Gallbladder Cancer

Gallbladder cancer, a relatively uncommon type, occurs when malignant (cancer) cells form in the tissues of the gallbladder. The gallbladder is a pear-shaped organ that lies just under the liver in the upper abdomen. It stores bile, a fluid made by the liver to digest fat. When food is being broken down in the stomach and intestines, bile is released from the gallbladder through a tube called the common bile duct, which connects the gallbladder and liver to the first part of the small intestine.


If diagnosed early enough, it can be cured by removing the gallbladder, part of the liver and associated lymph nodes. Most often it is diagnosed after symptoms like abdominal pain, jaundice and vomiting occur, and it has spread to other organs like the liver.

Symptoms

Some of the symptoms that manifest in a patient suffering from gallbladder cancer are:

  • Steady pain in the upper right abdomen

  • Weakness

  • Loss of appetite

  • Weight loss

  • Jaundice and vomiting due to obstruction

  • A swollen abdomen (tummy)

  • Gallbladder enlargement


Early symptoms mimic gallbladder inflammation due to gallstones. Later, the symptoms may be that of biliary and stomach obstruction.

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Causes

The exact causes of gallbladder cancer are as yet unclear. What we do know is that most gallbladder cancer begins in the glandular cells that line the inner surface of the gallbladder. Gallbladder cancer that begins in this type of cell is called adenocarcinoma. Some of the risk factors that increase the probability of getting gallbladder cancer are:

  • Gender of the patient: Gallbladder disease as such is more common in women. Similarly, gallbladder cancer affects women more commonly than men.

  • Cholecystitis: Gallstones and inflammation of the gallbladder is also known as cholecystitis. This is by far the most common risk factor that predisposes one to gallbladder cancer. Gallstones are hard stones that are formed within the gallbladder due to deposition of cholesterol and minerals from bile. About eight out of ten people with gallbladder cancer (80%) have gallstones or an inflamed gallbladder at diagnosis. However, most people with an inflamed gallbladder or gallstones do not get gallbladder cancer.

  • Family history of gallstones and gallbladder cancer: Those with a family history of gallstones have double the chance of gallbladder cancer. In addition, those with a family history of gallstones who also have gallstones themselves have almost 60 times the normal risk of gallbladder cancer. Those with a first degree relative with gallbladder cancer are five times more likely to develop gallbladder cancer than people who do not have a relative with it. The risk, however, still remains very small as the cancer is rare.

  • Genetics: Some races and ethnicities are more at risk of gall bladder cancer than others. The basis could be a family history of gallstones and gallbladder cancer: genetics. For example, north India has the highest rate of gallbladder cancer in the world.

  • Smoking and exposure to chemicals: Cigarettes and some industrial chemicals containing nitrosamines can damage the DNA and lead to genetic mutations and raise the risk of gallbladder and other cancers. Workers in the metal or rubber industry are more likely to develop gallbladder cancer

  • Porcelain gallbladder: This is a condition where calcium deposits build up on the inside wall of the gallbladder hardening the walls. This is usually seen in individuals who have repeated cholecystitis or inflammation of the gallbladder.

  • Defects of the pancreas and bile ducts: Defects of the pancreas and bile ducts raise gallbladder cancer risk. Abnormalities in the connection between the bile duct and the pancreas and outgrowths in the bile duct (choledochal cysts) may also be risk factors for gall bladder cancer. These conditions may affect a baby since birth but symptoms may appear much later.

  • Obesity: Being obese or overweight raises the risk of gallstones and cholecystitis. This is mainly because they change the hormonal balances of the body, particularly in women. Studies show that more than one in ten cases of gallbladder cancer in men and almost a third of cases in women are due to being overweight.

  • Diet: Diet high in carbohydrates and low in fibre may increase the risk of gallbladder cancer. A diet rich in fresh fruit and vegetables seems to reduce the risk of many cancers, including gallbladder cancer. Inclusion of vitamins A, C, E and antioxidant chemicals in diet is also important for cancer prevention.

  • Diabetes: Diabetes may also raise the risk of gallbladder cancer

  • Exposure to female hormones in hormone replacement therapy: Women who have increased exposure to the hormone oestrogen may have an increased risk of gallbladder cancer. With longer use of hormone replacement therapy, the risk of gallbladder cancer seems to rise

Treatment

There are different types of treatment for patients with gallbladder cancer. 

Three types of standard treatment that are used are:

  • Surgery

  • Radiation therapy 

  • Chemotherapy

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