Gallbladder cancer is a rare, rapidly progressing digestive system cancer with poor survival rate. It has a high incidence and death rate in India, Chile and Japan in the world. It is usually found incidentally in tissue samples from surgeries in which the gallbladder is removed (cholecystectomy). When it gives clinical symptoms, it is in the advanced stages.
What are the Causes of Gallbladder Cancer?
The causes of gallbladder cancer are not fully known. Most gallbladder cancers start from the cells lining and secreting the gallbladder. These cells lose their similarity to each other in the background of chronic inflammation and over time turn into invasive carcinoma in the place where it is located and then throughout the sac. It is accepted that this change takes 5-10 years.
The spread of bladder cancer in society is highly similar to gallstones. The presence of cancer in 0.5-3% of gallstones suggests that chronic inflammation in the gallbladder causes cancer. In addition, it is thought that other gallbladder diseases such as gallbladder polyps increase the risk of cancer.
The incidence of cancer in cases of porcelain sac, which is the most advanced form of chronic inflammation, is 25%. Therefore, cholecystectomy is indicated for all porcelain sacs.
Experimental studies have found higher than normal levels of secondary bile acids in the bile contents of patients with gallbladder cancer. In addition, methyldopa, oral contraceptives, taking isoniazid treatment and working in the tire industry are considered as predisposing factors.
The gallbladder consists of four anatomical parts; infindibulum, fudus, corpus and neck. The tumor is located in the ifindibulum in 10% of cases, and the rest is located in the corpus and fundus. The gallbladder consists of the fundus, corpus, infindibulum, and neck regions.
Symptoms of early-stage gallbladder cancer may be non-diagnostic or asymptomatic. Possible signs and symptoms;
- abdominal pain especially in the right upper quadrant,
- feeling of bloating in the abdomen,
- fever,
- involuntary weight loss,
- nausea,
- skin and it is yellowing in the white parts of the eye.
How to Diagnose Gallbladder Cancer?
In a patient presenting with abdominal pain in the right upper quadrant, medical history and physical examination should be evaluated for weight loss. loss, jaundice and palpable mass should be evaluated and clinical suspicion should be aroused first. The first procedure to be done is the evaluation of the sac with abdominal ultrasonography. Deterioration of the integrity of the pouch mucosa, increase in its echogenicity or hypoechogenic thickening of the tissue under the mucosa support the suspicion of cancer.
Laboratory tests such as blood count, liver function tests, alkaline phosphatase and bilirubin level secreted by the gallbladder provide information about the bladder function. If cancer is involved in the liver organ tissue, intra- or extrahepatic bile ducts, deterioration in laboratory values is detected. In addition to clinical findings, tumor markers carcinoembryonic antigen (CEA) are detected high in 50% of patients and cancer antigen (CA 19-9) is high in 80%.
Computed tomography (CT) examination is performed when ultrasonography finding strengthens the suspicion of cancer. . Thus, the involvement of the tumor in the liver, the region and other lymph nodes in the abdomen is evaluated.
By using magnetic resonance (MR)-cholangiography and MR imaging, the extent of spread of the cancer and tumor size can be learned in more detail from CT.
Pancreas (peripancreatic) and lymph nodes associated with the portal system (periportal) can be detected by endoscopic ultrasonography (endosonography). During this procedure, cases that cannot be operated can be determined by performing fine needle biopsy.
Endoscopic retrograde cholangiography (ERC) and percutaneous transhepatic cholangiography (PTC) can guide the decision of whether the tumor can be completely removed or the choice of palliative procedure. For this purpose, positron emission tomography (PET) scanning and biopsy are performed for definitive diagnosis.
How to Treat Gallbladder Cancers?
The main treatment for gallbladder cancer is surgery. However, the surgical approach differs among surgeons.
Some surgeons may perform prophylactic cholecystectomy in asymptomatic gallbladder. Some researchers �lar, on the other hand, does not recommend prophylactic cholecystectomy, arguing that gallbladder stones cause a low rate of gallbladder cancer. Presence of “pouch”,
Staging of gallbladder cancer:
Stage 1: In-situ carcinoma, bile The bladder tumor is located only intramuscularly.
Stage 2: The tumor has only involved the muscular layer of the gallbladder.
Stage 3: All layers of the gallbladder wall are faced with cancer tumor. Ductus cysticus lymph nodes may or may not be involved.
Stage 4: At this stage, gallbladder cancer has spread to the liver and other adjacent organs. Involvement of the bile ducts and other lymph nodes is present.
As the disease progresses (deteriorates), the surgical approach is wide resection, including the liver and lymph nodes. The aim of these approaches is to increase the survival rate of the patient.
In advanced stage patients who cannot be operated on, approaches to reduce jaundice with percutaneous drainage and reduce pain are included. Adjuvant treatments: Gallbladder cancers generally do not respond to chemotherapy. Since they have peritoneal and lymphatic spread, radiotherapy cannot be applied.
Recently, "warm chemotherapy" based on washing the abdomen with warm chemotherapy for 1-1,5 hours after tumor removal and some smart drug applications are used.
Palliative Treatment:
> Because of the insidious character of the disease, the fact that it is caught at a very late stage causes the patient to lose the chance of surgery. These patients are diagnosed with 12-month life expectancy is less than 5%. Palliative approaches aim to reduce the patient's prominent complaints or increase the patient's comfort.
Read: 20
