Gallbladder Cancer

Introduction

The gallbladder is a small, pear-shaped organ on the right side of the abdomen, just beneath the liver. The gallbladder stores bile, a digestive fluid produced by the liver. It is connected to the rest of the biliary tract by a duct called cystic duct. (Fig 1). When gallbladder cancer is discovered at its earliest stages, the chance for a cure is very good. But most gallbladder cancers are discovered at a late stage, when the prognosis is often very poor. (Fig 2

Symptoms

IN many patients, the diagnosis of gallbladder cancer is made after the first surgery

• Abdominal pain, particularly in the upper right portion of the abdomen
• Abdominal bloating
• Fever
• Loss of weight
• Nausea
• Yellowing of the skin and whites of the eyes (jaundice)

Risks

• Gallstones: Gallstones are the most common risk factor for gallbladder cancer. Gallstones are pebble-like collections of cholesterol and other substances that form in the gallbladder and can cause chronic inflammation. Up to 4 out of 5 people with gallbladder cancer have gallstones when they’re diagnosed.
• Porcelain gallbladder: Porcelain gallbladder is a condition in which the wall of the gallbladder becomes covered with calcium deposits. People with this condition have a higher risk of developing gallbladder cancer, possibly because both conditions can be related to inflammation.
• Female gender: Gallbladder cancer occurs 3 to 4 times more often in women than in men.
• Obesity
• Older age: Gallbladder cancer is seen mainly in older people, but younger people can develop it as well.
• Ethnicity and geography: Gallbladder cancer is extremely common in Asia, especially in North India and neighbouring Pakistan, Nepal
• Choledochal cysts: Choledochal cysts are bile-filled sacs along the common bile duct, the tube that carries bile from the liver and gallbladder to the small intestine. The cells lining the sac often have areas of pre-cancerous changes, which can progress to gallbladder cancer over time.
• Abnormalities of the bile ducts: Certain congenital abnormalities like pancreatobiliary malunion may increase the risk of gallbladder cancer.
• Gallbladder polyps: A gallbladder polyp is a growth that bulges from the surface of the inner gallbladder wall. Polyps larger than 1 centimeter are more likely to be cancer.
• Primary sclerosing cholangitis: Primary sclerosing cholangitis (PSC) is a condition in which inflammation of the bile ducts (cholangitis) leads to the formation of scar tissue (sclerosis). People with PSC have an increased risk of gallbladder and bile duct cancer.
• Typhoid: People chronically infected with salmonella (the bacterium that causes typhoid) and those who are carriers of typhoid are more likely to get gallbladder cancer.
• Family history: A history of gallbladder cancer in the family seems to increase a person’s chances of developing this cancer.
• Other possible risk factors: Smoking, exposure to chemicals used in the rubber and textile industries, exposure to nitrosamines