Gallbladder cancer is cancer that begins in the gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder stores bile, a digestive fluid produced by your liver. Gallbladder cancer is uncommon. It is possible to cure gallbladder cancer when tumors are treated surgically at an early stage.

1. Gallbladder Neoplasm

2. Anatomy and function of gallbladder
..The gallbladder is a pear-shaped,
hollow structure located under
the liver and on the right side of the
abdomen.
.. The gallbladder is part of
the biliary tract
.. Its primary function is to store and
concentrate bile, a yellow-brown
digestive enzyme produced by the liver
.. The gallbladder can be affected
by gallstones, formed by material that
cannot be dissolved
usually cholesterol or bilirubin, a
product of hemoglobin breakdown

3. What is gallbladder neoplasm
..Gallbladder neoplasm is a rare neoplasm
..Gallbladder cancer starts in the gallbladder.
.. In more than 90% cases it is adenocarcinoma

4. Types of gallbladder cancer
..Adenocarcinoma: This is the most common type of gallbladder cancer
..Squamous cell cancer: Squamous cell cancers develop from the skin like
cells that form the lining of the gallbladder, along with the gland cells
..Adenosquamous cancer
..Small cell cancer
..Sarcoma
..Neuroendocrine tumor
..Lymphoma
..Melanoma

5. Epidemiology
..It is a rare type of cancer
..Gallbladder cancer is the fourth most common cause of cancer
deaths
..More common in women than men
..Gallbladder cancer is more common in South American countries
..Worldwide occurrence of gallbladder cancer is less than 2/100000

6. Pathophysiology
.. The multistage pathogenesis of gallbladder carcinoma begins
with gallstones giving rise to a condition called chronic cholecystitis,
which increases to risk to gallbladder cancer formation. More than
90% of patients with gallbladder carcinoma show dysplasia and CIS
.. There are some other rare causes behind gallbladder cancer

8. Risk factors
..Gallstone: Gallstones are the most common risk factor for gallbladder
cancer.
..Gallbladder polyps
..Age: Most people diagnosed with gallbladder cancer are older than 70
..Gender: Women are about twice as likely to develop gallbladder cancer as
men.
..Obesity
..Smoking: Tobacco use may increase the risk of gallbladder cancer.
..Family history
..Ethnicity

9. Signs and symptoms of gallbladder neoplasm
Symptoms
..Abdominal pain particularly in the upper right portion of the abdomen
..Abdominal bloating
..Dyspepsia and loss of appetite
..Fever
..Weight loss
Signs
.. Lumps in the belly
..If obstruction present jaundice, dark urine, itchy skin and stool change is
present

10. Staging of gallbladder neoplasm
According to TNM classification
..Stage 0: Describes cancer in situ (Tis, N0, M0).
..Stage I: A tumor is only in the gallbladder and has not spread (T1, N0, M0).
..Stage II: A tumor has extended to the perimuscular connective tissue but has not
spread elsewhere (T2, N0, M0).
..Stage IIIA: A tumor has spread beyond the gallbladder but not to nearby arteries
or veins. It has not spread to any lymph nodes or other parts of the body (T3, N0,
M0).
..Stage IIIB: A tumor of any size has spread to nearby lymph nodes but not to
nearby arteries and/or veins or to other parts of the body (T1, T2, T3; N1; M0).
..Stage IVA: A tumor has spread to nearby arteries, veins, and/or nearby lymph
nodes, but it has not spread to other parts of the body (T4, N0 or N1, M0).
..Stage IVB: Describes any tumor that has spread to other parts of the body (any
T, any N, M1) or any tumor that has distant lymph node spread, even if it has not
spread to distant organs (any T, N2, M0).

12. Differential diagnosis
Possible differential diagnoses are:
..Gallstones
..Acalculous cholecystitis
..Ampullary carcinoma
..Benign or malignant pancreatic tumors
..Bile duct stricture
..Pancreatic carcinoma
..Cholangiocarcinoma
..Gallbladder mucocele
..Sclerosing cholangitis

13. Diagnosis of gallbladder neoplasm
..A complete medical history and physical examination is important for
diagnosis which may include risk factors and sign symptoms
Investigational approach
..Blood test : Test for liver and gallbladder function which may include Test
for bilirubin, albumin, liver enzymes(ALP, AST, ALT, and GGT)
..Tumor Marker: People with gallbladder cancer may have high blood levels
of the markers called CEA and CA 19-9.
..Imaging test

