The gallbladder - a part of the digestive system, a small, pear-shaped organ located on the right side of the body, under the liver. The liver produces bile, which is necessary for the body to process fats. It accumulates in the gall bladder and then is moved by special ducts to the small intestine. Gall bladder biliary system is a component of the body.
Sometimes irregularities in his work can provoke oncology, this applies to chronic inflammation. In most cases the malignant process affects body mucous glandular cells. This type of cancer is calledadenocarcinoma, Accounting for 85% of cases. Adenocarcinoma is divided into:
- Papillary when tumors develop in the connective tissue, have a low risk of spread and a better prognosis.
- Adenocarcinoma of intestinal type - cell tumors of the gastrointestinal tract are similar to cancer cells.
- Mucinous adenocarcinoma - often surrounded by mucus.
Sometimes the cancer process occurs in thin, flat cells called squamous epithelial cells, respectively cancer is called squamous cell. Much rarer, it is treated the same as adenocarcinoma.
Some tumors develop in the glandular cells and squamous cells. This mixed types of neoplasms. Treatment is the same as for adenocarcinoma.
Among the rare species of gall bladder cancer celebrate perstenevidno cell, clear cell carcinoma, undifferentiated carcinoma, neuroendocrine tumors, melanoma, lymphoma and sarcoma.
Causes of gallbladder cancer
No information on any one cause of this disease. Consider the impact of certain substances or conditions that increase the likelihood of cancer. In most cases, the development of a malignant process is influenced by many factors. However, some people have not detected any identifiable factors.
- Malignant tumor of the gallbladder mostly develops in the female half of humanity. This is due to the occurrence of stones and inflammation.
- Influenced by age, mostly ill patients older than 60 years.
- In some countries and ethnic groups - the incidence is higher - in India, Latin America, East Asia.
- Chronic inflammation of the gall bladder increases the likelihood of cancer.
- Stones in the bladder are the most common risk factor, especially in women.
- A consequence of chronic inflammation becomes calcium accumulation in the body of the walls and the formation of so-called "porcelain" gallbladder.
- Congenital disease. Cystic disease of biliary tract - rare pathology which is characterized by an abnormal current of bile, bile duct inflammation and organ directly. Another anomaly - wrong connection of the bile ducts and of pancreas, which leads to movement of digestive juices in the pancreas bile ducts and not in the small intestine, the gallbladder causing irritation.
- Bacterial infections that trigger chronic inflammation, increase the risk of cancer: Salmonella typhi, Helicobacter Bilis, Helicobacter Pylori.
- Numerous studies have confirmed that obesity contributes to the development of cancer, because it leads to the formation of gallstones.
- Polyps on organ mucosa can regenerate from benign to malignant, when they reach a certain size (more than 1 cm in diameter).
- Possible risk factors include family history, diabetes, partial resection of the stomach, the number of pregnancies.
- Also separately isolated group of factors, for which there is sufficient evidence: a professional contact with certain chemicals; hormones - the use of oral contraceptives or hormone replacement therapy; taking certain medications - isoniazid or methyldopa; consumption of contaminated drinking water with organochlorine pesticides or heavy metals (cadmium, chromium, lead); consumption of coffee, tobacco, alcohol.
You can take certain measures to reduce the risk of cancer:
- Be physically active and maintain a healthy body weight.
- If there are no symptoms, but there are large stones in the gall bladder, large polyps or calcium deposits, it is recommended to remove the body.
It should be borne in mind that the higher risk of developing cancer is marked with the following conditions:
- "Porcelain" gallbladder.
- Congenital cystic biliary tract disease.
- Abnormalities of the bile ducts.
- Chronic bacterial infection.
Recommended diagnostic tests - biochemical blood tests, ultrasound, ERCP.
