What is gallbladder carcinoma?

Gallbladder carcinoma (GBC) is one of the most common and aggressive forms of malignant bile duct cancer. It usually develops in the gallbladder, the bile ducts or the large bile duct and metastasises relatively quickly to the lymph nodes, liver and other distant organs. While gallbladder carcinoma is rather rare in western countries, it occurs relatively frequently in Chile, Japan, northern India and also in certain regions of eastern Europe. This is mainly due to the fact that parasitic diseases occur more frequently in certain tropical countries and are associated with an increased risk of gallbladder cancer.

Women are more likely than men to develop gallbladder cancer between the ages of 70 and 80. Gallbladder cancer usually only causes symptoms at an advanced stage, such as abdominal pain, mostly in the upper right quadrant, a feeling of dizziness, which can be accompanied by vomiting, as well as jaundice, anorexia and/or unwanted weight loss.

What are the different forms of gallbladder carcinoma?

Gallbladder carcinoma is differentiated into the following forms:

• Klatskin tumours: The carcinoma is located in the area of the bile ducts, which exit directly from the liver;
• Tumours in the area of the distal bile ducts: The carcinoma is located outside the liver and gallbladder;
• Tumours in the area of the papilla Vateri: The carcinoma is located at the point where the ductus choledochus (common bile duct) and ductus pancreaticus (pancreatic duct) join the duodenum (duodenum).

What factors favour the development of gallbladder carcinoma?

So far, the APOB gene has been identified as the cause of gallbladder carcinoma. Gallbladder carcinoma can also be favoured by the following risk factors:

• previous gallstone diseases, for example inflammatory reactions of the bile ducts (primary sclerosing cholangitis and/or ulcerative colitis)
• Presence of at least one gallstone (concretion) in the gallbladder (cholelithiasis),
• Porcelain gallbladder, in which there is a hardening of the gallbladder wall
• bacterial infections,
• cases of gallbladder carcinoma that have already occurred in the family,
• chronic liver disease, for example hepatitis B or C, cirrhosis of the liver or alcoholic liver disease caused by years of alcohol abuse,
• unhealthy diet

What are the symptoms of gallbladder carcinoma?

In most cases, the symptoms of gallbladder carcinoma only appear at a late stage of the cancer. However, gallbladder carcinoma can manifest itself earlier with the following symptoms, some of which are non-specific:

• Jaundice (icterus), which occurs especially when the bile ducts are narrowed,
• unintentional and severe weight loss
• generalised itching, which appears all over the body,
• Abdominal pain, which may be accompanied by loss of appetite.

What is the course of the disease in gallbladder carcinoma?

A gallbladder and/or bile duct tumour affects the surrounding organs in a very short time. This mainly affects the duodenum, but also the pancreas. Metastases can also spread to the lymph nodes and through the bloodstream throughout the body. So-called daughter tumours often form in the liver in particular, but also in the lungs and the peritoneum. Since in most cases the symptoms only appear when metastases are already present, the prognosis for gallbladder carcinoma is rather poor.

How is gallbladder carcinoma diagnosed?

Gallbladder carcinoma is diagnosed through laboratory tests and imaging. Even a blood test can provide information about the levels of liver enzymes and reveal the presence of tumour markers. If the gallbladder carcinoma is already in an advanced stage, the carcinoembryonic antigen (CEA) and the CA 19-9 tumour markers in particular will be elevated. Imaging procedures such as an ultrasound scan or a computer tomography (CT) scan can also show an enlarged gallbladder. In most patients, the carcinoma is found on the neck or trunk of the gallbladder.

How is gallbladder carcinoma treated?

Gallbladder carcinoma is preferably removed surgically. This can be done by a segmental liver or bile duct resection and/or an extensive lymphadenectomy (the removal of the lymph nodes). Surgery is possible especially if the carcinoma is localised to the bile ducts, the gallbladder or the adjacent liver tissue and no vital vessels are affected and the tumour has not yet spread to metastases.

If the gallbladder carcinoma is in an advanced stage, chemotherapy can improve the patient's quality of life. It is also possible to prolong the patient's life by a few months or years with chemotherapy (palliative chemotherapy). In the case of inoperable bile duct carcinoma, the drug gemcitabine in combination with cisplatin is administered as standard therapy. This treatment is intended to stabilise the tumour or, in some cases, even reduce its size. In addition to this standard therapy, other chemotherapeutic agents can also be used effectively for bile duct tumours. These include, for example, the drugs 5-fluorouracil or capecitabine, irinotecan and oxaliplatin.

In addition to chemotherapy, radiotherapy can also be useful for localised tumours. Especially after an operation, radiotherapy is often used if there are still tumour remnants in the body. In most cases, radiotherapy is used in combination with chemotherapy.

What is the aftercare for gallbladder carcinoma?

If the treatment is a palliative therapy, the patient should definitely make use of the regular follow-up examinations. If, on the other hand, the tumour was removed from the patient, regular follow-up examinations are carried out, especially within the first three years after the surgical intervention. In general, inpatient treatment in a rehabilitation clinic is also possible. However, the doctor treating the patient should decide in each individual case whether this is necessary. In any case, the inpatient treatment should be carried out in a facility that is familiar with gallbladder and bile duct tumours.

What is the prognosis for gallbladder carcinoma?

Because gallbladder carcinoma is often diagnosed at an advanced stage of the cancer, the prognosis is rather poor. The 5-year survival rate is about 20 percent.

Frequencies Gallbladder carcinoma

Frequencies Salmonella Thyphi

Frequencies Blood Purification