Cancer of the Gallbladder occurs more commonly in the Indian subcontinent than probably in any other continent in the world. Unfortunately, gall bladder cancer is diagnosed at an advanced stage in the majority of cases.
Surgical resection (removal) is the only potentially curative treatment. This means that gallbladder cancer can be completely cured only when removed by surgery. It is not amenable to medical treatment (chemotherapy) or radiation therapy. But unfortunately, less than one-fourth of all patients are diagnosed with gallbladder cancer in a timely manner such that their tumours can be completely removed by surgery.
It's true that the prognosis of gallbladder carcinoma especially in advanced cases is poor. But saying this does not justify leaving patients with no treatment or hope. In fact, it is important to spread awareness about this disease so that patients can get timely treatment.
COMMON SYMPTOMS OF GALL BLADDER CANCER:
YELLOW DISCOLOURATION OF EYES: Because of increasing jaundice, all body fluids (including urine), eyes and skin turn yellow. Jaundice in gallbladder cancer is due to blockage in the flow of yellow fluid called bile down its normal pathway from the liver to the intestines. As more and more bile
accumulates in the liver, its level also increases in the blood
and all other body fluids.
PAIN ABDOMEN mainly on the RIGHT UPPER side. As the tumour grows in size, it starts compressing on nearby structures. Lymph nodes are small structures near the gallbladder where tumour cells can spread. If the tumour spreads to the lymph nodes, then they start increasing in size, thereby compressing nearby nerve structures. This can cause pain as well.
VAGUE COMPLAINTS: Sometimes, patients visit the doctor with non-specific or vague complaints. Like, acidity, indigestion, poor appetite etcetera. Usually, these are incidental findings and unrelated to patients' diseases.
ADVANCED CASES: In advanced cases where the tumour has started compressing on the nearby structures, patients can have VOMITING due to compression of the stomach and or intestine by the tumour.
ITCHING (pruritis): High bilirubin levels in the blood can lead to excessive and continuous itching which can be very bothersome to the patients,
DIAGNOSIS OF GALLBLADDER CANCER:
Blood tests: Liver Function tests, Tumour markers (CA19.1, CEA) and other baseline investigations are needed. Liver function tests will show high bilirubin levels amongst other abnormalities. CA 19.9 levels are also abnormally elevated. But these have to be correlated with the patient's condition and findings on the imaging.
Ultrasound of the Abdomen: This is one of the initial tests that the patients are asked to get. It will help see the findings suggestive of gallbladder tumour and bile duct obstruction. If lymph nodes are enlarges significantly, then that may also become visible on ultrasound. Ultrasound helps us decide what further testing is required.
CT Scan of the Abdomen: A special type of CT scan is required to see all relevant structures in gallbladder cancer. This type of CT will be ordered by your specialist surgeon. It will help in deciding the stage of the disease and as well as if the tumour is resectable or not.
PET CT : to find out distant metastasis ( cancer spread in the rest of the body )
TREATMENT OF GALL BLADDER CANCER:
When the tumour is completely resectable (Removable) by surgery: The gallbladder is removed with surrounding lymph nodes and part of the liver. At times only a small portion of the liver needs to be removed. In some cases, the spread to the liver is more extensive. In those cases,
When the tumour is resectable (Removable) but also invading nearby organs: Gallbladder tumour can invade the nearby organs without having spread very far. This makes it still resectable completely by surgery. For instance, if it invades only the liver then that portion of the liver can be removed. Where the tumour has invaded the stomach or the intestines, then that portion of the stomach and/ or intestine is removed and a new route for food to travel is created.
Sometimes large portions of the liver need to be removed in gallbladder cancer and in hose cases advanced techniques like ALPPS, portal vein embolization can make liver removal possible.
When the tumour is advanced and CANNOT be removed by surgery alone: Then there are multiple options based on how and where the tumour has advanced. If the tumour is not resectable at all chemotherapy, though not very promising will need to be started and other palliative procedures can be done to relieve patients of symptoms and improve their quality of life.
The best way to fight gallbladder cancer is to fight it early. If you have any questions, do not hesitate to call or write to us:
Dr Siddharth Jain
MBBS, MS, Fellow ASTS (USA)
Jain Multispeciality Hospital, Delhi
MAX Hospital, Shalimar Bagh, Delhi
Ph: 01142233518, 9810087117
Email: jainhospitalmultispeciality@gmail.com
Comments