Gallbladder and Bile Duct Cancer: Why timely detection is important

The diagnosis of Biliary cancers, also known as cholangiocarcinoma or bile duct cancers can be devastating. Intrahepatic bile duct cancer develops within the liver's bile ducts, while extrahepatic bile duct cancer originates outside the liver.

Gallbladder cancer is a malignancy that arises in the gallbladder wall, often discovered during investigations for gallstones or gallstone removal
surgery.

Risk factors for bile duct and gallbladder cancer encompass various elements that elevate the likelihood of developing these types of cancer.
These include age, with the majority of cases occurring in individuals aged 55 to 70. Medical conditions such as primary sclerosing cholangitis (PSC), chronic liver diseases, inflammatory bowel diseases, a history of bile duct cysts (choledochal), liver fluke infection, family history, exposure to smoking, and excessive alcohol consumption can all contribute to an increased risk of developing bile duct and gallbladder cancer.

The symptoms of bile duct cancer: Bile duct cancer often presents with subtle and nonspecific symptoms in its early stages, making diagnosis challenging. Patients may experience unexplained weight loss, abdominal pain or discomfort, fatigue, and jaundice. Changes in urine colour and stool may occur due to the obstruction of bile flow. As the cancer progresses, individuals may develop nausea, vomiting, itching of the skin (pruritus), and a general feeling of malaise.

Advanced bile duct cancer can manifest with more severe symptoms such as ascites (fluid buildup in the abdomen), enlarged liver or spleen, and anaemia due to blood loss.

Early warning signs of gallbladder cancer include jaundice, abdominal pain, bloating, and unexplained weight loss. These symptoms may not seem alarming at first but should prompt a visit to the doctor for further investigation. As gallbladder cancer progresses, additional warning signs may become apparent.

These can include nausea, vomiting, fever, and an overall feeling of weakness or malaise.
Bile duct and gallbladder cancer often present complex treatment challenges due to late-stage diagnosis and limited treatment options. Surgery is the primary method for localised, resectable tumours, but the aggressive nature of these cancers often leads to recurrence or metastasis.
Emerging approaches such as liver transplantation show promise in select patients, offering new hope for improved long-term outcomes.
Chemotherapy and targeted therapy are being explored to combat advanced bile duct and gallbladder cancers. Immunotherapy has also shown potential in some cases, harnessing the body's immune system to target cancer cells. Endoscopy is helpful in patients with bile duct cancer. Diagnosis may be done using endoscopic techniques like endoscopic ultrasound where the needles can be used for biopsies from the tumour, biliary stenting - plastic or metal that helps in resolution of jaundice, fever, infection. If the tumour blocks the stomach, the patient has recurrent vomiting and he can't digest food well, then also endoscopy helps by either starting through the tumour to relieve the blockage or by creating a bypass from the stomach.

(Article courtesy: Dr Meghraj Ingle Director and Senior Consultant Gastroenterology Gleneagles
Hospital Parel Mumbai)