What are the symptoms of gallbladder cancer?
Unfortunately, gallbladder cancer is not discovered at an early stage. Gallbladder cancer can be difficult to detect during routine physical examinations. Sometimes, gallbladder cancers are found unexpectedly after removal of the gallbladder for other reasons, such as gallstones. When symptoms do occur, they include jaundice (yellowing of the skin and whites of the eyes), abdominal pain, nausea and vomiting, bloating, lumps in the abdomen, and fever.
What tests will I be required to undergo?
- Blood tests such as liver function tests and tumour markers (Serum CEA, serum CA19-9) are useful in patients with gallbladder cancer. It is important to realize that even in patients with gallbladder cancer, these tumour marker levels may be normal. If elevated, they help to support the possibility of cancer. These tests are also useful in the follow-up of patients with gallbladder cancer. If the levels after surgery suddenly begin to rise on follow-up, this could alert the doctor to the possibility that the cancer may have come back.
- Imaging techniques in the form of ultrasound, CT scan, MRI scan, and/or PET scan can provide valuable information regarding the cancer and whether it has spread (stage of the cancer).
- Endoscopic retrograde cholangio-pancreaticography (ERCP) with stenting (a tube is inserted into the bile duct through an endoscope which is inserted through the mouth) is planned if jaundice is present. If an ERCP is not possible and jaundice is present, a percutaneous transhepatic biliary drainage (PTBD) may be performed (a tube is placed into the bile duct through the skin by interventional radiologists). Jaundice is not a good sign and relieving of jaundice is preferable before any definitive treatment is started.
- Biopsy is often required if an operation is not being planned immediately. If the cancer was only detected after your gallbladder was removed, a review of the slides and/or blocks of the gallbladder biopsy specimen, by our own specialized pathologists, is performed to confirm the diagnosis and also acquire additional information if possible.
How will my treatment be decided?
After confirmation of the diagnosis and the essential tests are completed, a fair idea about the stage of the disease can be obtained. Treatment planning is performed by a multidisciplinary team which consists of a surgeon, gastroenterologist, radiation oncologist, intervention radiologist, medical oncologist, and pathologist. Treatment options and recommendations depend on various factors, including the type and stage of cancer, possible side-effects, and the patient’s preferences and overall health.
If the gallbladder has already been removed (laparoscopic/open cholecystectomy) and the tumour is limited to the innermost lining (lamina propria) of the gallbladder, no further treatment is required and regular observation is sufficient. If the tumour extends beyond this layer, another larger operation is usually required. If the tumour has extended beyond the gallbladder and an operation is not feasible, chemotherapy or chemo-radiotherapy is an option that may be considered. At times, an operation is possible after chemotherapy/chemo-radiotherapy if sufficient tumour shrinkage takes place. This situation is often dealt with in the setting of a possible clinical trial.
What type of operation will be performed?
Complete removal of the cancer is the best and only possibility of a cure. In the event that this is the first operation being performed on the gallbladder, it is called a radical cholecystectomy. If the operation is being performed after the gallbladder has already been removed, it is called a radical re-revision surgery. The operation essentially includes removal of the gallbladder (if not already removed) along with a part of the adjacent liver as well as the surrounding lymph nodes that drain the gallbladder with or without the removal of the bile duct.
If I am to undergo surgery how do I prepare myself for it?
Preparation for gallbladder surgery is similar to preparation for any major surgery. From the perspective of the patient, breathing exercises should be practiced as instructed. Smoking should be stopped. A nutritious diet should be implemented. Follow the anaesthiologist’s instructions regarding your regular medications. Necessary arrangements regarding the admission and other logistical issues related to the hospital stay for 10-14 days after the operation, or even longer in the event of any complication, should be made.
What are the risks involved if I get operated?
There is a possibility that during the operation (either open surgery or laparoscopy), it is found that the tumour has spread beyond that was previously thought or seen on preoperative imaging. In such an event, a major operation is not advisable and other options of treatment such as chemotherapy may be recommended. This unpleasant situation can be encountered in spite of adequate and best possible preoperative evaluation. In addition, as is the case with all major operations no matter how well done, there is a minimal but definite risk of complications associated with the surgery. There is almost a 10% chance that the recovery after the operation may be affected due to complications such as leakage of bile or bleeding. If complications do occur, adequate and timely intervention will solve such problems in the vast majority of cases. Up to 1% of patients are at risk of death during or immediately after surgery. These risks should be understood by the patient and relatives. This risk is acceptable even in the best centers world-wide.
Will I need further treatment after surgery?
Whether or not you will benefit from further treatment in the form of chemotherapy or chemo-radiotherapy will be decided after the operation. Selected patients will benefit from such treatment. This decision will be made taking into consideration the final biopsy report.
How long can I expect to live after treatment?
Some patients may want to know the survival statistics of patients in similar situations. Others may not find the numbers helpful, or even might not want to know. It is up to you whether you want to read about the survival statistics in patients with gallbladder cancer. These figures are at best a rough estimate of your life-span after treatment.
As with many other types of cancer, the outcome depends on how advanced your cancer is when it is diagnosed. Sadly, for most people cancer of the gallbladder does not have a very good outlook. By the time it is diagnosed, it is often in the later stages and treatment is unlikely to cure it. Of all the people diagnosed with cancer of the gallbladder, only around 1 out of 10 (10%) will live for more than 5 years. However, in the earlier stages of these cancers 5-8 out of 10 people (50-80%) will live for more than 5 years. This long term outcomes are further improved when complete radical surgery is performed. Chemotherapy and chemo-radiotherapy after surgery is also believed to improve survival by most experts. Keep in mind that every person’s situation is unique and statistics cannot predict exactly what will happen in your case.
Is there any chance of the cancer coming back?
Despite optimal treatment, there remains a risk of the cancer returning. The likelihood of tumour recurrence is highly subjective. After completion of treatment, reporting for regular check-ups as advised is the best way to detect and treat any tumour that has come back at an early stage
How often do I have to come back to the hospital for routine check-ups after the completion of treatment?
In the absence of significant symptoms, routine check-up is performed every 3-4 months for the first 2 years, very 6 monthly for 2 years after that, and annually thereafter. The check-up includes a few questions regarding any problem you might be facing, a physical examination, blood tests including liver functions and tumour markers, as well as an ultrasound. Further tests may be required if any problem is suspected.
Will I be able to adjust to this disease well?
Each patient’s experience with gallbladder cancer is different. Once you undergo an operation, you will be able to return to regular activity within a month of surgery. This will be with little or no dietary/lifestyle restrictions. Completing treatment can be both stressful and exciting. It may help to know that many cancer survivors have learnt to live with the uncertainty of the future and are leading full lives.