Gallbladder and Bile Duct cancer awareness month was observed recently. It is a very common cancer in India, says Dr. Sourav Kumar Mishra.
According to the GLOBOCAN 2018 data, 26,000 new cases of Gallbladder cancer are diagnosed annually in India making it the 14th most common cancer. There were 20000 deaths in the same year making it the 13th most common cause of death in cancer patients.
Gallbladder cancer happens when normal cells in the gallbladder change into abnormal cells and grow out of control. The gallbladder is a small, pear-shaped organ situated under the liver. The gallbladder stores bile, a fluid that is made in the liver and helps the body break down fat.
Most people with gallbladder cancer have or have had gall stones. Gallstones are small stones that form inside the gallbladder. Gall stones are present in > 70 % of patients with gall bladder cancer. Long standing stones and larger gall stones are at increased risk of Gall bladder cancer. Chronic irritation and infection due to gall stones leads to cancer.
Since gall stones are one of the major risk factors for gall bladder cancer, any incidentally detected gall stones should be taken seriously, as in long run these may lead to cancer. In such situations, opinion from a surgeon should be taken for removal of the gall bladder. Larger stones, symptomatic gall stones, gall stone cholecystitis, history of gall bladder cancer are some of the indications for cholecystectomy (surgical removal of gall bladder).
Typhoid fever can lead to chronic carriers of Salmonella typhi, the micro organism causing typhoid fever. Chronic infection can lead to gall bladder cancer. Other risk factors for gall bladder cancer include congenital billiary tract anomalies, obesity, diet rich in fat and sugars, smoking, alcoholism, genetic causes and Diabetes. The female sex too is at the risk.
Early on, gallbladder cancer might not cause any symptoms. In many cases, gallbladder cancer is found unexpectedly when cholecystectomy is done for gall stones. At times it is detected during routine screening ultra-sonography of the abdomen.
When gallbladder cancer causes symptoms, they can include belly pain, especially in the upper right side or upper middle part of the belly, loss of appetite, nausea or vomiting, weight loss and jaundice. Presence of jaundice signifies advanced disease. Many a time, prior to treatment stenting is done by Gastroenterologists to reduce the jaundice.
Once diagnosed with Gall bladder cancer, the outcome is poor. Most patients present in an advanced stage when the only treatment options are chemotherapy and supportive care. Ultimately, most patients succumb to their disease within 3 months to 1 year. Even if Gall Bladder cancer is diagnosed early; combination of surgery, radiotherapy and chemotherapy can increase the patients’ survival. Treatment should be carried out under the supervision of a surgical oncologist, medical oncologist and radiation oncologist at centers specializing in cancer care. Such facilities are available in our state. Right now, research is going on to identify the role of targeted therapy and immunotherapy in Gall bladder cancer.
Sadly, although gallbladder cancer is widely prevalent in our country, most of the information as regards treatment is from western countries. Government funding is essential to carry out large scale research into India-specific causes of gall bladder cancer.
Associate Professor, Department of Medical Oncology, IMS & SUM Hospital, Bhubaneswar