Gallbladder cancer is a rare but deadly form of cancer that develops in the gallbladder - a small organ located below the liver. According to the American Cancer Society, there will be an estimated 12,320 new cases of gallbladder cancer diagnosed in the United States in 2021. While it accounts for less than 1% of all cancers diagnosed annually in the US, the overall 5-year survival rate for gallbladder cancer is just 11.6% making it one of the deadliest forms of cancer. In this article, we explore more about gallbladder cancer, its causes, risk factors, symptoms, diagnosis and treatment.
What is the gallbladder and what does it do?
The gallbladder is a small pear-shaped organ located below the liver in the upper right part of the abdomen. Its main function is to store and concentrate the bile produced by the liver. Bile helps in digestion and absorption of fats and fat-soluble vitamins in the small intestine. The gallbladder contracts and releases bile into the small intestine via bile ducts in response to eating, especially foods containing fat. Gallbladder cancer develops in the inner lining of the gallbladder known as the gallbladder epithelium.
Causes and Risk Factors
The exact causes of gallbladder cancer are still not fully understood. However, certain risk factors are known to increase the chances of developing gallbladder cancer:
- Gallstones: the strongest risk factor is the presence of gallstones. Around 80% of gallbladder cancer patients have a history of gallstones. Gallstones produce chronic inflammation that damages the gallbladder over time and may lead to cancer.
- Gender: Women are nearly twice as likely to develop gallbladder cancer as men, likely due to higher risk of gallstones among women.
- Age: Risk increases with age, with most cases occurring in people over 65 years old.
- Chronic inflammation: Conditions causing long-term inflammation like gallbladder polyps, typhoid carrier state, and gallbladder parasites also raise the risk.
- Family history: Risk increases a little if a close relative has had gallbladder cancer. Inherited genetic disorders may play a role in some cases.
- Obesity: Being overweight or obese increases gallbladder cancer risk due to higher rates of gallstones.
Symptoms
Early gallbladder cancer may not cause any noticeable symptoms. As the cancer grows larger, the following symptoms may be present:
- Pain or discomfort in the upper right or middle abdomen - due to the swelling or blockage of bile ducts. This may be felt in the shoulders or back.
- Jaundice (yellowing of skin and eyes) - due to obstruction of the bile duct, which causes a buildup of bilirubin in the body.
- Nausea, vomiting, loss of appetite - due to swelling or ulceration of the gallbladder.
- Weight loss - from lack of appetite and absorption of nutrients.
- Fever or chills - associated with infections from blocked bile ducts.
Unfortunately, these symptoms are non-specific and can indicate many other non-cancerous conditions as well. This makes diagnosis of gallbladder cancer quite challenging in the early stages.
Diagnosis
If cancer is suspected based on factors like abdominal pain, imaging tests are used for diagnosis and determining the stage of cancer:
- Abdominal ultrasound scan: helps visualize the gallbladder and detects signs of cancer like thickening of gallbladder walls. Can also detect gallstones.
- CT or MRI scan: Provides higher quality images for precise detection and staging of tumors. Can reveal spread to lymph nodes and other organs.
- Endoscopic ultrasound scan: Done by passing an ultrasound probe down the throat to examine the gallbladder. Considered the best imaging test for staging gallbladder cancer.
- Blood tests: To check liver function, bilirubin levels and tumor markers like CA 19-9. High levels indicate more advanced cancer.
- Biopsy: Removal of a small piece of suspicious tissue for microscopic examination is the only definitive way to confirm cancer. Performed via minimally invasive methods or open surgery.
Staging helps to determine the extent of spread of cancer from the gallbladder to nearby tissues and organs. The TNM staging system is commonly used for gallbladder cancer staging.
Treatment Approaches
Treatment options depend on the stage of cancer and overall health of the patient:
- Surgery: For early stages that have not spread beyond the gallbladder (Stage I/II), gallbladder removal (cholecystectomy) combined with removal of nearby lymph nodes offers the best chance of cure.
- Radiation therapy: Used along with surgery to kill any remaining cancer cells and reduce risk of recurrence, especially for Stage I-III cancers. External beam radiation or brachytherapy may be used.
- Chemotherapy: The standard treatment for advanced Stage III-IV gallbladder cancers or in combination with radiation for earlier stages. Drugs like cisplatin and gemcitabine are commonly used. May help prolong life or cause remission.
- Targeted therapy: Drugs that target specific molecular pathways driving cancer growth, like trastuzumab, are being studied in clinical trials since gallbladder cancer is usually an aggressive disease.
- Palliative care: For late/metastatic stages where cure is unlikely, it aims to relieve symptoms and maximize quality of life. Pain management, nutrition, psychological support, etc are included.
Prevention
Unfortunately there are no definite ways known to prevent gallbladder cancer directly. However, limiting risk factors can help reduce the overall chance:
- Stay at a healthy weight: Maintain normal BMI to lower risk of gallstones associated with obesity.
- Eat fiber rich foods: Like fresh fruits and vegetables, to keep bowel movements regular and reduce gallstone formation.
- Get treated for gallstones: Especially if under 50 years old. Consider elective cholecystectomy for those with gallstones and multiple risk factors.
- Quit smoking: Lowers inflammation and risk of gallstones.
In conclusion, while gallbladder cancer accounts for less than 1% of cancers, it remains an extremely deadly disease due to non-specific symptoms and difficulties in early diagnosis. Managing gallstone disease through diet, lifestyle and timely treatment seems key to preventing cancer. Advances in diagnostic tools and targeted therapies hold promise for improved outcomes in future. Continued research is needed to better understand the causes and find more effective treatment approaches.
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