Why Choose Cedars Sinai Marina del Rey Hospital for Gallbladder Cancer Treatment?
With vast knowledge and extensive experience, our medical professionals can provide you with the treatment you need for gallbladder cancer, whether it is surgery or chemotherapy, in a warm and compassionate environment. As we are aware that most people who struggle with cancer are in great physical and emotional pain, we strive to create a comfortable atmosphere for every patient. By virtue of the state-of-the-art technology our hospital is equipped with, we can treat your gallbladder cancer with minimal risks of postoperative complications. Since 1969, we have been offering quality healthcare to the Los Angeles community and are bound to provide you with the treatment you need as well.
The gallbladder is a small organ that resides under the liver in the upper abdomen and has the purpose of storing bile, a fluid that promotes fat digestion. When food is present in the stomach and in the intestines, the gallbladder releases bile through a tube medically known as the common bile duct, which connects the liver and the gallbladder to the small intestine. Unfortunately, cancer can affect nearly any part of the body and the gallbladder is no exception. When malignant tumors begin developing on this organ, gallbladder cancer is diagnosed.
It is worthy of note that women are more susceptible to developing gallbladder cancer than men. Primary gallbladder cancer starts in the inner layer of the organ and spreads to other tissues from there if left untreated. Every year, over 11,000 people receive a gallbladder cancer diagnosis in the United States. However, gallbladder cancer is usually found in the late stages, as it is very challenging to diagnose as a result of the hidden position of the organ, as well as because the patient does not experience any symptoms in the early stages.
The treatment you will receive for gallbladder cancer will highly depend on the stage of the disease, whether it has spread to nearby tissues and organs, as well as on your general health. For people with gallbladder cancer that is confined to the organ, surgery is usually the most effective treatment option, as it will remove the organ entirely. Some patients will need to undergo chemotherapy or radiotherapy following surgery to ensure that no malignant cells remain in the body after the procedure. The most common type of surgery for early-stage gallbladder cancer is cholecystectomy. It is usually performed laparoscopically with the purpose of removing the gallbladder and the surrounding tissues, as well as the lymph nodes affected by cancer. However, for people whose gallbladder cancer has metastasized, the following palliative surgical treatments are available to alleviate their symptoms:
- biliary bypass: when the malignant tumor is blocking the bile duct and bile is accumulating in the gallbladder, you may be recommended to undergo a biliary bypass, during which the surgeon will cut the gallbladder or the bile duct in the area before the obstruction and subsequently sew it to the small intestine to form a new pathway around the blockage
- endoscopic stent placement: similarly, when the malignant tumor is obstructing the bile duct, surgery may be performed to insert a stent, a thin tube, in the blockage to drain the bile that has accumulated in the area and the surgeon may place the stent through a catheter that drains the bile into a bag on the outside of the body or the stent may be placed around the obstruction to drain the bile into the small intestine
- percutaneous transhepatic biliary drainage: when endoscopic stent placement cannot be carried out for various reasons, this procedure may be performed, which has the purpose of draining the bile that has accumulated as a result of a blockage and during which the surgeon will use ultrasound to guide the placement of the stent that will subsequently be left in the liver to drain bile into the small intestine or into a bag outside the body
The goal of treatment is to cure the cancer, to keep it under control, or to alleviate the symptoms of it in people whose disease is too advanced. Chemotherapy is often used for the treatment of gallbladder cancer, either before or after surgery or to help control the symptoms caused by this disease. As a systemic treatment, chemotherapy comes in the form of a pill or intravenous or intramuscular injection. When the medication reaches the bloodstream, it will destroy a part of the malignant cells in the gallbladder tumor. Some of the most common drugs used for gallbladder cancer chemotherapy are:
Radiotherapy may also be employed in the treatment of gallbladder cancer, with the goal of shrinking the malignant tumor as much as possible. As a local treatment, it works by delivering high-energy X-rays or another type of radiation to the area damaged by cancer, which will destroy some of the malignant cells and help keep the disease under control. Immunotherapy is also available for the treatment of gallbladder cancer, which entails using the immune system of the patient to fight cancer. There are multiple substances, either produced by the body or artificial, that can boost, direct or restore the immune system of the patient, as the majority of people who suffer from cancer have a very poor immune system that no longer fights against the disease. Pembrolizumab, a PD-1 inhibitor, is a very effective drug for people whose disease has spread to other parts of the body, as well as for individuals who cannot undergo surgery.
