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Cancer of the gallbladder is a very dangerous form of malignant disease arising from cells of the gallbladder wall. Gallbladder cancer is slightly are than other gastrointestinal tumors, but it is necessary to know some information about it.
The gallbladder is a hollow organ closely related to liver, both anatomically and functionally. The gallbladder is basically a sac, which stores the bile produced by liver cells. When food enters the gastrointestinal tract, the gallbladder gets contracted in order to expel the bile into the bile duct and further into the intestine. The bile contains bile salts, cholesterol and certain waste products of the liver and it is especially important for proper digestion of nutrients. Bile in the intestine activates digestive enzymes of the pancreas and in addition, bile helps to disperse fat molecules to make them better digestible.
The causes of gallbladder cancer are in many cases unclear. It is probable that the cancers occur more frequently in long-term untreated gallstones with chronic inflammation of the gallbladder (chronic cholecystitis) and the so-called porcelain gallbladder. Unhealthy diet and the lack of physical exercise resulting in obesity are also possible risk factors.
The cancer arises from the gallbladder wall and initially, it has no symptoms or it has only uncertain symptoms such as nausea, loss of appetite and vomiting. When the local growth of tumor compresses the bile ducts, it may manifest with a painless jaundice, dark urine and pale stool, which is oily and foul-smelling (due to malabsorption of fats). Bile acids can not be excreted and accumulate within body tissues causing an unpleasant itching.
The jaundice is caused by disrupted excretion of a waste product known as bilirubin. This pigment is formed from hemoglobin and causes the skin and mucous membranes to turn yellow. Sudden painless jaundice in an older person must be regarded as an extremely serious symptom.
The overall prognosis is poor and survival rate in advanced gallbladder is quite similar to the situation in pancreatic cancer.
The diagnosis is suspicious in patient with the above-mentioned symptoms. The physical examination should be focused on the abdomen where the enlarged gallbladder or even the tumor tissue may be palpated. The diagnosis may be confirmed by ultrasound or computed tomography. The imaging methods can not only evaluate the size of the tumor, but also presence of local and distant metastases.
ERCP may also help with the diagnosis. It is an endoscopic examination where a flexible hose (equipped with a light source and a video-camera) is inserted through the mouth, esophagus and stomach into the duodenum. In the duodenum, the device uses a special wire to enter the bile duct and pancreatic duct. The biliary system is filled with a contrast agent and it becomes visible on an X-ray including its narrowing and irregularities caused by a local tumor growth. The ERCP may even help us to obtain cells for cytological examination (brush cytology) that may confirm the presence of tumor cells.
The only prevention is a healthy lifestyle and prevention of obesity. Of course, these measures only lower the risk of gallbladder cancer. In addition, chronic gallstones with cholecystitis and porcelain gallbladder should be solved by surgical removal of the gallbladder.
The best therapeutic effect has the surgery, which can be lifesaving in early stages of the tumor. It is necessary to remove the whole gallbladder and sometimes even the surrounding anatomical structures, including parts of the bile duct. The bile drainage may be assured by a connection between the retained remnants of the biliary tract and the intestine.
Chemotherapy may be used after the surgery. However, the chemotherapy alone can not cure the patient and it is only a palliative form of treatment.
When the tumor is surgically inoperable and when it compresses the bile duct, it is possible to perform therapeutic ERCP with insertion of a special tube-like stent into the narrowed bile duct. This procedure ensures the bile outflow and significantly improves the life quality.