In the list of diseases of the digestive system, doctors also call cancer of the gallbladder. Despite the rarity of this disease (only 20% of cases are from cancerous tumors of the entire digestive system), this diagnosis is scary with long treatment and the absence of symptoms at an early stage.
People who have already encountered such a diagnosis will certainly have numerous questions. How to identify oncology in the early stages? How long do people live with stage 4 gallbladder cancer? Is it possible to completely get rid of the disease? These questions are extremely important, so all aspects of diagnosis and treatment should be sorted out in order.
Basic concepts
What is essentially a gallbladder? This is a fairly small bean-shaped organ. It is located in the lower part of the liver. The main task of the gallbladder is to store bile - a special secretory fluid that is involved in the digestion of food.
Cancer of the gallbladder is an oncological disease. It is characterized by the appearance of pathological cells in the tissues of the organ. Over time, these cells begin to grow and divide, forming a tumor. Suchthe neoplasm blocks the proper functioning of the gallbladder and neighboring organs. The code for the international classification of diseases of gallbladder cancer (ICD-10) is C23.
It is noticed that the female half of humanity is more susceptible to this disease: according to statistics, there are almost twice as many women with this diagnosis as men. Thus, in 2013 in Russia, tumors of the extrahepatic biliary tract were detected in 2180 women and 1122 men (separate data on the gallbladder are not available).
As for the age categories, the majority of patients are people who have reached the age of 50. Although doctors note: over the past decade, gallbladder cancer has been increasingly diagnosed in people 30 years and older. Cases of illness in children have also been identified, but they are isolated.
What is the difficulty of diagnosis and treatment? The main reason is the appeal of patients mainly in the last stages of the disease. This makes treatment much more difficult.
Causes of gallbladder cancer
Name the specific reasons that become the impetus for the development of atypical cells, scientists can not. However, constant statistics have revealed factors that may increase the risk of gallbladder cancer:
These are various diseases of the gallbladder of an inflammatory nature, the presence of stones. 85% of patients with oncology of this type in the past had problems with the gallbladder. These are chronic inflammations of the organ, and stones. At the same time, it was noticed: the larger the stones in the gallbladder, the higher the risk of a malignant tumor
- Constant contact with certain substances. Among the patients there are many workers in hazardous industries (rubber or metallurgical industry). This is explained by the high concentration of chemicals.
- Bile duct cyst. Such a pathological phenomenon is often called precancerous. The fact is that a cyst is a neoplasm filled with bile. Under certain conditions, the cyst can grow in size, and then degenerate into a malignant tumor and show symptoms of gallbladder cancer. At the first suspicion of a cyst, you should go to the clinic as soon as possible.
- “Porcelain” gallbladder. This medical term is used to define the pathological condition of the organ, in which all the walls of the gallbladder are covered with calcium deposits. This condition occurs with severe inflammation. Traditionally, the affected organ is removed, as it often causes oncology.
- Typhoid fever. To date, infection with typhoid fever is an extremely rare phenomenon, but if it occurs, a patient is almost 6 times more likely to develop signs of gallbladder cancer.
- Age-related changes. In the body of absolutely every person with age, irreversible phenomena occur at the cellular level, which can provoke the growth of atypical cells. This is fully confirmed by statistics: most of the patients belong to the category of elderly people.
- Bad habits. The list may include smoking, excessive drinking of alcoholic beverages,malnutrition.
Tumor histology
Gallbladder cancer is usually divided into several categories based on certain characteristics.
According to the histological structure of cells, several types of tumors are distinguished:
- squamous cell cancer - a tumor that occurs in the epithelial layer and mucous membrane;
- adenocarcinoma - such a neoplasm appears from the glandular cells located in the epithelium of the organ;
- scirrhous;
- solid - from the Latin word solidum (solid), such a tumor is a group of cells arranged in plates;
- poorly differentiated - cells of this cancer often have irregularly shaped nuclei and an abnormal structure.
Tumor localization
According to the location of the malignant neoplasm, there are 2 types of gallbladder cancer:
- Localized. This is the type of tumor that is located within the gallbladder itself and does not affect closely located tissues and organs at all. Most often, this picture is observed at the very beginning of the development of gallbladder cancer. Treatment prognosis is quite optimistic.
