Falling prey to diseases is perhaps among the most unpleasant phases of our lives. While diseases such as, fever, flu, upset stomach and the like are common and hardly require any special medical attention, certain other life-threatening diseases are capable of disrupting our daily affairs and render our lives upside down. Among the many diseases, cancer is one such disease that manages to induce a feeling of uncertainty and fear by the mere mention of the term. Although rare in occurrence as compared to other diseases, gallbladder cancer is one such disease that has the capability of disrupting the entire system. This article explains what is gallbladder cancer, and the causes, symptoms, stages, epidemiology, risk factors, prognosis, survival rate and treatment of gallbladder cancer.
Gallbladder Cancer: An Overview
The gallbladder is a small pear-shaped organ that is located in the right side of the abdomen, just underneath the liver. It can be seen as a storehouse of bile that is secreted by the liver which facilitates the process of digestion. Gallbladder cancer initiates in the gallbladder and is considered to be quite a rare disease. It often poses a certain level of difficulty in diagnosis with the symptoms not being clearly manifested, leading to the diagnosis of the disease at the last stage when cure becomes almost impossible. The 'hidden' location of the organ may also be seen as a factor behind the undetected growth of the cancerous cells.
Symptoms of Gallbladder Cancer
Gallbladder cancer might prove to be difficult to detect in the early stages owing to the location of the gallbladder deep inside the body which results in the symptoms not showing up. Certain signs and symptoms that are manifested may belong to other diseases and might be related to some kind of stomach virus. The cancer in the organ is often detected after the gallbladder is removed for some other purpose such as gallbladder stone. However, there are certain signs and symptoms that one could look out for-
- A feeling of nausea accompanied by vomiting and abdominal bloating and pain, specifically in the upper right area.
- Fever often accompanied by conditions associated with jaundice such as, yellowing of the skin and the whites of the eye.
- Loss of appetite accompanied by unexpected loss of weight.
Getting relieved of the symptoms of gallbladder cancer forms an important part of cancer treatment and is also known as symptom management or palliative care.
Stages of Gallbladder Cancer
The stage of cancer determines the extent to which the cancer has spread in the body and the treatment that has to be provided to the patients. There are two approved ways of staging gallbladder cancer, viz., the TNM process and the number system.
The TNM stage of gallbladder cancer can be defined as Tumor, Node and Metastasis and describes-
- The size and the extent to which the gallbladder tumor has spread.
- Whether the cancer cells have extended to the lymph nodes.
- If the cancer has extended to other organs of the body.
The number system divides gallbladder cancer into four major stages, namely stage 1 to 4 with some doctors even going in for a stage 0.
- Gallbladder Cancer Stage 0: This is one of the earliest gallbladder cancer stages where the cancer has just begun to affect the gallbladder tissue lining. The risk of the cancer spreading to other organs of the body is negligible at this stage.
- Gallbladder Cancer Stage 1: The earliest stage of invasive cancer, the internal layers of the tissue lining the gallbladder is affected and has not yet spread to the lymph nodes, neighboring tissues and other organs.
- Gallbladder Cancer Stage 2: The next stage of gallbladder cancer is where the cancer spreads to the layer of muscles of the gallbladder wall and into the connective tissue beneath but has not yet extended to the outer part of the organ.
- Gallbladder Cancer Stage 3: This stage of the gallbladder cancer can be divided into Stage 3A and Stage 3B.
- Stage 3A Gallbladder Cancer: This stage indicates the growth of cancerous cells along the gallbladder walls but has not yet extended into the lymph nodes.
- Stage 3B Gallbladder Cancer: This stage indicates that the cancerous cells have spread along the walls of gallbladder and has also spread to the neighboring lymph nodes.
- Gallbladder Cancer Stage 4: This stage of gallbladder cancer is also divided into two sub-stages, viz., Stage 4A and Stage 4B.
- Stage 4A Gallbladder Cancer: This refers to the fact that the cancerous cells have penetrated into one of the major blood vessels leading into the liver and/or more organs other than the liver. The lymph nodes might or might not be affected at this stage.
- Stage 4B Gallbladder Cancer: This means that the cancer has managed to penetrate into the lymph nodes located further from the gallbladder but has not yet penetrated to other distant organs of the body. However, the possibility of the disease spreading to other organs distant to the liver cannot be completely ruled out.
Prognosis and Survival Rate of Gallbladder Cancer
The prognosis and treatment procedure of patients suffering from gallbladder cancer depends on a number of factors viz:-
- The gallbladder cancer stage, that is, if the cancer has spread to other parts of the body.
- If the cancer can be absolutely eliminated by means of surgery.
- The kind of gallbladder cancer that the patient is suffering from.
- If the patients is suffering from cancer for the first time or if it is a recurrence.
Prognosis for gallbladder cancer is generally found to be poor for patients diagnosed with gallbladder cancer in the final stage. A marked improvement has been found in the overall 5-year survival rates by the advent of gallbladder cancer staging. The fact that gallbladder cancer often remains undetected as well as inaccurately detected is an unfortunate fact.
Around 10 out of every 100 people suffering from gallbladder cancer survive for 5 years or more. Around 80 out of 100 people in the Stage 0 of gallbladder cancer, that is, the cancer is detected only in the internal lining of the gallbladder are likely to survive for 5 years or more. However, this number reduces to 50 once the cancer spreads to the muscles, that is, when patients enter into stage 1 of cancer. The survival statistics among patients in the stage 2 of gallbladder cancer show even lower survival rates with 25 out of 100 people surviving for 5 years or more. The survival rates decreases drastically in patients suffering from stage 3 or stage 4 of gallbladder cancer with less than 10 out of 100 people surviving for 5 years or more.
