Gall Bladder Cancer

Gall bladder cancer is usually classified based on when it is detected:

• Incidental Gall Bladder Cancer: Found by chance after gall bladder removal for another reason (like gallstones).
• Non-Incidental Gall Bladder Cancer: Diagnosed before surgery, based on symptoms and imaging.

Only 30% of all gall bladder cancers are discovered preoperatively (non-incidental). The patient may present with vague symptoms, including:

• Abdominal pain and discomfort
• Nausea and vomiting
• Unexplained weight loss
• Jaundice (yellowing of skin and eyes)

Gall bladder cancer develops when the lining of the gall bladder undergoes long-term damage. Key risk factors include:

• Chronic inflammation of the gall bladder (chronic cholecystitis), often due to gallstones
• Gall bladder polyps (>1 cm in size): Small growths that arise from the gall bladder. Most polyps are usually benign and do not carry cancer risk, but it depends on the polyp size. Polyps >1 cm are at an increased risk of being cancerous, so surgery is usually recommended. As such, only 0.6% of all gall bladder polyps are malignant.
• Focal thickening and irregularity/induration on the gall bladder wall, as seen on ultrasound and imaging, may be associated with gall bladder cancer and requires gall bladder removal for confirmation.

Gall bladder cancer is often diagnosed either incidentally or through targeted imaging tests:

• Pathological examination: Microscopic testing of the gall bladder after removal can unexpectedly reveal cancer.
• CT scan/PET-CT scan: Accurate diagnosis of gall bladder cancer is made on CT scanning. Further imaging (PET-CT) will be required to rule out metastases. A CT scan is an accurate modality for staging the disease and defining further treatment, which is stage-dependent.

The precise treatment plan will depend on the presence/absence of metastatic disease, lymph nodes and local extent of the disease. In most instances, wherein the cancer is localised to the gall bladder (which is usually the case), further surgery is required

• Surgery (Mainstay of Treatment): Surgery is only done when the cancer is localised to the gall bladder and the surrounding structures including regional lymph nodes, and has not extensively spread to either within the abdomen or elsewhere. Since the gall bladder resides at the base of the liver, surgery for cancer involves
  • Gall bladder removal
  • Removal of part of the liver where the gall bladder is present
  • Regional draining of lymph nodes

Sometimes, more extensive surgery will be required to remove the cancer.

• Chemotherapy: Chemotherapy plays a role in the treatment and is provided following surgery. Chemotherapy is also sometimes given before surgery to shrink the tumour and make it operable.

Seek medical advice if you experience symptoms such as persistent abdominal pain, unexplained weight loss, jaundice, or vomiting without a clear cause. Patients with gall bladder polyps larger than 1 cm or abnormal findings on imaging should also be evaluated by a specialist.

There is no guaranteed way to prevent gall bladder cancer, but risk can be reduced by:

• Early removal of gall bladder polyps >1 cm.
• Timely treatment of gallstones and chronic gall bladder inflammation.
• Healthy diet and weight management, since obesity and gallstones are linked.
• Regular check-ups and ultrasound in high-risk individuals (such as those with a strong family history or chronic gall bladder disease).

Patients with suspected or confirmed gall bladder cancer should consult a:

• Gastroenterologist or Hepatobiliary Surgeon for diagnosis and surgery.
• Oncologist for chemotherapy or advanced treatment planning.