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Gallbladder cancer is cancer that begins in the gallbladder. Gallbladder cancer is uncommon. When gallbladder cancer is discovered at its earliest stages, the chance for a cure is very good. But most gallbladder cancers are discovered at a late stage, when the prognosis is often very poor. Gallbladder cancer is difficult to diagnose because it often causes no specific signs or symptoms. Also, the relatively hidden nature of the gallbladder makes it easier for gallbladder cancer to grow without being detected.

Symptoms

Gallbladder cancer signs and symptoms may include:
•    Abdominal pain, particularly in the upper right portion of the abdomen
•    Abdominal bloating
•    Itchiness
•    Fever
•    Loss of appetite
•    Losing weight without trying
•    Nausea
•    Yellowing of the skin and whites of the eyes (jaundice)

Causes

It's not clear what causes gallbladder cancer.
Doctors know that gallbladder cancer forms when healthy gallbladder cells develop changes (mutations) in their DNA. These mutations cause cells to grow out of control and to continue living when other cells would normally die. The accumulating cells form a tumor that can grow beyond the gallbladder and spread to other areas of the body. Most gallbladder cancer begins in the glandular cells that line the inner surface of the gallbladder. Gallbladder cancer that begins in this type of cell is called adenocarcinoma. This term refers to the way the cancer cells appear when examined under a microscope.


Risk factors

Factors that can increase the risk of gallbladder cancer include:
•    Your sex. Gallbladder cancer is more common in women.
•    Your age. Your risk of gallbladder cancer increases as you age.
•    Your weight. People who are obese are at higher risk for developing gallbladder cancer.
•    A history of gallstones. Gallbladder cancer is most common in people who have had gallstones in the past. Still, gallbladder cancer is very rare in these people.
•    Other gallbladder diseases and conditions. Other gallbladder conditions that can increase the risk of gallbladder cancer include porcelain gallbladder, choledochal cyst and chronic gallbladder infection.

Diagnosing Gall bladder cancer

Tests and procedures used to diagnose gallbladder cancer include:
•    Physical exam and history:
•    Ultrasound exam
•    Blood tests. Blood tests to evaluate your liver function may help your doctor determine what's causing your signs and symptoms.
•    Carcinoembryonic antigen (CEA) assay: A test that measures the level of CEA in the blood. CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of gallbladder cancer or other conditions.
•    CA 19-9 assay
•    Chest X-ray
•    MRI (magnetic resonance imaging)
•    PET-CT
•    Laparoscopy


Treatment

1.    Surgery
Gallbladder cancer may be treated with a cholecystectomy, surgery to remove the gallbladder and some of the tissues around it. Nearby lymph nodes may be removed. A laparoscope is sometimes used to guide gallbladder surgery. The laparoscope is attached to a video camera and inserted through an incision (port) in the abdomen. Surgical instruments are inserted through other ports to perform the surgery. Because there is a risk that gallbladder cancer cells may spread to these ports, tissue surrounding the port sites may also be removed.
If the cancer has spread and cannot be removed, the following types of palliative surgery may relieve symptoms:

    Surgical biliary bypass: If the tumor is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the gallbladder or bile duct will be cut and sewn to the small intestine to create a new pathway around the blocked area.

    Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin, flexible tube) to drain bile that has built up in the area. The stent may be placed through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.
    Percutaneous transhepatic biliary drainage: A procedure done to drain bile when there is a blockage and endoscopic stent placement is not possible. An X-ray of the liver and bile ducts is done to locate the blockage. Images made by ultrasound are used to guide placement of a stent, which is left in the liver to drain bile into the small intestine or a collection bag outside the body. This procedure may be done to relieve jaundice before surgery.
2.    Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the
3.    Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Key points

•    Gallbladder cancer is cancer that begins in the gallbladder. Gallbladder cancer is uncommon.
•    When gallbladder cancer is discovered at its earliest stages, the chance for a cure is very good. 
•    Gallbladder cancer is difficult to diagnose because it often causes no specific signs or symptoms.

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