Gallbladder cancer is a rare but devastating disease. It is commonly seen in Northern India but is infrequent in the Southern states including Kerala. Perhaps, the highest incidence of the cancer is seen among North Indian women (22 in 100,000). In patients diagnosed with the condition, late diagnosis and poor outcomes make this a much feared cancer.
Gallbladder stones are a major risk factor in the development of Gallbladder cancer. Furthermore an increase in cancer rates correlate with the presence of Gallstones in the local population. Up to 85% of patients who suffer from Gallbladder cancer are found to have pre-existing Gallstones. In addition, an increase in the size of Gallstones correspondingly increases the risk of development of cancer. Gallstones which are larger than 3 cm are found to have a ten fold higher risk of development of cancer. The type of Gallstones are also linked to development of cancer. Cholesterol stones irritate the lining of the gallbladder and this in turn leads to development of cancer.
Long standing inflammation of the gallbladder as in chronic cholecystitis (generalized inflammation of the gallbladder) can lead to development of malignancy in the gallbladder. Calcification of the gallbladder is associated with development of gallbladder cancer (Porcelain Gallbladder).
Individuals who suffer from a chronic inflammatory condition called Primary Sclerosing Cholangitis (PSC) are also prone to develop cancer of the gallbladder. In patients who have PSC it is advisable to undergo an annual ultrasound scan to detect the presence of any changes in the gallbladder and preempt the development of gallbladder malignancy.
Gallbladder Polyps – A precursor to Gallbladder Cancer
Multiple studies have confirmed that polyps can develop into cancerous tumours. It is recommended that individuals with polyps which are larger than 1 cm should undergo a cholecystectomy. However, for polyps which are smaller than 1 cm; there exists some difference of opinion among authorities in the subject. Some suggest preventive surgery, while others suggest a more conservative approach with multiple scans at annual or semi-annual intervals to monitor the polyp.
Signs of Gallbladder Cancer
Many patients who develop gallbladder cancer do not show any specific signs or symptoms. This dangerous cancer is often found when a scan of the abdomen is done for other symptoms. As a result gallbladder cancer is often not diagnosed at an early stage. It is difficult to detect during routine clinical examination. On some occasions the cancer is detected on examination of the specimen following a laparoscopic cholecystectomy. This is especially true when the procedure is carried out for gallbladder polyps.
When symptoms occur, they may include the following
- Abdominal Pain
- Jaundice (A yellowish discolouration of the white of the eyes and skin)
- A lump in the upper abdomen
- Nausea and vomiting
- Itching all over the body
- Dark coloured urine
- Pale colour of stools
- Bloating or a gassy feeling in the abdomen
- Loss of appetite and loss of weight
What if you have any of these symptoms?
Many cancers of the abdomen have similar symptoms. It is always prudent to seek advise from a specialist in the field who will run a routine set of blood investigations which should ideally include liver function tests and some tumour markers. This is generally followed by radiological investigations which may include an ultrasound scan followed by a CT scan or a MRI scan.
In the event where a malignancy of the gallbladder is detected; staging the disease accurately is essential. Surgery with an intention to cure may not be possible in many cases. However surgical options can be explored with a view to relieve symptoms and to improve the quality of life of the patient. This is often combined with chemotherapy and radiation therapy to improve symptoms of the patient.
Endoscopic procedures to improve drainage of bile from the liver to the small intestine are also carried out by placement of stents in the biliary system.
Can gallbladder cancer be prevented?
Significant research has been directed towards identifying the causative factors for gallbladder cancer. Some measures have been suggested to improve outcomes and for early detection.
Obesity has been linked to development of gallbladder cancer and a high BMI (Body Mass Index) is directly related to development of the cancer. Maintaining an ideal weight would therefore help in mitigating the risk of development of cancer.
When large gallstones are detected on ultrasound scans which exceed a size of 10 mm it is prudent to perform a cholecystectomy to mitigate the risk of development of cancer.
Gallbladder polyps measuring 7 mm and above warrant close observation. Polyps which are larger than 10mm should necessitate a cholecystectomy. Evaluation of the surgical specimen following cholecystectomy under a microscope by an experienced pathologist is mandatory to rule out the presence of early malignancy.
Dietary intake of reused oil and a high fat diet should be especially avoided as they are shown to increase the incidence of gallbladder cancer.
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