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Home :: Gallbladder And Bile Duct Cancers

Gallbladder And Bile Duct Cancers

Cancer of the gallbladder is rare, constituting fewer than 1 % of all cancer cases. It's usually found coincidentally in patients with cholecystitis; 1 in 400 cholecystectomies reveals cancer.

This disease is most prevalent in women over age 60. It's rapidly progressive and usually fatal; patients seldom live 1 year after diagnosis. The poor prognosis is due to late diagnosis; gallbladder cancer usually isn't diagnosed until after cholecystectomy, when it's typically in an advanced, metastatic stage.

Extrahepatic bile duct cancer is the cause of about 3% of all cancer deaths in the United States. It occurs in both men and women between ages 60 and 70 (incidence is slightly higher in men). The usual site is at the bifurcation in the common duct.

Cancer at the distal end of the common duct is often confused with pancreatic cancer. Characteristically, metastasis occurs in local lymph nodes and in the liver, lungs, and peritoneum.

Causes

Many consider gallbladder cancer a complication of gallstones. This inference rests on circumstantial evidence from postmortem examinations: 60% to 90% of all gallbladder cancer patients also have gallstones. Postmortem data from patients with gallstones show gallbladder cancer in only 0.5%.

Adenocarcinoma accounts for 85% to 95% of all cases of gallbladder cancer; squamous cell carcinoma accounts for 5% to 15%. Mixed-tissue types are rare.

Lymph node metastasis is present in 25% to 70% of patients at diagnosis. Direct extension to the liver is common (46% to 89% of patients); direct extension to both the cystic and the common bile ducts as well as the stomach, colon, duodenum, and jejunum produces obstructions. Metastasis also occurs through the portal or hepatic veins to the peritoneum, ovaries, and lower lung lobes.

The cause of extrahepatic bile duct cancer isn't known, but statistics reveal an unexplained increased incidence of this cancer in patients with ulcerative colitis. This association may be due to a common cause-perhaps an immune mechanism or chronic use of certain drugs by the colitis patient.

Signs and symptoms

Unfortunately, sometimes cancer of the gallbladder does not produce symptoms until late in the disease. When symptoms are evident, the most common is pain in the upper right portion of the abdomen, underneath the right ribcage. Patients with gallbladder cancer may also report symptoms such as nausea, vomiting, weakness, jaundice , skin itching , fever , chills, poor appetite, and weight loss.

Signs of bile duct cancer

Progressive, profound jaundice is commonly the first sign of obstruction due to extrahepatic bile duct cancer. The jaundice is usually accompanied by chronic pain in the epigastrium or right upper quadrant, radiating to the back. Other common symptoms, if associated with active cholecystitis, include pruritus, skin excoriations, anorexia, weight loss, chills, and fever.

Diagnosis

No test or procedure is in itself diagnostic of gallbladder cancer. However, the following laboratory tests support this diagnosis when they suggest hepatic dysfunction and extrahepatic biliary obstruction:

  • baseline studies (complete blood count, routine urinalysis, electrolyte studies, enzymes)
  • liver function tests (typically reveal elevated serum bilirubin, urine bile and bilirubin, and urobilinogen levels in more than 50% of patients as well as consistently elevated serum alkaline phosphatase levels)
  • occult blood in stools (linked to the associated anemia)
  • cholecystography (may show stones or calcification)
  • cholangiography (may locate the site of common duct obstruction)
  • magnetic resonance imaging (detects tumors).

The following tests help compile data that confirm extrahepatic bile duct cancer:

  • liver function tests (indicate biliary obstruction: elevated levels of bilirubin [5 to 30 mg/dl], alkaline phosphatase, and blood cholesterol as well as prolonged prothrombin time)
  • endoscopic retrograde pancreatography (identifies the tumor site and allows access for obtaining a biopsy specimen .

Treatment

Surgical treatment of gallbladder cancer is essentially palliative and includes various procedures, such as cholecystectomy, common bile duct exploration, T-tube drainage, and wedge excision of hepatic tissue.

If the cancer invades gallbladder musculature, the survival rate is less than 5%, even with massive resection. Although some cases of long-term survival (4 to 5 years) have been reported, few patients survive longer than 6 months after surgery for gallbladder cancer.

Surgery is normally indicated to relieve the obstruction and jaundice that result from extrahepatic bile duct cancer. The type of procedure used to relieve obstruction depends on the site of the cancer. Such procedures may include cholecystoduodenostomy and T­tube drainage of the common duct.

Prevention

Although it's usually not possible to prevent gallbladder and bile duct cancers, you can take steps to reduce your risk. In general, eating a healthy diet and exercising regularly can lower your risk of many types of cancer.



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