Is a rare cancer of the digestive system. We don’t know what causes most gall bladder cancers but different factors that increase your risk are age, gallstones, polyps, porcelain gallbladder, smoking, obesity, family history etc.
Gallbladder cancer may be diagnosed by chance during an operation to remove the gall bladder. This surgery is usually because of gallstones or inflammation.
Or you may be diagnosed after seeing your GP to have your symptoms checked. Your GP will then refer you to a hospital specialist. At the hospital, the specialist doctor will ask you about your general health and any previous medical problems. They will examine you and take blood samples. This is to check your general health and that your liver is working properly. They may also do the following tests:
Clinical evaluation by the doctor to look for the presence of jaundice (yellowness of skin and eyes) or presence of scar marks (due to itching) and presence of any lumps in the tummy.
Blood tests including LFT’s (bilirubin level in your blood will be high due to the blockage of the bile duct).
Hemoglobin (Hb level) can be low
Tumor markers. These are substances normally seen in the blood, however, in people with a cancer they may be high. In bile duct cancer, the tumor marker that has been associated with it is Ca19.9.
MRI (magnetic resonance imaging)
Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
Endoscopic ultrasound (EUS)
You may undergo one or more of the scans in order to help identify the tumor and assess your suitability for the various treatments.
Histology/cytology: All of the previously mentioned tests may lead the doctor to diagnose bile duct cancer. However the only definite way to confirm this diagnosis is to examine some of the abnormal tissue (cancer cells) under a microscope. If a sample of tissue is required we may perform a biopsy. This is when a needle is passed through your skin, into the affected area. If your doctor is planning to treat your cancer with surgery, you may not undergo a biopsy, as tissue confirmation can be obtained after the operation, by the laboratory.
Laparoscopy: This is a small operation that allows the doctors to look at your gallbladder, liver and other organs close to the gall bladder. It is done under a general anaesthetic and you will have a short stay in hospital. While you are asleep under anaesthetic, the doctor makes a small cut (incision) in your tummy (abdomen). They will insert a thin, flexible tube with a light and camera (laparoscope). They may take a small sample of tissue (biopsy) to look at under a microscope. After a laparoscopy, you will have one or two stitches in your tummy. You may have uncomfortable wind or shoulder pains for several days after the operation. You can often ease the pain by walking or taking sips of peppermint water.
TREATMENT OF GALLBLADDER CANCER:
The treatment you have depends on a number of factors, including:
- your general health
- the position and size of the cancer
Whether it has spread to other areas of the body
Surgery may be offered as a potentially curable or palliative treatment. At present complete surgical removal of the cancer offers the only possible cure. Sometimes doctors find the cancer by chance when they are doing keyhole surgery to remove the gall bladder (laparoscopic cholecystectomy). If this happens, they change the operation to open surgery. They remove the gall bladder and surrounding tissues through a larger cut in the tummy. This makes it easier to remove all the cancer.
A cancer may also be found after surgery for gallstones. When doctors examine the gall bladder. If this happens, you may need further surgery to try to make sure all the cancer is removed. If the cancer has spread outside the gall bladder, you may have a larger operation called a radical cholecystectomy to remove:
- the gall bladder
- the surrounding tissues
- the lymph nodes and parts of other organs.
After your operation, you will stay in an intensive care ward for the first couple of days. You will then be moved to a general ward until you recover. Most people need to be in hospital for about 8-10 days after this operation.
The treatment of cancer with drugs is called chemotherapy). This treatment may be offered as a palliative treatment, where surgery is not possible, or as an add-on to surgical treatment. The aim of the palliative it to potentially slow down and/or shrink the cancer
Radiotherapy uses high-energy x-rays to destroy the cancer cells, while doing as little harm as possible to normal cells. It may be used to relieve symptoms if gallbladder cancer has spread. You may only need a few treatments and the side effects are usually mild. We can send you more information about radiotherapy.
Blockages and stents
If the cancer is blocking your bile duct, this can often be treated with a flexible plastic or metal tube called a stent. The stent holds the duct open, so it is no longer blocked.
Bile duct stents are usually put in using an ERCP. The doctor can see the narrowing caused by the blockage in the bile duct by looking at x-rays. They stretch the narrowing using dilators (small inflatable balloons). They then insert the stent through the endoscope so the bile can drain. If you have any discomfort while this is being done, it is important to let your doctor know. The Endoscopic Retrograde Cholangio-Pancreatogram (ERCP) and it’s done by gastroenterologists/ hepatologists. This is preferred way of stent placement as it is more convenient for the patient.
In case of failed ERCP; the other way to insert the stent is called Percutaneous Transhepatic CholangioPancreatogram (PTC) and this procedure is done by specialist doctors called as interventional radiologists. This involves inserting the stent through the skin (percutaneous) and liver (transhepatic) into the top of the bile duct, using a needle and tube. The doctor injects some local anaesthetic into the skin to numb it. They then insert a long, thin, flexible needle through the skin into the liver. The doctor looks at x-ray images on a screen to help them guide the needle to the bile duct and inject a dye. You may feel warm all over when the dye is injected. This is normal and the feeling wears off quickly.
The dye flows through the ducts, showing the area that is blocked. The doctor passes a fine guide wire along the needle into the blockage in the bile duct. A stent is then passed along this wire. The stent holds open the bile duct where it has narrowed, allowing fluid to flow through it again. You may feel some pushing when the wire and stent are being put in. If this is uncomfortable or painful, let the doctor know so that you can be given painkillers.
To help prevent infection, you will be given antibiotics before and after the procedure. You will probably need to stay in hospital for a few days.
Sometimes a stent needs to be replaced if it becomes blocked or gets infected. If a plastic stent has been in place for a long time, it may need to be replaced with a new one.
If the cancer is causing a narrowing of the small intestine (duodenum) this can cause problems with your ability to eat and drink and leads to vomiting after meals. A stent, larger than that used for the bile ducts, can be used and inserted into the duodenum to allow you to eat and drink, without nausea and/or vomiting