On the scale of the overall structure of malignant pathologies, about eight percent of the cancer of the gall bladder( and among the oncological pathologies of the gastrointestinal tract it is no more than 0.5%), which is why many general practitioners do not know the specifics of its detection and treatment tactics.
Most often, a malignant neoplasm develops from the cells of the mucous membranes of the bottom of the gallbladder or its neck.
Definition and Statistics of Oncological Disease
Gallbladder cancer belongs to the category of rather rare malignant tumors that affect the tissues of this organ, which has a bean-shaped form, located at the bottom of the liver and intended for storage and accumulation of a special liquid - bile.
Produced by liver cells, bile is an indispensable part of the digestive process.
On the photo of ultrasound diagnosis, which shows the cancer of the gall bladder
Women are exposed to him four times more often than men. As a rule, this disease affects patients who belong to the age of over fifty years.
Causes and risk factors
Specific causes of culprit in the development of gallbladder cancer are not known for certain, therefore, the following risk factors are most likely to activate the oncogene:
- The presence of a genetic predisposition and cases of similar diseases in a family history.
- Prolonged contact with carcinogens that are part of household chemicals.
- Work on harmful production, related to the manufacture of rubber and metal smelting.
- Presence of parasitic invasion( clonorchosis, opisthorchiasis) or nonspecific ulcerative colitis.
- Addicted to drinking alcohol and smoking tobacco.
- Abuse of salted, smoked, fatty and fried foods.
- Accommodation in areas with an unfavorable ecological situation.
Predisposing to the development of gallbladder cancer may also be the presence of:
- of a long-term cholelithiasis( it is suggested that the impetus to epithelial tissue dysplasia is chronic inflammation and permanent trauma);
- sclerosing cholangitis( inflammation of the liver);
- of adenomatous gallbladder polyps, whose diameter exceeds one centimeter;
- of chronic cholecystitis;
- of biliary cirrhosis;
- congenital fibrosis and polycystic liver disease.
The different histological structure of malignant neoplasms of the gallbladder is the basis for dividing it into different types, represented by:
- by low-grade cancer;
- by mucosal cancer;
- solid cancer;
- squamous cell carcinoma.
All types are characterized by a high degree of malignancy and a tendency towards early metastasis( most often using lymphatic pathways).
The first symptoms of gallbladder cancer
In the early stages of the disease, specific signs are practically absent. As a rule, at this stage of development, gallbladder cancer is detected quite accidentally during the histological examination of tissues seized during the operation of cholecystectomy with calculous cholecystitis.
A tenth of patients have migrating thrombophlebitis( the so-called Tussaud's syndrome).In this syndrome phlebothrombosis is formed in different parts of the body, practically not amenable to treatment.
The duration of the jaundice period is due to the localization of the tumor and its proximity to the bile ducts. With the localization of the tumor process in the tail and body of the pancreas, the pre-egg period lasts much longer than with the defeat of its head or extrahepatic ducts.
General symptoms of
With further development of malignant neoplasm, intensive mechanical jaundice develops, accompanied by a whole complex of symptoms.
In a number of cases, they are the first to indicate the presence of a far-reaching process.
Jaundice is caused by the germination of the tumor or by mechanical squeezing of the bile duct, preventing free flow of bile into the cavity of the duodenum.
For icteric period, in addition to persistent jaundice, there is a significant increase in the liver, the presence of nausea, vomiting, permanent itching, a change in the color of urine( it darkens) and feces( it becomes lighter).
Blocking of bile ducts with malignant neoplasm leads to empyema or edema of the gallbladder, inflammation of the bile duct( cholangitis), and secondary biliary cirrhosis.
The defeat of the liver by cancer cells leads to the appearance of symptoms of hepatic insufficiency, manifested by lethargy, slowing of mental reactions, severe muscle weakness( adynamia).
Cancer of the gallbladder, which reached the late stages, leads to a carcinomatosis of the peritoneum, abdominal dropsy( ascites) and extreme exhaustion of the organism( cachexia).
Stages of the disease
- At the zero stage, mutated cells, concentrated on the inner wall of the gallbladder, begin to actively attack its healthy tissues.
