February is Gallbladder Awareness Month and although gallbladder cancer is uncommon, The American Cancer Society estimates that 10,910 new gallbladder cancer cases will be diagnosed in 2015. The gallbladder is a small, pear-shaped organ located under the liver that is usually about 3-4 inches long in adults. The gallbladder’s main job is to concentrate and store bile, a fluid made in the liver to help digest the fats in foods as they pass through the small intestine. Bile is released either from the liver directly into the ducts that carry it to the small intestine, or stored in the gallbladder and released later. When food is being digested, the gallbladder contracts and releases bile through a duct into the first part of the small intestine, called the duodenum.
In gallbladder cancer cases, 9 out of 10 cancers are adenocarcinomas. Adenocarcinoma is a type of cancer that begins in cells with gland-like properties and line internal or external surfaces in the body, including the inside of the digestive system. Because the gallbladder is deep inside the body, it is often hard to detect early gallbladder cancer. Early tumors can’t be felt or seen during routine physical exams, and there are no blood tests or other tests that can reliably detect the disease. For this reason, most gallbladder cancers are found after the cancer has grown enough to cause signs or symptoms. Some common symptoms of gallbladder cancer include:
- Abdominal Pain: Most often this pain is in the upper right part of the stomach
- Nausea/Vomiting
- Jaundice: If the cancer grows enough to block the bile ducts, bile from the liver can’t drain into the intestines. This causes a buildup of bilirubin, a chemical that gives bile its yellow color. If bilirubin builds up, it then settles in other parts of the body causing a yellowing of the skin and whites of the eyes.
- Stomach Lumps: If the cancer blocks the bile ducts, the gallbladder can swell. Gallbladder cancer can also spread to nearby parts of the liver, which can sometimes be felt as lumps on the right side of the body. These lumps can also be detected by imaging tests such as an ultrasound
Gallbladder cancer is not as common as other forms of cancer, and these symptoms are more likely to be caused by other diseases or medical issues. But, if you have any of these symptoms it is important to see your physician as soon as possible to find the cause and determine treatment. Some gallbladder cancers are found after the gallbladder has been removed to treat gallstones, but most cases are not found until a patient visits the doctor due to symptoms.
Doctors typically begin diagnosis with liver function tests to test for high levels of bilirubin. Imaging tests use x-rays, magnetic fields or sound waves to create pictures of your internal organs. Imaging tests are done to look at suspicious areas, help a doctor guide a biopsy needle and take a sample, determine if treatment is working, or learn how far the cancer has spread. Ultrasounds, CT scans, and MRI scans are just three of the various imaging tests used to detect gallbladder cancer.
A staging system is the standard way for doctors to describe the extent of a cancer, and gallbladder cancer is staged using the TNM system. The TNM system is based on 3 key pieces of information:
- T describes how far the main tumor has grown into the primary wall of the gallbladder, and if it has grown into nearby organs or tissues
- N describes whether the cancer has spread to nearby lymph nodes
- M describes whether the cancer has spread to other organs. The most common sites of gallbladder cancer spread are the liver, lining of the abdominal cavity, and the lungs.
Numbers or letters after T, N, and M provide more specific details about each factor. Once their categories have been determined, this information is used to group the cancer into a stage. Stage is expressed as different phases between stage 0, the least advanced, and Roman numeral IV, the most advanced form of gallbladder cancer. Once the stage is determined, doctors and your cancer care team can begin discussing treatment options. The stage of the cancer, side effects of treatment, overall general health, and symptom relief are all factors to consider when deciding on a form of treatment. Main forms of treatment for gallbladder cancer include:
- Surgery
- Radiation Therapy
- Chemotherapy
- Palliative Therapy
If you are experiencing symptoms of gallbladder cancer, contact your primary care physician for testing or for a referral to Southeastern Medical Oncology Center.
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