Gallbladder Cancer

Overview

The liver is the largest internal organ in our body. It performs more than 500 different vital functions. One of which is the liver acts like a detoxifier of the body, helping the body to get rid of toxins. It has a system of tubes within it called the bile ducts which collects a chemical called bile that is produced by the liver. Bile is needed by us to help us to digest fat, along with the help of enzymes produced by the pancreas. This bile is transported by the bile ducts into a main tube outside the liver called the common bile duct, which connects the liver to the small intestine (duodenum). The gallbladder is a small bag-like organ that is attached to the common bile duct. Its function is to store excess bile.

Gallbladder cancer is cancer arising from the cells of the inner lining of the gallbladder. The scientific medical term for this cancer is gallbladder adenocarcinoma. It is an uncommon cancer. There are certain parts of the world where this cancer has a slightly higher incidence, like Central and South America, Central and Eastern Europe, and Northern India.

If detected at an early stage, the chance for a cure is good. However most gallbladder cancers are discovered at a late stage, when the cancer has already spread.

Symptoms

By the time symptoms appear, the cancer is usually at an advanced stage. Symptoms include:

  • Abdominal pain, usually at the right upper part of the abdomen
  • Jaundice (yellowing of the skin and the whites of the eyes)
  • Weight loss
  • Loss of appetite
  • Abdominal bloating or distension

When to Seek Treatment

There are 3 scenarios where persons with gallbladder cancer can present to the doctor.

The first are those who have their gallbladder removed because of gallstones. As gallstones are very common, keyhole removal of the gallbladder is one of the most common operations performed all over the world. After the operation, the gallbladder will be sent for examination under the microscope (pathology examination). In rare occasions, gallbladder cancer is detected incidentally through this.

The second scenario is those who have gone for some form of medical check-up and were found by chance to have some abnormalities.

This may include elevation of cancer markers, in particular CA 19-9. Or there may be abnormalities in the liver function test.

Or they may have gone for some scans, like an ultrasound scan or CT scan, and were discovered to have a growth in the gallbladder.

The last scenario will be those who complained of one or more symptoms listed above.

Diagnosis

The doctor would usually order a specialized scan such as the CT scan or the MRI scan. He may also order a cancer marker, called CA 19-9. Sometimes the doctor may perform a diagnostic laparoscopy, during which he inserts a tiny telescope into the abdomen to check for cancer spread. Because gallbladder cancer can spread quickly, doctors would want to do a PET scan to stage the cancer before performing any complex operation.

Treatment

Treatment will depend on how advanced the cancer is and the health of the patient. Surgery offers the best chance of a long-term cure. Surgery may just involve removing the gallbladder only, but this is only applicable to the earliest cancer stage. If not, surgery usually involves removing the gallbladder and a portion of the liver next to the gallbladder.

If surgery is not possible, other treatment options include chemotherapy and radiation therapy.

Causes

Cancers, including cancer of the gallbladder, are due to genetic mutations of the cells.

As a result of these gene mutations, the gallbladder cells start to multiply uncontrollably. These cells also have the ability to detach from the gallbladder and invade into the bloodstream and spread to other parts of the body, or invade into the adjacent organs around the gallbladder.

As the wall of the gallbladder is very thin, cancer of the gallbladder can quickly penetrate through the wall and spread to the liver or to the rest of the abdomen.

Risk Factors

What are the risk factors of developing gallbladder cancer?

  • Female gender – tends to be more common amongst females
  • Older age
  • Gallstones, especially large stones >3cm
  • Gallbladder polyps, especially those which are larger than 1cm or sessile in shape
  • Chronic inflammatory condition of the gallbladder, called porcelain gallbladder. This is usually associated with gallstones

Consult Our Doctors

Dr Ho Choon Kiat
Senior Consultant HepatoBiliary, Pancreas & General Surgeon

MBBS (Singapore), FRCS (Edin), FRCS (Glasg), M.Med (Surgery), FRCSEd (Gen), FAMS (Surgery) Adjunct Assistant Professor, NUS Yong Loo Lin School of Medicine

Dr Chan Chung Yip
HepatoBiliary, Pancreas & General Surgeon

MBBS, MMed(Surg), FRCS(Edin), MD, FAMS

Consult Our Doctor

Dr Ho Choon Kiat
Senior Consultant HepatoBiliary, Pancreas & General Surgeon

MBBS (Singapore), FRCS (Edin), FRCS (Glasg), M.Med (Surgery), FRCSEd (Gen), FAMS (Surgery) Adjunct Assistant Professor, NUS Yong Loo Lin School of Medicine

FAQs

Avoiding standing still for long periods will reduce the pressure in the veins in the legs. For people who need to stand for long periods at work, wearing compression stockings will reduce the pressure build up in the legs.

The ultrasound will be done of the legs from the thigh to the calves. Please wear or bring along a pair of shorts to change into for the scan.

Have a question or need a second opinion?