In the list of diseases of the digestive system, doctors also call gall bladder cancer. Despite the rarity of this disease (only 20% of cases of cancerous tumors of the entire digestive system), this diagnosis is terrible with a long treatment and the absence of symptoms at an early stage.
People who have already encountered such a diagnosis will certainly have numerous questions. How to determine oncology in the initial stages? How many live with stage 4 gallbladder cancer? Is it possible to completely get rid of the disease? These issues are extremely important, so all aspects of diagnosis and treatment should be considered in order.
Basic concepts
What exactly is the gall bladder? This is a fairly small bean-shaped organ. It is located in the lower part of the liver. The main task of the gallbladder is to store bile - a special secretory fluid that is involved in the digestion of food.
Gallbladder cancer is an oncological disease. It is characterized by the appearance of pathological cells in the tissues of the organ. Over time, these cells begin to grow and divide, forming a tumor. Such a neoplasm blocks the proper functioning of the gallbladder and neighboring organs. The code for the international classification of diseases of the gallbladder cancer (ICD-10) is C23.
It is noted that the female half of humanity is more susceptible to this disease: according to statistics, there are almost twice as many women with this diagnosis as men. So, in 2013 in Russia, extrahepatic biliary tract tumors were detected in 2180 women and 1122 men (there are no separate data on the gallbladder).
As for age categories, the majority of patients are people over the age of 50. Although doctors say: over the past decade, gall bladder cancer is increasingly being diagnosed in people 30 years of age and older. Cases of children’s disease have also been identified, but they are single.
What is the complexity of diagnosis and treatment? The main reason is the treatment of patients mainly in the last stages of the disease. This greatly complicates the treatment.
Causes of gallbladder oncology
Scientists cannot name the specific reasons that become the impetus for the development of atypical cells. However, constant statistics have revealed factors that may increase the risk of gall bladder cancer:
- These are various diseases of the gallbladder of an inflammatory nature, the presence of stones. 85% of patients with oncology of this type in the past had problems with the work of the gallbladder. These are chronic organ inflammations and stones. It was noted: the larger the size of the stones in the gallbladder, the higher the risk of a malignant tumor.
- Permanent contact with certain substances. Among the patients there are many workers in hazardous industries (rubber or metallurgical industry). This is explained by a high concentration of chemicals.
- Bile duct cyst. This pathological phenomenon is often called precancerous. The fact is that a cyst is a neoplasm filled with bile. Under certain conditions, a cyst can increase in size, and then degenerate into a malignant tumor and exhibit symptoms of gallbladder cancer. At the first suspicion of a cyst, you should go to the clinic as soon as possible.
- “Porcelain” gall bladder. Such a medical term is used to determine the pathological condition of an organ in which all the walls of the gallbladder are covered with calcium deposits. This condition occurs in severe inflammatory conditions. Traditionally, the affected organ is removed, as it often causes oncology.
- Typhoid fever. Today, infection with typhoid fever is an extremely rare occurrence, but if it occurs, the patient is almost 6 times more likely to develop signs of gallbladder cancer.
- Age-related changes. In the body of absolutely every person with age, irreversible phenomena occur at the cellular level, which can trigger the growth of atypical cells. This is fully confirmed by statistics: the majority of patients are classified as elderly.
- Bad habits. The list may include smoking, excessive drinking of alcoholic beverages, improper diet.
Tumor histology
Gall bladder cancer is usually divided into several categories, taking into account certain characteristics.
According to the histological structure of cells, several types of tumors are distinguished:
- squamous cell cancer - a tumor that occurs in the epithelial layer and mucous membrane;
- adenocarcinoma - such a neoplasm appears from glandular cells located in the epithelium of an organ;
- scirrhous;
- solid - from the Latin word solidum (solid), such a tumor is a group of cells located by plates;
- low-grade - cells of such cancer often have irregularly shaped nuclei and anomalous structure.
Tumor location
According to the location of the malignant neoplasm, 2 types of gallbladder cancer are distinguished:
- Localized. This is the type of tumor that is located within the gallbladder itself and does not affect closely located tissues and organs. Most often, this picture is observed at the very beginning of the development of gallbladder cancer. The prognosis of treatment is rather optimistic.
- Inoperable. Tumors that have already metastasized belong to this category. What it is?
