By Dr Ananya Mandal, MD
Gallbladder cancer treatment primarily depends on the stage of the cancer and the grade of the cancer. Treatment also depends on the general health of the patient.
Surgery is the primary method of treatment in early stages of the cancer. This may be followed up with radiation therapy and/or chemotherapy with anticancer drugs.
Who treats gallbladder cancer?
The team of doctors and health care providers who work together in caring for gallbladder cancer patients include:
Therapy options, pros and cons and side effects are explained to the patient. He or she is allowed to have a say in choosing appropriate therapy. For example, those with very advanced and extensive cancers may wish not to have anticancer therapy that may bring more side effects and further reduce the quality of life. These patients may opt for palliative care, pain relief and end-of life care. 1-5
Surgery for gallbladder cancer
After diagnosis of the gall bladder cancer the specialists examine to see if the cancer is localized to the area and may be removed surgically. For those who are physically capable of withstand the major surgery, this is the primary mode of therapy.
There are a number of different operations for gallbladder cancer. The main one is just to remove the gallbladder or a cholecystectomy. The type of surgery usually depends on where the cancer is and whether it has spread to surrounding tissue, into the liver or to other organs and lymph nodes.
During the surgery the surrounding lymph nodes are examined and at least some of the nodes are removed from around the gall bladder. This is called lymphadenectomy. This is to check for cancer cells that may have spread into the nodes.
Radiation therapy for gallbladder cancer
This involves focussing high energy X ray and other beams onto the cancer to kill the cancer cells. Radiation therapy is usually undertaken after surgery to kill of the residual cancer cells. This is called adjuvant radiotherapy.
Radiation therapy may be performed at regular intervals on office visits. It can either be given externally from a radiotherapy machine or internally by placing radioactive material close to the tumour (brachytherapy).
Radiation therapy may also be used in advanced gallbladder cancer to alleviate symptoms. This is called palliative radiotherapy.
Chemotherapy for gallbladder cancer
This treatment involves the use of anticancer drugs like Gemcitabine, Capecitabine, Oxaliplatin, 5-Flurouracil and Cisplatin. This may be used after surgical removal of the gall bladder to kill of residual cells.
Sometimes chemotherapy may be combined with radiation therapy. Chemotherapeutic drugs come with a host of side effects like loss of hair, appetite, diarrhea, nausea, vomiting, propensity to get infections and bleeding tendencies.
Treatment of gallbladder cancer according to stages
Stage 1 treatment
It is rare to find gall bladder cancer at early stages. At this stage removal of the gall bladder by surgery usually suffices.
Around 20% of gallbladder cancers are found during a simple cholecystectomy for gallstones or inflammation of the gallbladder.
In rare cases the cancer may come back. This may be treated with an extended cholecystectomy or removal of part of the liver around the gall bladder as well as some surrounding lymph nodes.
Stage 2 treatment
Most of these are found during a simple cholecystectomy for gallstones or inflammation of the gallbladder. This requires a more extensive operation or an extended cholecystectomy. Chemotherapy and/or radiation therapy may be suggested after surgery.
Stage 3 treatment
For stage 3 cancers extended cholecystectomy is suggested and in some cases a more extensive or radical surgery may be undertaken.
Radiotherapy may be suggested after surgery. Radiotherapy with chemotherapy may be recommended to control symptoms.
Stage 4 treatment
Usually palliative therapy with radiation and chemotherapy is recommended. Palliative therapy is not a cure but may slow the growth of the cancer.
Stents may be inserted to allow for flow of the bile in cases with blocked bile ducts. Some patients may also benefit from photodynamic therapy. This uses a combination of laser light and a light-sensitive drug to destroy cancer cells.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)