Symptoms of gallbladder cancer
In the initial stages of the disease possible absence of any indication as organ located deep within the abdominal cavity. Most of the symptoms occurs in the later stages, when there are metastatic lesions affecting other organs. Basically, the disease is detected when there are already metastases. But sometimes the cancer is diagnosed by chance when, for example, remove gallstones.
But it is necessary to know what other disease can also cause these symptoms:
- Pain pulling character in the liver.
- Vomiting and nausea.
- Jaundice - a condition in which the color becomes yellow skin, eye whites, dark urine. The tumor is blocking the bile, stops its flow to the intestine, it begins to accumulate in the blood and tissues of the body.
- itchy skin caused by jaundice.
- Loss of appetite and body weight.
- Bloating or swelling. Gallbladder swells or increases in size due to swelling or accumulation of bile. Sometimes the doctor may test the increased body size during physical examination.
Diagnosis of cancer of the gallbladder in Israel in the clinic Assuta
At the initial stage the doctor will collect the history, ask about possible risk factors, signs and symptoms of the disease. Conduct a physical examination.
The following types of tests can be assigned to the clinic Assuta :
- Biochemical analysis of blood will give information about irregularities in the gall bladder. bilirubin is determined which indicates an excessive content of blocking the bile ducts or liver problems in connection with the malignancy. Also, set the number of alkaline phosphatase, alanine aminotransferase (ALT) and aspartate transaminase (AST), the excess of which indicates the spread of tumor to the liver.
- If there is a suspicion of cancer, the first test is often the ultrasound. Ultrasound display possible thickening, give information on the size of the tumor, possible liver damage.
- Computed tomography will reveal oncology , Very level of its development, effects on nearby organs and structures.
- Tests for tumor markers can help diagnose cancer, as they are used to verify the effectiveness of the treatment. Is measured carbohydrate antigen 19-9 (CA19-9) (indicates the last stage of the disease); carcinoembryonic antigen (CEA) (evidence of malignancy).
- A biopsy involves the removal of tissue samples for further histological examination. It can be performed needle aspiration biopsy under CT guidance. It is performed when other tests revealed metastases in the adjacent organs, and the lack of possibilities of surgical treatment and the removal of the tumor process. The tissue sample may also take during endoscopic retrograde cholangiopancreatography (ERCP) or laparoscopy. If the doctor is absolutely sure of the diagnosis "cancer" on the basis of other tests performed surgery to remove the gall bladder without a biopsy.
- Doctors perform ERCP, when there is suspicion of oncology. This study helps to define blocking ducts due to stones or tumors; to find out whether the tumor is operably; establish bile duct injury and take samples; place the stent if necessary; assists in the process of planning of the operation.
- MRI determines the degree of malignancy and the stage. It is used as a special type of MRI - magnetic resonance cholangiopancreatography.
- Transcutaneous transhepatic cholangiography - study of bile ducts and liver and by X-ray contrast agent. This test is used to determine whether there is a blockage of ducts; take a sample of bile, to explore for the presence of cancer cells; to establish whether there is a secondary foci in the liver.
- With laparoscopy physician can determine whether the tumor has spread process gallbladder. Also assists in the planning of surgery and other treatments. By laparoscopy address that confirm the presence and extent of the tumor process; take a tissue sample.
Gradation of gallbladder cancer
In planning treatment gallbladder cancer an important role evaluation of the disease according to the existing classification to make a correct prediction. gallbladder cancer is classified (differentiate) according to the appearance and microscopic behavior of cancer cells compared with healthy cells. This helps to evaluate the rate of cancer.
1 - cells were well differentiated, slow growing, low probability distribution.
2 - moderately differentiated cells, the average speed of development.
3 - poorly differentiated cells, grow fast, high probability of spread.
Prognosis of gallbladder cancer
The prognosis is determined by many factors. Only a doctor who knows the history of the disease, type of cancer, the stage of the treatment program, the body's response is to analyze and compare these data with the statistics of survival and to make a forecast.