Epidemiology of Gallbladder Cancer
Parts of South America such as, Chile, Ecuador and Bolivia along with certain areas of India, Korea, Pakistan and Japan are known to manifest high rates of gallbladder cancer with Chile showing the highest mortality rates in the world. Gallbladder cancer has been considered to be a rare disease in North America. This disease is also more likely to affect women than men with the rate being 2 to 6 times higher in the former than the latter.
Causes and Risk Factors of Gallbladder Cancer
The initiating point for Gallbladder Cancer is the internal lining of the gallbladder also known as glandular cells. Gallbladder cancer that originates from this point is also known as adenocarcinoma. The mutation in the DNA of the healthy gallbladder cells result in the uncontrolled multiplication and growth of cells which would have otherwise died. The accumulation of these cells gives rise to the formation of tumor which proves to be malignant in nature and spread to other parts of the body. The specific reason behind this development is not known. However, there are certain risk factors which might act as catalysts in the development of gallbladder cancer.
Age and Gender as a Risk Factor for Gallbladder Cancer
Though young people are also at potential risk, there remains the fact that gallbladder cancer is seen occurring more among older people, especially people above 72 years of age. 2 out of every 3 people with gallbladder cancer are found to be over 65 years of age. Women are more susceptible to developing gallbladder cancer than men as suggested by studies.
Obesity Increases the Risk for Gallbladder Cancer
Obesity can be counted as one of the many risk factors associated with gallbladder stones, thereby, leading to increased chances of gallbladder cancer.
Gallstone as a Potential Risk Factor for Gallbladder Cancer
Ascertained to be the most common risk factor for gallbladder cancer, gallstones can be defined as small pebble-like accumulation of cholesterol and other things in the gallbladder leading to chronic inflammation. 3 out of every 4 patients diagnosed with gallbladder cancer are found to be suffering from gallbladder stones. However, it should be noted that not all people suffering from gallbladder stones develop gallbladder cancer.
Family History as a Risk Factor for Gallbladder Cancer
People with a family history of gallbladder cancer are more susceptible to the disease than other people. However, this disease being a rare one, the chances of development of the cancerous cells is also quite low.
Gallbladder Polyps as a Potential Risk Factor for Gallbladder Cancer
Gallbladder polyps may be defined as a growth that protrudes from the surface of the internal gallbladder wall. While the smaller tumors are benign in nature, polyps larger than 1 cm can prove to be cancerous thus, increasing the risk factor.
Abnormalities in the Pancreas and Bile duct as a Risk factor for Gallbladder Cancer
The pancreas along with the bile duct acts as facilitators of digestion by releasing fluid into the smaller intestine. The pancreas secretes this fluid which reaches the small intestine via a duct which often joins up with the bile duct. These secretions from the pancreas are seen to reflux or flow backwards into the bile duct in people with abnormalities in this system. This abnormality also increases the chances of development of gallbladder cancer.
Diagnosis of Gallbladder Cancer
The health-care expert is likely to conduct certain tests in order to ascertain if the patient is suffering from gallbladder cancer.
- Blood Test: Blood tests are done for the evaluation of the functions of the liver, which helps the doctors in determining the cause of symptoms so manifested.
- Image Tests: Computerized Tomography, Ultrasound Imaging and MRI are some of the tests that the patients are likely to undergo.
Diagnosis of the extent of cancer is the next step in the diagnosis process. The doctor determines the stage of cancer that the patient is in and treatment progresses accordingly. The tests that are conducted in order to determine the stage of cancer are-
- Exploratory Surgery: The doctor inspects the organs surrounding the gallbladder in order to detect the extent of the spread of cancer by performing a laparoscopic incision.
- Bile Duct Examination: The health-care expert might also conduct tests on the bile duct by inserting dye into the organ in order to detect blockages.
Treatment of Gallbladder Cancer
The treatment that gallbladder cancer patients will depend on the stage of the gallbladder cancer the patient is in. The goal of the treatment for Gallbladder Cancer at the onset is to altogether eliminate the cancer. However, if that is not possible, other therapies can be resorted to.
- Treatment in the initial stages of gallbladder cancer includes the surgical removal of the gallbladder occasionally accompanied by a portion of the liver as well.
- Surgical procedures prove to be ineffective in removing gallbladder cancer that has spread to other areas of the body. Therefore, the later stages of the cancer is treated with-
- Chemotherapy: Here, chemicals are utilized to kill off the cancerous cells.
- Radiation therapy: High-power energy beams such as X-rays are used to kill the cancerous cells.
Lifestyle and Coping with Gallbladder Cancer
Patients suffering from gallbladder cancer need to modify certain aspects of their lifestyle. This is also true for patients who have already recovered from the cancer. Making certain healthier choices can be considered as one of the major changes that you could bring about. Reducing alcohol intake, quitting smoking and the like are some of the changes that could take you a long way. Patients also need to watch what they eat as gallbladder, a significant organ of the digestive system has been affected and it's obvious that one would now have to take better care. While patients are likely to feel fatigued after gallbladder cancer treatment, it is best to indulge in certain light exercises to keep the physique fit.