Gallbladder
cancer
Overview
Gallbladder cancer is an abnormal growth of
cells that begins in the gallbladder.
Your gallbladder is a small, pear-shaped organ
on the right side of your abdomen, just beneath your liver. The gallbladder
stores bile, a digestive fluid produced by your liver.
Gallbladder cancer is uncommon. When
gallbladder cancer is discovered at its earliest stages, the chance for a cure
is very good. But most gallbladder cancers are discovered at a late stage, when
the prognosis is often very poor.
Gallbladder cancer may not be discovered until
it's advanced because it often causes no specific signs or symptoms. Also, the
relatively hidden nature of the gallbladder makes it easier for gallbladder
cancer to grow without being detected.
Symptoms
Gallbladder cancer signs and symptoms may
include:
·
Abdominal pain,
particularly in the upper right portion of the abdomen
·
Abdominal bloating
·
Losing weight without
trying
·
Yellowing of the skin
and whites of the eyes (jaundice)
When to see a doctor
Make an appointment with your doctor if you
experience any signs or symptoms that worry you.
Causes
It's not clear what causes gallbladder cancer.
Doctors know that gallbladder cancer forms
when healthy gallbladder cells develop changes (mutations) in their DNA. A
cell's DNA contains the instructions that tell a cell what to do. The changes
tell the cells to grow out of control and to continue living when other cells
would normally die. The accumulating cells form a tumor that can grow beyond
the gallbladder and spread to other areas of the body.
Most gallbladder cancer begins in the
glandular cells that line the inner surface of the gallbladder. Gallbladder
cancer that begins in this type of cell is called adenocarcinoma. This term
refers to the way the cancer cells appear when examined under a microscope.
Risk factors
Factors that can increase the risk of
gallbladder cancer include:
·
Your
sex. Gallbladder
cancer is more common in women.
·
Your
age. Your risk of
gallbladder cancer increases as you age.
·
A
history of gallstones. Gallbladder
cancer is most common in people who have gallstones or have had gallstones in
the past. Larger gallstones may carry a larger risk. Still, gallstones are very
common and even in people with this condition, gallbladder cancer is very rare.
·
Other
gallbladder diseases and conditions. Other gallbladder conditions that can increase the risk of
gallbladder cancer include polyps, chronic inflammation and infection.
·
Inflammation
of the bile ducts. Primary
sclerosing cholangitis, which causes inflammation of the ducts that drain bile
from the gallbladder and liver, increases the risk of gallbladder cancer.
Diagnosis
Tests and procedures used to diagnose
gallbladder cancer include:
·
Blood
tests. Blood tests to
evaluate your liver function may help your doctor determine what's causing your
signs and symptoms.
·
Procedures
to create images of the gallbladder. Imaging tests that can create pictures of the gallbladder
include ultrasound, computerized tomography (CT) and magnetic resonance imaging
(MRI).
Determining the extent
of gallbladder cancer
Once your doctor diagnoses your gallbladder
cancer, he or she works to find the extent (stage) of your cancer. Your
gallbladder cancer's stage helps determine your prognosis and your treatment
options.
Tests and procedures used to stage gallbladder
cancer include:
·
Exploratory
surgery. Your doctor may
recommend surgery to look inside your abdomen for signs that gallbladder cancer
has spread.
In
a procedure called laparoscopy, the surgeon makes a small incision in your
abdomen and inserts a tiny camera. The camera allows the surgeon to examine
organs surrounding your gallbladder for signs that the cancer has spread.
·
Tests
to examine the bile ducts. Your
doctor may recommend procedures to inject dye into the bile ducts. This is
followed by an imaging test that records where the dye goes. These tests can
show blockages in the bile ducts.
These
tests may include magnetic resonance cholangiography and endoscopic retrograde
cholangiopancreatography (ERCP).
·
Additional
imaging tests. Most people with
gallbladder cancer will undergo a series of scans to help determine whether the
cancer has spread or remains localized. Which scans should be performed vary
depending on your circumstances. Common scans include a CT and MRI scans
of the abdomen and chest.
Your doctor uses information from these
procedures to assign your cancer a stage. The stages of gallbladder cancer
range from 0 to IV. The earliest stages indicate a cancer that's confined to
the gallbladder. Later stages indicate more-advanced cancer that has grown to
involve nearby organs or has spread to other areas of the body.
Treatment
What gallbladder cancer treatment options are
available to you will depend on the stage of your cancer, your overall health and
your preferences.
The initial goal of treatment is to remove the
gallbladder cancer, but when that isn't possible, other therapies may help
control the spread of the disease and keep you as comfortable as possible.
Surgery for
early-stage gallbladder cancer
Surgery may be an option if you have an
early-stage gallbladder cancer. Options include:
·
Surgery
to remove the gallbladder. Early
gallbladder cancer that is confined to the gallbladder is treated with an
operation to remove the gallbladder (cholecystectomy).
·
Surgery
to remove the gallbladder and a portion of the liver. Gallbladder cancer that extends beyond
the gallbladder and into the liver is sometimes treated with surgery to remove
the gallbladder, as well as portions of the liver and bile ducts that surround
the gallbladder.
