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Gallbladder Cancer

One of the most common diseases of the gallbladder is gallstones and the other is tumors. Gallbladder cancer is the 5th most common cancer that can develop in the digestive system. Because the body can survive even when the gallbladder does not function, its symptoms can usually be noticed when gallbladder cancer is very advanced. Gallbladder cancer, which is mostly seen in people aged 60 and over, can progress very quickly if precautions are not taken. Therefore, early diagnosis in gallbladder is very important as in all other cancers.

What is Gallbladder Cancer?

Gallbladder cancers are malignant tumors that arise especially from the wall of the bladder. Polyps in the gallbladder, gallbladder inflammation, obesity, some chemicals such as nitrosamines may be the main causes of gallbladder cancer. Gallbladder cancer, which can be diagnosed much more easily in people with gallstones, is caught in an advanced stage when it starts to show symptoms for different reasons.

Gallbladder Cancer Symptoms

Gallbladder cancer is a very insidious type of cancer, although it is more common in people aged 60 and over. Since the patient can survive without the gallbladder function, he may not show many symptoms or his symptoms may point to different diseases.

Among the symptoms of gallbladder cancer are often;

  • Jaundice,

  • Stomach ache,

  • digestive problems,

  • nausea, vomiting,

  • food intolerance,

  • Weakening,

  • Dark urine, white stools are observed.

The most important symptoms of advanced gallbladder cancer are jaundice, a feeling of a large mass in the abdomen and the area where the gallbladder is located, and pain. Gallbladder cancer symptoms usually make themselves felt 3-6 months before the onset of the disease. In some patients, gallbladder cancer may occur after 1 year of gallbladder-related disorders. Jaundice without any symptoms is also considered a sign of gallbladder cancer by itself. 75% of gallbladder cancer is seen in women, and stones in the gallbladder are detected in 80% of these patients. If the stones are larger than 3 cm, the risk of gallbladder cancer is also increased. If any of the symptoms of gallbladder cancer are noticed, it is necessary to apply to the General Surgery department of a fully equipped hospital as soon as possible.

Risk Factors For Gallbladder Cancer

Gallbladder cancer risk factors include gallbladder polyps and gallbladder disease called “porcelain gallbladder”. Obesity, unhealthy diet and exposure to chemicals such as nitrosamines are also considered important risk factors. In addition to these, recurrent infections in the biliary tract are also considered as one of the factors that cause gallbladder cancer. Infections progress with jaundice, fever and pain complaints occur, the patient applies to the hospital when the attacks are severe. Although its relationship with cancer has not been proven, it is recommended that patients with gallbladder stones should not delay their controls and have regular follow-up. 

Does Gallbladder Stone Cause Cancer?

The presence of gallstones in more than 90% of patients with gallbladder cancer has been proven by studies. However, although this situation has revealed the opinion that cancer can occur by being affected by gallstones, the opinion that "Gallbladder stones cause cancer" is not certain. Only the close association of gallstones and cancer has created suspicion for years. Cancer is the last among the diseases caused by gallstones. Gallstones cause infection, obstruction in the biliary tract, jaundice and pancreatic inflammation before cancer.

Diagnosis and Stages of Gallbladder Cancer

It is very important to diagnose gallbladder cancer at an early stage. According to the symptoms seen in the patient, imaging methods such as ultrasound, tomography and MRI are used. As in many types of cancer, the definitive diagnosis of gallbladder cancer is made by biopsy after advanced imaging techniques. Diagnostic methods; It is determined according to the patient's health status, age, signs of disease and previous test results.

These methods are used for the diagnosis of gallbladder cancer:

Blood tests: For the diagnosis of gallbladder cancer, it is necessary to measure the abnormal levels of bilirubin and other substances in the blood.

Ultrasound: It is the use of sound waves to check for tumors in the body. Cancerous tissues present different sound waves compared to normal tissues.

Computed tomography (CT) scan: A three-dimensional image of the body is obtained with a CT scan . It is checked for a tumor or any abnormality. It also provides an understanding of the size of the tumor.

Magnetic resonance imaging (MRI): With MRI, it can be learned whether the cancer has spread outside the gallbladder and the size of the tumor.

Biopsy: A definitive diagnosis can be made by biopsy, which is performed by examining a small tissue sample under a microscope. Biopsy can be performed with minimally invasive surgical technique or with fine needle or coarse needle aspiration. Computed tomography and endoscopy can also be used.

Endoscopic retrograde cholangiopancreatography (ERCP): The inside of the body is visualized with an endoscope instrument inserted down the patient's esophagus into the stomach and small intestine. A small tube or catheter is passed through the endoscope and into the bile ducts. Rather, it is more commonly used for the diagnosis of bile duct cancer. It is also used when gallbladder cancer has spread and blocked the bile ducts.

Percutaneous cholangiography: In this imaging method, a dyed needle and a thin needle are inserted through the skin into the gallbladder area in order to create a clear image on the x-ray. By looking at the X-rays, it can be understood whether there is a tumor from the gallbladder.

Laparoscopy: To look at the gallbladder and other internal organs, the endoscope is inserted into the abdomen through a small incision and imaging is performed.

Endoscopic ultrasonography (Endosonography): A more comprehensive and special endoscope can reach the stomach and intestines starting from the mouth with sedation.

Positron emission tomography (PET) scan: A PET scan is a way to create images of organs and tissues inside the body. In this way, it can be determined to which organs an existing tumor has spread in the body and the cancer can be staged.

Gallbladder stages can be defined as follows:

Stage 1: In-situ carcinoma, gallbladder tumor localized only intramuscularly.

Stage 2: The tumor has only involved the muscular layer of the gallbladder.

Stage 3: All layers of the wall of the gallbladder are faced with cancer tumor. The ductus cysticus lymph nodes may or may not be involved.

Stage 4: At this stage, gallbladder cancer has spread to the liver and other adjacent organs. There is involvement in the bile ducts and other lymph nodes.

Gallbladder Cancer Treatment

Gallbladder cancer treatment is based on surgical removal of the tumor. It may also be necessary to remove part of the liver during treatment, which consists of a major surgery. Since the diagnosis of gallbladder cancer is usually made at an advanced stage, patients often do not have the chance to undergo surgery. However, cancer that is detected early ensures successful treatment of gallbladder cancer. Some endoscopic procedures, pain treatment, percutaneous drainage (radiological intervention) can be performed to relieve jaundice and pain in patients with advanced disease that cannot be operated. Hot chemotherapy and some smart drugs that are being developed recently can also affect the progression of the tumor.

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