Gallbladder Cancer
T. Clark Gamblin, MD, MS, Medical College of Wisconsin cief surgical oncologist explains gallbladder cancer and how it is managed:
Cancers that
begin in the cells that line the inside of the gallbladder are called gallbladder cancer. These cancers may
be found because a person develops symptoms such as abdominal pain, bloating or yellow skin (jaundice), or they can found unexpectedly in a gallbladder that is removed for other reasons.
Up to 1% of gallbladders removed for non-cancerous causes are found to have a cancer within it.
Gallbladder cancer is rare in the United States, but very common in certain parts of the world including South America, Japan and India. The major risk factor for developing gallbladder cancer is gallstones.
Women are about three times more likely than men to develop gallbladder cancer. This is thought to be related to the hormone, estrogen, which can lead to gallstones. Obesity has been shown to be a risk factor for gallbladder cancer in many studies, perhaps because obesity is also a risk factor for gallstones.
Gallstones
Gallstones are found in over three quarters of patients with gallbladder cancer. However, only about 0.5-3% of individuals who have gallstones, develop gallbladder cancer.
High rates of gallstones are found in certain populations. For instance, the Pima Indians in Arizona often develop gallstones at an early age, and have high rates of gallbladder cancer. Similarly, the Arecunian and Mapuche Indians who live in Chile, and people in Northern India and Pakistan also have a high rate for developing gallstones. These regions have some of the highest rates of gallbladder cancer in the world. The reasons some people develop gallbladder cancer and some do not are not yet well understood.
Staging Gallbladder Cancer
Based on the level of tumor growth into the gallbladder wall, cancers can be classified as T1 when they infiltrate the mucosa or the tunica muscular (T1b) and as advanced when they infiltrate the subserosa or beyond the serosa and/or infiltrate the hepatic tissue (T2-T4).
The T (tumor) stage is very important for determining further treatment that may be recommended, for predicting the chance that the gallbladder cancer will return (recur). The wall of the gallbladder is very thin and leaky, and cancer cells can easily leave the gallbladder wall and spread to adjacent liver and lymph nodes.
Tumor dissemination (spread) takes place predominantly by lymph node pathways but also by local extension towards the liver. This is important information regarding the biological behavior and progression of this tumor.
Patients with gallbladder cancers that are found unexpectedly may require a second operation depending on how deeply the tumor has grown through the wall of the gallbladder. Tumors that have not invaded the muscle of the gallbladder (T1a) may not require further surgery as long as there are no other adverse factors. Tumors that invade into, but not through, the muscle (T1b) may benefit from further surgery although this is somewhat controversial and should be considered in discussion with surgeons and oncologists. Tumors that invade through the muscle (T2) and into other organs such as the liver (T3) should be considered for further definitive surgery.
The extent of the surgery that is considered “definitive” is controversial and may depend on various factors such as tumor stage, location and patient’s characteristics. Surgery for gallbladder cancer usually involves removal of the gallbladder as well as the adjacent liver and lymph nodes, and may require removal of the bile duct as well.
Last Updated on 2/14/2012 8:43:00 PM