- For the disease of stage 1 is characterized by the presence of a small elongated or oval neoplasm, localized on the wall of the gallbladder and slightly protruding into its cavity. Externally similar to the polyp, it is characterized by the rapidity of its growth. Tumor of the first stage in its development is two stages. During the first, the gallbladder walls are damaged: its internal and connective tissue layers. During the second stage, the tumor captures cells of the muscle tissue and another connective layer.
- Two stages are also characteristic for the development of the tumor of stage 2.In the first, the visceral peritoneum is affected. Then the tumor process extends to the tissues of the pancreas, liver, thick and small intestine and the nearest lymphatic vessels.
- In 3 stages, malignant neoplasm affects the blood vessels of the liver, giving the possibility of spreading throughout the body.
- Stage 4 is characterized by distant metastasis and damage to distant organs and lymphatic vessels.
Pathways of metastasis
Gallbladder cancer can metastasize in three ways:
- By germinating into adjacent tissues( liver, pancreas, thick and small intestine, lymphatic vessels).
- Lymphogenous way( through lymphatic vessels).
- Hematogenous way( along blood vessels along with blood flow).
Prolonged asymptomatic flow, as well as low specificity of its manifestations are culprits in the fact that in the majority( 70%) of cases, gallbladder cancer is diagnosed already at the stage of an inoperable tumor.
- At physical examination of the patient palpation reveals an increase in the gallbladder, spleen and liver, as well as the presence of an infiltrate in the abdominal cavity.
- Diagnostic laparoscopy is used to determine tumor operability and the presence of metastases.
- The ultrasound of the abdominal cavity and gallbladder allows not only to reveal a number of pathological changes that occurred in them as a result of the tumor process, but also help in the collection of biomaterials during the puncture.
- If in doubt, a liver biopsy or a percutaneous gallbladder biopsy is performed.
- In the patient's blood, the concentration of the cancer embryonic antigen is measured and its biochemical analysis is performed.
- Specific diagnostics is performed by CT, percutaneous transhepatic cholangiography, MRI, retrograde cholangiopancreatography and cholescintigraphy.
- Treatment of gallbladder cancer should be radical. When diagnosing it at early( 0, I and II) stages, simple or extended cholecystectomy( removal of the gallbladder) is performed.
- In stage III cancer, a more voluminous operation is carried out, in addition to cholecystectomy, which also includes excision of the affected tissues of the right lobe of the liver. In the presence of indications, removal of the pancreas and duodenum( pancreatoduodenectomy) is performed.
- When an inoperable tumor is performed a whole complex of palliative measures designed to reduce jaundice by recanalizing( restoring the lumen) of the bile ducts or creating a new pathway for the outflow of bile by applying a superficial biliary fistula.
Types of standard treatment for
After performing surgical operations, as well as in the presence of an inoperable gall bladder tumor, a course of chemotherapy and radiotherapy is mandatory.
Reviews of patients who have removed the gallbladder in cancer
My mother was removed from the gallbladder, regional lymph nodes and part of the liver during a holicystectomy and regional lymphadenectomy( the tumor was identified in the second stage).After the operation, she spent ten days in the intensive care unit, felt a strong weakness and nausea.
She was discharged from the hospital in a satisfactory condition. The results of the last MRI showed the presence of several neoplasms in the lungs, enlargement of the liver, the presence of fluid in the abdominal cavity, hyperplasia of the adrenal gland, and lymphadenopathy of the mammary glands.
After the operation, the pain in the left side became permanent, sometimes they are given to the abdomen and back. If you do not take into account the pain, the condition of the mother as a whole is normal. She has a good appetite and normal digestion( although the color of the stool is still light).After chemotherapy hair falls out strongly.
In gallbladder cancer, only a prognosis for a disease that is accidentally detected at the earliest stage during an operation to remove this organ( cholecystectomy) is favorable.
In such situations, the average life expectancy of patients does not exceed three months. To live about a year it is possible to insignificant( no more than 15%) quantity of the diseased. The five-year survival rate of operated patients does not exceed 13%.
A video about diet after gallbladder removal: