Gallbladder Cancer Treatment in Delhi, India

Gallbladder cancer types vary based on the type of cell from which they originate. Since there are different types of cells present in the gallbladder, any of these cell types can develop into cancer. Here are the common ones:

Adenocarcinoma

As one of the most common types of gallbladder cancer, Adenocarcinoma initially develops within glandular cells that line the organs in the digestive tract. The glandular cells produce mucus-like thick fluid.

Papillary Adenocarcinoma

These cancer cells are arranged in finger-like projections within the gallbladder. Compared to other types of gallbladder cancers, this type of cancer is less likely to spread to lymph nodes

In addition to the mentioned types of gallbladder cancer, there are some less common ones such as squamous cell cancer, adenosquamous carcinomas, small cell carcinomas, and Sarcoma

Usually, gallbladder cancer is hard to detect in its early stages as it doesn't cause any specific signs or symptoms during the early stages. However, it’s crucial to be aware of gallbladder cancer symptoms to prevent its progression and improve the chances of successful gallbladder cancer treatment. Here are some of the most common gallbladder cancer symptoms one must not ignore.

• Abdominal pain
• Abdominal bloating
• Itchiness
• Fever
• Loss of appetite
• Unintentional weight loss (Losing weight without trying)
• Nausea
• Yellowing of the skin and whites of the eyes ( Jaundice )
• Nausea and vomiting
• Lump in the abdomen
• Dark urine

Gallbladder cancer, like any other type of cancer, can develop due to a combination of factors. While the exact gallbladder cancer causes remains unclear, several risk factors have been identified. Here are some of them.

• Age: Being over the age of 70 increases the risk.
• Gallstones: A history of gallstones, particularly large ones and those present for long periods of time.

• Chronic Gallbladder Inflammation: Ongoing inflammation of the gallbladder can elevate the risk.

• Porcelain Gallbladder: This condition, where the gallbladder wall becomes calcified, is a risk factor.

• Medical Conditions: Certain medical conditions may increase the likelihood, including porcelain gallbladder, and gallbladder polyps, and primary sclerosing cholangitis (PSC).

• Obesity: Being overweight or obese is associated with a higher risk of gallbladder cancer.

• Family History: A family history of gallbladder cancer can also elevate the risk.

Diagnosing gallbladder cancer involves a series of medical evaluations and tests. Initially, a thorough medical history and physical examination are conducted to identify any symptoms and assess risk factors. Imaging tests such as ultrasound, CT scans, MRIs and PET scans are commonly used to visualise the gallbladder and surrounding structures for any abnormalities. Additionally, blood tests may be performed to check for specific markers associated with gallbladder cancer. If suspicious findings are detected, a biopsy may be recommended to confirm the diagnosis. During a biopsy, a tissue sample is collected from the gallbladder for laboratory analysis. Accurate diagnosis is crucial for determining the appropriate treatment plan and the stage of cancer, which guides the medical team in providing the most effective care.

At Max Hospitals, we offer the following tests and procedures to diagnose gallbladder cancer:

• Physical examination and history
• Blood tests such as liver function tests (LFT) and tumour markers (CEA assay, serum CA19-9 assay)

• Ultrasound
• Chest X-ray
• Imaging techniques in the form of Computerised Tomography Scan (CT Scan), Magnetic Resonance Imaging (MRI) Scan and/or Positron emission tomography (PET) Scan
• Laparoscopy
 

After confirmation of the diagnosis and the essential tests are completed, a fair idea about the stage of the disease can be obtained.

Ranked among the best gallbladder cancer hospitals in India, Max Hospitals are equipped to offer the best gallbladder cancer treatment. Our highly experienced gallbladder cancer surgeons work closely with patients to develop a personalised gallbladder cancer treatmentbplan based on the dynamics of their case. Here’s a quick overview of the gallbladder cancer treatments we offer:

• Gallbladder Cancer Surgery: Surgery is a common and effective treatment for gallbladder cancer. It can be used to remove tumours, relieve gallbladder cancer symptoms, or help other treatments work better. The type of gallbladder cancer surgery performed depends on the type and stage of cancer, as well as the patient’s overall health.Gallbladder cancer surgery can be further divided into:
• Cholecystectomy: A procedure where the gallbladder and some of the tissues around it are removed. Nearby lymph nodes may also be removed.
• Radical Gallbladder Resection: A procedure where the gallbladder and some part of the tissues around it (usually a small part of the liver and nearby lymph nodes) are removed. It may sometimes entail the removal of parts of other involved adjacent organs such as the liver, Bile ducts, duodenum/stomach, and colon.
 

If the cancer has spread and cannot be removed, the following types of palliative surgery may relieve symptoms:

• Biliary Bypass Surgery: If the tumour is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the gallbladder or bile duct will be cut and sewn to the small intestine to create a new pathway around the blocked area.
• Endoscopic Stent Placement: If the tumour is blocking the bile duct, surgery may be done to put in a stent (a thin, flexible tube) to drain bile that has built up in the area. The stent may be placed through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.
 

If the gallbladder has already been removed ( laparoscopic /open cholecystectomy) and the the tumour is limited to the innermost lining (lamina propria) of the gallbladder, no further treatment is required, and regular observation is sufficient. If the tumour extends beyond this layer, another larger operation (as mentioned above) is usually required even if there is no residual tumour is seen on PET CT.

