GALLBLADDER CANCER
Treatment and Surgery in Delhi, India

Dr. Nikhil Agrawal

1. 

   What is the gallbladder?

   • Gallbladder is small, pear-shaped pouch that sits under the liver.
   • It stores bile, concentrates it and releases it when we eat.
   • Common bile duct connects it to the intestine and liver.
2. 

   What is gallbladder cancer?

   Cancer forms when DNA of cells undergo changes (mutations). These cells then grow uncontrolled and forms a tumour or cancer. Gallbladder cancer begins in the inner layers of the gallbladder. It gradually grows beyond the gallbladder wall and spreads to the liver, bile duct, adjacent lymph nodes and other areas of the body.

3. 

   What is incidental gallbladder cancer?

   Gallstones are a common problem in India. Many people suffering from gallstones undergoes gallbladder removal surgery, a laparoscopic cholecystectomy. The gallbladder along with stones is removed in this surgery. The removed gallbladder is then sent for histopathological examination, also called biopsy. In one to two out of a hundred such patients, the biopsy of the gallbladder will show the presence of cancer. This condition is called incidental gallbladder cancer.

4. 

   What are the signs and symptoms of gallbladder cancer?

   Gallbladder cancer like most gastrointestinal cancers is asymptomatic in initial stages. Many of its symptoms are same as those of gallstones.

   The symptoms of gallbladder cancer include:

   • Abdominal pain
   • Unexplained weight loss
   • Loss of appetite
   • Jaundice (yellow eyes, skin and urine)
   • Itching
5. 

   What are risk factors of gallbladder cancer?

   Anything that increases the risk of someone getting cancer is a risk factor.

   Risk factors for gallbladder cancer are:

   • Gallbladder stones
   • Congenital abnormalities of the bile duct such as choledochal cyst
   • Biliary-enteric fistula
   • Calcified gallbladder wall (porcelain gallbladder)
   • Obesity
   • Female sex
   • Gallbladder polyps
   • Primary sclerosing cholangitis
6. 

   How is gallbladder cancer diagnosed?

   Diagnosis means identifying a disease. Once a gall bladder cancer is suspected, usually on an ultrasound, a CT scan, MRI scan or a PET scan is done to diagnose and stage the disease. In advanced tumours biopsy is done to confirm the diagnosis before starting chemotherapy/radiotherapy.

7. 

   How is gallbladder cancer staged?

   Staging determines the disease's extent by assessing the size, location, involvement of adjacent organs, and spread to lymph nodes and distant organs.

   Positron emission tomography (PET), contrast enhanced computed tomography (CT) scans or MRI scan are used for staging.

8. 

   What is TNM staging for gallbladder cancer?

   TNM (tumour, node and metastasis) classification developed by the American Joint Committee on Cancer (AJCC) is used for classification of stage and it spans from I to IV.

   • The extent (size) of the tumour (T): How far has cancer grown into the layers of the gallbladder wall? Has cancer reached nearby structures or organs, such as liver?
   • The spread to nearby lymph nodes (N): Has cancer spread to nearby lymph nodes? And to how many?
   • The spread (metastasis) to distant sites (M): Has cancer spread to distant lymph nodes or distant organs such as the peritoneum or lungs?

9. 

   How is gallbladder cancer treated?

   Treatment for gallbladder cancer depends on several factors:

   • The stage of the cancer
   • One´s overall health
   • The chances of curing the disease, extending life, or relieving symptoms.

   
   

   The main treatment for gallbladder cancer include:

   • Surgery for Gallbladder Cancer
   • Chemotherapy, targeted therapy and immunotherapy
   • Radiation Therapy
10. 

    Which surgery is done for gallbladder cancer?

    If detected early in a stage where it has not spread, gall bladder cancer can be treated by surgery. Surgery for gallbladder cancer is called radical cholecystectomy or extended cholecystectomy.

11. 

    How is advanced gallbladder cancer treated?

    If the patient has jaundice then some procedure is needed to open blocked bile ducts. It could be a percutaneous transhepatic biliary drainage (PTBD) or endoscopic retrograde cholangiopancreatography (ERCP), depending on the level of block. For patients who are not jaundiced or when jaundice clears, chemotherapy (with targeted therapy or immunotherapy) is given to improve survival and quality of life. Also, the patient is given medicines for pain and to control other symptoms of the disease.

Wish you a speedy recovery!