Gallbladder cancer is a malignancy that arises in the gallbladder. There are several types of gallbladder cancer.Some of them include:
- Adenocarcinomas – These are cancers that develop in the gland cells in the lining of the gallbladder. Gallbladder adenocarcinomas represent about 85% of gall bladder cancers. They include non papillary adenocarcinoma, papillary adenocarcinoma, and mucinous adenocarcinoma.
- Squamous cell cancer of the gallbladder – This is a rare form of gallbladder cancerand accounts for less than 12.7% of all gallbladder tumors. In general, a squamous cell cancer of the gallbladder develops from the skin-like cells that form the lining of the gallbladder.
- Adenosquamous cancer of the gallbladder – This is a rare histological form of the gallbladder carcinoma that affects both squamous epithelial cells and glandular cells of the bladder.
- Small cell cancer of the gallbladder – Also called oat cell carcinomas, small cell carcinoma of the gallbladder is a rare form of malignant tumor that has characteristics similar to those of adenocarcinoma of the gallbladder.
- Sarcoma of the gallbladder – This type of gallbladder cancer affects the muscle layer of the gallbladderand is very rare.
Gallbladder Cancer Statistics
Gallbladder cancer is a rare cancer that affects 2 to 3 times more women than men. In the United States, around 9,760 people were diagnosed with gallbladder cancer in 2009; about 3,370 died of it. However, the incidence varies substantially with race and sex. Gallbladder cancer rates are higher among American Indians/Alaska Natives and white Hispanic peoples.
- White Hispanic female incidence rate 4.2 per 100,000 people.
- American Indian/Alaskan Native female incidence rate is 4.1 per 100,000 people.
- White Hispanic male incidence rate 1.4 per 100,000 people.
- American Indian/Alaskan Native male incidence rate is 3. 3 per 100,000 people.
- Non-Hispanic white male incidence rate is 0.7 per 100,000 people.
Gallbladder Cancer Causes
The gallbladder is a pear-shaped organ. Located beneath the liver, the gallbladder has a thin wall covered with an inner lining, which is crossed by smooth muscle cells. It is connected to the liver, duodenum, and the bile duct by the cystic duct. Its main function is to store bile produced by the liver before going down into the small intestine to be used in digestion.
Gallbladder cancer develops when healthy cells in the gallbladder undergo mutations in their DNA. The mutation causes them to multiply and grow abnormally and continue to live even when they normally should die (natural cell death). Although the cause of this cellular degeneration is not clear, the majority of medical researchers believe that many cases of cancer of the gallbladder may be associated with the presence of stones inside of the organ.
Whatever the cause of the disease, cancer of the gallbladder is very serious and often leads to death.
Gallbladder Cancer Risk Factors
Some of the factors that increase the risk of the occurrence of gallbladder cancer include:
Sex – Cancer of the gallbladder affects about three times more women than men.
Age – Most victims of gallbladder cancer areover sixty years old. The disease occurs mainly after age 70.
Race – Higher rates of gallbladder cancer in the U.S. are found among Native American and Hispanic, especially Mexicans.
Obesity – Being obese increases your risk for developing many types of cancer, including gallbladder cancer.
Inflammation of the gallbladder – Primary gallbladder adenocarcinomas are sometimes linked to chronic inflammation of the gallbladder (cholecystitis).
Porcelain gallbladder – Also called calcification of the gallbladder, porcelain gallbladder accounts for 10-25% incidence of gallbladder cancer.
Certain professions – All professions that regularly expose you to caoutchouc and toxic chemicals increase your chance of becoming a gallbladder cancer victim.
Taking certain medications – Certain drugs used in the treatment of high cholesterol such as the fibrates are suspected in the development of gallbladder cancer.
Other suspected risk factors include:
- Crohn ileocolitis
- ulcerative colitis
- typhoid fever
- gallbladder polyps
- anomalous pancreatobiliary duct junction
Gallbladder Cancer Symptoms
You can live with gallbladder cancer for years without experiencing any symptoms. The tumor does not usually cause symptoms until it has begun to spread to adjacent organs or when the bile ducts are obstructed. When symptoms finally emerge, they are not specifically related to cancer; other diseases such as intestinal obstruction and gallstones can provoke the same signs and symptoms as gallbladder cancer.
As the cancer is gaining control of your body, you may experience at least one of these symptoms:
- weight loss
- loss of appetite
- swelling of the abdomen
- palpable mass in the right upper quadrant (abdomen)
- pain in the upper right of your abdomen
- digestion problems, especially when you eat fatty foods
Gallbladder Cancer Complications
Because a gallbladder cancer diagnosis is often delayed, the cancer can take an aggressive character. Cancer of the gallbladder tends to spread rapidly in the liver, duodenum, and surrounding lymph nodes. In some cases, the tumor can metastasize into the colon and makes treatment more difficult.
Gallbladder Cancer Diagnosis
Initially, your doctor will ask you questions about the signs and symptoms related to gallbladder cancer. In addition, he will seek to know your medical history. These approaches, however, are not enough to confirm the diagnosis. Other tests are needed.
Blood test – A blood test cannot confirm gallbladder cancer, but it shows the function of your liver. Certain gallbladder cancer symptoms such as jaundice tend to be similar to those of liver disease.
Imaging techniques – Usually, presence of gallbladder cancer is confirmed using CT scan, ultrasound, or magnetic resonance imaging (MRI).
