The gallbladder is the storehouse of concentrated bile before passing into the intestine. Bile plays a pivotal role in the absorption of fats and the excretion of excess cholesterol. Obesity, gallstones, and the habit of smoking aid in the formation of cancerous cells in the gallbladder, leading to gallbladder cancer. Gallstones are present in almost 80% of the patients diagnosed with gallbladder cancer. India witnesses around 10% of the global incidences of gallbladder cancer, making it crucial to seek timely gallbladder cancer treatment. In this article, we’ll explore different treatment options for this disease.
Treatment of Gallbladder Cancer
A mix of treatment modalities is required to stop the cancerous cells from multiplying. Gallbladder cancer treatment depends on the stage of the cancer and revolves around surgery.
- In the early stages, radical cholecystectomy completely removes the gallbladder along with the lymph nodes surrounding it. A specified area of the liver surface also needs surgical removal. However, relatively few patients are diagnosed with stage 1 cancer. Even those who undergo resection have a chance of recurrence of cancer.
- In stages 2 and 3, cancer begins to infiltrate the liver and adjacent nodes. Chemotherapy slows cell multiplication after surgery in such circumstances. Chemotherapy involves the administration of certain drugs to kill cancerous cells. If the gallbladder is unresectable, both radiotherapy and chemotherapy are required. In radiotherapy, a beam of X-rays is directed toward the affected area to kill cells and shrink tumours. Radio-sensitisers increase the intensity of rays and accelerate the damage to cancerous cells.
- In the advanced or metastatic stage, cancer starts spreading in the lungs and bones. The primary treatment for this stage is chemotherapy and immunotherapy. A positive result in Microsatellite Instability (MSI) screening indicates the need for immunotherapy. It prepares our immune system to fight against cancerous cells. Most gallbladder cancers are diagnosed at the advanced stage only. Unfortunately, the prognosis and survival rate at this stage are poor.
- In cases where open surgeries are not viable, laparoscopy and robotic surgeries work wonders. These are non-invasive methods to treat cancer and reduce patient trauma to a great extent. The advantages of laparoscopic surgery include minimal blood loss, early recovery, and reduced hospitalisation time.
- Palliative surgeries to relieve the symptoms include biliary bypass, endoscopic stent placement, and percutaneous transhepatic biliary drainage (PTBD). Biliary bypass lets the bile pass if a tumour is obstructing its passage. If the bypass doesn't yield results, a stent placed through a catheter in the gallbladder allows the bile to flow out of the body in a bag. If stent placement in the gallbladder is not possible, it is directed towards the liver so that bile drains into the intestine or a bag outside the body.
- Targeted drug therapy identifies and kills specific cancer cells. Certain molecules and immunised antibodies serve this purpose. Multiple drugs are under investigation to make the treatment successful.