Stages & Prevention of Gall Bladder Cancer | Dr Meenu Walia | DNB Medical Oncologist

Stage 0 (aka Carcinoma in Situ): The stage 0 marks with the presence of abnormal cells on the inner (mucosal) layer of the gall bladder. These are those abnormal cells which may become cancer and spread into nearby normal tissue at the later stages.

Stage I : In stage I, cancer has taken its form and spread beyond the inner (mucosal) layer. The cancerous cells, by now, have reached the muscle layer – or a layer of tissue that is connected by the blood vessels.

Stage II : In stage II, the cancer has reached the connective tissues around the muscle – beyond the muscle layer.

Stage IIIA : In stage IIIA, cancer has crossed the thin layers of tissue that forms the cover of the gall bladder and/or reached the liver and/or the other adjacent organ/s (such as the stomach, small intestine, colon, pancreas, or bile ducts outside the liver).

Stage IIIB : In stage IIIB, cancer has reached to the adjoining lymph nodes and has travelled:

1. Beyond the inner lining of the gall bladder; crossing to a layer of tissue connected with blood vessels – or to the muscle layer; or
2. Beyond the muscle layer, permeating the connective tissue available around the muscle; or
3. Beyond the thin layers of tissue that covers the gall bladder and/or reaching the liver and/or to one of the nearby organs (such as the stomach, small intestine, colon, pancreas, or bile ducts outside the liver).

Stage IVA : In stage IVA the cancer has dispersed to the main blood vessel of the liver or to two or more nearby organs (or areas) other than the liver. Chances are rife for the cancer to have spread to nearby lymph nodes as well.

Stage IVB : In stage IVB, there are chances that the cancer has spread to either the:

1. Lymph nodes present along large arteries – connecting the abdomen – and/or the lower potions of the backbone altogether; or
2. Organs or areas even lying far away from the gall bladder.

Prevention of Gall Bladder Cancer

# Cholecystectomy, the term used for the surgical removal of the gall bladder – including dissection of the part of the liver and lymph node – is the most common and among the most effective treatments available towards gall bladder cancer cure. But, it’s the poor prognosis of gall bladder cancer that, despite every effort, patients die within a year of cholecystectomy!

# In cases where surgery is not possible, endoscopic stenting of the biliary tree have been found to reduce jaundice – while a stent in the stomach to be effective in relieving the patient from recurrence of vomiting.

# Chemotherapy with radiation has also been found effective to go with surgery. In case gall bladder cancer is identified after an event of cholecystectomy carried out with respect to an event of stone formation/calcification (as incidental cancer), reoperation is advised in most cases with removal of the part of the liver and lymph nodes.

# An early detection and intervention can offer patients the best chances of long-term survival – and even complete cure in some instances!

Surgery

Surgery brings the best chances of curing early-stage cancer and in instances where the cancer has not spread beyond the gall bladder. To determine the possibility of surgery, the  oncologist may order images of the gall bladder, bile ducts and the liver. The experts will take aid of a camera and micro instruments in the identification process – which involves insertion made through tiny incisions in the abdomen (aka laparoscopic surgery) to estimate if the tumor has spread (metastasized) to the other regions.

The surgery options include:

1. Simple cholecystectomy– In instances where tumor has remained very small and has not spread to the deeper layers of gall bladder tissue, the surgeon may advice this procedure which involves removing only the gall bladder. On some occasions, this procedure can be carried out with the aid of laparoscope.
2. Extended cholecystectomy– The most commonly performed surgical methodology, extended cholecystectomy involves removal of the gall bladder – along with the liver tissue next to it, and the nearby lymph nodes.

Chemotherapy

1. In instances when the cancer has spread to other organs, chemotherapy is often recommended by medical oncologists.
2. While chemotherapy has not been found to cure advanced gall bladder cancer conditions, it, nevertheless, slows the progression of the disease.

Radiation

# A procedure involving high-energy beams can destroy cancer cells and shrink tumors. While used alone, radiation does not cure gall bladder cancer, but it may lead to an increase in the chances of survival.

# It may be radiation therapy in combination with chemotherapy (chemoradiation) that specialists  may recommend either before or after a surgery.

# One must know that chemoradiation may be used in instances of gall bladder cancers, which even if haven’t spread throughout the body but still cannot be removed by surgery – as well as during the cases of cancers that have been removed, but have chances of recurring with the stoppage of treatment.

Radiation options that come with a chemotherapy procedure include:

1. 3-D CRT– In Three-Dimensional Conformal Radiation Therapy (3-D CRT), a computer creates a 3-D picture of the tumor and conforms/matches the radiation beam to the shape of the tumor. The process involves directed throw of radiation beams from different angles towards the tumor – sparing normal tissue as much as possible, of course.
2. IMRT–Intensity Modulated Radiation Therapy   (IMRT) like its counterpart in 3-D CRT, attempts to maximize the radiation dose to the area of gall bladder comprising of cancerous cells – along with the lymph node regions that are at risk – ensuring minimum intervention with the nearby healthy organs.

# There are cases where doctors may even recommend the use chemoradiation before surgery – followed by Intraoperative Radiation Therapy (IORT).

# IORT involves delivery of a concentrated beam of radiation to tumors encountered during a surgery.