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Cancer / Oncology Treatments


Gallbladder Cancer

The gallbladder is a small, pear-shaped organ under the liver. Both the liver and the gallbladder are behind the right lower ribs. In adults, the gallbladder is usually about 3 to 4 inches long and normally no wider than an inch.
The gallbladder concentrates and stores bile, a fluid made in the liver. Bile helps digest the fats in foods as they pass through the small intestine. Bile is either released from the liver directly into ducts that carry it to the small intestine, or is stored in the gallbladder and released later. When food (especially fatty food) is being digested, the gallbladder contracts and releases bile through a small tube called the cystic duct. The cystic duct joins up with the common hepatic duct, which comes from the liver, to form the common bile duct. The common bile duct joins with the main duct from the pancreas (the pancreatic duct) to empty into the duodenum (the first part of the small intestine) at the ampulla of Vater.

Types of gallbladder cancers

About 9 out of 10 gallbladder cancers are adenocarcinomas. An adenocarcinoma is a cancer that starts in cells with gland-like properties that line many internal and external surfaces of the body (including the inside the digestive system).

Papillary adenocarcinoma or just papillary cancer is a type of gallbladder adenocarcinoma that deserves special mention. When seen under a microscope, the cells in these gallbladder cancers are arranged in finger-like projections. In general, papillary cancers are not as likely to grow into the liver or nearby lymph nodes. They tend to have a better prognosis (outlook) than most other kinds of gallbladder adenocarcinomas. About 6% of all gallbladder cancers are papillary adenocarcinomas.

Other types of cancer, such as adenosquamous carcinomas, squamous cell carcinomas, small cell carcinomas, and sarcomas, can develop in the gallbladder, but these are uncommon.

A team of Surgical Oncologists, Radiation oncologists, Medical oncologists and other medical specialties work together to treat each gall bladder cancer patient. They consider each patient's type and extent of gall bladder cancers to recommend the most appropriate treatment plan. They also carefully consider and select the treatment option that will allow the patient to maintain improved quality of life with good survival rate.

Several types of imaging studies are done to detect and evaluate gallbladder cancer. In tests that involve radiation, specialists carefully monitor doses to avoid the risk of radiation overexposure.

  • Ultrasound. Ultrasound is a painless procedure in which a technician moves a wand-like device (transducer) over the surface of the abdomen. High-frequency sound waves form images on a screen that can identify a tumor in the gallbladder and bile ducts (Biliary tract).
  • Endoscopic ultrasound (EUS). For more detailed images, an ultrasound probe is passed through a flexible tube (endoscope) into the stomach and intestines (gastrointestinal tract). Sound waves are directed toward the gallbladder, and a computer translates them into images.
  • Computerized tomography (CT) scans. CT scans generate cross-sectional images of the body that can show whether cancer has spread to other tissues or organs. All CT scanners at Mayo Clinic use spiral CT technology (an X-ray tube revolves around the patient) and several CT scanners use multi-detector row spiral technology, which creates three-dimensional images.
  • Magnetic resonance imaging (MRI) scans. MRI technology uses magnetic fields and radio waves to create detailed images of the gallbladder, bile ducts, liver and tumor. This highly sensitive technology can identify small abnormalities in the gallbladder.
  • Positron emission tomography (PET). To perform a PET scan, doctors inject sugar (glucose) and a very small amount of radiation into the bloodstream. The scan helps show if a tumor has spread, because tumors typically pick up the sugar and appear on the image as "hot spots."
  • Biopsy. In a biopsy, a pathologist removes a small tissue sample and looks under a microscope for cancer cells. Doctors may use fine-needle aspiration (FNA) to collect the tissue. During an FNA procedure a doctor will give you a local anesthetic and then gently guide a small needle through the skin and abdomen into the gallbladder. Ultrasound or CT scans help the doctor locate the tumor.

Treatment options for Gall Bladder Cancer would include one or more of  surgery, chemotherapy and radiation therapy. Treatment options depend on several factors, including:

  • Location and size of the tumor
  • Stage (extent) of the cancer
  • Overall health of the patient

Surgery

Surgery offers the best chance of curing early-stage cancer that has not spread beyond the gallbladder. To determine if surgery is possible, surgical oncologist may order images of the gallbladder, bile ducts and the liver. Surgeons will use a camera and miniature instruments inserted through tiny incisions in the abdomen (laparoscopic surgery) to see if the tumor has spread (metastasized). Surgery options include:

  • Simple cholecystectomy If the tumor is very small and has not spread to the deeper layers of gallbladder tissue, the surgeon may use this procedure, which removes only the gallbladder. Occasionally this procedure can be done using laparoscopic surgery.
  • Extended cholecystectomy. This is the most commonly performed surgery, involving removal of the gallbladder, the liver tissue next to it, and nearby lymph nodes.

Chemotherapy

  • When the cancer has spread to other organs, medical oncologists may recommend chemotherapy.
  • Chemotherapy currently does not cure advanced gallbladder cancer, but sometimes slows the disease's progression.

Radiation

Radiation refers to high-dose beams that destroy cancer cells and shrink tumors. Used alone, radiation does not cure gallbladder cancer, but may increase the chance of survival.

Specialists may recommend radiation therapy in combination with chemotherapy (chemoradiation) either before or after surgery. Chemoradiation may be used for gallbladder cancers that have not spread throughout the body but cannot be removed by surgery, or for cancers that have been removed but might come back without more treatment. Radiation options given with chemotherapy include:

  • 3-D CRT. In three-dimensional conformal radiation therapy (3-D CRT), a computer is used to create a 3-D picture of the tumor to conform or match the radiation beam to the shape of the tumor. Many radiation beams are aimed at the tumor from different angles, sparing normal tissue as much as possible.
  • IMRT. Some patients may benefit from intensity modulated radiation therapy (IMRT). As with 3-D CRT, this technique attempts to maximize the radiation dose to the gallbladder cancer and lymph node regions at risk, while minimizing the dose to nearby healthy organs.
  • In some cases, doctors may use chemoradiation before surgery, followed by intraoperative radiation therapy (IORT). IORT delivers a concentrated beam of radiation to tumors as they are found during surgery.


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