14. Imaging test
..CT Scan: Help diagnose gallbladder cancer by showing tumors in the
area. Also helps in staging the cancer
..Ultrasound: This is often the first imaging test done in people who
have symptoms like jaundice or pain in the right upper part of their
abdomen
..MRI
..MRCP
..ERCP
..Angiography
Other tests may include:
..Laparoscopy
..Biopsy
..FNAC

15. Treatment
Treatment options are:
Surgery
Radiation therapy
Chemotherapy
Targeted Therapy Drugs
Immunotherapy
Palliative Therapy

16. Surgery can potentially cure gallbladder cancer, but all of the cancer must be
removed. This is only an option when the cancer’s found early, before it’s
spread to nearby organs and other parts of the body.
Surgical options are:
1. Simple cholecystectomy: here only the gallbladder is removed. It can be
done by Open cholecystectomy or Laparoscopic cholecystectomy
2. Extended cholecystectomy: The extent of the surgery depends on where the
cancer is and how far it might have spread. An extended cholecystectomy
removes:
The gallbladder
About an inch or more of liver tissue next to the gallbladder
All of the lymph nodes in the region
Surgery is less likely to be done for unresectable cancers
Surgery for gallbladder cancer

17. Radiation therapy: Radiation therapy may be used as the main treatment in
people with gallbladder cancer that has spread throughout the body and
cannot be removed by surgery. The radiation will not cure the cancer, but it
may help people with advanced gallbladder cancer live longer.
Chemotherapy: Chemotherapy is treatment with cancer-killing drugs. Chemo
can help some people with gallbladder cancer, but so far it's not clear how
useful it is for this type of cancer. Still, chemo might be used. The chemo
drugs most often used for gallbladder cancer include:
Gemcitabine
Cisplatin
5-fluorouracil
Capecitabine
Oxaliplatin

18. Immunotherapy: it is the use of medicines to help a person's immune system
better recognize and destroy cancer cells. Many of these drugs are being
tested in clinical trials to see if they might help treat gallbladder cancer.
Palliative therapy: Palliative care is treatment used to help control or reduce
symptoms caused by cancer. It's not meant to cure the cancer. Palliative
treatment may include:
..painkiller
..chemotherapy
..radiation therapy
.. Biliary stent or catheter
..biliary bypass
..palliative surgery

19. After completing treatment, concerned doctor will still want to watch the
patient closely. It’s very important to go to all follow-up appointments.
During visits, doctors will ask about symptoms, and do physical exams,
and order blood tests or imaging tests, like CT scans.
If patient had surgery and have no signs of cancer remaining, it’s
recommended to follow-up with imaging tests about every 6 months for at
least the first 2 years.
Follow up care

20. Prognosis of gallbladder neoplasm
The 5-year survival rate for people with gallbladder cancer is 19%. However,
the survival rate depends on several factors, including the location of the
cancer and where it has spread
If the cancer is diagnosed and treated before it has spread outside the
gallbladder, the 5-year survival rate is 62%. About 1 out of 5 gallbladder
cancers are diagnosed at this localized stage. This is mainly because there is
not a good screening method and the disease often grows without causing
symptoms.
If the cancer has spread to surrounding tissues or organs and/or the regional
lymph nodes, the 5-year survival rate is 27%.
If the cancer has spread to a distant part of the body, the 5-year survival rate
is 2%

21. Prevention
Currently, there are no routine tests used to screen for gallbladder cancer. Symptoms of
gallbladder cancer usually do not appear until the cancer is in its later stages. Many of
the known risk factors for gallbladder cancer, such as age, gender, ethnicity,
and bile duct defects, are beyond our control. These factors make early detection
difficult.
Doing some steps helps maintain good health and may reduce a person's risk
of gallbladder cancer
..Stay at a healthy weight
..Keep physically active and limit the time you spend sitting or lying down
..Follow a healthy eating pattern that includes plenty of fruits, vegetables,
and whole grains, and limits or avoids red and processed meats, sugary
drinks, and highly processed foods
..It's best not to drink alcohol.

22. Miles’ doctor told her she had to stop treatment because the
chemo was damaging her liver. She’s decided to get a second
opinion.
“I can understand that there may not be a cure, but I just
want to live as long as I can.”
She said, “I just want to tell other people who are going
through it or know someone going through it that even if
there’s no cure, keep being yourself and stay positive. Live for
yourself; live for your children.”
Be a survivor