Gall Bladder Cancer

Gallbladder cancer is cancer that begins in the gallbladder. The gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder stores bile, a fluid produced by your liver to digest fat. As your stomach and intestines digest food, your gallbladder releases bile through a tube called the common bile duct. The duct connects your gallbladder and liver to your small intestine.

Gallbladder cancer is uncommon. Gallbladder cancer is difficult to diagnose because it often causes no specific signs or symptoms. Also, the relatively hidden nature of the gallbladder makes it easier for gallbladder cancer to grow without being detected.

When gallbladder cancer is discovered at its earliest stages, the chance for a cure is very good. However, most gallbladder cancers are discovered at a late stage, when the prognosis is often poor. Treatment options for gallbladder cancer include surgery, chemotherapy, and radiation, alone or in combination.

Gallbladder cancer does not usually cause signs or symptoms until later in the course of the disease, but sometimes symptoms can appear sooner and lead to an early diagnosis. If the cancer is found at an earlier stage, treatment might be more effective.

Some of the more common symptoms of gallbladder cancer are:

• Abdominal pain, particularly in the upper right portion of the abdomen
• Abdominal bloating
• Itchiness
• Fever
• Loss of appetite
• Losing weight without trying
• Nausea
• Yellowing of the skin and whites of the eyes (jaundice)

It is not clear what causes gallbladder cancer. Cancer occurs when cells in your gallbladder develop errors (mutations) in their DNA. The errors make cells grow and divide out of control. The accumulating abnormal cells form a tumor in the gall bladder that can grow to invade nearby structures and spread to other parts of the body.

Risk factors for developing gallbladder cancer include:

• Your sex. Gallbladder cancer is more common in women.
• Your age. Your risk of gallbladder cancer increases as you age.
• Your weight. People who are obese are at higher risk for developing gallbladder cancer.
• A history of gallstones. Gallbladder cancer is most common in people who have had gallstones in the past. Still, gallbladder cancer is very rare in these people.
• Other gallbladder diseases and conditions. Other gallbladder conditions that can increase the risk of gallbladder cancer include porcelain gallbladder, choledochal cyst, and chronic gallbladder infection.

Tests and procedures used to diagnose gallbladder cancer include:

Blood tests to evaluate your liver function.

Procedures to create images of the gallbladder such as ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI).

Once your doctor diagnoses your gallbladder cancer, he or she works to find the extent (stage) of your cancer. Your gallbladder cancer's stage helps determine your prognosis and your treatment options.

Tests and procedures used to stage gallbladder cancer include:

Exploratory surgery. Your doctor may recommend laparoscopic surgery to look inside your abdomen for signs that gallbladder cancer has spread.

Tests to examine the bile ducts. Your doctor may recommend procedures to inject dye into the bile ducts. This is followed by an imaging test that records where the dye goes. These tests can show blockages in the bile ducts.

Additional imaging tests. Most people with gallbladder cancer will undergo a series of scans to help determine whether the cancer has spread or remains localized. Which scans should be performed vary depending on your circumstances. Common scans include CT of the chest and abdomen, ultrasonography, and MRI of the liver and positron emission tomography.

The stages of gallbladder cancer are:

Stage I. At this stage, gallbladder cancer is confined to the inner layers of the gallbladder.

Stage II. This stage of gallbladder cancer has grown to invade the outer layer of the gallbladder and may extend beyond the gallbladder.

Stage III. At this stage, gallbladder cancer has grown to invade one or more nearby organs, such as the liver, small intestine or stomach. The gallbladder cancer may have spread to nearby lymph nodes.

Stage IV. The latest stage of gallbladder cancer includes large tumors that involve multiple nearby organs and tumors of any size that have spread to distant areas of the body.

If you have or have had gallbladder cancer, you can take steps to manage the stress that accompanies the diagnosis:

Learn about gallbladder cancer so you can make informed decisions about your care.

Have a schedule of follow-up tests and go to each appointment.

Take care of yourself so that you are ready to fight cancer. This includes eating a healthy that includes plenty of fruits, vegetables and whole grains, exercising for at least 30 minutes most days of the week, and getting enough sleep so that you wake feeling rested.

Accept help and support from family and friends and talk with a counselor, social worker, or clergy member.

Write down your medical wishes. Take steps to ensure that your wishes are known and respected.

Ask your doctor about advance directives, which allow you to indicate what types of treatment you would want in the event you cannot communicate your wishes. Also ask about designating a medical power of attorney, which is someone you designate to make your choices for you if you cannot communicate.

After gallbladder cancer is found and staged, your physician will discuss treatment options with you. The treatments will be based on your overall health and the extent and location of the cancer.

The initial goal of treatment is to remove the gallbladder cancer, but when that is not possible, other therapies may help control the spread of the disease and keep you as comfortable as possible.

Three types of standard treatment are used for gallbladder cancer:

Surgery. Gallbladder cancer may be treated with a cholecystectomy, surgery to remove the gallbladder and some of the tissues around it. Nearby lymph nodes may be removed. If the cancer has spread and cannot be removed, the palliative surgery may relieve symptoms of advanced cancer.

Radiation therapy. Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy: external radiation therapy uses a machine outside the body to send radiation toward the cancer; internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy. Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. Chemotherapy options for gallbladder cancer include:

5-fluorouracil (5-FU)

Capecitabine (Xeloda)

Cisplatin (Platinol)

Gemcitabine (Gemzar)

Oxaliplatin (Eloxatin)