gallbladder cancer diagnosisThe gallbladder - a small, hollow, pear-shaped organ located under the liver. It is concentrated and stored bile, a fluid necessary for the digestion of fats in the small intestine. When gallbladder cancer is important time to begin treatment, as the disease can be asymptomatic and often detected too late. Cancer can affect nearby organs and tissues and cure disease is much more complex.

Malignant tumors of the gallbladder - a rather rare phenomenon, more likely to develop in women, in 7 out of 10 cases.

Our company, a medical service «Tlv.Hospital», offers diagnosis of the organization and the treatment of gallbladder cancer in Israel :

1.Podbor doctors or clinics, individual approach taking into account all the wishes, comfortable conditions.

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4.Predostavlenie "second opinion" (getting advice from other specialists), after treatment to maintain relationships with your doctor.

Causes of gallbladder cancer

Several risk factors associated with this type of cancer.

  1. Like most types of malignant diseases, gallbladder cancer occurs more often in older people.
  2. Cancers of the gallbladder is a family history of the disease increases the risk of 5 times, especially if there is a genetic mutation known as BRCA2.
  3. Risk factors are gallstones and inflammation (cholecystitis). In 8 out of 10 people with cancer of the gallbladder diagnosed data breach. According to studies, the stones have a family history increases the risk of cancer.
  4. "Porcelain" gallbladder - calcium deposits on the inner wall of the body - one of the potential factors.
  5. Primary sclerosing cholangitis (PSC) - type of inflammation of the bile ducts, can increase the probability of cancer.
  6. Smoking and some industrial chemicals contain nitrosamines - chemicals that damage DNA and increase the risk of oncology.
  7. Certain abnormalities of the pancreas and bile ducts increase the likelihood of the disease. This inborn errors - buildup along the bile duct, abnormal compound biliary and pancreatic.
  8. Gallbladder polyps - small growths that appear on the mucous membrane of the body. The larger the size of the polyp, the higher the risk that it is transformed into malignant.
  9. Being overweight increases the likelihood of many types of cancer, including cancer of the gallbladder. Obesity means excess of more than 40% of the maximum desirable weight, respectively, certain growth. Excess weight causes a change in the hormonal balance in the body, which increases the risk of this type of cancer.
  10. According to some studies, diabetes increases the likelihood of cancer tumors of the gallbladder and bile ducts.
  11. There are certain details about that diet affects the risk of developing this disease.
  12. Ethnicity is a factor. The highest rate of cancer of the gallbladder - in North India.
  13. Salmonella infection increases the risk of this disease. According to some studies, the bacteria Helicobacter Pylori may also have an impact.

Signs and symptoms of gallbladder cancer

In the early stages of the disease does not cause any symptoms. When the disease is diagnosed, often it is already beyond the primary tumor and affects the surrounding tissues and organs.

Most of the symptoms of the characters for the later stages of the disease. It's worth knowing that other diseases also can cause these signs.

  1. Abdominal pain may be on the right side in the stomach. Some people describe it as nagging. If cancer or stones blocking the bile duct, the pain will be acute.
  2. Nausea is very common in the later stages of gallbladder cancer. It is easy to control with antiemetics.
  3. Jaundice means that the liver is not functioning properly. Among the symptoms noted: yellowing of the skin and whites of the eyes; dark urine; white stool. Jaundice is associated with the accumulation of bile salts in the blood. Half of people diagnosed with gallbladder cancer have jaundice - a sign of late stage cancer. It is worth remembering that hepatitis - a common cause of jaundice.
  4. Expansion gallbladder arises from blocking the bile duct and bile filling body.
  5. Other less common signs of the disease include loss of appetite, weight loss, and constipation.

Types of gallbladder cancer

In 85 out of 100 cases of this disease are diagnosed with adenocarcinoma. This type of cancer develops in the glandular cells of the body that produce mucus. Andenokartsinomu divided into papillary, nepapillyarnuyu and colloid.

Less common types of gallbladder cancer include squamous, small cell lung and sarcoma.

Among the rare type of cancer of the gallbladder note neuroendocrine tumors, lymphoma and melanoma.

Diagnosis of cancer of the gallbladder in Israel

Treatment of cancer of the gallbladder in IsraelOncologist collects anamnesis, queries about symptoms. Examines the patient, probing the abdomen for signs of increasing. Checks the whites of the eyes and skin color on the symptom of yellowing. Examines the lymph nodes in the neck and groin.

