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Gallbladder Cancer
Clinical Description
Symptoms
Diagnosis
Treatment Options
Cholangiocarcinoma
Clinical Description
Symptoms
Diagnosis
Treatment Options
Clinical Trials
Our Experts
Clinical Description: Gallbladder Cancer
Gallbladder cancer is a very rare but usually lethal malignancy, accounting for only 5,000 cases per year in the United States. If discovered early in its course there is a good chance for a cure, but due to lack of symptoms, most patients present with advanced disease, and at this stage, the prognosis is poor.
Symptoms of Gallbladder Cancer
Some of the symptoms of gallbladder cancer include: fever, pain in the right upper portion of the abdomen, nausea, loss of appetite, weight loss, jaundice (yellowing of the skin and eyes) and bloating. Older persons with a history of gallstones or other gallbladder diseases, along with women and Native Americans are all at increased risk of the disease.
How Gallbladder Cancer is Diagnosed
Initially, an abdominal ultrasound may be done to evaluate some the symptoms. A computed tomography (CT) scan will also be helpful in identifying the location of the tumor and the extent of disease. Another imaging modality is an endoscopic ultrasound which can also help visualize the extent of local spread to lymphatics and can be used to obtain a biopsy. Blood work to evaluate liver function as well as markers that can be elevated in gallbladder cancer, called carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) will help in the assessment and monitoring of the disease. A procedure to look at the bile ducts may be recommended to give the doctor more detailed information. This procedure is called an endoscopic retrograde cholangiopancreatography (ERCP). In this procedure, a small tube is inserted through the mouth, passed through the esophagus and stomach and then dye is injected into the bile ducts to look for obstructions. These obstructions can then be opened with the use of a stent (small tube) relieving pressure off of the ducts and liver and improving some of the symptoms, like jaundice, itching, and sometimes pain. With this method, it may also be possible to obtain a tissue sample for diagnosis. It is also possible to obtain a diagnosis by obtaining a biopsy surgically.
Stages of gallbladder cancer include:
· Stage I: cancer is confined to the inner layers of the gallbladder.
· Stage II: : cancer has grown to invade the outer layer of the gallbladder and may protrude into nearby organs, such as the liver, stomach, intestines or pancreas or involve nearby lymph nodes
· Stage III: cancer has grown to invade more than one of the nearby organs, or it may invade the portal vein or hepatic artery.
· Stage IV: includes tumors of any size that have spread to distant areas of the body.
Treatment Options for Gallbladder Cancer at Tufts Medical Center
For early stage disease, surgery can be curative. Surgery involves removing the gallbladder and sometimes part of the liver and surrounding lymph nodes, if the cancer is more extensive. Following surgery, a combination of chemotherapy or chemotherapy and radiotherapy can be useful to prevent recurrence in some cases.
With more advanced disease, surgery is not indicated. If the cancer has spread outside the gallbladder, chemotherapy and/or radiation therapy can be used to control the growth and symptoms of the disease. Occasionally a stent would be placed in the bile ducts to help with jaundice. The goal of these therapies is to control symptoms and maintain or improve the quality of life.
Clinical Description: Cholangiocarcinoma
Similar to gallbladder cancer, the cancer of the bile ducts, called cholangiocarcinoma, is a rare entity accounting for only 3% of gastrointestinal cancer cases and 2 in 100,000 people in the United States. Choangiocarcinomas usually become symptomatic when they obstruct the biliary drainage system, causing painless jaundice.
Symptoms of Cholangiocarcinoma Cancer
Other symptoms include: pruritus (itching), abdominal pain, fever and weight loss. Unfortunately, symptoms usually arise late in the disease and patients present with advanced cancer at diagnosis.
Risk Factors of Cholangiocarcinoma Cancer
Primary sclerosing cholangitis, Lynch syndrome, infection with certain parasites and having chronic liver disease, are some of the risk factors associated with Cholangiocarcinoma.
How Cholangiocarcinoma Cancer is Diagnosed
The initial evaluation will include a physical exam, laboratory and radiological studies. Laboratory studies will suggest a blockage of the biliary system, having increased levels of alkaline phosphatase and direct bilirubin. Tumor markers such as CEA and CA 19-9 can also be increased and help in the diagnosis, but they are not specific for bile duct cancers. To attain the diagnosis, imaging studies and a biopsy should be performed since benign conditions and other types of malignancy can present similarly.
Evaluation includes abdominal ultrasound, CT scan, magnetic resonance cholangiography (MRCP), or endoscopic retrograde cholangiopancreatography (ERCP). These tests help doctors localize the extent of the disease. Biopsy can be obtained either by ERCP, through the skin (percutaneous) guided through a CT scan or surgically as a last approach.
Treatment Options for Cholangiocarcinoma at Tufts Medical Center
Once the diagnosis is confirmed, surgical resection gives the only chance of cure, but treatment with a combination of chemotherapy and/or radiation therapy can also help control the disease. Surgery would involve removal of part of the bile duct and possibly removal of part of the liver. Chemotherapy agents such as gemcitabine, cisplatin, 5-fluorouracil and erlotinib may be useful. Novel treatment approaches are being used. Palliative measures such as endoscopic stents to relieve biliary obstruction can help with symptom control.
Clinical Trials Available for Patients
Our patients have access to novel therapies through participation in both Tufts Medical Center clinical trials and national clinical trials.
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For more information about Tufts Medical Center’s Gastrointestinal and Colorectal Cancer Program and our expert medical resources
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