Lastly, targeted therapy is another treatment for gallbladder cancer. It uses medication or other substances to identify and destroy certain malignant cells. A very important benefit of targeted therapy is that it causes less harm to the overall health of the patient than chemotherapy or radiotherapy. At the moment, there are 2 drugs that are used for targeted therapy in people with gallbladder cancer, namely:
- ivosidenib: it blocks a specific mutation in the gene known as IDH1 and works by slowing or preventing malignant cells from growing
- pemigatinib: this substance blocks a specific mutation in a gene known as FGFR2 and works by both slowing the rate at which malignant cells grow and by destroying them
There are numerous types of malignant cells that occur with gallbladder cancer. Correctly identifying the type of malignant cells in a gallbladder cancer tumor is essential for designing the most effective treatment plan. These are the types of gallbladder cancer, from the most common to the rarest:
- Adenocarcinoma: Responsible for approximately 85% of cases, adenocarcinoma is the most common type of gallbladder cancer, having 3 subtypes, namely non-papillary adenocarcinoma, papillary adenocarcinoma, and mucinous adenocarcinoma. It develops in the tissues that hold the gallbladder in place and people who struggle with adenocarcinoma usually have a good prognosis, as this cancer is less likely to spread to the liver and the adjacent tissues and organs.
- Squamous cell cancer: It develops from the cells that form the lining of the gallbladder, as well as from the gland cells. This type of gallbladder cancer is quite rare, accounting for only 5% of cases. People who have it receive the same treatment as those with adenocarcinoma.
- Adenosquamous cancer: This gallbladder cancer type has both squamous malignant cells and glandular malignant cells. It may be referred to as mixed histology and is also treated in the same way as adenocarcinoma.
- Small cell cancer: Also known as oat cell carcinoma, small cell cancer tumors are made of malignant cells that resemble oat. It is a rare type of gallbladder cancer.
- Sarcoma: This type of gallbladder cancer damages the supportive or protective tissues of the body, medically known as the connective tissues, which include muscles, blood vessels, and nerves. Thereby, cancer that begins in the muscles of the gallbladder is usually sarcoma.
- Neuroendocrine tumor: These malignant tumors are rare and grow from the hormone-producing tissues that are located in the digestive system. The most common type of neuroendocrine tumor is carcinoid.
- Lymphoma and melanoma: As extremely rare types of gallbladder cancer, lymphoma and melanoma do not usually qualify people for surgery, as they often respond well to chemotherapy and radiotherapy.
Symptoms of Gallbladder Cancer
Usually, people whose gallbladder cancer is in the early stage do not experience any symptoms. However, when cancer begins spreading, they may notice the following:
It is crucial to seek medical attention as soon as you notice one or more of the above symptoms, as you may have developed gallbladder cancer. At Cedars Sinai Marina del Rey Hospital, our specialists can easily detect the presence of gallbladder cancer by using advanced diagnostic technology. The earlier your cancer is found, the most favorable your prognosis will be.
Diagnosis of Gallbladder Cancer
By virtue of the advancement of medical technology, there are multiple diagnostic tests and exams used to determine whether you have gallbladder cancer. The following are the most common, as well as the most effective, diagnostic tools used to detect gallbladder cancer:
- Biopsy: Taking a sample of tissue from the gallbladder and subsequently having it examined by a pathologist is the most certain way to confirm or deny the presence of cancer in the organ. The sample of tissue can be collected in multiple ways, such as by using laparoscopy, during surgery, or by using endoscopy. Another way of collecting a sample of tissue from the gallbladder is by fine needle or thick needle aspiration, which is medically known as a core biopsy. During this procedure, the doctor uses computed tomography or ultrasound to guide the needle into the gallbladder.
