Create awareness for Gallbladder and Bile Duct Cancer
Surgery is a common treatment for gallbladder cancer. However, it may not always be possible.
February is Gallbladder and Bile Duct Cancer Awareness Month.
Part of the biliary system, the gallbladder is located in the right upper portion of the abdomen, attached to the underside of the liver.
About the size of a small pear, its primary function is to concentrate and store bile produced by the liver.
The stored bile is released via the common bile duct and joins the pancreatic duct where it forms the Ampulla of Vater.
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The presence of food in the stomach and duodenum stimulates the release of bile from the gallbladder.
According to the Cancer Association of South Africa (Cansa), gallbladder cancer is rare, with near nearly all of them being adenocarcinomas.
The association explained that adenocarcinoma is a cancer that starts in gland-like cells that line many of the body’s surfaces, including the interior of the digestive system.
Although a rare cancer, gallbladder cancer represents almost 50% of all biliary tract cancer.
Biliary cancers are highly fatal malignancies with a five-year survival rate of 17.6%.
The prognosis of gallbladder cancer is poor due to the aggressive tumour biology, its late presentation, the complicated anatomic position, and the advanced stage at diagnosis.
It is described as an aggressive cancer that continues to be a vital healthcare issue in some regions of the world.
Cansa said although gallbladder cancer is hard to detect and diagnose, the early signs and symptoms include jaundice, pain above the stomach, loss of appetite, fever, nausea, vomiting, abdominal bloating, passing dark-yellow urine or pale-coloured faeces, a lump or lumps in the abdomen and itchy skin.
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Although doctors do not know the risk factors and causes of gallbladder cancer, it is known that, like all cancers, an error, known as a mutation, in a person’s DNA causes the uncontrolled rapid growth of cells.
Some risk factors shared by Cansa include:
• Chronic inflammation of the gallbladder is the primary risk factor for gallbladder cancer.
• Some studies have shown that if one has a first-degree relative with gallbladder cancer, one is five times more likely to develop gallbladder cancer.
• Women have an increased risk of being diagnosed with cancer.
• Smoking.
• Employees in the metal and rubber industries are more likely to develop gallbladder cancer.
Cansa said there are three general locations where this type of cancer may arise within the bile drainage system:
• In the liver (intrahepatic), affecting the bile ducts in the liver.
• Just outside of the liver (extrahepatic or perihilar) located at the notch of the liver where the bile ducts exit.
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•Far outside the liver (distal extrahepatic), near where the bile ducts enter the intestine (called the Ampulla of Vater).
Several other risk factors for gallbladder cancer are being researched, for example, diet, being overweight and taking hormone replacement therapy (HRT).
Although gallbladder cancer is uncommon and can be hard to diagnose, Cansa said if the cancer is discovered at its earliest stages, the chance for recovery is good.
Besides a physical examination, several tests can diagnose gallbladder cancer. These include a biopsy, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous cholangiography, laparoscopy, computed tomography (CT or CAT) scan, magnetic resonance imaging (MRI), ultrasound, endoscopic ultrasonography, positron emission tomography (PET) or PET-CT scan or blood tests.
The staging of bile duct cancer is the process of finding out how far a cancer has spread.
The stage (extent) of bile duct cancer is one of the most crucial factors in selecting treatment options and estimating a patient’s outlook for recovery.
Intrahepatic bile duct cancers (those starting in the liver) are staged separately from extrahepatic bile duct cancers.
The TNM system, used in staging for all bile duct cancers, contains three key pieces of information:
• T describes whether the main tumour is still within the organ or has invaded nearby organs or tissues.
• N describes whether the cancer spread to nearby (regional) lymph nodes.
• M indicates whether the cancer has metastasised (spread) to other organs.
Numbers or letters that appear after T, N, and M provide more details about each of these factors.
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The numbers 0 to 4 indicate increasing severity, while the letter X means the cancer cannot be assessed.
According to Cansa, surgery is a common treatment for gallbladder cancer. However, it may not always be possible.
The type of surgery depends on where the cancer is and whether or not it has spread to other organs.
Surgery may be performed to remove the tumour completely if the cancer is still localised or to relieve symptoms or pain if the cancer is more widespread.
It can also involve the removal of the gallbladder and a portion of the liver, if necessary.
The procedure to remove the gallbladder is called a cholecystectomy
In cases when the cancer cannot be surgically treated, chemotherapy and radiation therapy may be used first to try to shrink the cancer to allow surgery.
If surgery is completed, chemotherapy is often prescribed afterwards to help prevent the recurrence of gallbladder cancer or to reduce the size and kill any remaining cancer cells.
