Gallbladder cancer and bile duct cancer (medically also: gallbladder carcinoma, bile duct carcinoma, cholangiocarcinoma) belong to the rarer cancers with a frequency of one percent of malignant tumors. Patients over 60 years of age are predominantly affected, with more women than men.
What is gallbladder cancer?
Gallbladder cancer develops from the mucosa of the gallbladder, while bile duct cancer develops within the bile ducts in the liver due to cell changes. A special form of bile duct cancer is Klatskin tumor, which spreads to the exit site of the intrahepatic bile ducts.
Causes
The causes of gallbladder cancer and bile duct cancer are largely unknown. However, an association with various pre-existing conditions of the liver and intestine is observed. High-risk groups include patients who have gallstones, larger gallbladder polyps, or chronic inflammation of the gallbladder that leads to calcification within the gallbladder (porcelain gallbladder). Liver parasites, salmonella diseases that cause continuous excretion, and chronic intestinal inflammation ulcerative colitis can promote the risk of gallbladder cancer or bile duct cancer.
Symptoms, complaints, and signs
Initially, gallbladder cancer and bile duct cancer do not have any symptoms. Therefore, the disease is often discovered very late. In many cases, the doctor first becomes aware of the tumor because of the so-called Courvoisier sign. The Courvoisier sign includes the two symptoms jaundice and palpable enlargement of the gallbladder. Jaundice is caused by a bile stasis. This causes bile to leak into the blood. The elevated bilirubin levels cause painless jaundice with yellowing of the eyes and skin. The patient also suffers from an excruciating and persistent itching. Furthermore, there is darkening of the urine and discoloration of the stool. The stool appears whitish to gray. The enlarged gallbladder also does not cause pain, although the enlargement can be diagnosed by ultrasound in addition to palpation. Other symptoms include increasing pain in the right upper abdomen, nausea and vomiting. The patient also suffers from loss of appetite and severe weight loss. If the disease is diagnosed after the first symptoms appear, its chances of cure are usually very poor because metastases have already formed by then. The so-called Klatskin tumor, however, has better chances of cure. This form of bile duct tumor produces a bile stasis at an early stage. Therefore, jaundice occurs here already at a stage in which the tumor can still be completely removed.
Diagnosis and course
Diagnosis of bile duct cancer and gallbladder cancer is made by physical examination and a detailed medical history. If the tumor is already very advanced, a pressure-insensitive resistance can also be palpated in the upper abdomen, which is medically referred to as the “Courvoisier sign.” Increased bilirubin levels and other elevated liver enzymes can be detected in the blood. Imaging techniques such as sonography, CT, MRI or endoscopic examinations are used for final diagnosis. Frequently, the diagnosis arises as an incidental finding during surgery in the upper abdomen or gallbladder resection. The 5-year survival rate is less than 20 percent due to increased late detection. Only very small carcinomas and slow-growing Klatskin tumor are considered to have a more favorable chance of cure.
Complications
Gallbladder cancer and bile duct cancer cause the usual symptoms and complications of cancer. A tumor cannot be completely removed in every case. The later the diagnosis and treatment, the higher the risk of the tumor spreading to other regions. In this case, a positive course of the disease cannot be guaranteed and, if necessary, life expectancy may be reduced. Gallbladder cancer and bile duct cancer cause general fatigue and exhaustion in the patient. Those affected usually no longer take an active part in life and also suffer from severe weight loss. Furthermore, there is jaundice and itching, which can develop in all regions of the skin.It is not uncommon for patients to also suffer from abdominal pain, vomiting and nausea. The patient’s quality of life is considerably reduced and limited by these tumors. Complications usually do not occur during the treatment itself. Gallbladder cancer and bile duct cancer can be removed with the help of surgical procedures or radiation therapy. However, complete removal is not possible in every case. If the tumor has already spread to other areas of the body, complete cure is usually not possible.
When should you go to the doctor?
A doctor should be consulted as soon as there is a feeling of pressure in the right side of the upper body. If pain or colic occurs, a doctor’s visit should be made as soon as possible. In case of nausea, vomiting, a general weakness or fever, a doctor is needed. Symptoms such as diarrhea, constipation or a decrease in general performance should also be clarified. If the affected person suffers from a diffuse feeling of illness, inner restlessness, insomnia or irritability, the signs should be discussed with a doctor. Consultation with a medical professional is recommended before taking a painkilling medication. If sudden attacks of pain occur, there is cause for concern. If these are particularly severe, an ambulance should be informed. If there are impairments in coping with everyday tasks or usual leisure activities, it is advisable to consult a doctor. Social withdrawal, increased need for sleep, fatigue or listlessness are also considered unusual. If the health condition worsens because the complaints increase in intensity or other symptoms appear, a check-up with a doctor is necessary. If there is a loss of appetite, noticeable changes in weight or fluctuations in mood, the indications should be examined more closely by a medical professional. In addition, discoloration of the skin or changes in the appearance of the skin indicate diseases that need to be treated.
