Bile juice produced by the liver and stored in the gallbladder has a valuable role in the digestion of fats. In the case of any disease that affects the production, storage or secretion of bile into the small intestine, the digestion of fats becomes difficult, which can lead to valuable problems in a person’s nutritional system. Gallbladder cancer, which is rarely seen in the general population, usually has a macular prognosis due to its late detection. For this reason, it is vitally important to have knowledge about gallbladder cancer, to be able to recognize the signs and symptoms in the early period, and to get an accurate diagnosis in the initial stages.
What is Gallbladder Cancer?
The gallbladder is a pear-shaped sac of muscle tissue and lies quickly under the liver. Gallbladder cancers are malignant tumors that often arise in the wall of the gallbladder and constitute ⅔ of the tumors of the extrahepatic biliary tract. This cancer type, which is in the 5th place after stomach cancer among the cancers of the digestive system, is also in the 9th place among the cancers that cause death.
When examined morphologically, it is possible to talk about two different types of gallbladder cancer as infiltrative and fungal types. The infiltrative type is more common and often involves all or most of the sac at the time of diagnosis. Tumor cells completely change the structure of the sac wall and the affected parts acquire a hard, white, solid consistency. In the advanced stage, the inner surface of the tumor tissue becomes ulcerated and this may lead to perforation in the wall of the sac.
In the fungal type, tumor tissues grow in the form of small, cauliflower-like masses, without errors, from the wall of the sac. By the time this type of gallbladder cancer is diagnosed, it is most likely that liver metastases have already occurred. Fungative type gallbladder tumors, which progress completely asymptomatically during development, are mostly detected by the development of gallbladder hydrops as a result of the mass reaching the size to obstruct the duct.
Gallbladder cancer stages
Stage 1: At this stage, the cancer is called carcinoma in-situ and the tumor is located only intramuscularly in the gallbladder wall. In cancers that can be noticed at this stage, the success rate with surgical treatment is quite high.
Stage 2: In the second stage of gallbladder cancer, the tumor has progressed from the inner side of the gallbladder to the outer surface of the gallbladder, but it still has not exceeded the gallbladder wall. Metastasis to neighboring organs such as liver or lymph is not seen.
Stage 3: All layers of the gallbladder are surrounded by cancerous cells. At this stage, metastases to the ductus cystic lymph nodes most likely develop.
Stage 4: In the last stage of the disease, cancer cells have spread from the gallbladder to the liver and other adjacent organs. Metastases are seen in the bile ducts and other lymph nodes.
Gallbladder Cancer Causes
Although the causes of gallbladder cancer are not known exactly, it is possible to talk about some factors that prepare the basis for this type of cancer.
Gallbladder cancers occur mostly in advanced age group individuals. More than 75% of all bile-related cancer cases occur in people 65 years of age or older. In addition, it was observed that gallbladder cancer was detected in approximately 10% of individuals over the age of 65 who underwent biliary tract surgery due to non-cancer disease. In this respect, the age factor is considered as one of the predisposing factors for gallbladder cancer.
The risk of developing gallbladder cancer is 3 to 6 times higher for women than men for all races and all age groups.
The etiological link between gallbladder cancer and gallstones has not been clearly demonstrated. However, it has been observed that 75-90% of all cases diagnosed with cancer have gallbladder stones, and approximately 1% of the patients who underwent surgical treatment with the diagnosis of stony cholecystitis (gallbladder inflammation) had previously unsuspected gallbladder cancer. Precancerous cell changes were observed in approximately 13% of patients who underwent cholecystectomy (removal of the gallbladder) for cholelithiasis (gallbladder stones), unusual cell clumps were observed in approximately 8% and the presence of malignant tumors directly in 4%. In this direction, it can be said that gallbladder stones are related to gallbladder cancers.
It has been reported that the risk of developing gallbladder cancer in individuals diagnosed with ulcerative colitis increases 5-10 times compared to the population of these individuals.
Other predisposing factors
Unhealthy diet routine, obesity, genetic predisposition, chemical carcinogen exposure, anatomical variations of pancreatic and bile secretions, porcelain gallbladder, primary sclerosing cholangitis, presence of chronic infection and use of various drugs are other factors considered to be associated with gallbladder cancer.
What are the Symptoms of Gallbladder Cancer?
Gallbladder cancer is a very insidious type of cancer. Therefore, signs and symptoms may be missed, especially in the first stages of cancer. The disease can develop without suffering a great deal, but it can manifest itself with some complaints in the later stages.
- Pain in the right upper quadrant is one of the common complaints associated with gallbladder cancer.
- Gastrointestinal symptoms such as nausea, vomiting and loss of appetite can be seen in gallbladder cancer, as in many bile-related diseases.
- Jaundice, which is visible on the skin and the white part of the eye, is one of the most common symptoms compared to the type of gallbladder cancer.
- It is one of the valuable symptoms of many diseases related to the gallbladder and liver that the color of urine becomes dark brown and the color of stool becomes almost transparent-white.
- The presence of a palpable mass near the navel can be seen especially in the later stages of gallbladder cancer.
How is Gallbladder Cancer Diagnosed?
Since the medical findings of diseases related to the gallbladder are very similar to each other, the tables that do not cause any complaints can be confused with gallstones and gallbladder inflammation. Therefore, even if laboratory findings point to the diagnosis, it is not sufficient on its own.
First, the findings obtained in the physical examination are taken into account, and then imaging with ultrasonography is preferred for detailed examination. If the USG result supports the suspicions about cancer, many imaging methods such as computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasonography, percutaneous cholangiography, endoscopic retrograde cholangiopancreatography (ERCP), positron emission tomography (PET) and laparoscopy can be applied.
Gallbladder Cancer Treatment Methods
As with all treatments, the treatment of gallbladder cancer is planned specifically for the patient. When determining the procedure to be preferred for treatment, many valuable factors such as the patient’s age, general health status, the type and stage of the current disease are taken into consideration.
Since gallbladder cancers can be diagnosed in advanced stages to a large extent, surgical treatment of these cancer cases is quite difficult. However, in cases where the cancer is detected at an early stage, patients have the opportunity to undergo surgery. For gallbladder cancers, which are now in stage 1 or 2, have not spread to the liver or lymph nodes, and have not caused significant deterioration in the general health of the patient, surgical treatment technique is often preferred and very successful results are obtained.
In cases where the cancer is noticed in the 3rd and 4th stages, the success rate decreases with surgical treatment. For patients diagnosed at this stage, different treatment plans may be preferred, such as radiotherapy, chemotherapy or all routes in one middle. In the case of diseases that are too advanced to be treated, interventional radiological processes such as endoscopic or percutaneous drainage can be applied to relieve the pain of the person.