- Inoperable. This category includes those tumors that have already metastasized. What is it?
Metastases are the spread of malignant cells from the primary focus (in this case, from the gallbladder) to various other tissues and organs of the human body. Most often, metastases of gallbladder cancer spread tolymphatic system, liver, intestines, stomach.
Stages of gallbladder cancer
For a more convenient classification and description of the pathological processes occurring in the human body, it is customary to differentiate gallbladder cancer at the stage:
- 0 stage - it is often called precancerous. At this time, pathological cells are located on the mucous membrane of the organ, and the size of the tumor is quite small. Starting treatment at stage 0 allows you to completely get rid of the disease, but it is extremely difficult to diagnose such an oncology - there are no symptoms at all.
- 1 stage. Malignant cells penetrate not only into the mucous membrane, but also into the adjacent layers of tissues. The diameter of the tumor also grows. At this stage, the first symptoms of gallbladder cancer may appear, but they are practically not noticeable. In most cases, the detection of the disease at this stage occurs during a medical examination prescribed for other reasons.
- 2 stage (moderate). This stage includes the period of active tumor growth. By this time, the neoplasm reaches an impressive size, but does not go beyond the gallbladder. The symptoms are getting worse.
- 3 stage. It is at this stage of tumor development that many patients turn to the clinic, as pronounced persistent symptoms appear. By this time, the tumor is already giving near metastases.
- 4 stage. Gallbladder cancer at this stage has several characteristics at once. This is a large size of the tumor, damage to nearby tissues(that is, metastases to other organs), the presence of a large number of symptoms of the disease, low susceptibility of the tumor to treatment.
Clinical picture
The main thing that distinguishes cancer from many others is the complete absence of symptoms in the early stages. This is the main problem that explains why many patients see a doctor late.
In addition, many of the symptoms of gallbladder cancer are very similar to those of some other non-cancer diseases (such as chronic cholecystitis). At the same time, it is not at all necessary that all symptoms appear - they may vary depending on the type of cancer and its location.
Among the first symptoms of gallbladder cancer are:
- pain in the right side of the abdomen under the ribs (at first, pain appears quite rarely and is of a short duration, but increases as the tumor grows);
- bloating and feeling of heaviness;
- appearance of frequent bouts of nausea, possible vomiting;
- stool disorders (flatulence can suddenly be replaced by constipation);
- lack of appetite or significant decrease.
If at this stage a person does not go to the doctor and treatment is not started, the tumor continues to progress. A little later, symptoms of gallbladder cancer appear, such as:
- pain in the right precostal space becomes more frequent and longer, they can radiate throughout the abdomen, back, neck or shoulder;
- severe nauseaends with vomiting, but even this does not bring relief;
- tumor growth leads to an increase in the size of the gallbladder - as a result, the enlarged liver can be felt on its own;
- appears slightly yellowish skin tone;
- burning and itching of the skin;
- dyspnea is present (not only after exercise, but even at rest);
- appetite may be good or absent altogether, while body weight is sharply reduced;
- prolonged high body temperature (from 37 to 39 degrees);
- fatigue, feeling weak, apathy.
Another characteristic sign may be a change in the color of urine and feces. Urine becomes darker, while feces, on the contrary, lighter.
Initial examination of patients
Prolonged absence of symptoms at stage 1 of gallbladder cancer leads to the fact that in 70% of cases patients go to the clinic when the tumor has already reached a significant size and requires long-term complex treatment.
To prescribe the most effective course of therapy, the doctor needs to get a complete picture of the disease. To do this, he prescribes a number of tests, and also conducts:
- Full examination of the patient. At the initial appointment, the doctor needs to get as much information as possible from the patient's words. This will allow you to judge the intensity of the symptoms. Based on this, the severity of the current illness can be assumed.
- Familiarization with the characteristics of the patient's life and the history of his illness. Such details allow to judge the magnitude of the risk.development of cancer.
- Physical examination. This concept includes examination of the patient, measurement of body temperature, palpation of the liver area (for an increase in the size of the organ), examination of the skin and eye sclera for the presence of a yellowish tint.
Laboratory studies
Laboratory tests will not reveal gallbladder cancer, but the test results will clearly indicate the pathological condition of a particular organ.
The following tests are performed:
- Complete urinalysis.
