Gallbladder Cancer

The abnormal growth of cells that begins in the gallbladder is called gallbladder cancer. The gallbladder is a pear-shaped organ located in the abdomen under the right side of the liver. Cancer may affect any part of the gallbladder. However, it is difficult to detect and diagnose early due to its small size, hidden behind the liver, and no early signs and symptoms.

Adenocarcinoma is the most common type of gallbladder cancer and starts in the gland cells found in the inner lining of the gallbladder.

The signs and symptoms of gallbladder cancer include:

1. Bloating and swelling  in the abdomen
2. Lumps in the belly
3. Loss of appetite
4. Jaundice (Yellowish white of the eye and skin)
5. Losing weight 
6. Itchy skin
7. Fever
8. Dark-coloured urine
9. Light-coloured stool with mucus
10. Fatigue
11. Abdominal pain, especially in the upper right side of the abdomen

The exact cause of gallbladder cancer is still unknown. However, several factors increase the chances of gallbladder cancer, such as:

1. Women are more likely to get gallbladder cancer than a men
2. If you are older than age above 72
3. Smoking
4. Stone, polyps in the gallbladder
5. Porcelain gallbladder (calcium deposits on the inside wall of the gallbladder)
6. Obesity 
7. Exposure to nitrosamines and certain chemicals like those used in the rubber and textile industry
8. Having primary sclerosing cholangitis
9. Having cysts in the common bile ducts
10. Infected with salmonella
11. Unhealthy diet
12. Inflammation and infection in the gallbladder
13. Family history of gallbladder cancer

Disease progression

The different stages of gallbladder cancer are:

1. Stage 0: The stage is also known as carcinoma in situ. In this abnormal cells are found in the innermost mucosal layer of the gallbladder. The cells may become cancerous and spread into nearby normal tissue. 
2. Stage 1: In this stage, the cancer is formed and divided into two further stages which :
   1. Stage 1A: Cancer is spread beyond the mucosal layer to the muscle layer.
   2. Stage 1B: The cancer is spread beyond the muscle layer to the connective tissue.
3. Stage 2: The cancer is spread all over the gallbladder.
4. Stage 3: In this stage, cancer spreads to one or more nearby organs and nearby lymph nodes.
5. Stage 4: It is the most advanced stage of gallbladder cancer and spreads to distant body areas

The following tests are performed for the diagnosis of gallbladder cancer:

1. Physical examination:  The doctor will perform the physical examination to check for lumps or anything unusual. A complete medical history along with the family history is taken into consideration. The doctor will ask you about the signs and symptoms to check for the disease.
2. Ultrasound: High-energy sound waves produce detailed images of the internal organs. 
3. Blood test: A small amount of blood is taken to evaluate your liver function and unusual concentration of substances to diagnose gallbladder cancer.
4. Computerised tomography (CT) scan: It is a diagnostic technique that uses X-rays and computerised technology to produce detailed images of the gallbladder and the tumour in the gallbladder.
5. MRI (Magnetic Resonance Imaging): In this, magnetic waves are used to produce detailed images of the gallbladder to check for the disease.
6. Carcinoembryonic antigen (CEA) assay: This test measures the CEA level in the blood released from normal and cancerous cells. A higher level of CEA can be a gin of gallbladder cancer or an unusual disease.
7. Chest X-ray: In this diagnostic technique, electromagnetic waves are used to produce detailed images of the structures inside the chest, including the gallbladder.
8. CA 19-9 Assay: In this level of CA, 19-9 is measured in the bloodstream. A higher level can be a sign of gallbladder cancer.
9. Endoscopic Retrograde Cholangiopancreatography: An endoscope is passed through the mouth, and then the catheter is inserted through the endoscope into the bile ducts. A dye is injected into the catheter. The doctor then takes many X-rays. It assists the doctors to examine the inside of the organs and check for abnormalities. 
10. Biopsy: A small part of the tissue is removed from the gallbladder and examined under the microscope to diagnose cancer.
11. Laparoscopy: The surgeon makes several minor incisions in the abdomen wall, and a laparoscope is inserted through the incisions. It allows looking inside the organs to check for the signs of the disease. 
12. Percutaneous Transhepatic Cholangiopancreatography: In this diagnostic technique, the needle is introduced through the skin into the liver and dye is injected, and then an X-ray is taken.

The following procedure is used for the treatment of gallbladder cancer:

1. Chemotherapy:  These are the drugs used to kill or shrink cancerous cells. These drugs also reduce the chances of cancer spreading from the gallbladder to other body parts. It is usually administered in combination with radiation or surgery for cancer treatment. It can be administered intravenously or orally for the treatment.
2. Surgery: Surgery is the treatment choice, usually in the early stage of gallbladder cancer. The goal of the surgery is to take out the cancerous cells as much as possible. The options for surgery include:
   1. Surgery to remove the gallbladder: It is carried out when the cancer is confined to the gallbladder only. The complete gallbladder is removed surgically from the body in this procedure.
   2. Surgery to remove the gallbladder along with a  portion of the liver: It is carried out when cancer extends beyond the gallbladder and affects some parts of the liver also. The complete gallbladder, along with the affected portions of the liver and bile ducts, is removed surgically.
3. Radiation therapy: A high-powered beam of energy (such as protons and X-rays) is used to shrink and kill cancerous cells. During the procedure, the doctor will instruct you to lie down on the table, and then the machine is moved over you, which ejects the energy beam.
4. Immunotherapy: In this, drugs are used which prepare the immune system to fight against cancer. The cancer cells evade the immune system by producing certain proteins. Immunotherapy interferes with this process of producing proteins and makes the cancer cells vulnerable to the immune system. 
5. Targeted therapy: The oncologists generally implement this treatment strategy in case of advanced gallbladder cancer. It involves the use of medications that interferes with the vital process specific to cancerous cells. Targeted therapy has fewer side effects than chemotherapy due to specificity to cancerous cells.