Gallbladder cancer

Gallbladder cancer is a relatively uncommon cancer. If it is diagnosed early enough, it can be cured by removing the gallbladder. Most often it is found after symptoms such as abdominal pain and jaundice occur, and it has spread to other organs such as the liver.

It is a rare cancer that is still being studied and thought to be related to gallstones building up, which also can lead to calcification of the gallbladder, a condition known as Porcelain gallbladder. Porcelain gallbladder is also rare. Some studies indicate that people with porcelain gallbladder have a high risk of developing gallbladder cancer, but other studies question this. The outlook is poor for recovery if the cancer is found after symptoms have started to occur.

(Gallbladder cancer infiltrating the liver. En bloc resection of the tumor mass with liver segments IVb and V. Arrows demonstrate demarcation of segment IVb after round ligament approach.)

Risk factors

• Gender: Approx. twice more common in women than men, mostly between the ages of 50 and 60.
• Obesity increases the risk for gallbladder cancer.
• Primary carcinoma is linked to chronic cholecystitis and cholelithiasis.
• Alcohol: alcohol drinking is a risk factor of gallbladder cancer.

Signs and Symptoms

• Steady pain in the upper right abdomen for around 2 months.
• Diarrhea
  
• Burping
• Weakness
• Loss of appetite
• Weight loss
• Vomiting
• Infection, leading to peritonitis, gangrene, perforation, and liver abscess
• Jaundice, due to obstruction

Early symptoms mimic gallbladder inflammation and gallstones, which must be excluded as the cause. Later, the symptoms may be that of biliary obstruction.

Disease Course

Most tumors are adenocarcinomas, with a small percent being squamous cell carcinomas. The cancer commonly spreads to the liver, pancreas, stomach,and duodenum.

Diagnosis

(Incidentally discovered gallbladder cancer (adenocarcinoma) following a

cholecystectomy. H&E stain.)

Early diagnosis is not generally possible. People at high risk, such as women with frequent gallstones, are evaluated closely. Endoscopic ultrasound, transabdominal ultrasound, CT scan, MRI, and MR cholangiopancreatography can be used to diagnose.

Treatment

The most common and most effective treatment is surgical removal of the gallbladder (cholecystectomy) with lymph node dissection. However, with gallbladder cancer's extremely poor prognosis, most will die by one year following the surgery. If sur

gery is not possible, endoscopic stenting of the biliary tree can reduce jaundice. Chemotherapy and radiation may also be used with surgery. Mutant Adenovirus based treatment is under investigation by several researcher and a company has even got license to use a mutant of Adenovirus (Onyx-15) to cure cancer.

Distal bile duct cancers (those near the ampulla of Vater) are treated with a Whipple resection, which is a resection of the proximal duodenum (first portion of the small intestine), head of the pancreas, common bile duct, and gallbladder. The Whipple procedure is the same operation performed for cancers of the head of the pancreas. More Whipple resections are performed at The Johns Hopkins Hospital than at any hospital in the world.