Gall Bladder Cancer – Diagnostic Procedures And Treatment

Gall bladder cancer diagnosis & tests

The doctor would conduct a detailed examination of the patient that would involve getting a comprehensive picture of the overall health condition and any past medical conditions. Blood samples would be drawn for checking the general health and the functioning of the liver. Several commonly employed tests for diagnosis of gall bladder cancer are:

• Ultrasound Scan
  During the test, sound waves are utilised for capturing images of the gall bladder and neighbouring organs. The patient is requested to not consume any solids or carbonated or milky consistency liquids and to solely sip clear fluids for four to six hours prior to the scan. The patient is told to lie down flat with the back against a comfortable surface. A gel is evenly applied over the abdominal area and a tiny microphone-alike appliance is then moved over the gel-covered surface. The sound waves produced are transformed into images with the assistance of a computer. This pain-free procedure lasts for fifteen to twenty minutes.
• CAT or CT or Computerised tomography Scan
  A CT scan captures a sequence of X-rays that are passed into a computer for building a 3-D imagery of the interior areas of the body. The scan is pain-free and lasts from ten to thirty minutes. CT scans employ miniscule quantities of radiation that would cause no harm to the person undergoing the test or to others who would be coming in contact with the patient. The person would be requested not to consume solids or liquids for at least 4 hours prior to the scan.

  On majority of the occasions, the person undergoing the scan would be offered a drink or shot for allowing certain areas to be viewed more lucidly. Prior to having the shot or the drink, it is vital to inform the person performing the test regarding whether one is having any form of allergic reactions to iodine or is asthmatic. Subsequent to the scan the person could return home.

• Spiral CT scan
  A spiral or helical CT scan is a novel form of CT wherein the x-ray device continually revolves around the body of the person as it follows a spiral route for making cross-sectional images of the body.
• MRI or magnetic resonance imaging scan
  This test is analogous to a CT scan but employs magnetic fields rather than x-rays. During the course of the scan, the person would be required to be totally motionless while lying within a metallic cylinder. The cylinder is a high-power magnet; hence prior to being seated inside it, one would need to take off all forms of metallic objects one might be carrying along. It is imperative to inform one’s doctor whether one has previously ever been working in an industry that is metal-related or have personally ever worked with metals and is there any kind of metal present in the body like a cardiac monitor, pacemaker, bone pins, operative clips or others. An MRI cannot be done in case one has any of these metallic implants present in the body due to the magnetic fields emitted from them.An injection would be administered to the person for facilitating better viewing of the interior parts of the body. The test lasts for thirty minutes and is pain-free, though the device could sound quite loud for which the person would be offered ear muffs or headphones. A dual way intercom facility would enable the patient to converse with the person in charge of the scanner.
• Endoscopic retrograde cholangio-pancreatography or ERCP
  During this procedure an x-ray image is taken of the pancreatic and the bile duct. In case required, it could additionally be employed for unblocking the bile duct and for inserting the stent.No eating or drinking is allowed for nearly 6 hours prior to the test in order to clear out the stomach or the initial section of the small bowel (duodenum). A pill or shot could be given for relaxing – a sedative and a local anaesthetic spray would be used for de-sensitizing the throat. A fine pliable tube called the endoscope would then be passed via the mouth inside the stomach and the duodenum just ahead of it.By peering down the endoscope the doctor would be able to locate the aperture where the bile duct and the pancreatic duct are draining into the duodenum. A dye that would appear on the X-rays would be infused inside these ducts and the doctor would be able to clearly view any anomalies or obstructions.
• Angiogram
  The bile duct being located quite near the vital blood vessels of the liver, an investigative procedure known as the angiogram could be conducted for checking if there is any effect on the blood vessels due to the tumour.A delicate tube is introduced within an artery in the groin and a dye is infused via the tube. The circulation of the dye in the arteries facilitates better depiction on the x-rays. At times an MRI scan could be performed for revealing the blood vessels of the liver, after which there is no need for the angiogram.
• Laparoscopy
  This small operative procedure allows for easier viewing of the gall bladder, liver and other internally placed organs in the region around the gall bladder. This is performed under the influence of general anaesthesia and would translate to briefer hospital stays.Once the person is anaesthetized, a tiny slit would done by the doctor in the front of the abdominal region and a fine mini pliable, illuminated tube attached with a camera (laparoscope) would be inserted. This now makes it easier for the doctor to clearly view the gall bladder and remove a tiny tissue sample for microscopic evaluation (biopsy procedure).During the surgery, the abdominal cavity is pumped with carbon-dioxide gas that could cause discomforting wind and at times cause shoulder pains for many days on end. The pain is mostly allayed when one takes walks or has gulps of peppermint-infused water. Subsequent to the laparoscopy, 1-2 sutures would be done on the abdomen.At times during the course of a laparoscopy, there could be the removal of the gall bladder for treating gallstones or chronic inflammation affecting the gall bladder. The surgery is known as laparoscopic cholecystectomy. In case gall bladder cancer is diagnosed or is doubted during the surgery, the surgeon would alter the surgery to an open cholecystectomy wherein the gall bladder is removed via wider incision done in the abdomen. This would facilitate total removal of the cancer.
• Laparotomy
  In case the doctor is unable to make the detection using the above mentioned tests then a procedure known as a laparotomy could be conducted under the influence of general anaesthesia. During the procedure, an incision is made on the abdomen to allow easier examination of the gall bladder and the tissue adjacent to it for the presence of cancer. In case cancer has been diagnosed, but appears to not have metastasized to the neighbouring tissues, then the surgeon would be able to remove the cancer or reduce the obstruction it could be causing.

