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List of All Topics
Gallbladder Cancer
Introduction
Gallbladder cancer and bile duct cancer are rare cancers of the biliary tract. Your gallbladder stores and your bile duct transports bile, a fluid produced by your liver that's essential to the digestive process.
Gallbladder cancer seldom produces symptoms in the early stages. In fact, early gallbladder cancer is often only discovered when the gallbladder is removed as a treatment for gallstones. Otherwise, gallbladder cancer is often quite advanced by the time it's diagnosed.
When gallbladder cancer is caught early, removing your gallbladder or part of the bile duct may eliminate all the cancerous cells. In advanced cases, treatment won't cure gallbladder cancer but can help relieve symptoms and improve your quality of life.
Signs and symptoms
Gallbladder cancer rarely produces early signs and symptoms. When symptoms do appear, they often resemble those of other, more common, gallbladder problems such as gallstones or infection. Gallbladder cancer symptoms include:
- Abdominal pain. Many people with gallbladder cancer have some abdominal pain — usually in the upper right part of the abdomen.
- Nausea and vomiting. These symptoms can occur when a tumor blocks the common bile duct.
- Yellowing of your skin and the whites of your eyes (jaundice). Jaundice results from high blood levels of bilirubin — the residue from the breakdown of red blood cells. Normally, bilirubin is metabolized in your liver and eliminated through the bile ducts. But a blocked bile duct can cause bilirubin to accumulate in your blood. The built-up pigments may turn your skin and the whites of your eyes yellow and your urine dark brown. Because bilirubin isn't being eliminated through your bile, your stools also may turn pale yellow or white.
- Unintended weight loss or loss of appetite. Tumors can prevent the normal passage of food or interfere with its absorption by blocking the flow of pancreatic enzymes.
- Jaundice. A yellowing of your skin and the whites of your eyes, along with tea- or coffee-colored urine and light-colored stools, are common initial signs of bile duct cancer.
- Enlarged gallbladder. A blocked bile duct can cause bile to accumulate in your gallbladder, making it larger than normal. Although your gallbladder is hidden behind other organs in your abdomen, your doctor can sometimes feel this enlargement during a physical exam or it may be detected on an ultrasound.
- Intense itching (pruritis). When the flow of bile is obstructed by a tumor, bile salts may be deposited in your skin, leading to intense itching.
Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. Its main function is to store bile, a bitter, yellow-green fluid that's produced in the liver cells. Bile is essential for the proper digestion of fats and is one of the main ways your body eliminates drugs, cholesterol and waste products of metabolism. It flows from your liver through a thin tube called the common hepatic duct and enters your gallbladder through another small tube (cystic duct).
When you eat, your gallbladder releases a highly concentrated form of bile into the common bile duct, a continuation of the hepatic and cystic ducts. The bile flows through this duct to the upper part of your small intestine (duodenum), where it begins to break down the fat in your food.
How gallbladder cancer begins
Healthy cells grow and divide in an orderly way — a process that's controlled by DNA, the genetic material that contains the instructions for every chemical process in your body. When DNA is damaged, changes occur in these instructions. One result is that cells may begin to grow out of control and eventually form a malignant tumor — a mass of cancerous cells.
Although the exact cause of gallbladder and bile duct cancers isn't clear, researchers believe that DNA in the cells of your biliary tract may be damaged by toxins that are routinely metabolized by your liver. These toxins are released into bile so that they can be eliminated from your body. But if bile empties more slowly than normal, it increases the amount of time your cells are exposed to cancer-causing substances (carcinogens).
Most gallbladder tumors develop in the cells that line the inner surface of the gallbladder. These tumors are most commonly adenocarcinomas — a term that describes the way the cancer cells look when viewed under a microscope.
Gallbladder adenocarcinoma is highly invasive and can quickly penetrate deep into the gallbladder wall, moving through layers of tissue from the inner surface to the outside of the gallbladder. Eventually the cancer may spread to nearby lymph nodes, obstruct the bile duct or invade other organs such as the liver. Cancer cells may also travel through the bloodstream to more remote parts of the body.
Bile duct cancer (cholangiocarcinoma)
Cancer can develop in any part of the bile duct that stretches from your liver to your small intestine. Many tumors occur in the hepatic duct just as it leaves the liver (perihilar tumors). Other tumors may develop in the bile duct near your small intestine (distal tumors) or inside the liver itself (intrahepatic tumors).
The majority of bile duct cancers are adenocarcinomas that originate in the mucous glands lining the inside of the ducts. By the time these cancers are diagnosed, they often have spread to other tissues and organs.
