Dr Jason Naicker educates us on gallbladder cancer.
What is gallbladder cancer?
Gallbladder cancer is cancer that begins in the gallbladder (a small, pear-shaped organ on the right side of the abdomen, just beneath the liver). The gallbladder stores bile (a fluid made by the liver that helps digest fats).
Gallbladder cancer is rare. In South Africa, just over 400 new cases were reported to be diagnosed in 2014, while the American Cancer Society estimated about 12 000 new cases would be diagnosed in 2018.
Gallbladder cancer is difficult to diagnose because it often causes no specific signs or symptoms. Also, the relatively hidden nature of the gallbladder makes it easier for gallbladder cancer to grow without being detected.
In cancer treatments, we often discuss five-year survival rates, that is, what percent of people will live at least five years after the cancer is found. The five-year survival rate for gallbladder cancer is 19%. However, the survival rate depends on several factors, including the location and spread of the cancer at the time of diagnosis.
It’s important to remember that statistics on survival rates for gallbladder cancer patients are an estimate, measured every five years. So, the estimate may not show the results of better diagnosis or treatment available for less than five years.
There are several factors known to increase the risk of developing gallbladder cancer. These include: gallstones; gallbladder polyps; being overweight or obese; advanced age (usually over 70); females are more likely to develop gallbladder cancer than men; smoking; and a family history of gallbladder cancer.
Difficult to diagnose
Gallbladder cancer is usually not found at an early stage because the gallbladder is located deep inside the body, and sometimes there may be no symptoms, or some of the symptoms may overlay with biliary colic and gallstones.
When symptoms do occur, they include: abdominal pain (usually in the right upper aspect of the abdomen); bloating; nausea and vomiting; jaundice; fever; weight loss; swollen abdomen; itchy skin; dark urine and pale stool
Symptoms usually only appear at later stages of the disease. Your doctor may do blood tests to evaluate your liver function which may help to determine the cause of your symptoms. Therefore, gallbladder cancer can be difficult to detect during routine physical examinations.
Sometimes, gallbladder cancer is found unexpectedly after removal of the gallbladder for another reason, such as gallstones or infection of the gallbladder.
Tumour markers (proteins in your blood that are often present if you have a particular type of cancer) are not specific to cancer but may assist once the overall presentation of the patient has been taken into consideration.
Imaging tests allows your doctor to ‘see’ the gallbladder. This can take the form of an ultrasound, CT scan, an MRI of the liver and gallbladder, or even a PET/CT scan
To properly make the diagnosis, your doctor requires a biopsy. A biopsy is the removal of tissue from the suspicious area for examination by a pathologist under a microscope.
Stages of gallbladder cancer
With all these results, your doctor will be able to ascertain the stage of your gallbladder cancer. In general, Stage 1 is cancer that is confined to the gallbladder; Stage 2 is when it grows into the walls of the gallbladder; Stage 3 is when it spreads to surrounding tissue or lymph nodes; and Stage 4 is when it spreads to lung, liver, bone, or brain.
You and your doctor will decide what treatment, or combination of treatments, is the best option to treat your gallbladder cancer. There are three standard treatments for gallbladder cancer:
- Surgery to remove the gallbladder and nearby lymph nodes.
- Radiation – which uses high energy rays to kill cancer.
- Chemotherapy (drugs which are given either orally or intravenously to kill cancer cells).
MEET OUR EXPERT
Dr Jason Naicker (MBChB Wits University) is a consultant medical oncologist at Rosebank Hospital. He served as medical advisor at Janssen Cilag, covering oncology and anti-infectives.