What are the symptoms?
Gallbladder cancer rarely produces signs and symptoms in the early
stages. When symptoms do appear, they often resemble those of
other, more common, gallbladder problems, such as gallstones or
infection.
The signs and symptoms include:
* Abdominal pain
* Nausea and vomiting
* Jaundice results from high blood levels of bilirubin. Normally,
bilirubin is metabolised in the liver and eliminated through the
bile ducts. But a blocked bile duct can cause bilirubin to
accumulate in the blood.
* Loss of appetite or weight
Jaundice is the most common initial sign of bile duct cancer (cholangiocarcinoma).
Other signs and symptoms include:
* Enlarged gallbladder
* Intense itching (pruritus)
* Brown coloured urine
* Loss of appetite and weight
* White or clay-coloured stools
* Fever
How is the diagnosis made?
Many gallbladder cancers are discovered when a pathologist
examines a gallbladder that has been removed for symptoms of
gallstones. But many gallbladder and most bile duct cancers are
found only after related signs and symptoms appear. The doctor
conducts a physical exam and the following tests:
1. Blood tests: This is to check for elevated levels of bilirubin
or the enzyme alkaline phosphatase.
2. Ultrasound: Ultrasound is usually one of the first tests done
in the evaluation of patients with jaundice and is especially good
at diagnosing the presence of gallstones and obstructed bile
ducts. It can also show the presence and extent of tumours.
3. CT scan: This helps determine if cancerous cells have spread to
the common bile duct, lymph nodes or the liver.
4. MRI: This test uses a powerful magnetic field and radio waves
to create images and can help determine whether the flow of bile
is blocked or a tumour has invaded the liver.
5. Endoscopic retrograde cholangiopancreatiography (ERCP): This
test is most sensitive for detecting an obstruction of the bile
ducts and its cause, and can also be used in preparation for
surgery. ERCP can also allow a biopsy to be performed, confirming
a diagnosis.
6. Laparoscopy: This is often used to confirm how far the cancer
has spread.
7. Biopsy: In this procedure, a small sample of tissue is removed
and examined for cancerous cells under a microscope. It is the
only way to make a definitive diagnosis of cancer.
What is the treatment?
Treatment for biliary tract cancers depends on the type and stage
of cancer as well as on the patient’s age and overall health. The
goal of treatment is to completely eliminate the cancer.
Unfortunately, this is often not possible and the focus may need
to be changed to treating the signs and symptoms the cancer is
causing or preventing the tumour from causing more harm.
* For gallbladder cancer: Surgical removal of the gallbladder
usually offers the best hope for people with gallbladder cancer.
If the tumour is very small and has not spread to the deeper
layers of the gallbladder tissue, the surgeon may perform a simple
cholecystectomy, which removes only the gallbladder. If the cancer
is more advanced, some liver tissue and nearby lymph nodes are
removed along with the gallbladder.
* For bile duct cancer: Surgery usually offers the best chance for
people with bile duct cancer. But the type of surgery varies
depending on the location of the cancer and how extensive it is.
For example, removing the affected part of the liver treats
tumours that are within the liver. Tumours that develop where the
hepatic duct leaves the liver (perihilar tumours) are usually
treated by surgically removing a portion of the bile duct, the
gallbladder, and parts of the liver, pancreas and the small
intestine.
What are the complications?
A tumour that blocks the bile duct can cause pain, jaundice,
nausea and vomiting. Tumours located where the pancreatic duct
enters the small intestine may block the small intestine,
preventing normal passage of food. Tumours may make it difficult
to digest and absorb nutrients from the food by blocking the flow
of the pancreatic enzymes. The most serious complication of
biliary tract cancer is metastasis. Since biliary tract cancers
are rarely discovered in the early stages, they often tend to
spread to the other organs around the gall bladder, including
liver, stomach, pancreas and intestines or to the nearby lymph
nodes.
Gallbladder Cancer Symptoms
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