Gallbladder cancer refers to malignant tumors originating from the gallbladder; from the histological classification, adenocarcinoma accounts for the highest proportion (more than 80%), followed by squamous carcinoma, mixed carcinoma and undifferentiated carcinoma; because of its high malignancy, easy early metastasis, difficult early detection and insensitivity to chemotherapeutic drugs, patients diagnosed with gallbladder cancer before surgery have poorer long-term outcome than liver cancer and pancreatic cancer.
Causes
Gallbladder cancer is often observed to coexist with benign gallbladder disorders, most commonly gallbladder stones (accounting for more than 80% of cases). Therefore, most scholars believe that chronic irritation of gallbladder stones is an important causative factor. There are also some gallbladder cancers secondary to cancer of larger gallbladder polyps.
Disease symptoms
The symptoms of gallbladder cancer are generally manifested as the following.
1.Gastrointestinal symptoms: Most of the patients (90%) have indigestion, aversion to greasy belching and reduced appetite, which is due to incomplete gallbladder function and cannot digest fatty substances.
2, right upper abdominal pain: more than 80% of patients due to the combination of gallbladder stones, thus showing similar symptoms to gallbladder stones cholecystitis, with right upper abdominal discomfort followed by persistent vague or dull pain, sometimes with paroxysmal sharp pain and radiation to the right shoulder.
3. Right upper abdominal mass: About half of the patients present with a mass in the right upper abdomen or epigastrium, mostly an enlarged gallbladder.
4.Jaundice and skin itching: often appear in the late stage of the disease, due to the bile duct obstruction caused by the invasion of cancer tissue into the bile duct or the compression of the bile duct by metastatic enlarged lymph nodes.
5, fever and wasting: about 25% of patients have fever, mostly due to secondary biliary tract infection. Advanced patients are often accompanied by wasting and even cachexia.
Auxiliary examination
1.Ultrasound examination: Ultrasound examination is simple, non-invasive and can be used repeatedly, and its diagnostic accuracy rate reaches more than 90%, which is the first choice for diagnosing gallbladder disease. With the continuous replacement of instruments, it is now possible to clearly observe not only the size of the gallbladder lesion, but also the blood flow of the lesion tissue to help determine whether cancer has occurred, and to observe whether there are obvious lymph node metastases and whether the liver is involved, and experienced examiners can even determine which layer of the gallbladder is involved in the lesion.
2.CT scan: CT scan is not as good as ultrasonography in the diagnosis of early gallbladder cancer. However, for patients with highly suspicious gallbladder cancer detected by ultrasound examination, enhanced CT examination is necessary.
3.Magnetic resonance imaging (MRI): MRI is generally not the first choice or necessary examination for gallbladder cancer, but can be considered when it is necessary to determine whether the lesion involves the liver or when the patient has obstructive jaundice; its accuracy rate is similar to that of CT, but it has the advantage of no radiation damage and can be repeated several times.
4.PET-CT: As a relatively qualitative test, it can help to make a qualitative diagnosis of occupying gallbladder lesions and determine the presence of lesions other than the gallbladder if acute cholecystitis is excluded, but it is more expensive and prone to false-positive results when combined with acute cholecystitis, so it is generally not done as a routine test.
5.Laboratory examination: When gallbladder lesion becomes cancerous, it will be accompanied by the increase of tumor marker level. Checking whether serum tumor markers (CEA, Ca125, Ca19-9, Ca724, Ca153, etc.) are elevated is helpful for qualitative diagnosis of gallbladder cancer, but early stage cancer may not show elevation, or when combined with other gastrointestinal diseases and certain tumors, the test may have false positive results. Liver function tests are usually normal, with abnormalities only in the presence of biliary tract obstruction.
Disease diagnosis
Early symptoms are very atypical and diagnosis is difficult. Most patients have clinical manifestations similar to chronic cholecystitis and cholelithiasis. The main symptom is right upper abdominal pain, radiating to the right scapula, accompanied by loss of appetite, weakness, abdominal distension, low fever, nausea and jaundice. For female patients over 40 years old with long-term history of chronic cholecystitis and cholelithiasis, if the nature of pain changes from paroxysmal attacks to continuous dull pain in the right upper abdomen with progressive aggravation, local palpable gallbladder mass, progressive jaundice and significant wasting, gallbladder cancer should be considered.
In the advanced stage of gallbladder cancer, there may be liver enlargement, liver occupancy, ascites and cachexia, which are easily confused with liver cancer, pancreatic cancer and bile duct cancer, etc.
Most of the cases show weight loss, weakness and malignant physique soon.
In some cases, metastatic lymph nodes can be palpated on the clavicle, and metastatic masses can also be found in the breast and other places.
In advanced cases, there may be gastrointestinal bleeding, ascites and liver failure due to portal vein compression.
In summary, when ultrasound examination reveals occupying lesions or irregular thickening of gallbladder wall, further laboratory tests and examinations are needed to clarify whether gallbladder cancer exists.
Disease Treatment
Surgery: Surgery is the preferred treatment for early-stage gallbladder cancer. As long as the general condition of the patient permits, surgery should be performed to remove the diseased gallbladder as much as possible, and whether to perform extended removal surgery should be decided according to the pathological results. It is generally believed that when the lesion involves the muscular layer of the gallbladder, extended debulking surgery should be performed, including removal of liver tissues near the gallbladder bed and soft tissues of the hepatoduodenal ligament and debulking of lymph nodes draining the gallbladder area.
The treatment of advanced gallbladder cancer should be analyzed on a case-by-case basis. It is generally believed that the long-term survival rate of patients with lymph node metastasis will not be significantly improved if they undergo extended resection.
Drug therapy: The known chemotherapeutic drugs are not ideal for gallbladder cancer, but drugs for digestive tract tumors can be used as a reference. Immune-enhancing drugs can be used as important adjuvant drugs for gallbladder cancer.
Radiation therapy: For local residual or recurrent lesions, radiation therapy can control their growth rate and relatively prolong the survival time of patients.
Other treatments: Traditional Chinese medicine and maintaining a good state of mind can help enhance patients’ confidence in fighting with the disease and help improve the quality of survival.
Treatment of complications: Patients with advanced gallbladder cancer can have various complications, and taking corresponding treatment measures according to different complications can help improve the quality of survival and prolong the survival time.
Disease prevention
Regular ultrasound examination is the key to early detection of gallbladder cancer, and the incidence of gallbladder cancer can be significantly reduced by closely observing the changes of the detected gallbladder lesions and taking timely measures to remove the lesions when necessary.
Expert opinion
With the continuous improvement and popularization of ultrasound instruments, gallbladder lesions can be detected at an early stage and the incidence of gallbladder cancer can be greatly reduced with timely treatment. The prognosis of early cancer is good through correct treatment. However, the treatment effect of middle and late stage gallbladder cancer is very unsatisfactory. Some patients miss the opportunity of early treatment and the lesion progresses to advanced cancer, at this time, overly aggressive treatment cannot bring benefits to patients, and sometimes not only cannot prolong the survival time, but also reduce the quality of survival and shorten the survival time.