Gall Bladder Treatment

The kind of treatment offered is dependent on several factors inclusive of general health, the placing and the size of the cancer present in the gall bladder and has the cancer metastasized to other regions in the body.

Consent (Permission)

Prior to undergoing any form of treatment, the doctor would provide complete details regarding what one could expect and elucidate the objectives of the treatment being decided for the patient. The person would generally be requested to give a signature on a document that says that one is giving his/her consent or permission to the hospital staff to conduct the treatment. Without the person’s consent, no medical treatment could be offered.

Pros and cons of the treatment

Treatment could be offered for varying reasons and the potential advantages would differ in each case. In case one has been suggested a treatment which targets at curing the cancer, it is not that difficult to agree to such plan-of-action. But, in case the cure is not likely and the treatment is being suggested for controlling the cancer for a span of time, then it could be tricky for the person to come to a conclusion on whether or not to undergo the treatment.

In case one is undecided regarding the treatment when firstly elucidated, one could always request further time in order to make up one’s mind.

One is free to decide not to undergo the treatment and the hospital staff would expound what one could expect in case one does not go in for the treatment. No reasons are necessary to be given when one does not desire to undergo treatment, though it could be beneficial to let the staff know about one’s apprehensions so that they could offer the best possible advice on the same.

Surgery

Surgery is the key treatment in case of gall bladder cancer and could be used for removal of all the cancer existent in case it has not metastasized past the gall bladder.

In case the cancer has reached beyond the gall bladder, then surgery could still be beneficial for the individual in improving the arising symptoms by removal of majority of the cancer- inflicted parts.

In case surgery could be done or is not dependent on the outcome of the examinations illustrated above then in such a situation the person could be referred to a surgeon who has a keen interest in this atypical cancer.

Radiotherapy

Radiotherapy is used for the treatment of cancer by utilising high-power x-rays for obliterating the cancerous cells while at the same time doing minimal damage to the neighbouring healthy cells. This is infrequently employed for gall bladder cancer. It might optionally be administered externally with the assistance of a radioactive machine or a radioactive substance could be placed within the body in close proximity to the tumour.

Chemotherapy

Chemotherapy employs cancer-fighting or cytotoxic drugs for destroying the cancerous cells. They function by interrupting the spread of the cancer cells. Chemotherapy has been observed to not provide very effectual outcomes for treating gall bladder cancer. Though, it is considered to be beneficial in curbing the cancer for some span of time for the kind of gall bladder cancer that has metastasized in another place in the body.

Stent Insertion

In case the cancer present in the gall bladder is causing an obstruction in the bile duct then it could be likely that the doctor would introduce a fine tube also called as stent during the ERCP procedure. This could assist in allaying any jaundice with no requirement for surgical intervention.

The stent measures nearly five to ten centimetres in length and having the thickness of an ink pen refill. The stent helps in opening the route through the bile duct thus allowing the bile in draining away. The grounding and process is analogous to that of ERCP. By observing the x-ray imagery the doctors would be able to notice the constriction in the bile duct. The constriction could be dilated by making use of the inflatable balloons or dilators and the stent could be introduced via the endoscope for enabling the bile in draining.

The stent generally requires to be changed in a time interval of every three to four months to avert it from becoming clogged-up. In case that it does clog-up, then jaundice that at times might be accompanied by high temperatures could occur. It is imperative to inform one’s specialist regarding these signs on the earliest possible. A treatment course of antibiotics might be required in such a situation and the specialist could suggest the replacement of the stent with a new one. In majority of the individuals such a procedure could be done with relative ease.

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