can occur in several organs throughout the body, including the gallbladder.
• Sarcomas: These rare cancers start in the muscle and fat cells of the gallbladder.

Stages of Gallbladder Cancer

The stage of gallbladder cancer helps determine the severity and spread of the cancer, which in turn guides treatment options. The stages are as follows:

• Stage 0 (Carcinoma in Situ): Cancer is confined to the inner layer of the gallbladder at this earliest stage. It has not spread deeper into the gallbladder or to other organs.
• Stage I: The cancer has grown into the gallbladder's connective tissue or muscle layer but hasn't spread outside the gallbladder.
• Stage II: The cancer has grown through the wall of the gallbladder and may extend into the liver but hasn't spread to nearby lymph nodes or distant sites.
• Stage IIIA: The cancer has spread to the lymph nodes near the gallbladder, but not to other parts of the body.
• Stage IIIB: The cancer has grown into a vein leading into the liver or one or more nearby organs (like the stomach, small intestine, colon, pancreas, or bile ducts outside the liver), and it may have spread to nearby lymph nodes.
• Stage IV: This is the most advanced stage of gallbladder cancer. The cancer has spread to lymph nodes further away or to other organs in the body, such as the lungs or bones.

Diagnosis of Gallbladder Cancer

Diagnosing gallbladder cancer typically involves a series of steps:

• Physical Exam: The doctor will review your symptoms and perform a physical examination, which may involve pressing on areas of your abdomen to check for pain or abnormalities.
• Imaging Tests: Ultrasound, computerised tomography (CT) scans, and magnetic resonance imaging (MRI) can help visualise the gallbladder and surrounding structures, potentially revealing signs of gallbladder cancer.
• Blood Tests: Blood tests can provide information about your overall health and how well your liver works, which can help diagnose gallbladder issues.
• Biopsy: A tissue sample (biopsy) may be taken from the gallbladder for examination under a microscope to look for cancer cells. However, in some cases, doctors might avoid a biopsy due to the risk of cancer spreading.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure involves passing a long, flexible tube (endoscope) down your throat, through your stomach and into the upper part of your small intestine. A dye is injected through the tube into the bile ducts, making them appear on an X-ray.
• Laparoscopy: This surgical procedure uses a long, thin tube with a high-intensity light and a high-resolution camera at the front (a laparoscope). The instrument is inserted through an incision in the abdominal wall to check the gallbladder and surrounding organs for signs of disease.

Treatment of Gallbladder Cancer

Treatment for gallbladder cancer depends on the stage of the disease, your overall health, and your preferences. Options may include:

• Surgery: An operation to remove the gallbladder (cholecystectomy) might be done for early-stage gallbladder cancers. In certain cases, nearby liver tissue and lymph nodes might also be removed.
• Radiation Therapy uses high-powered energy beams, such as X-rays and protons, to kill cancer cells. It can be administered externally or placed inside your body near the cancer cells (brachytherapy).
• Chemotherapy: This uses drugs to kill cancer cells. It can be given intravenously or taken orally. It can be used after surgery to kill any remaining cancer cells or for advanced gallbladder cancers to slow the growth of the cancer and relieve symptoms.
• Immunotherapy: This helps your immune system fight cancer. It's often used for advanced gallbladder cancers when other treatments aren't effective.
• Palliative Care: This is supportive care for people with serious illnesses, aiming to improve the quality of life by relieving symptoms and side effects.

What if Gallbladder Cancer is Untreated?

If left untreated, gallbladder cancer can lead to severe health complications and ultimately be fatal. The disease would continue to progress and may have the following impacts:

• Growth and Spread of the Tumour: The tumour in the gallbladder would continue to grow, potentially obstructing the bile duct and causing symptoms such as severe abdominal pain, jaundice (yellowing of the skin and eyes), and other digestive problems.
• Metastasis: Gallbladder cancer, like all forms of cancer, can potentially metastasise or spread to other body parts. If it metastasises, it can affect the functioning of other organs, such as the liver, pancreas, or lungs, leading to a range of additional health problems.
• Systemic Effects: As with other cancers, untreated gallbladder cancer can cause general symptoms that can severely impact the quality of life. These might include chronic fatigue, significant unintentional weight loss, and loss of appetite.
• Death: If left untreated, gallbladder cancer is likely to be life-threatening. The survival rates drop significantly when the cancer is more advanced and has spread to other body parts.

Cancer treatment aims to remove the cancer, prevent its spread, and manage symptoms. While treatment can be difficult and may have side effects, it is crucial for improving outcomes, extending survival, and maintaining quality of life. If you or someone else has been diagnosed with gallbladder cancer, discussing treatment options with a doctor as soon as possible is important.