If your gallbladder cancer is very small and
can be removed completely with cholecystectomy, you may not need additional
treatments. If there's a risk that cancer cells may remain after surgery, your
doctor may recommend chemotherapy or other treatments.
Chemotherapy
Chemotherapy uses drugs to kill rapidly
growing cells, including cancer cells. Chemotherapy can be administered through
a vein in your arm, in pill form or both.
Chemotherapy might be recommended after surgery
if there's a risk that some gallbladder cancer cells might remain. It can also
be used to control the cancer if surgery isn't an option.
Radiation therapy
Radiation therapy uses high-powered beams of
energy, such as X-rays and protons, to kill cancer cells. The energy beams come
from a machine that moves around you as you lie on a table.
Radiation therapy is sometimes combined with
chemotherapy after surgery for gallbladder cancer if the cancer couldn't be
removed completely. Radiation therapy can also control gallbladder cancer
that's causing pain if surgery isn't an option.
Targeted drug therapy
Targeted drug treatments focus on specific
weaknesses present within cancer cells. By blocking these weaknesses, targeted
drug treatments can cause cancer cells to die. Targeted drugs might be an
option for people with advanced gallbladder cancer.
Your doctor may test your cancer cells to see
which targeted drugs are most likely to work for you.
Immunotherapy
Immunotherapy is a drug treatment that helps
your immune system to fight cancer. Your body's disease-fighting immune system
might not attack cancer because the cancer cells produce proteins that make it
hard for the immune system cells to recognize the cancer cells as dangerous.
Immunotherapy works by interfering with that process.
Immunotherapy might be an option for treating
advanced gallbladder cancer.
Coping and support
Learning you have any life-threatening illness
can be devastating. And coping with a diagnosis of gallbladder cancer can be
especially difficult because the disease often carries a poor prognosis. Some
ideas for learning to cope with gallbladder cancer include:
·
Ask
questions about gallbladder cancer. Write down questions you have about your cancer. Ask these
questions at your next appointment. Also ask your doctor for reliable sources
where you can get more information.
Knowing
more about your gallbladder cancer and your treatment options may make you more
comfortable when it comes to making decisions about your care.
·
Stay
connected to friends and family. Your cancer diagnosis can be stressful for friends and
family, too. Try to keep them involved in your life.
Your
friends and family will likely ask if there's anything they can do to help you.
Think of tasks you might like help with, such as caring for your home if you
have to stay in the hospital or just being there when you want to talk.
You
may find comfort in the support of a caring group of your friends and family.
·
Find
someone to talk with. Find someone you
can talk to who has experience with people facing a life-threatening illness.
Consult a counselor, medical social worker, clergy member or a support group
for people with cancer.
·
Write
down your medical wishes. Take
steps to ensure that your wishes are known and respected. Ask your doctor about
advance directives, which allow you to indicate what types of treatment you'd
want in the event you can't communicate your wishes. Also ask about designating
a medical power of attorney, which is someone you designate to make your
choices for you if you can't communicate.
Preparing for your
appointment
Start by making an appointment with your
family doctor if you have signs or symptoms that worry you.
If your doctor suspects you may have
gallbladder cancer, you may be referred to a specialist, such as:
·
A doctor who
specializes in treating digestive conditions (gastroenterologist)
·
A surgeon who operates
on the liver or gallbladder
·
A doctor who
specializes in treating cancer (oncologist)
Because appointments can be short, and because
there's a lot of information to discuss, it's a good idea to be prepared.
Here's some information to help you get ready, and what to expect from your
doctor.
What you can do
·
Be
aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if
there's anything you need to do in advance, such as restrict your diet.
·
Write
down any symptoms you're experiencing, including any that may seem unrelated to the reason for
which you scheduled the appointment.
·
Write
down key personal information, including any major stresses or recent life changes.
·
Make
a list of all medications, as
well as any vitamins or supplements, that you're taking.
·
Consider
taking a family member or friend along. Sometimes it can be difficult to remember all the
information provided during an appointment. Someone who accompanies you may
remember something that you missed or forgot.
·
Write
down questions to ask your doctor.
Your time with your doctor is limited, so
preparing a list of questions will help you make the most of your time
together. List your questions from most important to least important in case
time runs out. For gallbladder cancer, some basic questions to ask your doctor
include:
·
What is my stage of
gallbladder cancer?
·
Can you explain the
pathology report to me? Can I have a copy of my pathology report?
·
Will I need more
tests?
·
What are the treatment
options for my gallbladder cancer?
·
What are the benefits
and risks of each option?
·
Is there one treatment
option you recommend over the others?
·
What would you recommend
to a loved one in my same situation?
·
Should I get a second
opinion from a specialist? What will that cost, and will my insurance cover it?
·
Are there any
brochures or other printed material that I can take with me? What websites do
you recommend?
In addition to the questions that you've
prepared to ask your doctor, don't hesitate to ask other questions during your
appointment.
What to expect from
your doctor
Your doctor is likely to ask you a number of
questions. Being ready to answer them may allow more time later to cover other
points you want to address. Your doctor may ask:
·
When did you first
begin experiencing symptoms?
·
Have your symptoms
been continuous or occasional?
·
How severe are your
symptoms?
·
What, if anything,
seems to improve your symptoms?
·
What, if anything,
appears to worsen your symptoms?
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