Where can gallbladder cancer spread?

Tumors of the biliary tract and gallbladder, biliary tract cancer and gallbladder cancer

Biliary tract tumorsGallbladder Tumors: Neoplasms benign and malignant in the biliary tract or gallbladder. Benign tumors such as adenomas or polyps are rare, and malignant bile duct cancer (cholangiocarcinoma) is also a rarity. Gallbladder cancer is a little more common, especially women over 70 years of age. All tumors in the gallbladder and bile duct have in common that they cause few symptoms and are usually discovered late. Because the malignant tumors have often already formed daughter tumors (metastases), their treatment is difficult and the prognosis is mostly poor.

Leading complaints

Benign tumors

  • Mostly none
  • Later, possibly epigastric discomfort, rarely jaundice.

Malignant tumors

  • Fatigue, fever
  • Right upper abdominal pain with loss of appetite and weight loss
  • In bile duct cancer, discolored stools and dark urine
  • Jaundice (yellowing of the eyes and / or skin)
  • With large liver metastases, uncomfortable feeling of pressure in the abdomen and pain.

When to the doctor

In the next few days if

  • the person concerned feels dull and exhausted
  • Added abdominal pain
  • Jaundice occurs
  • The stool is noticeably pale and the urine is dark.

The illness

Tumors in the gallbladder and bile duct grow for a long time without causing discomfort. They therefore only draw attention to themselves late, e.g. through increasing yellowing of the skin, abdominal pain, nausea and vomiting. This is why they are often only discovered at an advanced stage. Malignant tumors such as bile duct cancer or gallbladder cancer form metastases in the liver relatively early. In addition, they often spread towards the pancreas and duodenum and spread through the bloodstream to the ovaries, bones and spleen.

Risk factors

A number of diseases are associated with the appearance of cancer in the gallbladder or in the bile ducts:

Diagnostic assurance

Tumors of the gallbladder and biliary tract are often incidental findings. The doctor discovers them z. B. in ultrasound, when analyzing a distant gallstone or as part of an ERCP, an endoscopic examination of the biliary tract with the help of a tube inserted through the mouth into the duodenum and the biliary tract. If there is any suspicion, the following examinations in particular are required:

  • Physical examination. The so-called Courvoisier symbol is typical. This is an enlarged, palpable, painless gallbladder with simultaneous jaundice.
  • laboratory. Increased bilirubin, alkaline phosphatase, gamma-GT show how much the outflow of bile is hindered by the formation of new tissue (bile congestion).
  • Tumor markers. The tumor marker CA 19-9 is a protein to which sugar residues are bound and which is excreted in the bile. It is increased in various cancers, gallstones and inflammation in the gastrointestinal area. It is therefore not used for diagnosis, but as a progress marker. If the previously elevated CA 19-9 values ​​drop during cancer therapy, this is an indication that the therapy is working, e.g. B. a tumor shrinks.
  • Imaging procedures. With the help of abdominal ultrasound, endoscopic ultrasound, MRI, CT and ERCP, the doctor assesses the size and spread of the tumor and assesses whether it can be surgically removed.

treatment

Benign tumors of the gallbladder and biliary tract

The doctor initially leaves benign tumors less than 1 cm in diameter. Every 6 months, an abdominal ultrasound is used to check whether the tumors are growing. Doctors usually remove tumors over 1 cm in diameter, as there is a risk that they can become malignant.

Gallbladder cancer

Gallbladder cancer can only be cured surgically and only at an early stage. Therapy then consists of surgery; H. Doctors remove the gallbladder, the gallbladder bed in the liver, and the surrounding lymphoid tissue. In most cases, however, a complete removal is no longer possible due to the spread of the tumor. Doctors then remove part of the tumor to at least treat symptoms such as B. To alleviate strong feelings of pressure. Sometimes they also place a stent to relieve symptoms of biliary disorders (see below).

Bile duct cancer

In less than a quarter of cases, bile duct cancer is discovered early enough for doctors to cure it with surgery. Depending on the location of the tumor, different methods are then used. If the bile ducts within the liver are affected, doctors perform a partial liver resection, i.e. a partial resection of the liver. H. they only remove the affected part of the liver. If the malignant tumor is located in the bile duct between the liver and the intestine, the bile duct is removed along with the gall bladder. Depending on the spread of the tumor, a liver transplant should also be considered.

Palliative (relieving) procedures

In both gallbladder cancer and bile duct cancer, there is very often no cure, but only an alleviation of the symptoms. There are various options for this palliative therapy.

Stent insert. In order to maintain or restore the outflow from the biliary tract into the duodenum, the doctors endoscopically insert a tube (stent) into the biliary tract using an ERCP. Sometimes cancerous tissue overgrown prevents doctors from using ERCP to reach the biliary tract and place the stent. Then they puncture the bile from the outside and drain the bile through the skin into a bag (percutaneous transhepatic cholangiodrainage PTCD).

chemotherapy. The chemotherapy drugs gemcitabine and cisplatin are used for inoperable gallbladder cancer and mostly also for inoperable bile duct cancer. This does not cure the cancer, but it slows down the growth of the tumor and thereby reduces the symptoms.

In addition to palliative chemotherapy, the doctors also try to help Irradiation stop tumor growth and thus improve the patient's quality of life.

Transarterial chemoembolization to reduce the size of a bile duct cancer in The liver: Doctors insert a catheter into the hepatic artery through the groin and inject a chemotherapeutic agent and plastic pellets or gelatine directly into the vicinity of the tumor. The chemotherapeutic agent attacks the tumor directly, the beads or gelatin seal the vessels supplying the tumor. Together, both should lead to a reduction in the size of the tumor.

forecast

The 5-year survival rate for both gallbladder cancer and bile duct cancer is 5%, which is very poor. Patients receiving palliative care live an average of 6 months.

Further information

  • www.krebshilfe.de - Very informative website of the Deutsche Krebshilfe e. V., Bonn (Ed.): Under the heading "Inform" you will find brochures and information material, including the blue guide No. 15 on cancer of the liver and biliary tract, which you can order or download here free of charge.

Authors

Dr. med. Arne Schäffler, Dr. Bernadette Andre-Wallis in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 10:12


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.