- Endoscopic retrograde cholangiopancreatography: This procedure allows the doctor to see the inside of the body by inserting a thin and flexible tube, known as an endoscope, through the mouth while the patient is lightly sedated so as not to experience any discomfort. The endoscope will eventually reach the bile duct and dye will be injected into it so that the doctor will be able to see in great detail the potential abnormalities of the gallbladder. This diagnostic procedure is usually carried out by a gastroenterologist, who specializes in the function and disorders of the digestive tract.
- Percutaneous cholangiography: By inserting a needle in the gallbladder, a dye is injected into the organ so that the doctor will be able to see a potentially malignant tumor that occurs on it on X-rays. A cholangiography also provides images of the bile duct. However, this procedure is not always effective, as the doctor may miss the malignant tumor that has developed on your gallbladder. For this reason, you will undergo multiple diagnostic tests and exams before you are assigned a correct and accurate diagnosis.
- Laparoscopy: During laparoscopy, which entails a surgeon making several small incisions in your abdomen, the doctor will be able to see your gallbladder and diagnose cancer if it is present. The endoscope is also used in this procedure, as it is a very useful tool in the examination of the gallbladder. A sample of tissue may be collected from the gallbladder during laparoscopy, which will subsequently be analyzed by a pathologist to confirm or deny the presence of malignant cells.
- Blood tests: There are several blood tests used for the diagnosis of gallbladder cancer, such as measuring your levels of bilirubin, a chemical that is usually found in large amounts in the blood of people with gallbladder cancer due to the obstruction of the common bile duct by a malignant tumor.
- CT scan: Computed tomography offers clear images of the inside of your body and is thereby very helpful in the diagnosis of gallbladder cancer. It is often used when you already have a gallbladder cancer diagnosis to assess the size of the malignant tumor and the extent to which it has spread. This procedure uses X-rays to provide three-dimensional images of your gallbladder.
- MRI scan: Magnetic resonance imaging is another test that provides the doctor with clear images of your gallbladder. Unlike computed tomography, it uses magnetic fields to create images of the inside of your body. A special dye, medically known as a contrast agent, may be injected into one of your veins so that your gallbladder will appear more clearly in the images provided by the MRI scan.
- Ultrasound: By using sound waves to create images of your gallbladder, ultrasound may prove to be a very effective way to diagnose cancer. Since malignant tumors generate different echoes of the sound waves than healthy tissue, gallbladder cancer is relatively easy to diagnose by using this method.
- Endoscopic ultrasonography: After light sedation, a special endoscope that can also emit sound waves is inserted through your mouth with the purpose of reaching your stomach and small intestine. This test is useful to assess the malignant tumor present on the gallbladder, as well as to collect a sample of tissue for a biopsy.
- PET scan: Positron emission tomography is also effective in examining malignant tumors that occur on the gallbladder since this diagnostic tool also offers the doctor clear images of the inside of your body. Before the procedure, a small amount of radioactive sugar substance may be injected into one of your veins so that the images of your gallbladder will appear clearer.
Medical researchers do not exactly know what causes gallbladder cancer. However, they have identified several risk factors, some of which you can avoid, that increase your susceptibility to developing the disease. Some of these risk factors are:
There is not much you can do to prevent gallbladder cancer if you have a predisposition to developing it, but there are certain risk factors you can avoid, which may lower your risk of receiving this diagnosis. What you can do to reduce your risk of gallbladder cancer is the following:
- seeking treatment for gallstones, gallbladder polyps, bile duct reflux, and bile duct cysts
- maintaining a healthy weight for your height by eating a balanced diet and engaging in physical activity on a regular basis