Symptoms | Gall bladder cancer

Symptoms

In most cases, no symptoms appear in the early stages, which is why the disease does not attract attention until it is at an advanced stage. The initial symptom is usually painless jaundice (icterus), which is caused by the narrowing of the bile ducts through the tumor, causing the bile to accumulate in the liver. The symptoms of icterus are a yellowing of the skin and the white color of the eyes (sclera) and a stressful itching due to deposited bile salts in the skin.

In addition, there is a loamy discoloration of the stool due to the lack of bile pigment and a dark coloration of the urine, since the kidney takes over the excretion of the bile pigment. Due to the absence of the bile acids in the small intestine, fats can be digested more poorly, which can lead to intolerance to fatty meals and to fatty stools (steatorrhea). Very rarely, pain can also occur in the right arm, as the pain is projected into this area because this is where the gallbladder has its “dermatome“, the area where we feel pain when something is wrong with the organ.

If the outflow from the gallbladder is prevented, in addition to the painless icterus, a bulging gallbladder can be palpated under the right costal arch. This symptom complex is also known as the Courvoisier ́sches sign. Other symptoms can be unspecific, diffuse upper abdominal pain, nausea, vomiting, loss of appetite and digestive problems.As late symptoms, pain in the right upper abdomen can be added, as well as other non-specific symptoms that can occur in most cancers, such as weight loss (tumor cachexia), anemia, fatigue and listlessness. –>

Tumor spread (metastasis)

Different forms of metastasis can be described:

• Lymphogenic metastasisThe lymph vessels drain lymph fluid from all parts of our body, especially the gallbladder has an excellent lymph supply. When the tumor connects to a lymph vessel through its growth, it is easy for some cells to detach from the tumor cell cluster and be carried along with the lymphatic flow. There are numerous lymph nodes in the course of a lymph vessel.

  They are the seat of the immune system, which has the task of intercepting and fighting germs (bacteria). The tumor cells settle in the nearest lymph nodes and multiply there again. This leads to a lymph node metastasis.

  This type of cancer affects lymph nodes in the immediate vicinity and later also those in the course of the main artery (aorta). This type of cancer is characterized by very rapid lymphogenic metastasis, so that it is always advisable to remove the surrounding lymph nodes during surgical bile removal.

• Hematogenous metastasisWhen the tumor grows and connects to a blood vessel, cells can break free and be scattered throughout the body via the bloodstream (hematogenous). The first station is the blood flow through the liver, where the carcinoma cells can settle and form daughter tumors (distant metastases).

  As the disease progresses, cells can also detach from the liver metastases and spread further into the lungs. Later on, metastases may spread into the peritoneum, which is also called peritoneal carcinosis, as well as into the ovaries, skeletal system or spleen.

• Per continuitatemThe tumor can invade other neighboring organs on its path of spread (tumorous infiltration). This is often the case with gallbladder cancer (gallbladder carcinoma) at the time of diagnosis. For example, gallbladder cancer can grow into the liver, duodenum, pancreas and other adjacent structures.