Metastases are the spread of malignant cells from the primary focus (in this case, from the gallbladder) to various other tissues and organs of the human body. Most often, metastases of gallbladder cancer spread to the lymphatic system, liver, intestines, stomach.
Stages of malignant neoplasm of the gallbladder
For a more convenient classification and description of the pathological processes occurring in the human body, it is customary to differentiate gallbladder cancer at the stage of:
- 0 stage - it is often called a precancerous. At this time, pathological cells are located on the mucous membrane of the organ, and the size of the tumor is quite small. Starting treatment at stage 0 allows you to completely get rid of the disease, however, diagnosing such an oncology is extremely difficult - the symptoms are completely absent.
- 1st stage. Malignant cells penetrate not only into the mucous membrane, but also into neighboring layers of tissues. The diameter of the tumor also grows. At this stage, the first symptoms of gall bladder cancer may appear, but they are practically not noticeable. In most cases, the detection of the disease at this stage occurs during a medical examination prescribed for other reasons.
- Stage 2 (moderate). This stage includes the period of active tumor growth. By this time, the tumor reaches an impressive size, but does not go beyond the gallbladder. Symptoms are becoming more vivid.
- 3 stage. It is at this stage of tumor development that many patients go to the clinic, as pronounced persistent symptoms appear. By this time, the tumor already gives near metastases.
- 4 stage. Gallbladder cancer at this stage has several characteristics at once. These are large tumor sizes, damage to nearby tissues (i.e. metastases to other organs), the presence of a large number of disease symptoms, and low susceptibility of the tumor to treatment.
Clinical picture
The main thing that distinguishes oncological diseases from many others is the complete absence of symptoms in the early stages. This is the main problem that explains the late visit of many patients to the doctor.
In addition, many symptoms of gallbladder cancer are very similar to the manifestations of some other diseases of a non-oncological nature (for example, chronic cholecystitis). In this case, the manifestation of all symptoms is not necessary at all - they can vary depending on the type of cancer and its location.
Among the first symptoms of gallbladder cancer appear:
- pain in the right side of the abdomen under the ribs (at first the pains appear rather rarely and are short-term in nature, but intensify as the tumor grows);
- bloating and a feeling of heaviness;
- the appearance of frequent bouts of nausea, vomiting is possible;
- stool disorders (flatulence can suddenly give way to constipation);
- lack of appetite or a significant decrease in it.
If at this stage the person does not go to the doctor and treatment is not started, the tumor continues to progress. Symptoms of gallbladder cancer appear a little later, such as:
- pains in the right hypochondrium become more frequent and longer, they can give out throughout the abdomen, in the back, neck or shoulder;
- severe nausea ends with vomiting, but even this does not bring relief;
- tumor growth leads to an increase in the size of the gallbladder - as a result of this, an enlarged liver can be felt independently;
- a slightly yellowish tint of the skin appears;
- burning and itching of the skin is observed;
- there is shortness of breath (not only after physical exertion, but even at rest);
- the appetite may be good or absent altogether, while body weight is sharply reduced;
- long-term maintenance of high body temperature (from 37 to 39 degrees);
- fatigue, a feeling of weakness, apathy.
Another characteristic sign may be a change in the color of urine and feces. Urine becomes darker, and stool, on the contrary, brightens.
Initial examination of patients
A prolonged absence of symptoms at the 1st stage of gallbladder cancer leads to the fact that in 70% of cases, patients go to the clinic when the tumor has already reached a significant size and requires long-term comprehensive treatment.
To prescribe the most effective course of therapy, the doctor needs to get a complete picture of the disease. To do this, he assigns a number of analyzes, and also conducts:
- Full examination of the patient. At the initial appointment, the doctor needs to get as much information as possible from the patient's words. This allows you to judge the intensity of the symptoms. Based on this, the severity of the current disease can be assumed.
- Acquaintance with the life features of the patient and the history of his illness. Such details make it possible to judge the magnitude of the risk of developing cancer.
- Physical examination. This concept includes examination of the patient, measurement of body temperature, palpation of the liver area (for an increase in organ size), examination of the skin and eye sclera for a yellowish tint.
Laboratory research
Laboratory tests will not detect gallbladder cancer, but the test results will clearly indicate the pathological condition of a particular organ.
