Bile fluid, produced by the liver and stored in the gallbladder, has an important role in the digestion of fats. In case of any disease that affects the production, storage or secretion of bile into the small intestine, fat digestion becomes difficult and this can cause serious problems in the person’s diet. Gallbladder cancer, which is rare in the general population, generally has a poor prognosis due to late detection. Therefore, it is vitally important to be informed about gallbladder cancer, to be able to recognize the signs and symptoms at an early stage, and to receive the correct diagnosis in the early stages.
What is Gallbladder Cancer?
The gallbladder is a pear-shaped bag made of muscle tissue and is located just below the liver. Gallbladder cancers are malignant tumors that often occur in the bladder wall and constitute ⅔ of the tumors of the extrahepatic bile ducts. This type of cancer, which ranks 5th among digestive system cancers after stomach cancer, is also the 9th among cancers that cause death.
When examined morphologically, it is possible to talk about two different types of gallbladder cancer: infiltrative and fungative type. The infiltrative type is more common and usually involves the entire sac or a large part of it at the stage it is diagnosed. Tumor cells completely change the structure of the sac wall and the affected parts take on a hard, white, solid consistency. In the advanced stages, the part of the tumor tissue facing the inner surface becomes ulcerated and this may lead to perforation in the sac wall.
In the fungative type, tumor tissues grow from the sac wall inwards as irregular, small, cauliflower-like masses. When this type of gallbladder cancer is diagnosed, liver metastasis has most likely occurred. Fungative type gallbladder tumors, which are completely asymptomatic during the development process, are usually detected when gallbladder hydrops develops as a result of the mass reaching a size that blocks the duct.
Stages of gallbladder cancer
Stage 1: In this stage, the cancer is called in-situ carcinoma and the tumor is located only intramuscularly in the gallbladder wall. The success rate with surgical treatment is quite high in cancers that can be detected at this stage.
Stage 2: In the second stage of gallbladder cancer, the tumor has progressed from the inner surface of the gallbladder to the outer surface, but has still not penetrated the gallbladder wall. Metastasis to neighboring organs such as liver or lymph is not observed.
Stage 3: All layers of the gallbladder are surrounded by cancerous cells. At this stage, metastases to the ductus cysticus lymph nodes will most likely develop.
Stage 4: In the last stage of the disease, cancer cells have spread from the gallbladder to the liver and other neighboring organs. Metastases occur in bile ducts and other lymph nodes.
Causes of Gallbladder Cancer
Although the exact causes of gallbladder cancer are not known, it is possible to mention some factors that predispose to this type of cancer.
Gallbladder cancers mostly occur in older age individuals. More than 75% of all bile-related cancer cases occur in people aged 65 and over. In addition, it has been observed that gallbladder cancer is detected in approximately 10% of people over the age of 65 who underwent biliary tract surgery for non-cancerous diseases. In this regard, the age factor is considered one of the predisposing factors for gallbladder cancer.
The risk of developing gallbladder cancer is 3 to 6 times higher in women than in men for all races and all age groups.
The etiological relationship between gallbladder cancer and gallstones has not been clearly established. However, it has been observed that 75-90% of all cases diagnosed with cancer have gallstones, and previously unsuspected gallbladder cancer is detected in approximately 1% of patients who underwent surgical treatment with the diagnosis of calculous cholecystitis (inflammation of the gallbladder). Precancerous cell changes were observed in approximately 13% of patients who underwent cholecystectomy (gallbladder removal) due to cholelithiasis (gallbladder stones), abnormal cell groups were detected in approximately 8%, and the presence of a malignant tumor was directly detected in 4%. In this regard, it can be said that gallstones are associated with gallbladder cancers.
It has been reported that the risk of developing gallbladder cancer in people diagnosed with ulcerative colitis increases 5-10 times compared to the population of these people.
Other predisposing factors
Unhealthy nutritional routine, obesity, genetic predisposition, exposure to chemical carcinogens, anatomical variations of pancreatic and bile secretions, porcelain gallbladder, primary sclerosing cholangitis, presence of chronic infection and use of various medications 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 overlooked, especially in the early stages of cancer. The disease can develop largely without any problems, but it may present itself with some complaints in the later stages.
- Pain in the right upper quadrant is one of the common complaints that occur with gallbladder cancer.
- Digestive system 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 common symptoms depending on the type of gallbladder cancer.
- Urine color turning dark brown and stool color turning almost transparent-white is one of the important symptoms of many diseases related to the gallbladder and liver.
- The presence of a palpable mass near the umbilicus can be seen especially in the later stages of gallbladder cancer.
How is Gallbladder Cancer Diagnosed?
Since the medical findings of gallbladder-related diseases are very similar to each other, symptoms that do not cause any complaints can be confused with gallstones and gallbladder inflammation. Therefore, even if laboratory findings indicate the diagnosis, they are not sufficient on their own.
First, the findings obtained in the physical examination are taken into consideration, and then ultrasonography and imaging are preferred for detailed examination. If the USG result supports cancer-related suspicions, 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 used.
Gallbladder Cancer Treatment Methods
Like all treatments, the treatment of gallbladder cancer is planned specifically for the patient. When determining the preferred method for treatment, many important factors such as the patient’s age, general health condition, type and stage of the existing disease are taken into consideration.
Since gallbladder cancers are mostly diagnosed at advanced stages, it is very difficult to treat these cancer cases with surgical methods. However, in cases where cancer is detected at an early stage, patients have the chance of surgery. For gallbladder cancers that are still in the 1st or 2nd stage, have not spread to the liver or lymph nodes, and have not caused serious deterioration in the general health of the patient, surgical treatment is often preferred and very successful results are obtained.
In cases where cancer is detected in the 3rd and 4th stages, the success rate of surgical treatment decreases. For patients diagnosed at this stage, different treatment plans in which radiotherapy, chemotherapy or all methods are applied together may be preferred. In cases of disease that is too advanced to be treated, some interventional radiological procedures such as endoscopic or percutaneous drainage can be performed to relieve the person’s pain.