NAIROBI, Kenya, Mar 2 – Gall bladder and bile duct cancer is a rare form of cancer that is difficult to diagnose. The early signs are non-specific and are common to many other conditions, including non-cancer conditions.
In an interview with Capital Health, Medical Oncologist at the Nairobi Hospital Professor Muthoni Musibi noted that this type of cancer is the most confusing as far as presentation is concerned. This, she explains, is because most of what the disease presents tends to be vague or non-specific.
“The gallbladder is a small, pear-shaped pouch that lies beneath the liver, in the upper abdomen. It stores bile. This fluid, produced by the liver, helps digest fat. The gallbladder releases bile into the small intestines through the bile duct. This thin tube connects the liver and gallbladder to the small intestine. Cancer develops when abnormal cells in these structures multiply and grow rapidly,” Prof. Musibi explained.
“Majority of the patients will come in with abdominal discomfort, acidity, complaints because what happens is that there is a reflux of the bile back into the gastric system.”
When cancer develops in the gallbladder, it usually starts in the innermost layers and gradually spreads to surrounding tissues.
That makes it hard to detect it early or during a routine physical exam because the gallbladder is tiny and largely hidden by the liver.
According to Prof. Musibi , although it usually does not cause symptoms until later, sometimes signs do appear, including lumps in the belly, nausea and or vomiting, abdominal pains, weight loss, jaundice, persistent fever, fatigue and white colored stool.
Gallbladder and bile duct cancers are rare. Gallbladder cancer is more common in women than in men. People with gallstones have a slightly higher risk of developing gallbladder and bile duct cancer.
“The persistent irritation on the gall bladder lining is what predisposes one to cancer,” Prof. Musibi explained.
Other risk factors include Primary sclerosing cholangitis (PSC) a long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts which normally allow bile to drain from the gallbladder, chronic liver disease, bile duct problems present at birth, liver fluke infection which can occur from eating raw or undercooked fish, Old age ‘more common from the ages of 50’ and smoking.
These diseases can cause inflammation and scarring of the bile duct, colon or liver.
Gallbladder and bile duct cancers may cause no symptoms. Nor can they be seen or felt during a routine physical exam. Rather, many of them are found when the gallbladder is removed as a treatment for gallstones.
Prof. Musibi notes that on the suspicion of this form of cancer, one may be subjected to the following diagnostic tests: Ultrasound which can detect about half of gallbladder cancers. It can also help find a bile duct obstruction or tumor, if it’s large enough.
Computed tomography (CT) which can identify a tumor inside the gallbladder or one that has spread outside of it. It also can help to determine whether the tumor has spread to the bile duct, liver, or nearby lymph nodes.
Magnetic Resonance Imaging (MRI) can make more detailed images than ultrasounds and CT scans. That is why they are effective in showing whether a tumor is only in the gallbladder or has invaded the liver.
Endoscopic Retrograde Cholangio Pancreatography (ERCP). In this procedure, a flexible tube is passed down the throat, through the esophagus and stomach, and into the common bile duct. A small amount of contrast dye is used to help outline the bile duct in x-ray images. These pictures can show if the bile duct is narrowed or blocked. The advantage of ERCP is that it can be used to take biopsies of a blocked area and relieve the blockage.
Surgery – done to determine if there is cancer in the gallbladder or bile duct.
Biopsy, to be certain of the diagnosis, a tissue sample will be taken from the tumor or mass and examined in a laboratory. Bile may be taken to see if it contains cancer cells.
It is worth to note that unless treated, the gallbladder and bile duct cancers will continue to grow.
Upon confirmation of diagnosis of this form of cancer and the stage of the disease, the treatment options will then be determined. The options include when possible, surgical removal of as much cancer as possible is done. Liver transplant – Surgery to remove your liver and replace it with one from a donor may be an option in certain cases.
Chemotherapy – Uses drugs to kill cancer cells. This is mostly used for people with advanced disease to slow down progression and relieve symptoms. Radiation therapy – This involves use of high radiation beams to damage cancer cells.
Photodynamic therapy – A light-sensitive chemical is injected into a vein and accumulates in the fast-growing cancer cells. Laser light directed at the cancer causes a chemical reaction in the cancer cells, killing them.
Biliary drainage – A procedure to restore the flow of bile which can involve bypass surgery to reroute the bile around the cancer or stents to hold open a bile duct being collapsed by cancer. Biliary drainage helps relieve signs and symptoms.
According to Prof. Musibi, there is no way to prevent this condition, but reducing one’s risk factors may be possible.
“The risky habits to look out for include smoking, moderate alcohol intake to reduce the risk of preventable Chronic liver diseases well as maintaining a healthy diet and weight,” advised Prof. Musibi.