The following types of surveys can be assigned depending on the results:

  • blood tests called liver function tests. This series of tests that check the liver and gallbladder. Also included in the analysis of bilirubin, a chemical in bile. A small amount of bilirubin in the blood is completely normal. But a high level, it usually means that there is a problem with the gallbladder or liver.
  • Ultrasound. If the tumor is found in the gallbladder, using ultrasound can determine whether the cancer has spread organ wall.
  • CT displays tumor growth within the gallbladder and near it, whether struck by the common bile duct, lymph node or liver.

If the scan shows abnormal area around or in the gallbladder can be carried out:

  • ERCP - roentgen body via the endoscope (endoscopic retrograde cholangiopancreatography - ERCP). The patient swallows a flexible tube through which the doctor examines the inside of the small intestine and take a biopsy from the areas that look abnormal. This test shows the narrowing or blockage of the bile ducts of the pancreas, it helps to plan the operation. It takes from 30 minutes to 2 hours.
  • MRCP - type MRI gallbladder, pancreas and bile ducts. MRCP is magnetic resonance cholangiopancreatography. The procedure requires preparation, 2 hours to stop taking food and liquids. MRCP less uncomfortable than ERCP, does not require anesthetics and other drugs, but does not allow to extract tissue samples.
  • The biopsy and needle aspiration. It means taking the biopsy tissue sample and studying them with a microscope. This is the only way to determine whether the tumor is malignant. But if a doctor is absolutely certain on the basis of results of other tests that the cancer, a biopsy is not necessary. The gallbladder will be removed in any case.

If a biopsy is needed, it can perform a variety of ways: during laparoscopy at ERCP or by fine needle aspiration biopsy.

For the purpose of monitoring and further treatment gallbladder cancer, as well as for aspiration biopsy, doctors use CT or ultrasound to guide the needle to the right place. It takes a sample of cells and sends it to a laboratory for further study. It may be a tissue sample taken from the liver or lymph nodes to determine whether not spread them neoplastic process. After the biopsy, the gall bladder patient remains in the hospital for several hours or overnight. This is necessary because there is a risk of bleeding.

If the tests indicate gallbladder cancer, further research may be needed to determine the extent of the cancer. Most often, cancer affects the liver - 8 out of 10 people. It can also penetrate into the lymph nodes in the abdomen polosti.Dlya treatment gallbladder cancer, the following types of diagnostics can be performed.

  1. MRI more accurately reflects the soft tissue than CT. Applying MRI cholangiography may show blocking tumor bile flow and spread of cancer in the portal vein. If the body has a metal (eg, a pacemaker), this test is contraindicated.
  2. Endoscopic ultrasonography and ultrasonic scanner uses an endoscope, helping to determine the stage of the cancer, tumor germination process in a wall of an organ or spread to the liver. All this facilitates the process of planning the operation.
  3. Explores the bile duct cholangiography using the dye, X-ray and endoscope. The procedure lasts 30-60 minutes, it can help to find out whether there is a tumor in the gallbladder, if the duct is blocked. If there is a blockage, the stent can be installed.
  4. Laparoscopy is a minor operation. The laparoscope is equipped with a camera and light is introduced into the abdomen through small incisions and learn whether there are signs of cancer. With the laparoscope the surgeon has the opportunity to look inside the gallbladder. Laparoscopy helps in the planning of the operation and the choice of other methods of treatment for cancer treatment gallbladder cancer. The procedure requires the use of general anesthesia, hospitalization is needed for the night. In the course of its implementation biopsy may be performed. If the gallbladder has stones or inflammation, the surgeon will remove the body immediately. This operation is called cholecystectomy. The advantage of this kind of treatment - a shorter recovery period.

stage of cancer of the gallbladder

Stage show growth and spread of malignant process. Determining the stage of the disease it is necessary to select the optimal treatment options for cancer of the gallbladder.

For the classification of gallbladder cancer the TNM system is used.

  1. T - points to the size and distribution of the gall bladder tumor.
  2. N - in the lymph nodes.
  3. M - penetration of tumor in other body parts.

According to this classification distinguish five stages - T1 - T4 and very early - or Tis called carcinoma in situ.

Tis (carcinoma in situ) - The tumor is located within the body. At this stage, the disease is rarely diagnosed. Most often it occurs when the gallbladder is removed for other reasons, e.g., due to the presence of stones.

