Gallbladder Cancer

What is Gallbladder Cancer?

Gallbladder cancer is a rare but aggressive form of cancer that originates in the gallbladder, a small organ located beneath the liver that stores bile. It is typically difficult to detect in its early stages as symptoms often resemble those of other digestive disorders. 

In Singapore, gallbladder cancer is relatively uncommon, but it still presents a significant health concern. In fact, gallbladder cancer accounts for approximately 2 to 3% of all gastrointestinal cancers in Singapore. The prevalence of gallbladder cancer is higher in individuals with certain risk factors, such as a family history of biliary tract and gallbladder cancer, history of gallstones (link to gallstones and bile ducts page) or chronic gallbladder disease. Additionally, lifestyle factors like obesity, and a high-fat diet may contribute to the increased incidence of gallbladder cancer in the region.

While gallbladder cancer is not as prevalent as other types of cancer, its aggressive nature, and the challenges involved in early detection make it essential for individuals to be vigilant, and seek medical advice if they experience symptoms. 

What causes Gallbladder Cancer?

The exact cause of gallbladder cancer remains largely unknown, but several factors can increase the risk of developing the condition, including:

• Chronic inflammation of the gallbladder
• Certain genetic mutations
• Certain medical conditions such as cholecystitis or gallstones
• History of gallbladder diseases
• Medical conditions such as primary sclerosing cholangitis
• Older age (65 years, and older)

Although the exact cause remains unclear, research continues to explore genetic, and environmental factors that may contribute to the development of gallbladder cancer.

Symptoms of Gallbladder Cancer

Gallbladder cancer often goes unnoticed in its early stages due to its subtle symptoms. As the cancer progresses, more noticeable symptoms may appear. These include:

• Abdominal pain or discomfort, particularly in the upper right part of the abdomen.
• Bloating or a feeling of fullness after eating.
• Dark urine or light-coloured stools due to bile obstruction.
• Jaundice (yellowing of the skin or eyes), which occurs when the tumour blocks bile ducts.
• Nausea or vomiting, which may occur after eating.
• Unexplained weight loss or loss of appetite.

Who is at risk of Gallbladder Cancer?

While gallbladder cancer can affect anyone, certain factors can increase an individual’s risk. Some of the common risk factors are:

• Age — individuals who are 65 years, and older have a higher risk of being diagnosed with gallbladder cancer due to increased inflammation, and reduced function.

• Gender — women are more likely to be diagnosed with gallbladder compared to men as it is theorised that elevated estrogen levels play a role in exacerbating the condition. 

• Family history — individuals with a family history of gallbladder cancer or other gastrointestinal cancers are at an increased risk of developing the condition. 

• Gallstones — the presence of gallstones is a significant risk factor for may be associated with gallbladder cancer as gallstones can lead to chronic inflammation of the gallbladder, which can, over time, increase the likelihood of developing cancer.

• Chronic inflammation — conditions such as chronic cholecystitis (inflammation of the gallbladder), and primary sclerosing cholangitis (a disease affecting the bile ducts) increase the risk of gallbladder cancer. This is because the continuous inflammation of the gallbladder due to these conditions can damage the organ, and lead to abnormal cell growth, which may result in cancer.
  
• Lifestyle — a sedentary lifestyle, lack of physical activity, and obesity can significantly increase the risk of gallbladder cancer.
  
• Diet — a diet high in fat, and low in fibre has been linked to the development of gallstones, and chronic gallbladder disease, both of which are risk factors for gallbladder cancer.
  
• Obesity — obesity raises the likelihood of gallstone formation, which can lead to chronic inflammation, and subsequently, gallbladder cancer.

How is Gallbladder Cancer diagnosed in Singapore?

Gallbladder cancer is often diagnosed incidentally after surgery is done for gallbladder infection due to stones. Further evaluation will determine the next step in the management.

When suspected before surgery, diagnosing gallbladder cancer typically involves a combination of physical examination, imaging tests, and additional tests. At Tan Siong San Surgery, our doctor will perform a thorough assessment to determine the extent of the cancer.

Physical Examination

The first step in diagnosing gallbladder cancer involves a thorough physical examination. During the examination, the doctor will:

• Assess your medical history.
• Inquire about your symptoms.
• Look for any signs of jaundice.
• Palpate the abdomen for any masses or tenderness in the upper right side.

Imaging Tests

In the event the physical examination suggests the possibility of gallbladder cancer, our doctor may proceed with imaging tests. These imaging tests are performed to visualise the gallbladder, and its surrounding structure in more detail:

• Ultrasound — an ultrasound uses sound waves to create an image of the gallbladder, and detect any abnormalities, such as thickening of the gallbladder wall or the presence of tumours. It is often the first imaging test performed when gallbladder cancer is suspected.
  
