Gallbladder Cancer

What is gallbladder cancer?

Gallbladder cancer is a relatively rare form of cancer in Singapore that originates in the gallbladder. The gallbladder stores and concentrates bile, a digestive fluid produced by the liver. Gallbladder cancer is known for being hard to detect in its early stages since it often presents with no specific symptoms. Because of the gallbladder's hidden location, symptoms may not appear until the disease has advanced.

In Singapore, gallbladder cancer is relatively uncommon, affecting approximately 1.7 in every 100,000 people. 

Gallbladder cancer is usually of adenocarcinoma variant: it is the most common type of gallbladder cancer, accounting for approximately 90%. It starts in the glandular/epithelial cells lining the gallbladder's interior.

What causes gallbladder cancer?

All cells in our body contain DNA, which instructs what a cell should do—when it needs to die, reproduce, and stop growing. However, sometimes, a mutation in the DNA occurs, causing the cell to reproduce uncontrollably and continue living despite being abnormal. When this happens, there is an accumulation of cells that eventually clump together to form a tumour. The cause of this DNA mutation remains unknown.

Most gallbladder cancer begins in the glandular cells lining the surface of the gallbladder; this type of cancer is known as adenocarcinoma.  

What are the symptoms of gallbladder cancer?

Gallbladder cancer does not usually exhibit symptoms in the early stages. However, in the later stages of gallbladder cancer, symptoms may include: 

• Jaundice: jaundice is characterised by yellowing of the skin and whites of the eyes, which results from bile duct blockage.
• Abdominal pain: abdominal pain, especially in the upper right portion of the abdomen, may be a sign of advanced gallbladder cancer.
• Bloating: bloating is an unusual feeling of fullness in the abdomen that may occur in late-stage gallbladder cancer.
• Weight loss and loss of appetite: unintended weight loss is typical in cancer patients.
• Fever: fever is a less common symptom and is usually a sign of concurrent infection.

Is gallbladder cancer painful?

Pain associated with gallbladder cancer typically arises from the tumour's growth, which can stretch the gallbladder or invade nearby tissues, resulting in discomfort or pain in the upper right abdomen. The pain might vary in intensity and can become quite severe as the disease progresses.

Who is at risk of gallbladder cancer in Singapore?

While gallbladder cancer is rare worldwide, including in Singapore, certain individuals may have a higher risk. Risk factors for developing gallbladder cancer include:

• Women: women have an increased risk of developing gallbladder cancer than men. In fact, women are two times more likely to get gallbladder cancer than men.
• History of gallstones or gallbladder polyps: approximately 75-90% of individuals with gallbladder cancer have a history of gallstones. Although most gallbladder polyps are benign, individuals with a history of gallbladder polyps are at an increased risk of developing gallbladder cancer.
• Age: the risk of developing gallbladder cancer increases with age. 
• Family history: a family history of gallbladder cancer or other types of cancer increases an individual's risk of developing gallbladder cancer.
• Lifestyle factors: smoking or being obese increases the risk of developing gallbladder cancer.
• Medical conditions: individuals with conditions such as porcelain gallbladder, primary sclerosing cholangitis, or choledochal cysts increase the risk of developing gallbladder and bile duct cancer. These likely cause long-term inflammation and cell change.

How is gallbladder cancer diagnosed in Singapore?

Early diagnosis of gallbladder cancer is challenging due to its asymptomatic nature in the early stages. However, when symptoms prompt medical investigation, the following tools may be used for diagnosing gallbladder cancer:

• Ultrasound: ultrasound is often the first step in identifying abnormalities in the gallbladder.
• Imaging tests: imaging tests such as computed tomography (CT) scans and magnetic resonance imaging (MRI) provide detailed images of the gallbladder and surrounding structures, aiding in the diagnosis of gallbladder cancer.
• Endoscopic ultrasound (EUS): an endoscopic ultrasound combines endoscopy and ultrasound to obtain close-up images of the gallbladder if other modality fails. 
• Biopsy: a biopsy may be required if a patient requires systemic treatment such as chemotherapy. It involves removing tissue samples for examination under a microscope, which is sometimes necessary to confirm a cancer diagnosis.

What are the treatment options for gallbladder cancer in Singapore?

The treatment plan for gallbladder cancer is highly individualised, based on the cancer's stage, the patient's overall health, and personal treatment goals. Here are the primary treatment options for gallbladder cancer:

• Cholecystectomy: a cholecystectomy involves removing the gallbladder. In very early-stage gallbladder cancer, this may be sufficient to eradicate the cancer.
• Radical cholecystectomy: a radical cholecystectomy may be conducted for more advanced cancer; this procedure involves removing the gallbladder, a portion of the liver, part of the bile duct and lymph nodes to ensure all cancer cells are eradicated.
• Palliative surgery: in cases where cancer cannot be completely removed, surgery might still help relieve symptoms and improve quality of life.
• Chemotherapy: chemotherapy shrinks tumours before surgery, makes surgery more feasible, or reduces the risk of recurrence after surgery. It can also be a primary treatment when surgery isn’t an option. When to give chemotherapy depends on the stage of cancer. 
• Radiation therapy: radiation therapy is often used in combination with chemotherapy, especially for patients who cannot undergo surgery. It can help control the growth of the tumour and alleviate symptoms such as pain.
• Targeted therapy and immunotherapy: targeted therapy and immunotherapy are newer forms of treatment that might be available through clinical trials or for specific situations. They target cancer cells more precisely, reducing damage to healthy cells and potentially offering new hope for treatment. A discussion with an oncologist is required before any systemic treatment.

Frequently asked questions

What is the survival rate of gallbladder cancer?

The prognosis of gallbladder cancer is poor because it is usually diagnosed only when it has reached the late stage. This is when symptoms typically occur. For metastasised gallbladder cancer, the 5-year survival rate is 2%. For gallbladder cancer, which has not spread, the survival rate is approximately 66%. 

Is cancer of the gallbladder curable?

Gallbladder cancer is curable if it is diagnosed and treated before it has spread or metastasised.

Is gallbladder cancer an aggressive cancer?

Although gallbladder cancer is rare, it is aggressive, making it difficult to treat once it has metastasised or spread.

Is gallbladder cancer serious?

Yes. Gallbladder cancer is serious, particularly because early-stage gallbladder cancer does not display any symptoms. Once symptoms occur, it means that gallbladder cancer is already in the late or advanced stage, making it difficult to treat.