The month of February is observed as Gallbladder and Bile Duct Cancer Awareness Month. Gallbladder cancer is an uncommon but highly fatal malignancy. The majority are found incidentally in patients undergoing exploration for cholelithiasis; a tumour will be found in 1 to 2 per cent of such cases. According to Dr Vijay Kumar C Bada, Sr. Consultant Surgical Gastroenterology, HPB, Bariatric & Robotic Sciences, Clinical Director, Yashoda Hospitals Hyderabad, the poor prognosis associated with GBC is thought to be related to the advanced stage at diagnosis, which is due both to the anatomic position of the gallbladder, and the vagueness and nonspecificity of symptoms.
What are the symptoms of Gallbladder and Bile Duct cancer?
Patients with early invasive GBC are most often asymptomatic, or they have nonspecific symptoms that mimic or are due to cholelithiasis or cholecystitis. Before ultrasonography and CT became widely available, the preoperative diagnosis rate for GBC was only 10 to 15 per cent. However, with an appropriate index of suspicion and better imaging techniques, a preoperative diagnosis may be reached in 75 to 88 per cent of cases. Early tumours as small as 5 mm can be recognised as polypoid masses projecting into the gallbladder lumen or as focal thickening of the gallbladder wall.
Among symptomatic patients, the most common complaint is pain, followed by anorexia, nausea, or vomiting. The symptoms of advanced GBC often differ from usual biliary colic and are more suggestive of malignant disease (eg, malaise, weight loss). Patients who present with a symptom complex suggestive of acute cholecystitis more often have earlier-stage disease and a better long-term outcome than those who present otherwise. Patients with GBC may also present with obstructive jaundice, either from direct invasion of the biliary tree or from metastatic disease.
Some of the risk factors for Gall Bladder cancer:
- Gall Bladder stones: GB cancers have associated gallbladder stones in 70-80 % of patients. However, the risk of developing cancer in patients with gallstones is 0.5-3%
- Gall Bladder polyps
- Primary sclerosing cholangitis
- Chronic infections viz: Salmonella, Helicobacter
- Congenital Biliary cysts
GBC may be diagnosed preoperatively, intraoperatively at the time of surgical exploration for abdominal symptoms attributable to another disease process, or postoperatively upon examination of the gallbladder specimen, typically removed for cholecystectomy due to symptomatic cholelithiasis.