Gallbladder And Bile Duct Cancers

Gallbladder and bile duct cancers are usually discovered coincidentally in patients with cholecystitis (about 90% have gallstones); these account for less than 1% of all cancer cases. The predominant type is adenocarcinoma (responsible for 85% to 95% of cases). Squamous cell carcinoma accounts for between 5% and 15%. Mixed-tissue types are rare.

Gallbladder cancer is most prevalent in women over age 60. Because it's usually discovered after cholecystectomy and at an advanced stage, the prognosis is poor. If the cancer invades gallbladder musculature, the survival rate is less than 5% - even after extensive surgery. Although some long-term survivals (4 to 5 years) have been reported, few patients survive more than 6 months after surgery. In most patients, with or without surgery, the disease progresses rapidly. Patients seldom live a year after diagnosis.

Carcinoma of the extrahepatic bile duct causes less than 3% of all cancer deaths in the United States. This disease affects men and women between ages 60 and 70. The usual site is the bifurcation in the common bile duct. About 50% of patients also have gall­stones. Carcinoma at the distal end of the common duct is commonly confused with carcinoma of the pancreas. Metastasis affects local lymph nodes, the liver, the lungs, and the peritoneum. Patients typically die of hepatic failure. No staging protocol exists for this type of cancer.

Causes

Whereas tumors of the biliary system are usually related to cholelithiasis, bile duct cancer seems to accompany infestation by liver flukes or other parasites.The cause of extrahepatic bile duct cancer isn't known; but statistics show an unexplained increase of this cancer in patients with sclerosing cholangitis, portal bacteremia, viral infections, or ulcerative colitis. Suspected causes include failure of an immune mechanism or chronic use of certain drugs by the colitis patient.

Signs and Symptoms

Jaundice -- a yellowing of the skin -- or itching of the skin are the first signs of a problem in nearly all patients with gallbladder or bile duct cancer. Other symptoms may include malaise or a general feeling of poor health, loss of appetite, weight loss, fever, fatigue, bloating, itching, swelling of the legs, or weakness.

Diagnostic tests 

In addition to a complete medical history and physical examination, diagnostic procedures for bile duct cancer may include the following:

• ultrasound (Also called sonography.)
• cholangiography
• Laparoscopy
• computed tomography scan (CT or CAT scan)
• biopsy

Treatment

surgery is the treatment of choice for gallbladder cancer, including cholecystectomy, common bile duct exploration, T-tube drainage, and wedge excision of hepatic tissue.

As a rule, surgery can relieve obstruction and jaundices, resulting from extrahepatic bile duct cancer. The procedure depends on the cancer site and may include cholecystoduodenostomy or T-tube drainage of the common bile duct.

Radiation therapy may be palliative, and adjuvant chemotherapy (infrequently used) may produce some good results.