Definition

Gallbladder cancer is characterized by the abnormal and uncontrolled growth of cells in the gallbladder. Normally, body cells undergo a cycle of life and death, but mutations can disrupt this process, allowing the mutated cells to survive and proliferate, leading to the development of cancer.

The gallbladder, a small pear-shaped organ located beneath the liver in the upper right abdomen, plays a role in storing bile produced by the liver. Bile is essential for digesting fat in the food as it passes through the intestine.

Gallbladder carcinoma is considered a rare form of cancer, ranking 6th among digestive tract cancers. However, in the United States alone, approximately 12 thousand people were diagnosed with gallbladder carcinoma in 2019. 

The chances of recovery are higher when the cancer is detected in the early stages, but unfortunately, symptoms often do not manifest until the disease is in its advanced stages. The hidden location of the gallbladder under the liver adds to the challenge of early detection. Despite these difficulties, some individuals can survive without a gallbladder.

Causes

The exact cause of genetic mutations that lead to the development of malignant tumors in the gallbladder is not fully understood. DNA serves as the blueprint for normal cell function, and when a gene undergoes mutation, it disrupts these instructions. This can result in abnormal characteristics in the affected cell, such as:

• Resistance to cell death: Mutated cells do not undergo the normal process of programmed cell death.
• Uncontrolled growth: Mutated cells proliferate uncontrollably.
• Malignancy: Mutated cells can become malignant, invading and affecting healthy cells in the vicinity.

The accumulation of these rapidly growing and aberrant cells forms tumor tissue. As the tumor progresses, it can extend beyond the gallbladder, becoming malignant. Eventually, cancerous cells gain the ability to spread to other parts of the body.

Gallbladder carcinoma typically originates from changes in the cells of the supporting gland that covers the inner lining of the gallbladder. This type of cancer, known as adenocarcinoma gallbladder, constitutes nearly all cases of gallbladder cancer.

Risk factor

Several factors can contribute to an increased risk of gallbladder cancer:

• Gender: Gallbladder cancer is more commonly diagnosed in women.
• Age: The incidence of gallbladder cancer tends to rise with age.
• History of Gallbladder Stones: Individuals with a history of gallbladder stones, particularly larger ones, face an elevated risk.
• Gallbladder Disease or Disorders: Conditions such as gallbladder polyps, chronic inflammation over an extended period, and infections can heighten the risk.
• Inflammation in the Bile Duct: Inflammation in the bile duct is associated with an increased risk of gallbladder cancer.
• Family History: A family history of gallbladder cancer can contribute to an individual's susceptibility to the disease.

Symptoms

Gallbladder cancer in its early stages often presents with few symptoms, and signs typically become apparent after the cancer has spread to lymph nodes or other organs. Some of the symptoms that may manifest include:

• Abdominal Pain: Pain, typically felt in the upper right section of the abdomen.
• Bloating Stomach: A sensation of fullness or swelling in the abdominal area.
• Unexplained Weight Loss: Significant weight loss that cannot be attributed to changes in diet or lifestyle.
• Jaundice: Yellowing of the skin and eyes.
• Vomiting and Nausea
• Lump in the Abdomen: The presence of a palpable mass in the abdominal region.
• Unexplained Fever: Persistent fever without an apparent cause.
• Dark Urine: Urine that appears darker than usual.

Diagnosis

The diagnosis of gallbladder carcinoma involves a comprehensive evaluation of symptoms through interviews and physical examinations. In addition to these initial assessments, doctors may also conduct additional examinations, such as:

• Blood Test: This helps evaluate liver and kidney function, identify signs of infection, and assess blood components that may be indicative of underlying issues.
• Imaging or Radiology Examination: Various imaging techniques are used to visualize the gallbladder externally and determine whether cancer cells have spread to other organs. Common imaging methods include ultrasonography (USG), computed tomography (CT) scans, and magnetic resonance imaging (MRI).

Upon confirming the diagnosis of gallbladder carcinoma, further examinations are conducted to determine the cancer's stage and type. Staging is crucial for selecting appropriate treatment options, estimating prognosis, and predicting life expectancy. The stages range from 0 to 4, and various procedures and tests are employed, including:

• Exploratory Surgery: Laparoscopy, which involves using a small camera, is employed to explore the spread of cancer within the abdominal cavity.
• ERCP (Endoscopic Retrograde Cholangiopancreatography): This procedure examines the inner part of the gallbladder by injecting a contrasting substance and conducting imaging studies. It assesses fluid flow within the gallbladder and identifies any obstructions.
• Biopsy: Tissue samples from the tumor are collected for microscopic examination, helping determine whether the cells are cancerous.

Management

The management of gallbladder cancer is tailored based on several factors, including the cancer stage, overall health, and the chosen treatment plan. 

The primary goal of therapy is to eliminate cancerous cells from the body. If complete eradication is not feasible, the focus shifts to controlling disease progression and alleviating associated symptoms. Medical interventions such as analgesics, anti-nausea medications, and oxygen therapy may be prescribed to manage symptoms and improve the patient's quality of life.

Surgery

In the early stages of gallbladder cancer, surgery may be recommended. The extent of the surgery, whether it involves the removal of the gallbladder alone or along with some liver tissue, depends on the assessment by the doctor. The decision for additional procedures arises when cancerous cells have spread to parts of the liver and bile duct. Surgical intervention is more feasible when the cancer or gallbladder is small. Even after surgery, the doctor may suggest additional therapies to eliminate any remaining cancer cells.

Other treatment

• Radiotherapy:

This treatment employs X-rays and protons to eliminate cancerous cells. It is often administered in conjunction with chemotherapy to ensure the complete eradication of cancer cells after surgery.

• Targeted medication

Targeted therapy aims to exploit specific weaknesses in cancer cells, inducing their demise. This approach is typically considered in the advanced stages of cancer.

• Chemotherapy

Chemotherapy involves the use of specific drugs to rapidly kill cancer cells. These medications can be administered intravenously or orally. Post-surgery, chemotherapy may be chosen to alleviate symptoms and prolong life expectancy.

• Immunotherapy:

Immunotherapy utilizes drugs to enhance and fortify the immune system's ability to combat cancer cells. By assisting the immune system in recognizing and attacking dangerous cells, this therapy is often reserved for the late stages of gallbladder cancer.

Complications

There is a risk of gallbladder carcinoma recurrence, especially in early-stage patients. After initial treatment, doctors typically recommend regular follow-up examinations to monitor the patient's condition. If there are any signs of suspicious symptoms or an increased likelihood of recurrence, early intervention with appropriate therapies can be initiated to address the potential reappearance of cancerous cells. 

Prevention

While certain risk factors for gallbladder cancer, such as age and gender, are beyond one's control, adopting a healthy lifestyle can potentially contribute to reducing the risk. Key preventive strategies include:

• Maintain a Healthy Lifestyle:
• Consume a balanced and nutritious diet.
• Engage in regular exercise.
• Maintain an ideal body weight.
• Limit Alcohol Consumption: Avoid excessive alcohol intake.
• Quit Smoking: Stop or avoid smoking.

When to see a doctor?

If you experience any of the symptoms mentioned earlier, seek prompt medical attention. Additionally, if you have identified risk factors related to gallbladder cancer, it is advisable to undergo regular health check-ups. Early diagnosis and timely medical intervention can significantly improve treatment outcomes and overall health.

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