Cancer of Gallbladder

Apr 14, 2012 , Eva Papežová

rakovina-zlucniku.jpg - kopie
rakovina-zlucniku.jpg - kopie
Gallbladder cancer is a malignant tumour of the gallbladder. Cancer of the gallbladder in the early stages mimics biliary troubles or inflammation of the gallbladder and the treatment, therefore, often starts late. Treatment for cancer of the gallbladder is based on surgical removal of the gallbladder, chemotherapy and radiotherapy. Gallbladder cancer is a disease with one of the worst prognoses among malignant tumours.

Cancer of Gallbladder

Generally, cancer develops when cells in our body get out of control, begin to multiply and grow uncontrollably. Cancer of the gallbladder is the fifth most common cancer within the digestive system, yet forming no more than 6% of the tumours of the digestive system. Same as for the rest of the body, tumours of the gallbladder can be divided into malignant and benign. Unfortunately, the malignant variant is prevailing.

Tumour of Gallbladder

Tumour is generally composed of tumour cells that have undergone changes in the genetic information. As a result, behaviour of these cells changes. Tumours can be divided into benign and malignant. Benign tumours grow slowly, do not penetrate into surrounding structures and do not metastasize (establish secondary tumours). However, in time benign tumours can oppress surrounding organs and interfere with their function. The prognosis of benign tumours is usually good. Malignant tumours, on the contrary, grow quickly, soon penetrate and destroy the surrounding tissue. Most of the malignant tumours metastasize early.

Cancer of Gallbladder

Cancer of the gallbladder is a synonym for malignant tumour of the gallbladder. Histological classification of the malignant tumour of the gallbladder is mostly adenocarcinoma. Adenocarcinomas are based on the epithelial cells, which form the inner surface of the gallbladder and are therefore part of the mucosa. Malignant tumours tend to spread to the surrounding tissues and destroy them. Due to the close relationship between the gallbladder and the liver, in the later stages of the disease the gallbladder cancer affects also liver tissue. In addition, it can penetrate into the intestine, pancreas, or spread among peritoneum. Cancer of the gallbladder often metastasizes into the liver, where the metastases can be multifocal, and to the nearest lymph nodes.

Incidence of Gallbladder Cancer

Gallbladder cancer is relatively rare disease; most often it occurs in women aged 70 years and above. The incidence in women in general is up to five times higher than in men, probably due to more frequent presence of gallstones in women. Close connection between occurrence of gallbladder cancer and ulcerative colitis was also described.

Symptoms of Gallbladder Cancer

Symptoms of gallbladder cancer in the early stages mimic prolonged bile problems, especially uncharacteristic problems with digestion. The cancer may first manifest as a sudden inflammation of the gallbladder. In later stages, the cancer of the gallbladder is characterized by chronic pain in the right upper quadrant of the abdomen, soon accompanied by jaundice, loss of appetite, weight loss and vomiting.

Diagnosis of Gallbladder Cancer

Diagnosis of gallbladder cancer is very arduous, since in the early stages there are practically no symptoms and therefore the cancer is mostly revealed first in the advanced stages. Diagnosis of gallbladder cancer should consist of a careful patient's history, physical examination and imaging techniques. Hepatomegaly and solid formation in the right hypochondrium might be revealed during physical examination by the doctor. Blood test show only changes characteristic for bile stasis (elevated liver enzymes and bilirubin), representing narrowing of the bile ducts. Among imagining methods, ultrasound is used in the first place. Unfortunately, at the beginning most tumours of the gallbladder resemble inflammatory process of the gallbladder due to uniform thickening of the wall of the gallbladder. In case a suspicion of gallbladder cancer is raised, ultrasound should be followed by a CT scan. Sometimes even endoscopic retrograde cholangiopancreatography, shortened to ERCP, can be used. It is an examination performed using flexible tubular instrument. It is introduced through the mouth into the biliary tract; the bile tract is than filled with contrast material and displayed using X-rays. If necessary, samples of tissue for histological examination can be collected.

Treatment of Gallbladder Cancer

The most efficient treatment for gallbladder cancer is surgery, when the entire gallbladder with impaired hepatic tissue and lymph nodes are removed. However, this operation is only suitable for patients in early stages of the disease. As mentioned above, due to lack of early symptoms, the diagnosis of gallbladder cancer is usually made late. Jaundice developed due to narrowing of the biliary tract is already present in most patients. In these later stages of gallbladder cancer mainly chemotherapy and radiotherapy are used. Gallbladder cancer is a serious disease; its symptoms should not be underestimated. As with other types of cancer, early detection of the disease is key to successful treatment.

Prevention and Prognosis of Gallbladder Cancer

In the prevention of gallbladder cancer, it is essential to treat any condition that might lead to long lasting inflammation – gallstones and acute inflammation above all. If necessary, surgical removal of the gallbladder should be performed in order to get rid of gallstones.

Once the gallbladder cancer appears, the five-year survival rate for patients diagnosed in early stage of the disease and treated surgically is up to 80%. Unfortunately, patients diagnosed in an advanced stage of the disease have much worse prognosis. The five-year survival rate in this group after surgical treatment is around 30%. Patients in advanced stage of the disease who cannot be treated surgically survive only about 6 months.

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