The following analyzes are carried out:
- General urine analysis.
- Analysis of feces (coprogram).
- Blood biochemistry. In diseases of the gallbladder, an increase in the level of transaminases, bilirubin, as well as alkaline phosphatase is observed.
- Assign a blood test to identify tumor markers. This diagnosis allows you to obtain data on the presence of malignant cells in the body.
Instrumental diagnostics
Instrumental methods of research can be safely called the basis of diagnosis, since it is from the results of these studies that the doctor receives information about the state of the gallbladder, the presence or absence of a tumor, its location, size and presence of metastases:
- Ultrasound of the gallbladder and internal organs of the abdominal cavity. Using this diagnostic method, it is possible to identify the size and location of the tumor. In addition, it is possible to assess the condition of internal organs and detect metastases.
- CT scan. This procedure is carried out on a special device and reveals all the near and far metastases that are in the body.
- Magnetic resonance imaging. Gives information about the state of the brain (the presence or absence of metastases).
- Biopsy. This study is one of the main ones. The procedure involves the collection of pathological cells from the gallbladder. The doctor carries out the fence using a long thin needle, and then sends the tissue for histological examination. The result is accurate data on the nature and histological features of cancer cells.
- Cholecystography is a diagnostic method in which a contrast agent is used.
Gallbladder Cancer Treatment
The main way to treat this disease is surgery. During it, the surgeon removes the gallbladder. In this case, 2 options are possible:
- Cholecystectomy A surgery in which the gallbladder is removed. Such an approach to treatment is possible only in cases of early detection of oncology.
- Cholecystectomy + liver resection. At stage 3, removal of the gallbladder will be ineffective, since malignant cells have already spread to the liver tissue. In this case, the right lobe of the liver is also removed during the operation. In some cases, resection of nearby lymph nodes will be required.
In the last stages of the disease, oncology of the gallbladder is considered inoperable, therefore, surgery is not prescribed. This is explained by numerous metastases that affect the lymphatic system, liver, lungs, and brain. In this case, radiotherapy and chemotherapy courses are prescribed as treatment.
Radiotherapy is a method of treating oncology in which the patient is exposed to ionizing radiation. The essence of the method is that malignant cells are sensitive to radiation, therefore, under such an impact, they are destroyed. Quite often, radiotherapy is also used as an additional effect before or after surgery. This treatment is quite effective, but it has severe side effects.
Chemotherapy is another way to treat a tumor without using a scalpel. In this case, the treatment is based on taking strong drugs that have a detrimental effect on the pathological cells of the tumor. Depending on the stage, concomitant diseases and the general condition of the patient, the doctor prescribes intravenous infusion of drugs or taking tablets. Dosage and duration are tightly controlled by the attending physician. The entire treatment period is divided into courses with a break of several weeks.
Special diet for gallbladder cancer
Oncological diseases are a rather difficult test for the whole human body. At the same time, it is extremely important that the gall bladder is involved in digestion, and therefore nutrition issues in this period should be taken very seriously.
The diet of a cancer patient should be built in such a way as to unload the gall bladder and liver as much as possible.
Meals should be at least 5-6 per day, and portions are made small.
You need to give preference to dishes with fiber and protein, which are easily digested.
You need to completely abandon junk food: fatty, salty, fried, smoked, sweet.
The diet should be so diverse that it includes vegetables and fruits, low-fat varieties of meat, fish.
Be sure to take a complex of vitamins prescribed by your doctor. Such a dietary supplement will help restore human immunity.
Forecast
Each patient with such a diagnosis certainly wondered how long they live with gall bladder cancer. In fact, no one can give an accurate forecast. The result of treatment depends on several factors at once, namely: the stage of the disease, the age of the cancer patient, concomitant diseases, the type and location of the tumor.
At stage 1, more than 60% of patients can be cured of oncology.
Initiated treatment at stage 2 gives five-year patient survival in 30% of cases.
At stage 3, five-year survival is observed in 10% of cases.
The smallest percentage of cure for gallbladder cancer at stage 4 is less than 10%.
Such data were obtained thanks to the constant maintenance of statistics for several decades. Statistics can only suggest what percentage of survival may be at one stage or another of the disease, but in each case, these statistics will not work. Even at the last stage, there is a chance of recovery, so you need to fight the disease in any case.