Have a favorable prognosis:
- Initial stages of malignancy. However, only 10% of people diagnosed with the disease in the early stages of development, the majority - in the later.
- Tumors completely bounded inner layer (mucosa) of the gallbladder.
- Resectable tumors that can be removed completely. Surgery - the most efficient treatment. However, only twenty-five percent of patients can be completely resect the tumor process.
- Papillary adenocarcinoma.
- Low-grade neoplasms of the gallbladder, well differentiated and slow growing.
Treatment of cancer of the gallbladder in Israel
Patients doctors offer israeli will most advanced the Methods of Treating cancer . As the disease is usually diagnosed in the later stages, when it progresses and is difficult to treat, it is important to choose the medical center that specializes in the treatment of tumors of the gallbladder is a great experience.
Personalized treatment plans, interdisciplinary approach
Israeli doctors priority is to provide patients and their families exclusive care. With the patient runs a team of doctors - a gastroenterologist, oncologists, radiotherapists, surgeons, pathologists, radiologist, palliative care physicians, as well as support staff (dietician, therapist, etc.). Patient offer the most advanced treatments possible, helping to maintain the quality of life during therapy. He offered to actively participate in decision-making.
Clinical trials and genetic studies
Assuta Hospital doctors are actively involved in scientific research and apply the latest knowledge, providing medical assistance. Genetic screening is available for all patients. Targeted therapy in a clinical trial is part of an approach to the treatment, patients can take part in it.
Assuta Hospital provides a wide range of maintenance therapy - individual and family counseling, rehabilitation and physical therapy, symptoms and pain management, acupuncture, massage, support groups.
For treating the disease use surgery, treatment with cytotoxic agents, radiation therapy and palliative.
Surgery in the treatment of cancer of the gallbladder in Izarile
Surgeons Assuta clinics have extensive experience in conducting transactions tumors biliary system, innovative methods are used:
- Minimally invasive robotic surgery using laparoscopic techniques.
- Resection and reconstruction of the bile duct, often with the removal of liver segment.
- New surgical methods to remove large tumors previously considered inoperable.
Selection of operation due to the location of tumors:
- Gall bladder: the removal of superficial tumors produce bladder with the surrounding portion of the liver, lymph nodes adjacent to ensure that malignant cells remained.
- Bile ducts: the choice of surgery is determined by the localization of tumors. Some tumors require the removal of the distal (far) end of the bile duct - the operation Whipple, or resection of the pancreatic head and duodenum. More proximal tumor can be removed without pancreas resection, but require removal of the liver segment to provide a fully malignant cell extract.
Chemotherapy in the treatment of cancer of the gallbladder in Israel
Assuta large multidisciplinary team works with the patient, this tight integration, extensive experience in helping to develop the best treatment plan. Clinic oncologists participate in clinical trials and basic research aimed at the use of chemotherapy in the treatment of cancer of biliary system.
Assuta doctors know how to optimize chemotherapeutic treatment and reduce the side effects, they use extensive knowledge to determine the most appropriate treatment regimen. Have experience of working with the latest methods of treatment, and its ability to adapt to each patient in order to achieve the highest probability of success. These options are discussed with the patient to determine an appropriate treatment plan.
Radiation therapy in the treatment of cancer of the gallbladder in Israel
The approach that is used in the clinic to Assuta gallbladder cancer treatment, is unique, combining the external and internal radiation therapy, technically complicated method that provides a high dose of radiation directly to the affected organ.
Also used stereotactic radiation therapy that uses focused, high-precision X-ray radiation to deliver a high dose of radiation to treat inoperable tumors. With this therapy, it is possible to treat patients without surgery.
Radiation therapy is carefully thought out and planned as part of a therapy program. It is often recommended:
- After surgery and chemotherapy in addition to reduce the likelihood that the cancer will return.
- In order to reduce tumor size prior to surgery and make operable.
- To control the disease, when the malignancy can not be removed surgically.
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