Gallbladder CANCER
Bile juice produced by the liver and stored in the gallbladder has an important role in the digestion of fats. In case of any disease that affects the production, storage or secretion of bile into the small intestine, the digestion of fats becomes difficult and this can cause significant problems in the person’s diet. Gallbladder cancer, which is rare in the general population, usually has a poor prognosis due to its late detection. For this reason, it is vitally important to have knowledge about gallbladder cancer, to be able to recognize the signs and symptoms at an early stage, and to get the correct diagnosis in the initial stages.
What is Gallbladder Cancer?
The gallbladder is a pear-shaped bag made of muscle tissue and is located just below the liver. Gallbladder cancers are malignant tumors that often arise in the wall of the gallbladder and constitute ⅔ of the tumors of the extrahepatic bile ducts. This cancer type, which is in the 5th place after stomach cancer among the cancers of the digestive system, is also the 9th among the cancers that cause death.
When examined morphologically, it is possible to talk about two different types of gallbladder cancer: infiltrative and fungal. The infiltrative type is more common and usually involves all or most of the sac at the time of diagnosis. Tumor cells completely change the structure of the sac wall and the affected parts acquire a hard, white, solid consistency. In the advanced stage, the inner surface of the tumor tissue becomes ulcerated and this may lead to perforation in the wall of the sac.
In the fungal type, the tumor tissues grow inwards from the wall of the sac as irregular, small, cauliflower-like masses. By the time this type of gallbladder cancer is diagnosed, it is most likely that liver metastases have already occurred. Fungative-type gallbladder tumors, which are completely asymptomatic during development, are usually detected by the development of gallbladder hydrops as a result of the mass reaching the size to obstruct the duct.
Gallbladder cancer stages
Stage 1: At this stage, the cancer is called carcinoma in-situ and the tumor is located only intramuscularly in the gallbladder wall. In cancers that can be noticed at this stage, the success rate with surgical treatment is quite high.
Stage 2: In the second stage of gallbladder cancer, the tumor has progressed from the inner side of the gallbladder to the outer surface of the gallbladder, but still has not exceeded the gallbladder wall. Metastases to neighboring organs such as liver or lymph do not occur.
Stage 3: All layers of the gallbladder are surrounded by cancerous cells. At this stage, metastases to the ductus cystic lymph nodes most likely develop.
Stage 4: In the final stage of the disease, cancer cells have spread from the gallbladder to the liver and other adjacent organs. Metastases occur in the bile ducts and other lymph nodes.
Gallbladder Cancer Causes
Although the causes of gallbladder cancer are not known exactly, it is possible to talk about some factors that predispose to this type of cancer.
Age
Gallbladder cancers occur mostly in elderly individuals. More than 75% of all bile-related cancer cases occur in people 65 years of age or older. In addition, it was observed that gallbladder cancer was detected in approximately 10% of people over the age of 65 who underwent bile duct surgery for non-cancer disease. In this respect, the age factor is considered as one of the predisposing factors for gallbladder cancer.
Gender
The risk of developing gallbladder cancer is 3 to 6 times higher for women than men for all races and all age groups.
gallstones
The etiological relationship between gallbladder cancer and gallstones has not been clearly demonstrated. However, it has been observed that 75-90% of all cases diagnosed with cancer have gallbladder stones, and approximately 1% of patients who underwent surgical treatment with the diagnosis of stony cholecystitis (gallbladder inflammation) had previously unsuspected gallbladder cancer. Precancerous cell changes were observed in approximately 13% of patients who underwent cholecystectomy (removal of the gallbladder) due to cholelithiasis (gallbladder stones), abnormal cell groups were observed in approximately 8% and the presence of malignant tumors directly in 4%. In this direction, it can be said that gallstones are associated with gallbladder cancers.
ulcerative colitis
It has been reported that the risk of developing gallbladder cancer in people diagnosed with ulcerative colitis increases 5-10 times compared to the population of these people.
Other predisposing factors
Unhealthy diet routine, obesity, genetic predisposition, chemical carcinogen exposure, anatomical variations of pancreatic and bile secretions, porcelain gallbladder, primary sclerosing cholangitis, presence of chronic infection and use of various drugs are other factors considered to be associated with gallbladder cancer.
What are the Symptoms of Gallbladder Cancer?
Gallbladder cancer is a very insidious type of cancer. Therefore, signs and symptoms may be overlooked, especially in the early stages of cancer. The disease may develop without a major problem, but may manifest itself with some complaints in the later stages.
- Pain in the right upper quadrant is one of the common complaints associated with gallbladder cancer.
- Gastrointestinal symptoms such as nausea, vomiting and loss of appetite can be seen in gallbladder cancer, as in many bile-related diseases.
- Jaundice, which is visible on the skin and in the white part of the eye, is one of the most common symptoms, depending on the type of gallbladder cancer.
- It is one of the important symptoms of many diseases related to the gallbladder and liver that the color of urine becomes dark brown and the color of stool becomes almost transparent-white.
- The presence of a palpable mass near the umbilicus can be seen especially in the later stages of gallbladder cancer.
How is Gallbladder Cancer Diagnosed?
Since the medical findings of diseases related to the gallbladder are very similar to each other, the tables that do not cause any complaints can be confused with gallstones and gallbladder inflammation. Therefore, even if laboratory findings indicate the diagnosis, they are not sufficient on their own.
First, the findings obtained in the physical examination are taken into account, and then imaging with ultrasonography is preferred for detailed examination. If the USG result supports the suspicions related to cancer, many imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasonography, percutaneous cholangiography, endoscopic retrograde cholangiopancreatography (ERCP), positron emission tomography (PET) and laparoscopy can be applied.
Gallbladder Cancer Treatment Methods
Like all treatments, the treatment of gallbladder cancer is planned specifically for the patient. When determining the method to be preferred for treatment, many important factors such as the patient’s age, general health status, type and stage of the current disease are taken into consideration.
Since gallbladder cancers can be diagnosed in advanced stages, it is very difficult to treat these cancer cases with surgery. However, in cases where the cancer is detected at an early stage, patients have a chance of surgery. For gallbladder cancers that are in the 1st or 2nd stage, have not spread to the liver or lymph nodes, and have not caused serious deterioration in the general health status of the patient, surgical treatment is often preferred and very successful results are obtained.
In cases where the cancer is noticed in the 3rd and 4th stages, the success rate decreases with surgical treatment. For patients diagnosed at this stage, different treatment plans may be preferred, in which radiotherapy, chemotherapy or all methods are applied together. In cases of advanced disease that cannot be treated, interventional radiological procedures such as endoscopic or percutaneous drainage can be applied to relieve the pain of the person.
