What is Gallbladder Cancer?

Gallbladder cancer is a rare disease that effects the gallbladder, a major part of the digestive system. Hard pebble-like substances sometimes form in the gallbladder, and if large enough, can lead to the blocking of bile ducts. Bile ducts help the body break down food to be digested. When the bile ducts are blocked, obstruction occurs. Obstruction of the bile ducts can lead to inflammation of the gallbladder. Inflammation of the gallbladder can lead to infection or the build up of cancerous cells. Cancerous cells in the gallbladder may lead to a malignant tumor forming and the first stage of gallbladder cancer will begin. It is important to note that while almost all patients with gallbladder cancer also have gallstones, even more people with gallstones do not have or will never develop gallbladder cancer.

Most people do not realize they have gallbladder cancer until after the first stage because the symptoms associated with the first stage of gallbladder cancer are not specific to the disease. If a patient is fortunate to discover gallbladder cancer early on, they can be treated and saved, going on to live a normal life. Gallbladder cancer that is discovered in a later stage carries a poor prognosis and most patients pass away within a few years time. The only way to discover and treat the earliest stage of gallbladder cancer is through diagnostic tests that will be discussed later on in this overview.

Gallbladder Cancer Causes

While there is no direct cause of gallbladder cancer, there are certain risk factors that increase an individual's risk for the disease. Women are twice as likely as men to develop gallbladder cancer. Obesity has also been linked to higher incidences of the disease. Races that are more likely to have gallbladder cancer include Mexicans and Native Americans. Those with a family history of gallbladder cancer or gallstones have an increased chance of being diagnosed with one of the two conditions yet the disease is still very rare overall.

Gallstones

Gallstones in the gallbladder increase one's chances of developing gallbladder cancer. Simply having gallstones does not mean gallbladder cancer is going to develop next. Gallstones are hard, pebble-like substances that grow in the gallbladder and can disrupt the functions of the gallbladder by causing an obstruction. When the bile duct is blocked by gallstones, infection, or inflammation in the gallbladder can occur, leading to a higher risk of gallbladder cancer.

Gallbladder Cancer Prevention

Gallbladder cancer does not have any proven prevention methods. The causes of the disease, such as gallstones, cannot be prevented from forming in the gallbladder. Prevention through treatment is difficult because it is often not treated until the cancer reaches an advanced stage. Patients usually do not suffer serious symptoms in the early stage of gallbladder cancer, leading to a late diagnosis. Once the cancer has spread, there is little hope of preventing the cancer from taking a patient's life within a few years.

Types of Gallbladder Cancer

There are two main types of gallbladder cancer tumors, adenocarcinoma and non-adenocarcinoma. Adenocarcinoma tumors occur more frequently than non-adenocarcinomas.

Papillary and Non-Papillary

Under a microscope, papillary cancer is arranged like fingers. Papillary cancer tends to have a better prognosis than other gallbladder cancers because they are less likely to spread to the liver or nearby lymph nodes. Papillary cancer can either be invasive or non-invasive. Invasive papillary cancer is likely to spread to other organs while non-invasive papillary cancer is rarely malignant and carriers a better prognosis.

Mucinous Adenocarcinoma

Mucinous adenocarcinoma are cancer cells that develop in a pool of mucus. The mucus lines the walls of the gallbladder and becomes very thick. The gallbladder can get clogged or backed up due the thickness and quantity of the mucus. The inflammation caused by the mucinous adenocarcinoma could lead to gallbladder cancer, though mucinous adenocarcinoma is rare.

Non-Adenocarcinoma

There are six types of non-adenocarcinoma gallbladder cancers, they are squamous cell cancer, adenosquamous carcinomas, small cell, sarcoma, neuroendocrine, lymphoma, and melanoma.

Gallbladder Cancer Symptoms

The symptoms of gallbladder cancer are usually not felt until the stages advance. This causes a diagnosis of the disease to be made in a later stage when symptoms are more prevalent.

    Symptoms of Gallbladder Cancer

·         Weakness

·         Loss of appetite

·         Weight loss

·         Vomiting caused by obstruction in the gallbladder

·         Jaundice (yellowing of the skin) caused by obstruction in the gallbladder

Gallbladder Cancer Diagnosis

A gallbladder cancer diagnosis can be made once a series of tests have been completed. First, there will be a physical test where a doctor checks the patient's body for obvious signs of cancer, such as tumors or a yellowing of the eyes known as jaundice. A discussion about symptoms should also take place. Blood tests can be performed to measure the amount of bilirubin there is in the blood. Bilirubin is used in the gallbladder and an excess of it may be a sign of trouble in the gallbladder. Elevated protein levels known as tumors markers can also be checked for in the blood.

Imaging tests serve as the most important aspect of diagnosis gallbladder cancer. Imagine tests that will help determine if a patient has gallbladder cancer include x-rays, ultrasounds, CT scans, cholangiogram, a laparoscopy and a biopsy.

Gallbladder Cancer Staging

A staging system to recognize how developed the cancer has become is used for gallbladder cancers. The staging model factors in the severity of tumors, spreading to lymph nodes and the chances of the cancer metastasizing.

