Gallbladder cancer is a cancer that originates primarily in the gallbladder or spreads from another organ to the gallbladder (metastasis). Often diagnosed at an advanced stage due to no or subtle symptoms, such as abdominal pain or jaundice, the prognosis is frequently poor. Factors like chronic inflammation, gallstones, or genetic predisposition are the risk factors for its development. Treatment typically involves surgery, but late detection limits options. Chemotherapy or radiation may follow surgery, but effectiveness varies. Challenges persist in early detection and effective treatments despite the availability of advanced treatment options. Gallbladder cancer requires awareness, prompt diagnosis, and early treatment to improve outcomes.
Gallbladder cancer is relatively rare, comprising about 1% of all cancers. It is more common in older adults and occurs slightly more often in women. Geographic and ethnic disparities exist, with higher rates reported in some regions and populations. In India, gallbladder cancer is relatively common, particularly in the northern regions. It ranks among the top five cancers in some parts of the country, with a higher incidence among women. Factors such as diet, genetics, and the prevalence of gallstones contribute to its occurrence.
Some of the most common types of gallbladder cancer are:
Gallbladder adenocarcinoma is the most common gallbladder cancer, arising from glandular cells lining the organ. Often diagnosed at advanced stages, it presents with symptoms like abdominal pain and jaundice. Treatment typically involves surgery, chemotherapy, or radiation, but the prognosis remains poor due to late detection.
Gallbladder squamous cell carcinoma is a rare subtype, comprising about 1-3% of all gallbladder cancers. It arises from squamous cells lining the gallbladder. Associated with chronic inflammation, gallstones, and other risk factors, it presents unique challenges in diagnosis and treatment, often with a poor prognosis.
Gallbladder sarcoma is rare, representing less than 0.5% of all gallbladder malignancies. It arises from connective tissue cells within the gallbladder wall. A gallbladder cancer diagnosis, especially of the sarcoma type, is challenging, often requiring biopsy confirmation. Treatment typically involves surgery, but outcomes vary due to its aggressive nature and limited therapeutic approaches.
Gallbladder lymphoma is rare and involves lymphoid tissue within the gallbladder. Diagnosis requires biopsy confirmation. Treatment typically involves chemotherapy, sometimes supplemented with radiation therapy or surgery. Prognosis depends on factors such as the type and stage of lymphoma, with early detection offering the best chance of successful treatment.
The stages of gallbladder cancer are:
Stage 0 gallbladder tumor, also known as carcinoma in situ, is characterized by the presence of abnormal cells in the innermost layer of the gallbladder. It has not spread beyond the mucosal lining and is often discovered incidentally during surgery for other conditions. Treatment involves surgical removal of the gallbladder, offering a favorable prognosis.
During stage 1 gallbladder cancer, the abnormal cells develop into the muscle layer (muscular) or the lamina propria. Malignant gallbladder cells have not invaded the nearby lymph nodes or the distant sites. It is confined to the inner layers of the wall of the gallbladder. Treatment involves surgical removal of the gallbladder, with the potential for additional therapy depending on individual factors. The prognosis at this stage is generally more favorable compared to advanced stages.
During stage 2A of gallbladder cancer, the cancer cells spread beyond the inner layers of the wall or to the nearby organs, such as the bile ducts or the liver. However, during stage 2B of gallbladder cancer, which is a further advancement of stage 2A, cancer spreads further deep into the wall of the gallbladder or involves surrounding lymph nodes. Treatment often includes surgery to remove the gallbladder and affected tissues, followed by additional therapies such as chemotherapy or radiation to target the remaining cancer cells and improve the prognosis. The cancer invades the muscle layer on the side of the liver.
In stage 3A of gallbladder cancer, the cancer has spread through the serosa (the outermost gallbladder covering) and/or it has spread directly into the liver and may or may not involve one nearby structure like the stomach, duodenum, colon, bile ducts or pancreas, outside the liver. It does not affect the nearby lymph nodes or distant sites.
At stage 3B of gallbladder cancer, the cancer may or may not have spread outside the gallbladder into the liver or another nearby structure, but it has not spread to the portal vein or hepatic artery. It has spread to ≤3 nearby lymph nodes. It has not invaded distant sites.
In stage 4A of gallbladder cancer, the disease spreads into the portal vein or hepatic artery or invades ≥2 structures outside of the liver. It may or may not invade ≤3 nearby lymph nodes. It also may not spread to distant sites during stage 4A.
During stage 4B of gallbladder cancer, the cancer may spread to ≥4 nearby lymph nodes. It may also spread to organs outside the gallbladder, such as the liver.
Gallbladder cancer refers to cancer of the gallbladder. It poses a significant challenge due to its late diagnosis and limited treatment options. Different types of gallbladder cancer, like squamous cell carcinoma, sarcoma, and lymphoma, require customized approaches for effective management. Early stages offer a better prognosis, emphasizing the importance of prompt detection and treatment. Further research is imperative to improve outcomes across all types. To increase the chances of gallbladder cancer prevention, one has to opt for healthy lifestyle habits.