Gallbladder cancer (patient information)

For the WikiDoc page for this topic, click here

Editor-in-Chief: C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor-In-Chief: Jinhui Wu, M.D.

Overview
Gallbladder cancer is rare. It is more common in women and Native Americans. The gallbladder is a pear-shaped organ that stores bile, which is a fluid made by the liver to digest fat. When your stomach and intestines digest food, your gallbladder releases bile through a tube called the common bile duct. Symptoms of gallbladder cancer include jaundice, abdominal pain and lump, nausea, vomiting, etc. It is hard to detect gallbladder cancer early on. Possible treatments include surgery, radiation and chemotherapy.

What are the symptoms of gallbladder cancer?
Because the gallbladder is located deep inside the body, your doctor cannot see or feel tumors during a routine physical exam. Therefore, it is hard to diagnose gallbladder cancer early. Sometimes, gallbladder cancers are found unexpectedly after removal of the gallbladder for other reasons, such as gallstones. As the cancer progresses, people may notice one or more symptoms as the following:


 * Jaundice: Is a yellowing of the sclera and skin. Normally, bilirubin is made in the liver and the liver excretes it into bile. Then bile goes into the intestines eventually leaving the body in the stool. Once the common bile duct becomes blocked, bile can't reach the intestines, and the level of bilirubin builds up. If the bile duct is blocked, bilirubin cannot get through to the intestines then stools may become lighter in color.
 * Abdominal pain: Experiencing abdominal pain due to gallbladder cancer is because advanced gallbladder cancer start to compress other nearby organs. The pain may be constant or it may come and go.
 * Gallbladder enlargement or lump in abdomen: Is because the cancer blocks the bile duct and bile builds up in the gallbladder to enlarge. Sometimes a doctor can feel this enlargement during the physical exam
 * Digestive problems: Patients with gallbladder cancer are unable to digest fatty foods when cancer blocks the release of the bile into the intestine. This can cause nausea and vomiting that tend to be worse after eating. Undigested fat may cause stools to be pale, bulky, and greasy.
 * Weight loss and marasmus, poor appetite: Unintended or unexpected weight loss is very common in patients with gallbladder cancer. These people also complain of being very tired and having little or no appetite.

Other health problems such as gallstones, hepatitis, and other pancreatic diseases may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell his/her doctor so that problems can be diagnosed and treated as early as possible.

Who is at highest risk?
There are some factors that may increase the chance of acquiring gallbladder cancer. These risk factors include:


 * Gallstones: This is the most common risk factor for gallbladder cancer. It is estimated that about 75% and 90% of people with gallbladder cancer have a history of gallstones. Gallstones are the most common digestive disease in the United States, but only a small proportion of people develop gallbladder cancer.


 * Gallbladder polyps: Gallbladder polyp is caused by small gallstones or cholecystitis. Because gallbladder polyps larger than 10 millimeters are likely to develop into cancer, surgeons often recommend removing the gallbladder.


 * Family history. People with family history of gallbladder cancer have a higher probability of developing gallbladder cancer.


 * Ethnicity: Epidemiology data demonstrates that Mexican Americans and Native Americans, particularly in the southwestern United States, are more likely to develop gallbladder cancer than the general population.


 * Age: Clinical data shows most people with gallbladder cancer are older than 70.


 * Gender: Epidemiology data shows women are about twice as likely to develop gallbladder cancer as men.


 * Smoking: Smoking may increase the risk of gallbladder cancer.

When to seek urgent medical care?
Gallbladder cancer forms tumors which are very difficult to detect in the early stages. If symptoms of gallbladder cancer develop, go to see your doctor as soon as possible:


 * Severe abdominal pain, especially when accompanied with jaundice and fever

Diagnosis
It is hard to detect early forms of gallbladder cancer. Like other cancer diseases, doctors need to administer many tests to diagnose cancer and determine whether it has metastasized. For most types of cancer, a biopsy is the best way to make a definitive diagnosis of cancer. If a biopsy is not possible, other image tests are recommended such as computed tomography (CT) scan, Magnetic resonance imaging (MRI) or Positron emission tomography (PET) scan.


 * Endoscopic retrograde cholangiopancreatography (ERCP) and biopsy: During this procedure, a thin, lighted and flexible tube is passed down your throat, through the esophagus and stomach, then into the first part of the small intestine. A small amount of contrast material is then injected through the tube into the common bile duct and x-rays are taken. The x-ray images can show narrowing or blockage of these ducts that might be due to gallbladder cancer. At the same time the doctor doing this test can also put a small brush through the tube to remove cells for a biopsy.


 * Computed tomography (CT) scan and biopsy: CT scans are often used to diagnose gallbladder cancer. It can confirm the location of the cancer and show the organs near the gallbladder, as well as lymph nodes and distant organs where the cancer might have spread. These are helpful in staging the cancer and in determining whether surgery is a good treatment option. CT scans can also be used to guide a biopsy procedure and a biopsy sample is then removed and looked at under a microscope.


 * Magnetic resonance imaging (MRI): An MRI uses magnetic fields, which is a different imaging technique then the computed tomography (CT) scan and is used to produce detailed images of the body. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture. An MRI scan takes longer to perform than a CT scan.


 * Positron emission tomography (PET) scan: When doing this test, a small amount of a radioactive medium is injected into your body and absorbed by the organs or tissues. This radioactive substance gives off energy to produce the images. PET scans can provide more helpful information than CT and MRI scans. It is useful to see if the cancer has spread to lymph nodes and also useful for your doctor to locate where the cancer has spread.


 * Ultrasound: This is an atraumatic test which uses sound waves to create a picture of the internal organs. Because tumors generate different echoes of the sound waves than normal tissue, the doctor can locate a mass inside the body.


 * Blood tests: Blood tests that look at levels of different kinds of bilirubin are also useful to decide whether a patient's jaundice is due to a disease of the liver or to blockage of bile flow.

Treatment options
Patients with gallbladder cancer have many treatment options. The type of treatment depends on the stage of the tumor. The options include: surgery, radiation therapy, chemotherapy, or a combination of methods and palliative treatment.

Surgery: The surgeon will select a kind of surgery for you depending on your cancer stage and overall health. Surgical procedures include the following:


 * Cholecystectomy
 * Radical gallbladder resection
 * Palliative surgery

Radiation therapy: This is a cancer treatment that kills cancer cells or keeps them from growing by using high-energy x-rays or other types of radiation.

Chemotherapy: This treatment uses drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing.

Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.

Diseases with similar symptoms

 * Hepatitis and liver diseases


 * Gallstones, cholecystitis


 * Peptic ulcer


 * Pancreatic cancer, pancreatitis

Where to find medical care for gallbladder cancer?
Directions to Hospitals Treating Gallbladder cancer

Prevention of Gallbladder cancer
Epidemiology data shows the following intervention may help to reduce your risk of gallbladder cancer:


 * Keeping a healthy diet and maintaining a healthy weight: It is recommended by health care professionals to consume 5 or more servings of a variety of vegetables and fruits each day and limit your intake of red meats.


 * Physical activity: The American Cancer Society recommends at least 30 minutes, preferably 45 to 60 minutes, of physical activity on 5 or more days of the week.

What to expect (Outook/Prognosis)?
The prognosis is not good for most gallbladder cancer patients if the cancer is detected in its late stages. The prognosis of gallbladder cancer also depends on the following factors:


 * Whether or not the tumor can be removed by surgery
 * The stage of the cancer: the size of the tumor, whether the cancer has spread outside the gallbladder
 * The patient’s general health
 * Whether the cancer has just been diagnosed or has recurred

Source
Medlineplus