Gallbladder Cancer Treatment

8/14/2019 Gallbladder Cancer Treatment

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GALLBLADDER CANCER TREATMENT INFORMATION

What does the Biliary System Do?

The gallbladder is an organ in the abdomen which collects bile drained by the liver into this sac,which is connected to the liver by the cytic duct . It is then transported as needed, through thecommon bile duct into the small intestine. It then travels to meet the draining pancreatic duct atthe "Ampulla of Vater". The bile and pancreatic secretions then pass into the first portion of thesmall intestine ("duodenum") through the sphincter of Odi", a small drainage hole. Bile is aputrid greenish substance which helps digest fats, by coating them and breaking them down. Thisprocess is called emulsification. Digested fats can then be absorbed into the bloodstream andused to make energy for the body. Any inflammation of the bile system is called "cholangitis",while specific inflammation of the gallbladder only is called"cholescystitis".

Inflammation can be caused caused by germs, drugs, radiation, immune diseases, or mostcommonly a blockage of the bile flow by gallstones or a tumor. When the bile flow is blocked,for whatever reason, it tends to backflow into the bloodstream and remain unprocessed("unconjugated") by the liver.

The form which bile takes in the bloodstream is called "bilirubin" and there is normally somepresent (


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"tissues". The cells in the bile duct system grow rapidly in womb life, childhood and throughpuberty. In adulthood, they divide much more slowly, to replace those that die of injury or oldage. Like all cell division in the body, this process is tightly controlled to proceed in an orderlymanner. This control is exerted by the genetic material ("genes") in each cell, which are in turnare made up of "DNA" . Biliary cancer starts within a single cell. Something changes the controlmechanisms within this cell, the genes become damaged, and it starts dividing in a rapid anddisorganized manner . Eventually these abnormal cells for a clump, or"tumor".

A tumor is merely a swelling, as isn't necessarily cancerous. A "benign" tumor just grows in it'slocal area, and although it may become very large it doesn't spread and isn't cancer . By contrast,a malignant tumor is cancer and has a capacity to spread to any area of the body. The process ofspread of called"metastasis" . Thus, any metastatic tumor is by definition cancerous. Only acancer which starts in the biliary system is called "primary" biliary cancer. A cancer that hasspread there from another area (i.e. lung, colon, ovary) is named for it's place of origination.

How Common is Biliary Cancer?

Hepatobiliary cancer (meaning in either the liver or bile ducts) occurs in 20,000 new patients andcauses 15,000 deaths each year in the United States. About 3000 of the cases are in the liveritself, the remaining 17,000 cases are in the Gall Bladder and bile drainage ducts. Bile ductcancer is equally common in males and females, and the average patient is 60 years old.However, gall bladder cancer is three times more common in women than men, (similar to thehigher rate of gallstones in women). Any biliary cancer is rare (


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The liver pulls ammonia off of amino acids (protein) we eat and turns it to urea.4. Jaundice and light stools, from blockage of the bile draining system.5. Itching ("pruritis") from buildup of bile ("bilirubin") in the blood.6. Fever from secondary bacterial infection of the blocked biliary tract.7. Digestion problems like diarrhea and gas when eating fatty foods.8. Pancreatitis with blood sugar problems ("diabetes") and abdominal pain.9. Liver failure in advanced disease, symptoms include body swelling, easy bruising, spider-likeveins on the skin, and breast growth in males.10. Signs of Distant Spread such as bone pain or Neurological symptoms from spread to otherareas. Lung, liver, bone and brain are common sites to spread.

The time until the symptoms become noticeable tends to be longer with cancers in the lowerportion of the biliary system than in the upper portion (nearer the liver). About 70% of cancersarise in the upper portion of the biliary system, and 15% each in the middle and lower portions(close to the small bower).

Bile is manufactured in the liver and helps the body digest fats. The bile ducts course throughout

the liver collecting bile, then travel to the gall bladder where bile is stored. When bile is needed,such as after a fatty meal, it is released into the small intestine via another duct which connectsthe gallbladder to the small intestine.

Bile duct cancers, also called cholangiocarcinomas, may arise in many locations in and aroundthe liver. They are rare, affecting only 16,600 people in the United States per year. The onlydefinitive treatment is the complete surgical removal of the tumor, which is not often possible. Ifthe cancer cannot be entirely removed, the principal goals of therapy become the relief ofsymptoms caused by the accumulation of bile, and relief from pain.

How It Spreads

Bile duct cancer tends to spread into the adjacent liver, along the bile duct surface and throughthe lymph system to lymph nodes in the region of the liver. Tumors in the bile duct leading fromthe gall bladder to the common bile duct (cystic duct) can spread to involve the gall bladder.Ultimately, other lymph nodes as well as other organs within the abdomen may becomeinvolved.

What Causes It

The cause is unknown although people with chronic inflammatory processes such as ulcerativecolitis or parasitic infections of the bile ducts, or with congenital abnormalities of the bile ductsare at higher risk for developing this cancer. No one cause has been clearly demonstrated.

