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Gallbladder Cancer

Gallbladder cancer is often asymptomatic in its early stages; only about 20% of cases are caught early.

Gallbladder cancer is often asymptomatic in its early stages; only about 20% of cases are caught early.

Overview

Gallbladder cancer is more common in women than it is in men1https://www.cancer.org/cancer/gallbladder-cancer/about/key-statistics.html. Many of the disease’s known risk factors are related, at least to some degree, to chronic gallbladder inflammation2https://www.cancer.org/cancer/gallbladder-cancer/causes-risks-prevention/risk-factors.html.

Common imaging tests for gallbladder cancer include ultrasounds, CT scans, and MRIs3https://www.cancer.org/cancer/gallbladder-cancer/detection-diagnosis-staging/diagnosis.html. CT scans, however, expose you to potentially harmful radiation4https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/what-are-radiation-risks-ct, and MRIs have been shown to be more effective in diagnosing gallbladder carcinomas than CT scans5https://www.ncbi.nlm.nih.gov/pubmed/30551027.

Symptoms

Typically, gallbladder cancer is asymptomatic until the original tumor is large or has spread to other body parts. Some common symptoms of the disease may include6https://www.cancer.org/cancer/gallbladder-cancer/detection-diagnosis-staging/signs-and-symptoms.html:

  • Nausea and/or vomiting
  • Jaundice 
  • Dark urine
  • Greasy or light-colored stools
  • Weight loss
  • Appetite loss 
  • Abdominal swelling
  • Itchy skin
  • Fever
  • Belly lumps

Many of these symptoms may be a result of the cancer blocking the gallbladder’s bile ducts; it is also important to remember that gallbladder cancer is rare, and these symptoms can also be a sign of other illnesses.

If you are having any of the above symptoms you need to talk to a doctor about the appropriate diagnostic work up. The Ezra scan is a screening test for asymptomatic individuals and it is not designed to diagnose existing or suspected cancers.

Causes

Some risk factors known to increase an individual’s likelihood of developing gallbladder cancer include7https://www.cancer.org/cancer/gallbladder-cancer/causes-risks-prevention/risk-factors.html:

  • Gender: gallbladder cancer is 3-4 times more common in women than it is in men; this is likely because gallbladder inflammation and gallstones are far more common in women than men.
  • Obesity: patients with gallbladder cancer are frequently obese or overweight.
  • Ethnicity: Latin Americans, Mexicans, and Native Americans have a higher risk of developing gallbladder cancer than other ethnoracial groups. On the other hand, African Americans have the lowest chance of developing the disease in America.
  • Geography: on a worldwide scale, gallbladder cancer is far more common in South America, Central Europe, Pakistan, and India.
  • Older age: gallbladder cancer’s average age of diagnosis is 72.
  • Bile duct abnormalities: some individuals have a bile duct abnormality that causes pancreatic juice to reflux into the bile ducts, keeping bile from flowing out from the bile ducts as fast as it should. These individuals are at a higher risk for gallbladder cancer.
  • Gallbladder polyps: these are growths that protrude from the inner gallbladder wall surface.
  • Choledochal cysts: these are sacs filled with bile that line the common bile duct, which shuttles bile from the liver and gallbladder to the small intestine. Over time, these cysts can increase in size and contain up to 2 quarts of bile, and can eventually progress to gallbladder cancer.
  • Gallstones: these are collections of cholesterol and other materials that form and may cause chronic inflammation. They are the most common risk factor for gallbladder cancer, and up to 4 out of 5 individuals diagnosed with gallbladder cancer also have gallstones at the time of diagnosis.
  • Porcelain gallbladder: this is a condition that involves the gallbladder wall becoming covered in calcium deposits that sometimes develops after long term inflammation.
  • Previous typhoid infection: individuals who are typhoid carriers or who have been chronically infected with salmonella, the bacterium that causes typhoid, are at a higher risk of developing gallbladder cancer. Specialists believe this is because typhoid can lead to gallbladder inflammation.

However, some people with many risk factors never get gallbladder cancer, while some with little to no risk factors still develop the disease. 

One common thread connecting many of gallbladder cancer’s known risk factors is chronic gallbladder inflammation, which can cause gallbladder cells to be exposed to bile chemicals for longer than usual.

Researchers are beginning to unearth how known risk factors, such as chronic inflammation, can lead to certain genetic changes, or mutations. Sometimes, these mutations occur in oncogenes or tumor suppressor genes, which are in charge of when cells grow, divide, or die. Such mutations can at least in part be responsible for cancer and can be inherited from one’s parents or be picked up randomly during one’s life. Furthermore, some gallbladder cancer risk factors are known to sometimes cause changes specifically in gallbladder cell DNA.Genetic mutations linked to gallbladder cancers are generally acquired during one’s lifetime as opposed to inherited from one’s parents. Many cases of the disease, for example, are linked to acquired changes in the tumor suppressor gene known as TP538https://www.cancer.org/cancer/gallbladder-cancer/causes-risks-prevention/causes.html.

Detection

If your doctor is looking for gallbladder cancer, they will likely begin with a physical exam, checking your abdomen for any fluid buildup, tenderness, and lumps. They’ll also check for signs of jaundice, as well as the lymph nodes for other signs of cancer. If there is any cause for concern, they’ll likely move on to bloodwork and imaging tests to further assess the situation.

Blood tests may check for bilirubin, which is the chemical responsible for jaundice. They may also check for albumin or liver enzymes, to diagnose other bile duct, liver, or gallbladder diseases. Your doctor could also do blood work to check for tumor markers known as CA 19-9 and CEA. These tests, however, are not gallbladder cancer-specific: the levels of these markers are only high in advanced cases of the disease, and are useful analyses while performing treatment for gallbladder cancer9https://www.cancer.org/cancer/gallbladder-cancer/detection-diagnosis-staging/diagnosis.html.

Common imaging tests for gallbladder cancer include ultrasounds, CT scans, and MRIs10https://www.cancer.org/cancer/gallbladder-cancer/detection-diagnosis-staging/diagnosis.html. CT scans, however, use x-rays, which expose you to radiation that can be harmful11https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/what-are-radiation-risks-ct. Furthermore, a 2019 study showed that MRIs are a more efficient tool in diagnosing gallbladder cancer than CT scans12https://www.ncbi.nlm.nih.gov/pubmed/30551027.

Diagnosis

If a suspicious area is identified, an ultrasound or CT-guided needle biopsy will likely be performed to further analyze it13https://www.cancer.org/cancer/gallbladder-cancer/detection-diagnosis-staging/diagnosis.html. If you are diagnosed with the disease, your doctor’s next step will likely be to stage the cancer; a cancer’s stage describes how much of it is in the body and helps inform the best treatment route. Gallbladder cancers are most often graded on the TNM system:

  • T stands for tumor: how far into the gallbladder wall has the cancer grown? Has it grown through it into nearby organs like the liver?
  • N stands for lymph nodes: has the cancer spread to lymph nodes nearby? If so, how many of them?
  • M stands for metastasis: has the cancer metastasized to distant organs?

(Source)

Treatment

The best treatment for gallbladder cancer depends on the nature of the disease and how far it has spread. Treatment options may include: surgery, chemotherapy, radiation, immunotherapy, and targeted therapy14https://www.cancer.org/cancer/gallbladder-cancer/treating.html.

Please consult with a physician on treatment options as necessary.

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