Treatment
Gallbladder cancer treatment depends on the type and stage of cancer, as well as on your age, overall health, feelings and personal preferences. Especially when cancer is advanced, choosing a treatment plan is a major decision, and it's important to take enough time to consider your choices.
You may also want to consider seeking a second opinion. This can provide additional information to help you feel more certain about the option you're considering.
The goal of any treatment is to eliminate the cancer completely. When that isn't possible, the focus may be on preventing the tumor from growing or causing more harm. In some cases, an approach called palliative care may be best. Palliative care refers to treatment aimed not at removing or slowing the disease, but at helping relieve symptoms and making you as comfortable as possible.
Gallbladder cancer
Surgical removal (resection) of the gallbladder usually offers the best hope for people with gallbladder cancer. If the tumor is very small and hasn't spread to the deeper layers of gallbladder tissue, your surgeon may perform a simple cholecystectomy, which removes only the gallbladder. Sometimes this may be done laparoscopically, using a camera and miniature instruments inserted through small incisions in your abdomen.
If the cancer is more advanced, your surgeon will likely perform what's known as an extended cholecystectomy — an operation in which some liver tissue and nearby lymph nodes are removed along with your gallbladder.
Once the cancer has spread beyond the walls of your gallbladder, it can no longer be completely removed with an operation. In that case, your treatment team will discuss other options with you. These may include radiation — either external beam radiation (high-energy X-rays) or implanted radiation "seeds" — or chemotherapy, which is anti-cancer medication.
These additional treatments may be used alone or in combination. Some doctors believe that radiation together with chemotherapy after surgery is more effective than either alone.
Radiation and chemotherapy may also be used for palliative care to help make you more comfortable if your cancer is so advanced that treating the cancer is no longer an option. For example, either treatment may be used to help shrink a tumor that's blocking a bile duct.
Bile duct cancer
Surgery usually offers the best chance for people with bile duct cancer. But the type of operation you may have will vary, depending on the location of the cancer and how extensive it is:
- Perihilar tumors. Tumors that develop where the hepatic duct leaves your liver (perihilar tumors) are usually treated by surgically removing a portion of the bile duct, the gallbladder and surrounding lymph nodes.
- Distal tumors. Treatment for these tumors, located in the bile duct near your small intestine, is often by what's known as a Whipple resection. In this operation, your surgeon removes part of your pancreas, the common bile duct and your gallbladder, as well as a small portion of your intestine where the common bile duct and pancreatic duct enter the intestine together.
- Tumors that can't be removed. When a tumor is too close to major blood vessels, your surgeon may suggest an operation to bypass some of your small intestine. This may help prevent further blockage of your bile duct and digestive tract and may also help relieve symptoms, but won't cure the cancer. If a bypass isn't an option, your surgeon may place metal or plastic tubes known as stents into the bile duct to keep it open. After surgery, your doctor may also recommend radiation or chemotherapy.
Although it's usually not possible to prevent gallbladder and bile duct cancers, you can take steps to reduce your risk. In general, eating a healthy diet and exercising regularly can lower your risk of many types of cancer.
Aim for at least five servings of fruits and vegetables every day, along with foods from other plant sources such as whole-grain breads, cereals, rice and beans. In addition, try to limit your intake of high-fat foods.
Other steps you can take to reduce your risk of many types of cancer include the following:
- Maintain a healthy weight. This is one of the best ways to reduce your chance of developing gallbladder cancer. If you need to lose weight, remember that a slow, steady loss is the healthiest way to reach your goals. Regular exercise can help you maintain a healthy weight.
- Stop smoking. You can also greatly reduce your risk of many types of cancer by stopping smoking. Cigarette smoke contains carcinogens that can damage the DNA that regulates cell growth. Tobacco use is associated with 180,000 cancer deaths annually. Talk to your doctor about the best ways to quit, or contact the American Cancer Society at 800-ACS-2345, or 800-227-2345, or the National Cancer Institute's quit line at 877-44U-QUIT, or 877-448-7848, for more information.
Avoid toxic chemicals. Among these are highly hazardous substances such as dioxin — a byproduct of plastics and chlorinated pesticide manufacturing — and PCBs, which were used in a number of industrial materials in the past. Because PCBs don't break down easily, they're still found worldwide in the air, water, soil and especially in fish. Also implicated in bile duct cancers are nitrosamines, a group of carcinogenic chemicals found in products ranging from tobacco leaves to cured meats.
Information obtained from National Institute of Health