If the tumour has extended beyond the gallbladder and an operation is not feasible, chemotherapy or chemo-radiotherapy is an option that may be considered. At times, an operation is possible after chemotherapy/chemo-radiotherapy if sufficient tumour shrinkage takes place. 

• Radiation Therapy

Radiation oncology, a type of gallbladder cancer treatment, utilises high-energy radiation to treat gallbladder cancer. It is usually used after chemotherapy if the disease is inoperable or the biopsy of the removed tumour shows very extensive disease.

• Chemotherapy for Gallbladder Cancer

A treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing.

• Targeted Therapy

Targeted therapy for gallbladder cancer involves using specific drugs designed to target and inhibit the growth of cancer cells by interfering with certain molecules or pathways that play a crucial role in cancer development. Unlike traditional chemotherapy, which affects both healthy and cancerous cells, targeted therapy is more focused on cancer cells, minimising damage to normal tissues. This is usually indicated in the setting of recurrent cancer or cancer that has spread and is not removable.

Max Institute of Cancer Care (MICC) is one of the leading facilities in India, which offers the latest treatments in surgical oncology, radiation oncology, and medical oncology. It is one of the largest chains of Cancer Centres in North India, with a presence in Saket, Vaishali, Patparganj, Shalimar Bagh, Vaishali, Mohali and Bathinda. The centres are highly efficient and offer specialised and dedicated daycare with all significant sub-specialities, disease management groups and privacy to cancer patients.

With over 100 oncologists, Max Institute of Cancer Care provides world-class gallbladder cancer treatment facilities and focused care to cure various types of oncological diseases. The facility has the best cancer specialists, many of whom specialise in treating gallbladder cancer. Max Institute of Cancer Care has advanced medical therapies for gallbladder cancer. There is a Disease Management Group (DMG) to look further into the matter. Various specialities at the DMG came together for this. They participate in weekly tumour board meetings and share information to help the entire care team to help guide gallbladder cancer treatment planning. An individualised treatment plan is made for each patient by a specialist multidisciplinary team of surgeons, medical oncologists, radiation oncologists, surgeons, histopathologists, molecular pathologists, gastroenterologists, interventional radiologists, nuclear medicine, dietitians, physiotherapists and geneticists.

The doctors understand how to eradicate malignant cells in some patients' tumours without using standard treatments like t raditional chemotherapy and radiation. The pathologists sub-specialise in the diagnosis of gallbladder cancer and are internationally recognised and Consulted. Our holistic cancer care includes the following:

• Adherence to the latest international cancer treatment protocols
• Superior cancer treatment technology: Max Institute of Cancer Care is the first facility in Northern India to acquire Novalis Tx for IMRT/IGRT, Radiosurgery, and SRS/5RT. Other technologies at our disposal include the Da Vinci XI Robotic System and Linear Accelerator (LINAC).

• Complete cancer care: Right from cancer screening, early detection, multidisciplinary treatment to rehabilitation.

• Dedicated daycare chemotherapy centres outside the hospital or in separate areas with chemo chairs and recliners, patient beds, a library, TV sets, and iPads are provided to take patients’ minds off from the treatment.
• A wider range of medical resources to draw from, with our multi-super speciality Backups.

Tumour Board

There is a constant cross-chat between the various specialities at the respective Disease Management Group (DMG) Tumour Board meeting of gallbladder cancer. The main motive of the DMG is to make the best skills available to patients. Site-specific oncology allows the clinicians involved in patient care to focus only on certain cancers at which they become world Experts.

Meetings are held once a week to discuss the situation with patients and arrive at the best possible management for the patient. The surgical, medical and radiation specialists of the gallbladder DMG, along with the pathologists, radiologists and molecular oncologists, attend these meetings.

Treatment options and recommendations depend on various factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health.

1. What are the symptoms of gallbladder cancer?

Gallbladder cancer can show up with symptoms like abdominal pain, yellowness (your skin and eyes), losing weight without reason, and feeling queasy.

2. What are the common causes of gallbladder cancer?

While gallstones and an inflamed gallbladder are known risk factors, the exact cause of gallbladder cancer is unknown.

3. What is the best treatment for gallbladder cancer?

The right treatment varies based on the cancer stage. It usually involves surgery, chemotherapy, radiation, or a combination of these treatments. It's best to consult a gallbladder cancer specialist for personalised advice.

4. What is the cost of gallbladder cancer treatment?

Costs can differ a lot, depending on things like the cancer stage and where you get treatment. Health insurance can help cover some of these bills.

5. Is gallbladder cancer surgery the most effective treatment for gallbladder cancer?

Surgery is often the go-to option, especially in the early stages. Its success depends on how far the cancer has spread and individual factors. Even though cure rates are low, surgery, when feasible, is the only curative option for patients with gall bladder cancer.

6. Are there any preventive measures to reduce the risk of gallbladder cancer?

Keeping a healthy weight, eating well, and taking care of gallbladder issues early on can help lower your risk. But it’s smart to talk to a gallbladder specialist for personalised tips.

Reviewed by Dr. Vivek Mangla, Senior Director - Gastrointestinal and Hepatopancreatobiliary (GI & HPB) Surgical Oncology on 21-Nov-2023.

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