Common Signs and SymptomsThere are no signs or symptoms unique to bile duct cancer. Even if the findings associated withbile duct cancer are present, other explanations, such as gallstones, are far more likely.Symptoms generally develop slowly and are often subtle. Jaundice (the skin turning yellow) anditching are the most common signs. Jaundice is caused by the accumulation in the skin of acomponent of bile (bilirubin) that normally empties into the intestines after traveling through thebile ducts.


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Bloating, weight loss, decreased appetite, fever, nausea or an enlarging abdominal mass are allsigns that may be attributable to bile duct cancer. Pain usually signifies advanced disease.

Staging and TreatmentsA TNM staging system is used for bile duct cancer, but when deciding which treatment option to

use there are really only two stages - localized and unresectable disease.

The optimal treatment for bile duct cancer is surgery. Unfortunately, by the time symptomsdevelop, the cancer has usually spread throughout the bile ducts and into the liver, meaning thatthe tumor cannot be entirely removed.

Chemotherapy and radiation therapy are occasionally useful to relieve symptoms. Although theyhave not been shown to be effective in curing the cancer, these measures can be taken tomaintain the quality of life.

StageSigns andSymptoms

DiagnosticProcedures

Treatments Survival

Early

Tumor is isolatedto the bile duct andis generally toosmall to bedetected

Generallynone

No screeningmethodsavailable

Surgery followed by radiationtherapy

Unknown

Resectable

Tumor is confined

to the bile duct. Itis quite rare to finda bile duct cancerat this limited stagebecause symptomsof bile flowobstruction are rare

Generallynone

Blood tests:hemoglobin(anemia); white

blood count;abnormal liverfunction tests;abnormal clotting(PT, PTT) tests

Ultrasound:Enlarged bileduct due toblockage

MRI: May helpdetermine if bileduct cancer canbe surgicallyremoved

PTC: Aninjected dye

Surgery: Surgery can be donewith hopes of a cure. The extent ofsurgery depends on the location

and size of the tumor. If the tumoris isolated to either the right or leftbile duct, it may be possible toremove the tumor and itsaccompanying lobe of the liver.Tumor involving both ducts ortheir junction create moreproblems and more difficultoperation. The overall health ofthe patient is important whendetermining if surgery is possible.Radiation therapy is often

recommended following surgery

Chemotherapy: Studies have notshown that chemotherapyprolongs survival. Mitomycin C or5-FU, however, may cause tumorshrinkage in 20-25% of patients.Even with shrinkage, however,

5 years:less than25%


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followed by x-ray may revealsite of blockage

ERCP: Along

with PTC, thismay help definethe site and causeof obstructionand correctlypredict thepresence ofcancer 90% ofthe time

Chest x-ray: If

cancer isconfirmed, thisshould be done tolook for tumorspread to thelung

patients may not be better off asthe tumor ultimately regrows andtreatment has side effects.

Radiation therapy: If the tumor

is fairly small, it may be treatedwith radiation without muchdamage to the surrounding liver. Itmay also apply to patients withsmall or microscopic deposits oftumor following surgery

Unresectable

Tumor has spreadto organs beyondthe bile duct

(lymph nodes,liver) and cannotbe removed

Jaundice,itching, bileinfections,pain,appetite,

edema,nausea,insomnia

There are no standard treatments,so chemotherapy and/or radiationtherapy clinical trials should beconsidered. Palliative measures,such as relieving symptoms of

itching or infection by surgicalbypass system for bile may bedone.

2 years:less than1%

Supportive Therapies.Problems associated with jaundice can include severe itching and infections in the bile. Ifthe drainage procedures described above are not effective, itching will often be relieved byBenadryl, Atarax or cholestyramine.

Large doses of narcotics may be needed to relieve pain. Such drugs may have excessive sideeffects, since they are eliminated by the liver, which may not be functioning properly.

Non-steroidal anti-inflammatory drugs may be surprisingly effective even against the painassociated with bile duct cancer.Frequent small meals may be necessary to get enough nutrition since an abdominal massmay reduce the size of the stomach.Water pills (diuretics) can reduce fluid in the abdomen or legs. They may cause significant


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imbalance in kidney function, however, and can create problems if not carefully monitoredand adjusted.

Nausea will often be relieved by standard medications, including suppositories.Loss of appetite may be helped by a drug called Megace.

Sleep disturbances are common, but most sleeping pills are broken down by the liver, sothey should be used carefully.

The Most Important Questions to Ask Your Doctor.

1. Should I see another physician to confirm that this tumor can or cannot be removed?2. Can the drainage of my bile ducts be done through my intestines so I won't have to havea tube coming out through my skin?3. Am I a candidate for an investigational therapy at another medical center?4. How sick will radiation and/or chemotherapy make me, and does the potential benefit

make it worthwhile?5. Is the treatment worthwhile if the tumor is too advanced for surgery?6. Can anything be done to improve the quality of my life?

People don't think about their gallbladder unless it is diseased with gallstones, or itdevelops cancer. In the past gallbladder cancer was almost always fatal, since it tended tobe advanced when first be diagnosed and effective treatments were not available.

There has been much research in the past decade on treating gallbladder and other biliarytract cancers. It is crucial to make the right choices in treating this condition. It can makethe difference between life and death. Understanding your options for gallbladder cancer

will give you the peace-of-mind knowing that you have done everything possible to fightthis disease successfully.

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Gallbladder Cancer Treatment