Gallbladder Cancer

Diagnostics Tests For Gallbladder Cancer

Clinical History and examination: The doctor will ask for symptoms such as pain in the abdomen, bloating, fever, weight loss, nausea and jaundice as well as do an abdominal examination.

Biopsy: A biopsy is a tissue sample removed from the suspicious area and analysed under a microscope. It can confirm the presence or absence of cancer as well as provide key insights for the clinical team to decide the best path forward. The tissue sample could be retrieved during surgery itself, with a fine-needle guided by a CT scan or ultrasound scan or with an endoscope (a thin, lighted, flexible tube) through the mouth.

Endoscopic retrograde cholangiopancreatography (ERCP): This procedure allows the gastroenterologist to look inside the gut. The patient is sedated, and an endoscope is passed through the mouth, down the esophagus, stomach and into the small bowel. A smaller tube is then passed through the endoscope and into the bile ducts to inject a dye. Post this, an x-ray is taken that reveals whether a tumour is present in the area.
Percutaneous cholangiography: A thin needle is inserted through the skin and into the gallbladder area to inject the dye for X-ray visualisation. The clinician will use these films to be able to confirm a gall bladder tumour.

Laparoscopy: This procedure uses an endoscope to look at the gallbladder and other internal organs by passing them through a small incision in the abdomen.
Blood tests: The patient’s blood is collected to check for specific markers of liver or gall bladder related complications. These are chemicals include bilirubin. Bilirubin is a chemical that reaches a high level in gallbladder cancer due to blockage of the ducts by a tumour. Your doctor may also order carcinoembryonic antigen - CEA test or CA19-9 test.

Radiological tests: Computed tomography (CT scan): A CT scan creates takes pictures of the inside of the body using x-rays and combines these images into a detailed, 3D image. Sometimes, a special dye is given before the scan to provide better detail on the image. It is used to measure the tumour size.

Positron emission tomography (PET) scan: A PET scan allows the visualisation of organs and tissues inside the body using a small amount of a radioactive sugar-like substance. This substance is taken up by active cells which are detected when scanned. Tumour cells tend to take up this substance and hence is useful to detect spread (metastasis).

Magnetic resonance imaging (MRI): An MRI uses magnetic fields, not X-rays, to produce detailed images of the body and can be used to find out whether the cancer has spread outside the gallbladder. MRI can be used to measure the tumour’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow. A specialized MRI used for the gallbladder is called MRI cholangiopancreatography. A contrast medium may be given before the MRI to create a clearer picture. Ultrasound: Ultrasound uses sound waves to create a picture of the internal organs and is used by a radiologist to detect a tumour or a suspicious mass inside the body.

Endoscopic ultrasonography: A long flexible endoscope, is inserted through the mouth and reaches the stomach and some of the intestine. It has an ultrasound probe at the end that can be used to look for tumours through an internal ultrasound.

Treatment Of Gallbadder Cancer

The management of cancer depends on various factors, including the stage of the cancer, additional health issues, age etc. Surgery, radiation or chemotherapy may be used.

• Surgery: Gallbladder cancer can be treated surgically, and patients may receive a cholecystectomy, in which the gallbladder and surrounding tissue with the lymph nodes are removed. There are two broad types of cholecystectomy: Simple (only the gall bladder is removed) and Radical (Removes the gall bladder, an inch or more of liver tissue next to the gallbladder, all of the lymph nodes in the region). Sometimes a surgeon may offer patients laparoscopic surgery in cases of simple cholecystectomy in which a video camera and inserted in a small incision along with surgical instruments leading to lesser hospitalisation time and less scarring. However, there is a risk that the cancer cells can spread to these small incisions. as they can be complex. In cases in which the cancer has spread, palliative surgery may be considered. These may include Biliary bypass (removing the tumour blocking the bile duct leading to the collection of bile), Endoscopic stent placement (a thin tube is inserted in cases in which the tumour is blocking the bile duct to drain the bile), Percutaneous transhepatic biliary drainage (When stenting is not possible this procedure connects the liver to a drain bile into the small intestine or a collection bag outside the body.) It is especially advisable to choose surgeons who have expertise in these types of surgeries (cholecystectomy, pre-op biliary drainage, bile duct excision).

• Side effects: Pain, infection, liver failure, bile leakage into the abdomen, problems with digestion etc.
• Radiotherapy: Radiotherapy destroys tumour cells using ionizing irradiation and may be used alone or in combination with chemotherapy, especially prior to surgery or post-surgery in selected patients. Radiotherapy may be external source radiotherapy or internal radiation, which involves injecting tiny microspheres or radioactive material into arteries that supply the tumour. Radiotherapy may be used post-surgery (to kill any cancer that might have been left after surgery) as the main therapy in advanced cancers, or as palliative therapy to help relieve symptoms if the cancer is too advanced to be cured. Side effects: Redness, blisters, nausea, vomiting, diarrhoea, fatigue, liver damage.

• Chemotherapy: This form of treatment that uses drugs to stop the growth of cancer cells and may be taken by mouth or injected into a vein. When the drugs enter the bloodstream and reach cancer cells throughout the body, it is known as systemic chemotherapy. When chemotherapy agent is placed directly into an organ, it affects cancer cells in those areas and is known as regional chemotherapy.

• Palliative care: In patients in whom the cancer has spread too far to be removed by surgery, the management focuses on palliative treatments which deal with the symptoms of the cancer and the side effects of treatment. It also helps patients deal with the anxiety of the cancer prognosis and prepares for end-of-life care.

Sources: National Cancer Institute ; American Cancer Society;