• CT Scan (Computed Tomography) — a CT scan provides more detailed cross-sectional images of the body, allowing doctors to assess the extent of the cancer, how far it has spread, and its impact on surrounding organs such as the liver and bile ducts. This helps in staging the cancer, and planning the appropriate treatment.
  
• MRI (Magnetic Resonance Imaging) — an MRI provides high-resolution images of the gallbladder, liver, and surrounding areas. It is particularly useful in evaluating soft tissues, and identifying any tumours or changes in the bile ducts, and liver that may not be clearly visible on a CT scan.
  
• Endoscopic Ultrasound (EUS) — an EUS involves inserting an ultrasound probe through the digestive tract to get a closer look at the gallbladder, and surrounding organs. EUS provides highly detailed images, and is especially useful in detecting small tumours or assessing the involvement of nearby lymph nodes.
• Positron Emission Tomography (PET CT) scan - For staging and assessment for any distant spread of the cancer 

Additional Tests

In some cases, further diagnostic tests may be necessary to confirm the diagnosis or provide additional information about the cancer's nature:

• Biopsy — if imaging tests show signs of a tumour, a biopsy may be performed to confirm the diagnosis. During a biopsy, a small tissue sample is removed from the suspected tumour for examination under a microscope. This allows pathologists to determine if cancer cells are present, and help guide the treatment plan.
  
• Blood Tests — blood tests are often conducted to check for elevated levels of certain markers, such as bilirubin or alkaline phosphatase, which may suggest liver dysfunction or bile duct obstruction. Although blood tests cannot confirm gallbladder cancer, they can provide important information about the patient's overall health and liver function.

Stages of Gallbladder Cancer

Gallbladder cancer is classified into several stages based on the size of the tumour, and whether it has spread to other areas. The stages of gallbladder cancer are:

How is Gallbladder Cancer treated in Singapore?

The treatment for gallbladder cancer depends on several factors, including the stage of the cancer, the patient's overall health, and whether the cancer has spread to other organs. It is important to remember that early detection of gallbladder cancer significantly improves the chances of successful treatment.

A multidisciplinary approach involving a team of healthcare professionals, including surgeons, oncologists, and radiologists, ensures that each patient receives a tailored treatment plan that maximises the chances of recovery and quality of life.

The main treatment options for gallbladder cancer include:

Surgical Treatments

Surgical treatment (cholecystectomy) is usually performed if the cancer is detected early, and confined to the gallbladder. However, a portion of the nearby tissues or organs may also need to be removed to ensure the cancer cells are removed effectively. These include:

• Keyhole Gallbladder Surgery (Laparoscopic Cholecystectomy) — in this procedure, the surgeon uses small incisions, and a camera-guided instrument to remove the gallbladder. It offers quicker recovery, less post-operative pain, and a shorter hospital stay compared to open surgery. This is only suitable for the earliest stages of gallbladder cancer, whereby chemotherapy will not be needed after the surgery.

• Gallbladder Cancer Surgery (Radical Cholecystectomy — this procedure involves the surgeon removing the gallbladder along with a portion of the liver, and nearby lymph nodes. The procedure aims to eliminate all cancerous tissue, and prevent the spread of the disease. It typically involves open surgery, although in selected cases, minimally invasive techniques may be used.

Other Treatments and Therapies 

• Chemotherapy — chemotherapy is often recommended if the cancer has spread or cannot be removed surgically, as it can help kill cancer cells or shrink the tumour.

• Radiation therapy — radiation therapy is typically used alongside other treatments to target, and destroy cancer cells, particularly if the cancer has spread to the bile ducts or other nearby structures.

• Targeted therapy — targeted therapy involves the use of targeted drugs to target specific cancer cells or their growth pathways, providing a more focused treatment option.
• A combination of the above therapies may be used to convert an initially inoperable cancer to become amenable to curative surgery.

• Palliative care — if the cancer is advanced, and untreatable, palliative care may be recommended to improve the patient’s quality of life by alleviating symptoms like pain, and jaundice.

Summary

Gallbladder cancer, though rare, is an aggressive condition that requires timely diagnosis, and treatment. If you or a loved one are experiencing symptoms such as unexplained abdominal pain, jaundice or digestive issues, it is essential to seek medical attention promptly. The earlier gallbladder cancer is detected, the better the chances of successful treatment, and recovery.

At Tan Siong San Surgery, we are dedicated to providing comprehensive care, and guiding you through every step of your treatment journey. Contact us today  for a detailed diagnosis and personalised treatment plan.