Gallbladder Cancer

The exact cause of gallbladder cancer is unknown; however, several factors may contribute to its development.

• Chronic inflammation: Persistent inflammation of the gallbladder, often due to conditions like chronic cholecystitis (inflammation of the gallbladder), increases the risk of cancer.
• Gallstones: These may lead to irritation and inflammation, which increases the risk of cancer. Further, inflammation and infection from gallstones can promote the accumulation of genetic mutations in the gallbladder cells.
• Bile duct abnormalities: Biliary dysplasia or abnormal changes in the bile ducts, are a risk factor for gallbladder cancer.
• Age and gender: Gallbladder cancer is more common in people over the age of 65 and is also more common in women than men.
• Obesity and overweight: These increase the risk of gallbladder cancer, likely due to changes in bile composition and increased inflammation in the gallbladder.
• Family history and genetics: A family history of gallbladder cancer or other types of gastrointestinal cancer may increase the risk of developing gallbladder cancer. Genetic conditions, such as familial adenomatous polyposis (FAP) or Lynch syndrome, may also predispose individuals to gallbladder cancer.
• Tobacco and alcohol use: Smoking and heavy alcohol consumption have been linked to an increased risk of gallbladder cancer.
• Other medical conditions: Conditions like primary sclerosing cholangitis (a disease of the bile ducts) or porcelain gallbladder (a condition where the gallbladder wall becomes calcified) are associated with a higher risk of gallbladder cancer.

Gallbladder cancer often does not present any symptoms until it reaches an advanced stage, which makes early detection difficult. When symptoms do occur, they may include:

• Upper right abdominal pain: The most common symptom (pain may be dull or sharp).
• Nausea and vomiting: Often due to the obstruction of the bile ducts or inflammation.
• Jaundice: Caused by bile buildup in the bloodstream.
• Unexplained weight loss: Sudden and unexplained weight loss can be a sign of gallbladder cancer.
• Loss of appetite: A common symptom in individuals with cancer.
• Feeling of fullness or bloating: Often accompanied by a change in bowel movements.
• Fever: Can occur as a result of an infection or inflammation in the gallbladder.
• Dark urine: Due to the presence of excess bilirubin in the bloodstream.
• Clay-coloured stools: Due to the inability of bile to reach the intestines.

Gallbladder cancer can be difficult to diagnose because the associated symptoms often resemble those of other conditions, such as gallstones or cholecystitis (inflamed gallbladder). The diagnostic strategy generally includes:

• Imaging tests:
  • Ultrasound: The first imaging test often used to detect gallbladder abnormalities and tumours.
  • CT: Can detect tumours and provide information regarding the spread of cancer (if the cancer has spread to other parts of the body).
  • MRI: Useful for assessing the liver and bile ducts.
  • Endoscopic ultrasound (EUS): May be used for better visualisation, especially for small tumours.
  • Cholangiography: An X-ray or MRI-based test that helps visualise bile duct obstructions.
• Biopsy:
  • Needle biopsy: A sample of tissue from the gallbladder is taken for examination under a microscope to confirm cancer.
  • Endoscopic biopsy: If the cancer is accessible via the digestive tract, an endoscopic procedure may be used to obtain tissue samples.
• Blood tests:
  • Tumour marker analysis: Elevated levels of CA 19-9 and CEA (carcinoembryonic antigen) may indicate the presence of gallbladder cancer, though the levels of these markers can also be elevated in other conditions.

Treatment for gallbladder cancer depends on the stage at the time of diagnosis, whether the cancer has spread, and the patient's overall health.

• Surgery:
  • Cholecystectomy (gallbladder removal): Primary treatment if the cancer is detected early on and is localised. If cancer has spread to nearby structures, a partial liver resection or removal of nearby lymph nodes may be required.
• Chemotherapy (gemcitabine and cisplatin): This may be used as an adjuvant treatment after surgery or in advanced cases where the tumour cannot be surgically removed.
• Radiation therapy: This therapy may be used to shrink tumours or relieve symptoms in cases where surgery is not an option. It is often used in combination with chemotherapy for treating advanced gallbladder cancer.
• Targeted therapy: Targeted drugs like HER2 inhibitors may be used in cases where genetic mutations have been identified.
• Palliative care: In advanced stages of gallbladder cancer, palliative care is provided to manage symptoms and improve quality of life, including drainage of bile ducts to alleviate jaundice.

While there is no guaranteed way to prevent gallbladder cancer, certain lifestyle changes and medical interventions can reduce the risk:

• Removing the gallbladder: Removal of the gallbladder (cholecystectomy) in patients with gallstones can reduce the risk of gallbladder cancer.
• Healthy diet: Eating a balanced diet with a focus on fruits, vegetables, and low-fat foods may help lower the risk of gallbladder cancer.
• Maintaining a healthy weight: Avoiding obesity can reduce the risk of gallbladder cancer.
• Avoid smoking and excessive alcohol consumption: These risk factors should be minimised to reduce the likelihood of developing gallbladder cancer.
• Regular medical check-ups: For individuals at higher risk of gallbladder cancer (family history, chronic inflammation, or genetic conditions), regular screenings and medical check-ups are important for early detection.