Stage 0: Tis, N0, M0- The cancer has not spread outside the gallbladder. Patient's have an 81% five-year survival rate at this stage.

Stage 1A: T1 (a or b) N0, M0- The tumor spread to the muscle layer or lamina propria but does not spread outside the gallbladder. Patient's have a 50% five-year survival rate at this stage.

Stage 1B: T2, N0, M0- The tumor spreads into the perimuscular fibrous but not outside the gallbladder. Patient's have a 29% five-year survival rate at this stage.

Stage 2A: T3, N0, M0- The tumor extends to the serosa layer or grows into the liver or another nearby organ or tissue. There has been no spread to lymph nodes or distant organs. Patient's have a 7% five-year survival rate at this stage.

Stage 2B: T1-T3, N1, M0- More growth in the gallbladder continues. The cancer has spread to the lymph nodes but not distant organs or tissues. Patient's have a 9% five-year survival rate at this stage.

Stage 3: T4, any N, M0- Blood vessels have been infected leading to liver have been infected with blood. More than one nearby organ other than the liver has bee infected. Cancer may have spread to tissues but has not spread to distant organs. Patients have a 3% five-year survival rate at this stage.

Stage 4: Any T, Any N, M1- The cancer has spread to distant organs and tissues from the gallbladder. Patient's have a 2% five-year survival rate at this stage.

Gallbladder Cancer Prognosis

A gallbladder prognosis refers to the estimated chance for survival and recovery, treatment options, and the chance for a recurrence of the disease. Gallbladder cancer carries a poor prognosis. This is because most patient's are not diagnosed with the disease until the later stages when it become more difficult to treat. The staging model along with other factors such as age and previous medical history all factor into a prognosis. If a patient is fortunate to discover the disease in the earliest stage, the prognosis improves and patient may go on to lead a normal full life.

Gallbladder Cancer Treatment

Gallbladder cancer treatment relies on surgeries, drugs, and radiation. Treatment options depend on stage progression, past medical history, prognosis, and the opinion of the patient. If the patient is feeling very ill, and does not want to go through the process of radiation drugs or painful surgeries, they may elect to not receive treatment. For some, one surgery may be enough to lead a long and healthy life. Others could experience extended surgery, chemotherapy, and radiation treatment, but still remain sick and die within a few years.

Surgery

Surgery is performed to remove the gallbladder and any cancerous cells and tumors associated with gallbladder cancer surgery. Laparoscopic, open surgery and extended surgery are three different methods of gallbladder cancer surgery.

Cholecystectomy

Cholecystectomy is the term for removing the gallbladder through surgery.

Laparoscopic Surgery

Laparoscopic surgery during a cholecystectomy involves small incisions made in the abdomen and a small camera placed on the tiny instrument used by the doctor. The images are shown on a monitor next to the patient. This type of surgery allows for a faster recovery time but is still efficient for removal of the gallbladder.

Radiation Therapy

Radiation therapy involves high energy rays similar to x-rays that are capable of killing cancer cells. There are two main forms of radiation to treat gallbladder cancer -- external beam radiation therapy and brachytherapy. Radiation therapy is used to shrink tumors, kill cancer cells and help clear any obstructions in the gallbladder. Radiation therapy is often combined with chemotherapy. That process is known as chemoradiation.

Chemotherapy

Chemotherapy is a popular method to kill cancer cells in the body. A combination of drugs is inserted in a patient's mouth or injected in a vein. The drugs travel in the blood stream, killing cancer throughout the body. Chemotherapy is not known to be as successful in treating gallbladder cancer as it is with other cancers. A a new method called hepatic chemotherapy is being tested. It involves injecting the gallbladder area directly with chemo drugs and doctors hope it is more effective than regular chemo treatment.

Gallbladder Cancer Research

Gallbladder cancer research is constantly being conducted around the world. New chemotherapy drugs and surgical methods are tested in clinical trials. Successful research toward treating gallbladder cancer often comes directly out of clinical trial in which sick volunteers offer their bodies to science in hope of creating new ways to treat or cure the disease. For many patients, approved medical practices have failed to treat them to their needs and only new ideas and methods can help. Clinical trials along with statistical information on past patients go toward researching new and better ways to cure gallbladder cancer.

Gallbladder Cancer Statistics

The American Cancer Institute estimates 9,720 will be diagnosed with gallbladder cancer in 2009 and 3,370 will die from the disease in the same year. Statistics also show that women are twice as likely to develop gallbladder cancer than men. Mexicans and Native Americans are the ethnic groups at most risk to develop the disease.
Gallstones may be a leading cause in gallbladder cancer, but out of 500,000 people who needed surgery for gallstones issues, less than 10,000 of those people will be diagnosed with gallbladder cancer.

Survival rates are determined by the cancer's stage. The size and severity of the tumor, the spreading of cancer to the lymph nodes, and spreading of malignant cancer to other organs determine the stages.
The American Cancer Institute measures gallbladder cancer patient's based on a five-year survival rate.