  • T1 tumors began to grow into the wall of the gallbladder. The stage is divided into T1a and T1b. T1a indicates lesion tie layer under the inner shell body wall, T1b - penetration of cancer into the muscular layer, located behind the coupling.
  • T2 tumor is localized in the gall bladder, but through the muscle layer prorosla next behind it a layer of connective tissue.
  • T3 tumor has gone beyond the boundaries of the body, it has spread to the liver or other organ located close - stomach, intestine or pancreas.
  • T4 - the cancer has penetrated into the portal vein or hepatic artery, gave the secondary outbreaks in two or more organs outside the liver.

There are three stages of lymph nodes in malignant tumors of the gallbladder

  • N0 -limfaticheskie nodes are healthy.
  • N1 - tumor process affected one or more neighboring nodes, for example, along the main bile duct or the liver artery.
  • N 2 - abnormal cells have spread to the lymph nodes located on the gallbladder.

M indicating that the penetration of tumor to other organs and tissues.

  • M0 - malignant process not affected located far organs or structures.
  • M1 - any secondary foci in other organs, such as in the brain or lungs.

The combination of T, N and M give a complete description of the stage of the disease.

Treatment of cancer of the gallbladder in Israel, the pricesStages of cancer of the gallbladder, according to another classification

Are 4 main stages, some doctors also speak of stage 0.

Stage 0 or carcinoma in situ. This cancer at a very early stage. Malignant cells are found only in the layer of tissue lining the gallbladder. There is a low risk of spreading diseases.

Step 1. The earliest stage of invasive cancer. It means that the process of malignant located only in the inner layers of the lining of the gallbladder tissue. No penetration of the surrounding tissues or organs. Step 1 is identical to T1, N0, M0 on the TNM classification.

Step 2. Cancer grows through the muscle layer of the gallbladder wall into connective tissue, following it, remains localized within the body. Step 2 corresponds to T2, N0, M0 by TNM.

Step 3 is separated into 3A and 3B.

  1. 3A - Cancer sprouted through the gallbladder wall, there are no cancer cells in the lymph nodes. Meets 3, N0, M0.
  2. 3B - the tumor is located within the boundaries of the gallbladder or sprouted through the outer layer and the nearest lymph nodes struck. Identical T1, T2 or T3, N1 or M0.

Step 4 indicates a metastatic cancer is divided 4A and 4B.

4A - neoplastic process hit an artery leading to the liver, or has spread to 2 or more organs outside the liver. They may be affected by the surrounding lymph nodes (T4, N0, or N1, M0).

4B indicates a cancer of any size that:

  • He struck lymph nodes located on the gall bladder, but has not spread to distant organs (any T, N2, M0);
  • He gave metastases in organs or structures that are further from the gallbladder (any T, any N, M1).

A simple staging system

Sometimes doctors use a simplified staging system, to decide what treatment gallbladder cancer is needed. There are three stages:

  1. Localized gallbladder cancer (1 and 2) - the tumor is located within the boundaries of the gallbladder, may be surgically removed.
  2. Unresectable cancer of the gallbladder (3 and 4) - malignancy has spread beyond the primary tumor can not be removed quickly. Sometimes it is possible to resect the tumor stage 3.
  3. Relapse - the disease has returned after treatment. A secondary tumor can occur in the gall bladder or in another area.

Forecast treatment gallbladder cancer

Presents international statistics intended for general guidance only.

Unfortunately, the overall prognosis of gallbladder cancer is not very good. According to the majority of medical articles, only 10 of 100 (10%) will live five years or more (5-10 survival). Generally it depends on the stage of the disease. The diagnosis is often put in the later stages, when it is impossible to cure a disease.

Prospects in stages - 5-year survival rate and more after diagnosis.

  • Stage 0 - from 80 to 100 (80%).
  • Stage 1 - 50 to 100 (50%). Some doctors believe that the removal of nearby lymph nodes, and some liver tissue during surgery prevents recurrence - performed an extended holetsistketomiya.
  • Step 2 - For 25 out of 100 (25%).
  • Stage 3 and 4 - less than 10 out of 100 (10%).

The reliability of static data

No static information that will tell exactly what will happen. Every disease is unique, like the human body. For example, the same type of cancer can develop at different rates in different people. Many individual factors can affect treatment and prognosis, you need to know about it.

Research has shown that participation in clinical trials may improve prognosis.

 

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