Treatment and therapy
Gallbladder cancer and bile duct cancer are relatively difficult to treat because of their advanced development. Surgical removal of the gallbladder, extrahepatic bile duct, and possibly part of the liver is therefore the most common method. During surgery, any metastasis to the liver, duodenum, and other organs can also be detected. Subsequent radiotherapy is very rarely performed because of the risk of damaging healthy neighboring organs. Chemotherapy has had little success to date. It is therefore mostly used only for pain relief. Treatment therefore concentrates on palliative therapies, which are intended to enable the patient to continue living as symptom-free as possible. Stents are used to dilate the bile ducts so as not to obstruct the flow of bile and to prevent backflow into the liver. Medical research is still looking into the therapy of so-called “afterloading”. This is a special form of radioactive irradiation that is performed inside the body directly in the bile ducts. Radioactive iridium is delivered to the tumor with a probe in order to stop the primary tumor growth in gallbladder cancer and bile duct cancer. If both therapies cannot be performed because of anatomic conditions, it is possible to use a catheter to drain the bile and collect it outside the body.
Outlook and prognosis
The prognosis of gallbladder cancer and bile duct cancer depends on various influencing factors. It must always be made according to the individual specifications and cannot be regarded as universally valid. The decisive factors for a cure are the progress of the disease, the spread of the tumor cells throughout the organism, the age of the patient and the general state of health of the person affected. The disease occurs more frequently in people over the age of 60. Often other diseases are already present, which weaken the organism as a whole. Since gallbladder cancer and bile duct cancer are usually difficult to treat due to their location, surgical intervention and subsequent cancer therapy are performed. Removal of the gallbladder is an easy procedure in comparison. Nevertheless, the difficulty is to remove all the diseased tissue completely. The cancer therapy prevents the new formation of the cancer cells.At the same time, however, healthy cells are destroyed, which are elementary for the healing process. There is the additional difficulty that only a few methods of cancer therapy can be applied here. A complete recovery is possible. It takes a few years, as the cancer therapy must be successfully completed for this to happen. Since there may be secondary diseases due to the cancer as well as psychological disorders in addition to possible other existing diseases, an unfavorable prognosis takes place in most cases.
Prevention
A specific prevention for bile duct cancer or gallbladder cancer is not known. It is therefore important to pay timely attention to any symptoms that occur and to seek medical attention. In patients who have had gallstones more frequently in the past or belong to high-risk groups, regular monitoring of liver values is advised, possibly in combination with sonographic examinations, in order to detect the occurrence of a malignancy in the gallbladder or bile ducts in good time.
Follow-up
Treatment is followed by constant rehabilitation in a clinic. This is intended to improve quality of life and abolish acute symptoms. The unfavorable long-term prognosis in gallbladder cancer and bile duct cancer leads to regular follow-up examinations. Anamnesis, sonography, elevation of liver values and computer tomography have established themselves as recognized methods. The last imaging procedure is necessary if a recurrence of the disease is to be confirmed or excluded. Control intervals have become established in medical practice. For example, patients should present quarterly during the first three years after a disease. Subsequently, the intervals are extended from semi-annual to annual appointments. The time of diagnosis also determines the intensity of follow-up care. In most cases, gallbladder cancer and bile duct cancer can only be completely surgically removed in the early stages. Then a complete cure is possible. No metastases have developed yet. Statistically, only five percent of most patients live on after five years. This aspect in particular places an extraordinary burden on those affected and their environment. Psychological problems arise with a “life on call”. For this reason, end-of-life care also represents a central instrument of aftercare, in which sufferers can discuss existential issues.
What you can do yourself
Because the causes of gallbladder cancer, as well as bile duct cancer, are still largely unclear, there is insufficient information for comprehensive self-help measures according to the current state of scientific knowledge. Frequently, people do not develop the cancer until the second half of their lives, so that people over the age of 50 in particular belong to the risk group. These people are increasingly recommended to maintain a healthy and conscious lifestyle as a precautionary measure, even if they have already been diagnosed. This includes a balanced diet rich in vitamins. Excessive intake of fats, fiber or sugar should be avoided or reduced. Weight should be kept within the normal range to avoid additional risks of disease. Furthermore, sporting activities and sufficient exercise strengthen the immune system. This leads to a reduction in the general susceptibility to disease. Stress, hectic activity and prolonged emotional strain should be reduced. This may require changes in general lifestyle. A positive attitude towards life, optimistic thinking as well as a stable social environment help in maintaining health as well as in a necessary recovery process. Sleep conditions should also be reviewed and optimized if possible. In addition, the consumption of harmful and toxic substances should be avoided. In particular, the consumption of nicotine and alcohol should be refrained from.
