Gallbladder Cancer: Understanding Symptoms, Diagnosis, and Treatment

Early-stage gallbladder cancer often presents with minimal or no symptoms. However, as the disease progresses, the following signs may become noticeable:

1. Abdominal Pain: Persistent pain in the upper right side of the abdomen.
2. Bloating: Feeling of fullness or discomfort.
3. Itchiness: Unexplained itching.
4. Fever: Elevated body temperature.
5. Indigestion: Difficulty digesting food.
6. Nausea and Vomiting: Persistent nausea and vomiting.
7. Loss of Appetite: Reduced desire to eat.
8. Weight Loss: Unintended weight loss.
9. Malaise: Generalised weakness and fatigue.
10. Yellowing of Skin and Eyes (Jaundice): Due to bile duct obstruction.

Causes and Risk Factors

The exact cause of gallbladder cancer remains unclear, but it often begins with genetic mutations in gallbladder cells. Risk factors associated with this condition include:

• Gallstones
• Advanced age
• Obesity
• Poor diet
• Exposure to carcinogens
• Other gallbladder conditions: chronic inflammation or infections

Detecting gallbladder cancer can be challenging due to the organ’s small size and location. However, the following diagnostic methods are employed:

Liver Function Tests (LFTs): Blood tests to assess liver function.

Ultrasound: Imaging to visualise the gallbladder and detect tumours.

Computed Tomography (CT) Scan: Detailed abdominal images.

Magnetic Resonance Imaging (MRI) Scan: Assesses disease severity.

Biopsy: Tissue sample analysis to determine malignancy.

Treatment for gallbladder cancer depends on the stage and extent of the disease:

Surgery (Cholecystectomy)

• Cholecystectomy is the primary treatment for gallbladder cancer if the tumour is localised and has not spread beyond the gallbladder. The procedure involves the surgical removal of the gallbladder, along with nearby lymph nodes and surrounding tissues, if the cancer has spread.
• Risks: Surgical risks include infection, bleeding, bile leakage, injury to nearby organs (such as the liver or bile ducts), and complications associated with anaesthesia.
• Pros: Cholecystectomy offers the best chance of cure for localised gallbladder cancer and may also help alleviate symptoms such as abdominal pain and jaundice.
• Cons: Surgery may not be suitable for advanced-stage cancers or patients with significant underlying health issues that increase surgical risks.
• Cholecystectomy is typically recommended for early-stage gallbladder cancer or localised tumours that have not spread to nearby organs. It may be followed by adjuvant therapies such as chemotherapy or radiation therapy to reduce the risk of recurrence.

Chemotherapy

• Chemotherapy uses powerful medications to target and kill cancer cells throughout the body. It may be used before or after surgery to shrink tumours, prevent cancer spread, or alleviate symptoms in advanced-stage disease.
• Risks: Common side effects of chemotherapy include nausea, vomiting, fatigue, hair loss, and increased susceptibility to infections due to suppressed immune function. More serious side effects can occur, depending on the specific drugs used.
• Pros: Chemotherapy can help improve survival rates and quality of life for some patients with gallbladder cancer, particularly when used in combination with surgery or radiation therapy.
• Cons: Chemotherapy may not be effective for all types of gallbladder cancer, and it can cause significant side effects that impact daily functioning and quality of life.
• Chemotherapy is often recommended as adjuvant therapy after surgery to reduce the risk of cancer recurrence or as palliative treatment for advanced-stage or metastatic disease.

Radiation Therapy

• Radiation therapy uses high-energy rays to target and destroy cancer cells. It may be delivered externally (external beam radiation) or internally (brachytherapy) and is often used in combination with surgery and/or chemotherapy to treat gallbladder cancer.
• Risks: Side effects of radiation therapy may include skin irritation, fatigue, nausea, diarrhoea, and damage to nearby organs or tissues.
• Pros: Radiation therapy can help shrink tumours, alleviate symptoms such as pain or jaundice, and improve overall survival rates in some patients with gallbladder cancer.
• Cons: Radiation therapy may not be suitable for all patients, particularly those with advanced-stage disease or certain medical conditions that increase the risk of complications.
• Radiation therapy may be recommended as part of a multimodal treatment approach for localised or advanced gallbladder cancer to improve treatment outcomes and quality of life.

Stenting

• Stenting involves the insertion of a small tube (stent) into the bile duct to relieve blockages caused by tumours. It is often used to alleviate symptoms such as jaundice, abdominal pain, and digestive issues in patients with advanced-stage gallbladder cancer.
• Risks: Risks associated with Stenting may include infection, bile duct injury, stent migration, and obstruction.
• Pros: Stenting can provide rapid relief of symptoms associated with bile duct blockage, improving quality of life for patients with advanced-stage gallbladder cancer.
• Cons: Stenting is typically a palliative measure and does not address the underlying cancer. In some cases, stents may need to be replaced periodically due to blockage or other complications.
• Stenting is often used as a palliative treatment option for patients with advanced-stage gallbladder cancer who are not candidates for curative surgery or when surgery is not feasible.

Lymphadenectomy

• Lymphadenectomy involves the surgical removal of affected lymph nodes near the gallbladder to prevent the spread of cancer. It is often performed in conjunction with cholecystectomy for early-stage gallbladder cancer or localised tumours with suspected lymph node involvement.
• Risks: Risks of lymphadenectomy are similar to those of other surgical procedures, including bleeding, infection, and damage to nearby structures.
• Pros: Lymphadenectomy may help prevent cancer recurrence by removing cancerous lymph nodes and reducing the risk of cancer spreading to other parts of the body.
• Cons: Lymphadenectomy is a more extensive surgical procedure and may be associated with increased risks and longer recovery times compared to cholecystectomy alone.
• Lymphadenectomy is typically recommended for patients with early-stage gallbladder cancer or localised tumours with suspected lymph node involvement to improve long-term outcomes and reduce the risk of recurrence.

In summary, the choice of treatment for gallbladder cancer depends on various factors, including the stage and extent of the disease, the patient's overall health, and individual preferences. A multidisciplinary approach involving surgeons, medical oncologists, radiation oncologists, and other healthcare professionals is essential to develop a personalised treatment plan that maximises the chances of success and improves the quality of life for patients with gallbladder cancer.

The prognosis varies based on the stage at diagnosis. Unfortunately, most cases are detected late, leading to a poor outlook. Early detection and timely intervention improve survival rates.

When to Seek Medical Attention

If you experience any of the symptoms mentioned above, especially persistent abdominal pain, jaundice, or unexplained weight loss, seek medical help promptly. Early diagnosis offers the best chance for effective treatment.

Remember, knowledge and awareness play a crucial role in managing gallbladder cancer. Regular health check-ups and vigilance are essential for early detection and improved outcomes.