Gall bladder cancer
Gall bladder cancer is a rare disease worldwide and is thought to be a result of chronic inflammation in the gall bladder and the development of mutation in the cells lining the inner surface of the organ. The highest incidence in Asia has been reported in parts of Northern India, China and Japan, with females affected 2-6 times more than men.
Gall bladder is a small, pear-shaped structure located on the right side of the abdomen, just beneath the liver. The gall bladder stores bile, a digestive fluid produced by the liver. Unfortunately, gall bladder cancer is detected in late stages and symptoms such as jaundice, pain in abdomen, bloating, fever, nausea and vomiting and loss of weight should be investigated for gall bladder cancers as similar symptoms also occur for gallstones and biliary colic, which are of course non-cancerous conditions.
When there is anorexia and weight loss along with jaundice, gall bladder cancer is usually in the advanced stages and carries a poor chance for survival. Gall bladder cancer is classified into various pathological stages to guide therapy. In early stages post surgery /cholecystectomy, a carcinoma may be a surprise diagnosis.
- Stage 0 (carcinoma in Situ) : Microscopy will reveal few abnormal cells in the inner (mucosal) layer of the gallbladder that might turn malignant
- Stage I : Cancer has formed and has spread beyond the inner (mucosal) layer to the organs tissue containing blood vessels or muscles
- Stage II : Cancer has spread beyond the muscle layer to the connective tissue around the muscle
- Stage IIIA : Cancer has spread through all layers of the gallbladder and/or to the liver and/or to one nearby organ (stomach, small intestine, colon, pancreas, or bile ducts outside the liver)
- Stage IIIB : Cancer has spread to nearby lymph nodes and/or to the liver and/or to one nearby organ
- Stage IVA : Cancer has spread to a main blood vessel of the liver or to 2 or more nearby organs or areas other than the liver, with nearby lymph node spread
- Stage IVB : Cancer has spread to the lymph nodes along large arteries to distant sites in the body
Treatment involves surgical resection, radiotherapy, chemotherapy, and a palliative approach when cancer is not curable. Very few, about a fourth of gall bladder cancer cases can undergo curative resection. After curative surgery, survival rates are Stage 0-I, 33- 100%; Stage II, 9-33%; Stage III, 0-25%; and Stage IV, 0-5%.
Adjuvant radiotherapy controls and shrinks the tumor growth providing a palliative de-bulking with bypass possible, as well as it controls lymphatic spread. With or without chemotherapy, radiotherapy could improve survival, and also provide palliation of symptoms. Radiotherapy treats the tumor bed and the porta hepatic and pancreaticoduodenal nodes, as well as the celiac nodes and retroperitoneal nodes.
Significant increases in survival rates after surgery alone ranges from 6-7 months and can be prolonged to longer than 12 months with external beam radiotherapy administered as adjuvant therapy. All patients with tumors beyond the mucosa are candidates for external beam radiotherapy. 5-FU–based chemotherapy is usually given with concurrent radiation therapy in the adjuvant setting. Adjuvant chemotherapy can be given with single agent gemcitabine or a fluorpyrimidine-based agent.