Ultrasound – This medical technique allows your doctor to detect in the bladder the presence of acoustic shadows caused by gallbladder stones. In addition, the ultrasound can reveal an intraluminal mass, a vivid indicative of a tumor of the gallbladder.
CT scan: This test allows your physician to detect thickening of the gallbladder wall and/or the presence of a polypoid mass within the gallbladder. If the cancer has already metastasized, the CT scan will reveal signs of liver invasion by an adjacent gallbladder tumor; the test can also reveal metastasis in the lymph nodes or liver.
Magnetic resonance imaging (MRI) – A MRI is an imaging technique used to create an image of your gallbladder by applying a combination of electromagnetic waves at high frequency. To enhance the tumor, your health care will inject a liquid into your vein. The magnetic resonance imaging (MRI) allows your doctor to detect not only the malignancy but also the presence of metastasis.
Laparoscopy – Sometimes imaging techniques cannot distinguish between an inflammatory mass and a tumor. The diagnosis will then be confirmed by a surgical procedure called laparoscopy. Laparoscopy allows your doctor to detect not only the cancer but discover if the tumor has already spread to other organs.
Gallbladder Cancer Stages
Once the cancer is confirmed in your gallbladder, your physician will determine its stage, which will help him to choose the most appropriate and effective treatment to fight the tumor. In general, gallbladder cancer includes the following stages:
Carcinoma in situ (CIS) – Also called stage 0, carcinoma in situ is the genesis of the cancer; the cancer cells are located only in the layer of tissue lining the gallbladder.
Stage I – At this stage, the cancer is confined to the top layers of the tissues lining the gallbladder.
Stage II – The cancer has spread to the muscle layer of the gallbladder wall; the cancer may also spread to nearby organs such as liver.
Stage III – At stage 3, the cancer has spread from the wall of the gallbladder to affect the nearby lymph nodes and the body tissues next to your gallbladder.
Stage IV – Stage 4 is the most advanced stage of gallbladder cancer; the tumor has spread to distant lymph nodes and other parts of the body such as the stomach, pancreas, stomach, or intestines.
Recurrent– if after the treatment, the cancer returns, it is considered as a recurrent gallbladder cancer. In general, recurrent cancers are more difficult to be treated; survival chances decrease.
Gallbladder Cancer Treatment
A gallbladder cancer can be treated with surgery, chemotherapy, and/or radiation.
If the cancer is detected at an early stage (stage 1 for example), the tumor can be completely removed surgically; in fact, total removal of the gallbladder may lead to complete recovery. In most cases the cancer is diagnosed at an advanced stage. Surgery is performed to reduce the symptoms and improve life.
If the tumor has already crossed the mucosa of the gallbladder, it will be removed along with the regional lymph nodes. Furthermore, if the duodenum, pancreas, and organs close to the gallbladder are also affected, your surgeon will remove them and do an artificial communication between your stomach and bile ducts.
Surgery is not without side effects. Nearly 20% of patients have diarrhea for a prolonged period after the removal of their gallbladder.
Chemotherapy and radiation therapy may also be used with the surgery. However, the effectiveness of chemotherapy in the treatment of gallbladder cancer is rare.
Chemotherapy is the use of powerful chemical agents to destroy cancer cells. Unlike surgery and radiotherapy, chemotherapy is a systematic therapy that affects your body in its entirety. In most cases, the medications will be given approximately five times per week over a period of three months. The drugs can be taken orally or by intravenous injection. Your oncologist will chose the method he thinks will be more effective.
The chemotherapy drugs cause side effects. The most common include:
- nausea and vomiting
- loss of appetite
- loss of hair loss
- low sex desire
- menstrual irregularity
- increased risk of infections
Radiation therapy is a cancer treatment that uses high-powered beams of energy to destroy cancer cells by preventing them from dividing. Unlike chemotherapy, radiation acts locally on the tumor.
Although it less toxic than chemotherapy, radiation therapy can also cause adverse effects such as fatigue, nausea, and redness of the skin. Contact your doctor immediately if you develop a severe skin reaction after the radiotherapy.
Gallbladder Cancer Prevention
The best way to prevent development of cancer in your body is to live a healthy lifestyle and avoid carcinogenic environments; lifestyle and environmental factors can be open doors to development of cancer. Even if you are at low risk, you might get cancer if you continue to expose your body to carcinogens.
Gallbladder cancer is not attributable to a unique cause or factor; several factors can cause the formation of cancerous cells in your gallbladder. Although some risk factors such as sex and age are impossible to be avoided, other causative factors can be easily prevented. If you want to prevent gallbladder cancer and many other cancers, it is important to:
- avoid tobacco smoke, including second hand smoke
- adopt a healthy diet: a diet containing 5 to 10 servings of fruits and vegetables a day may help prevent occurrence of gallbladder cancer
- maintain a healthy weight
- limit your alcohol intake
- reduce your exposure to ultraviolet (UV) radiation
- exercise regularly
- practice safe sex
- tell your dermatologist about skin changes
- tell your doctor or dentist of any change that indicates the presence of cancer
Gallbladder Cancer Survival Rates
Gall bladder cancer is often diagnosed late, which makes its prognosis alarming. Most patients in whom the cancer is detected at an advanced stage will die within one year following the treatment. In the United States, the overall five-year survival rate is estimated at 15-20%.
However, if cancer cells have not spread beyond the gallbladder wall, the prognosis is generally very good. Nearly 80 percent of patients with stage 1 gallbladder cancer live more than five years after the surgery.
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