Gallbladder and bile duct cancers are relatively uncommon. Gallbladder cancer is a malignancy that starts in the gallbladder. It is diagnosed in women about 1.5 times as often as in men. Bile duct cancer, or cholangiocarcinoma, originates in bile ducts located inside or outside the liver.

Risk of disease

Cholelithiasis (presence of gallstones in the gallbladder) increases the risk of gallbladder cancer. Therefore, removal of the gallbladder is a preventive measure. Most gallbladder cancers are detected as incidental findings in connection with gallstone surgery. Obesity increases the risk of gallbladder cancer. Being female also increases the risk. The risk of cholangiocarcinoma increases considerably if the bile ducts are chronically inflamed due to an autoimmune disease or infection (the latter is rare in Finland).

Symptoms

The disease may present jaundice, pain, fever, nausea and vomiting, but these symptoms usually indicate an advanced cancer. Some symptoms (jaundice, itching) may be due to bile duct obstruction caused by the tumor, while other symptoms are of a more general nature (weight loss, loss of appetite, tiredness). An autoimmune disease of the bile ducts is sometimes found when elevated liver values are detected in a routine health check-up or during examinations related to another autoimmune disease (such as ulcerative colitis).

Diagnosis

Gallbladder cancer cannot be diagnosed solely on the basis of lab test results, and ordinary X-ray examinations are not particularly useful in the diagnosis of gallbladder cancer. Recurring, difficult-to-manage cholecystitis may be a sign of a gallbladder tumor. An ultrasonic or CT scan may reveal a thickened gallbladder wall and/or enlarged lymph nodes. Distinguishing between a malignancy and inflammatory lesions in the gallbladder may be difficult.

Ultrasonic and CT scans are often used to complement each other in the staging of the cancer. A cholangioraphy is often necessary for the diagnosis of bile duct cancer. Today, it is usually an endoscopic retrograde cholangiography (ERC). Magnetic resonance cholangiopancreatography (MRCP) is also efficient for detecting a bile duct obstruction and its location.

Treatment

Gallbladder cancer is treated surgically. In addition to gallbladder removal, local lymph nodes and some surrounding liver tissue are often also removed. Cancer of intrahepatic bile ducts is treated surgically whenever possible. However, at the time of diagnosis, the cancer has often spread so that it cannot be operated on. Extrahepatic bile duct cancer surgery resembles pancreatic cancer surgery, in which the bile ducts, the gallbladder, part of the pancreas, the duodenum and surrounding lymph nodes are removed. Surgery is curative only in the event that the cancerous tumor can be completely removed, so that all of the remaining surrounding tissue is healthy. This is particularly challenging when operating on the liver.

The response of gallbladder and bile duct cancers to chemotherapy varies. Their natural growth rate also varies a lot. In some cases, chemotherapy is efficient, has a long-lasting effect and can considerably prolong the patient’s survival.

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