Is Gallbladder Cancer Aggressive?

Gallbladder cancer (GBC) usually spreads locally to the liver and adjacent organs.

Gallbladder cancer (GBC) is one of the aggressive cancers of the biliary tract. The gallbladder is a pear-shaped organ under the right lobe of the liver. The gallbladder generates and concentrates bile that aids in the digestion of fats. GBC is a rare, yet deadly cancer of the gastrointestinal tract. It is considered lethal because it is asymptomatic in a majority of patients. In others, symptoms are merely vague which is why the cancer is frequently diagnosed at an advanced stage, typically with an extremely bad outlook. GBC ranks fifth among gastrointestinal cancers. GBC usually spreads locally to the liver and adjacent organs.

The overall survival rate for patients with GBC is six months, if not treated. GBC staging includes

• Stage 0: The cancer is small and found only in the epithelial (innermost) layer of the gallbladder. It has not spread to the lymph nodes or other places in the body.
• Stage I (stage 1 GBC): The cancer is still localized within the gallbladder, but the tumor has begun to penetrate into the lamina propria and muscle layer (the second and third layers of the gallbladder).
• Stage II (stage 2 GBC): The cancer is still localized within the gallbladder, but has now penetrated the deeper layer of the perimuscular fibrous tissue. It has not spread to the nearby lymph nodes or other organs.
• Stage III (stage 3 GBC): This stage is divided into two subcategories
  • Stage IIIA: Cancer has extended through the serosa (the outermost layer of the gallbladder) and/or may have extended into the liver or another nearby structure. However, it has not spread to the nearby lymph nodes or more distant organs.
  • Stage IIIB: The cancer cells have spread to the nearby lymph nodes, but the tumor has not spread into the blood vessels leading to the liver or more than one nearby organ other than the liver. Cancer has also not reached distant organs.
• Stage IV (stage 4 GBC): This stage is divided into two subcategories
  • Stage IVA: Cancer has spread into the blood vessels leading to the liver and/or has extended to a nearby organ other than the liver. Cancer cells may have reached the nearby lymph nodes, but they have not reached the distant organs.
  • Stage IVB: Cancers at this stage are the most advanced. Cancer cells have either spread to the lymph nodes farther away from the gallbladder or have spread to distant organs.

The common symptoms of gallbladder cancer (GBC) include

• Abdominal pain 
• Vomiting 
• Jaundice (yellow eyes, skin, and urine) 
• Recurrent fevers
• Larger gallbladder
• Loss of appetite 
• Unexpected weight loss
• Swollen abdominal area
• Severe itching
• Black tarry stool

Common risk factors include

• It is more common in people over the age of 75 years old
• Patients with a history of gallstones or cholecystitis (an inflamed gallbladder) have a high risk.
• Polyps are benign (noncancerous) tumors of the gallbladder that may later become malignant.
• People with calcium buildup in the wall of the gallbladder are at an increased risk of gallbladder cancer (GBC).
• Gallbladder cancer may be common in people born with abnormal bile ducts.
• People with unhealthy lifestyles such as those who smoke, those who have a poor diet, and those who are obese have an increased risk of GBC.
• Close relatives (a parent, brother, or sister) of people with gallbladder cancer have a high risk of GBC.

Treatment for gallbladder cancer may include

• Surgery: It can be used to remove the gallbladder. If cancer has spread, then surgery can also be used to remove the surrounding tissue, lymph nodes, and parts of other organs.
  • Cancer found in the wall of the gallbladder can be completely removed by surgery.
  • Unresectable cancer cannot be removed completely by surgery. Most patients with gallbladder cancer (GBC) have unresectable cancer.
  • Recurrent cancer is cancer that has recurred (come back) after it has been treated. GBC may come back in the gallbladder or in other parts of the body.
• Chemotherapy: This usually uses cytotoxic drugs to destroy the cancer cells.
  • For gallbladder cancer, it may be used after surgery if the surgeon cannot remove all cancer.
  • It may also be used if surgery is not possible or if cancer has come back after surgery.
  • The chemotherapy drugs most commonly used are Gemzar (gemcitabine) and cisplatin.
• Radiotherapy: This uses high-energy rays to destroy cancer cells.
  • It may be used to relieve symptoms of gallbladder cancer has spread.
• Stents: If cancer is blocking the bile duct, this can often be treated with a flexible plastic or metal tube called a stent. The stent holds the duct open, so it is no longer blocked.