Gallbladder cancer is an uncommon cancer. In Malaysia, it accounts for approximately 0.8% of new cancer cases reported between the years 2007-2011 (Malaysian Cancer Registry).
Over 85% of gallbladder cancers are adenocarcinoma that begins in the gland cells lining the gallbladder (National Health Service, UK). There are 3 subtypes of adenocarcinoma,
- Non-papillary adenocarcinoma
- Papillary adenocarcinoma
- Mucinous adenocarcinoma
Non-papillary adenocarcinoma accounts for more than 75% of adenocarcinoma cases (Cancer Research, UK). Papillary adenocarcinoma has a better prognosis compared with other types of gallbladder cancers as it is very less likely to spread to nearby organs like liver and lymph nodes. Cancer cells in mucinous adenocarcinoma are often in pools of mucus and is a rare gallbladder cancer.
In the early stages, gallbladder cancer does not cause symptoms until later in the course of the disease. Common symptoms of gallbladder cancer include,
- Abdominal pain
- Nausea and vomiting
- Jaundice (yellowing of the skin and whites of eyes)
- Lumps on the side of the belly or the abdomen
- Unexplained weight loss
Other less common symptoms include, itchy skin, dark urine and light coloured or greasy stools.
Typically, lower grade cancer has a better prognosis and is less likely to spread quickly compared to higher grade cancer. If there is a recurrence after a completed treatment, the cancer will be re-staged and treated once more.
Diagnosis & Treatment
In some cases, gallbladder cancers are found after the gallbladder has been removed to treat gallstones or chronic inflammation. When presented with symptoms, a physical examination will be done and mainly focused on checking for any lumps on the abdomen, tenderness or build-up of fluid. Ultrasound is often used to help find the tumour and to check if the tumour has spread to nearby areas.
The primary goal of treatment is to completely remove the cancerous tumour by resecting it. There are a few types of surgery that is used for gallbladder cancer. Cholecystectomy is a procedure to remove the entire gallbladder, all the lymph nodes in the area as well as a bit of the liver tissue. Radical gallbladder resection is a surgery to remove the gallbladder, a section of the liver, the common bile duct and parts of ligaments between liver and intestines and the lymph nodes around the pancreas and blood vessels.
Radiation therapy is another treatment option. The most common type of radiation therapy to treat gallbladder cancer is external-beam radiation therapy regime. Radiation therapy may be used to reduce the size of the tumour before a surgery or to destroy remaining cancer cells after the surgery.
Depending on the course of treatment determined by the oncologist, chemotherapy may be used as a treatment regime for gallbladder cancer. Chemotherapy uses drugs to destroy cancer cells by disabling it from growing and spreading. Common methods for receiving chemotherapy includes intravenous tube (IV) placed into a vein using a needle, by injection, or by taking a pill orally.
There are several risk factors that make a person more prone to developing gallbladder cancer and most of which are related to chronic inflammation in the gallbladder. Knowing the risk factor that causes cancer can help one be more informed about lifestyle choices that affect their health.
The most common risk factor is gallstones. These are pebble-like formations of cholesterol and bile salts that can cause chronic inflammation. However, only 1% of people with gallstones develop gallbladder cancer.
Conditions like porcelain gallbladder, where the wall of the gallbladder becomes covered with calcium deposits, is also a risk factor for developing this disease. People with this condition have a higher risk of developing gallbladder cancer.
According to the Ministry of Health Malaysia, women are at higher risk and are twice as likely to develop gallbladder cancer as compared to men due to the estrogen hormone found in women. Age is a risk factor as well as most gallbladder cases are found in people older than 70 years old. Family history and genetics can slightly increase a person’s risk of getting gallbladder cancer.
Dr. Mani, Beacon Hospital Malaysia