- Fecal analysis (coprogram).
- Biochemistry of blood. In diseases of the gallbladder, an increase in the level of transaminases, bilirubin, and alkaline phosphatase is observed.
- Assign a blood test to detect tumor markers. Such diagnostics allows obtaining data on the presence of malignant cells in the body.
Instrumental diagnostics
Instrumental research methods can be safely called the basis of diagnosis, since it is from the results of these studies that the doctor receives information about the state of the gallbladder, the presence or absence of a tumor, its location, size and presence of metastases:
- Ultrasound of the gallbladder and internal organs of the abdominal cavity. Using this diagnostic method, it is possible to determine the size and localization of the tumor. In addition, you can assess the condition of internal organs and identify metastases.
- Computed tomography. This procedure is carried out on a special apparatus and reveals all near anddistant metastases that are present in the body.
- Magnetic resonance imaging. Gives information about the state of the brain (presence or absence of metastases).
- Biopsy. This study is one of the most important. The procedure involves the collection of pathological cells from the gallbladder. The doctor takes a sample using a long thin needle, and then sends the tissue for histological examination. As a result, accurate data on the nature and histological features of cancer cells are obtained.
- Cholecystography is a diagnostic method that uses a contrast agent.
Treatment of gallbladder cancer
The main way to treat this disease is a surgical operation. During it, the surgeon removes the gallbladder. In this case, 2 options are possible:
- Cholecystectomy. A surgical operation in which the gallbladder is removed. Such an approach in treatment is possible only in cases of early detection of oncology.
- Cholecystectomy + liver resection. At stage 3, the removal of the gallbladder will be ineffective, since the malignant cells have already spread to the liver tissue. In this case, during the operation, the right lobe of the liver is also removed. In some cases, resection of nearby lymph nodes will be required.
In the last stages of the disease, gallbladder cancer is considered inoperable, so surgery is not prescribed. This is explained by numerous metastases affecting the lymphatic system, liver, lungs, and brain. In this case, inas treatment, courses of radio- and chemotherapy are prescribed.
Radiotherapy is a method of treating oncology, in which the patient is exposed to ionizing radiation. The essence of the method is that malignant cells are sensitive to radiation, therefore, under such exposure, they are destroyed. Quite often, radiotherapy is also used as an additional effect before or after a surgical operation. This treatment is quite effective, but has severe side effects.
Chemotherapy is another way to influence the tumor without the use of a scalpel. In this case, the treatment is based on taking strong drugs that have a detrimental effect on pathological tumor cells. Depending on the stage, concomitant diseases and the general condition of the patient, the doctor prescribes an intravenous infusion of drugs or oral administration. Dosage and duration are strictly controlled by the attending physician. The entire treatment period is divided into courses with a break of several weeks.
Special diet for gallbladder cancer
Oncological diseases are a rather difficult test for the entire human body. At the same time, it is extremely important that the gallbladder is involved in digestion, and therefore nutrition during this period should be taken very seriously.
The diet of a cancer patient should be built in such a way as to relieve the gallbladder and liver as much as possible.
Meals should be at least 5-6 per day, and portions should be small.
You need to give preferencemeals with fiber and protein that are easy to digest.
Completely give up heavy food: fatty, s alty, fried, smoked, sweet.
The diet should be so varied that it includes vegetables and fruits, lean meats, fish.
Definitely need to take a complex of vitamins prescribed by a doctor. Such a dietary supplement will help restore human immunity.
Forecast
Every patient with such a diagnosis certainly wondered how long they live with gallbladder cancer. In fact, no one can give an accurate forecast. The result of treatment depends on several factors at once, namely: the stage of the disease, the age of the cancer patient, concomitant diseases, the type and location of the tumor.
At stage 1, more than 60% of patients can be cured of oncology.
Initiated treatment at stage 2 gives a five-year survival rate of patients in 30% of cases.
At stage 3, a five-year survival rate is observed in 10% of cases.
The smallest cure rate for stage 4 gallbladder cancer is less than 10%.
Such data was obtained thanks to the constant maintenance of statistics for several decades. Statistics can only suggest what percentage of survival can be at a particular stage of the disease, but in each case, this statistic will not work. Even at the last stage, there are chances for recovery, so you need to fight the disease in any case.
