Cancer Treatment

Gall Bladder Cancer

Gall bladder is a small pear shaped organ just beneath the liver. The gallbladder stores and concentrates bile from the liver before releasing into intestine.

Gall bladder cancer is abnormal growth of cells in uncontrolled manner.

It is the one of the most common biliary tract cancer.

Incidence increases with age

Females more commonly affected than males

Most commonly it is diagnosed at an advanced stage due to non-specific symptoms.

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Symptoms of Gall bladder cancer:

Gallbladder cancer is often diagnosed at an advanced stage because it is often asymptomatic in its early stages.
Symptoms mimics biliary colic or chronic cholecystitis.
It has an aggressive nature that can spread rapidly.
It can also be incidentally diagnosed after cholecystectomy for cholecystitis.
The presence of jaundice in patients with gallbladder cancer is associated with a poor prognosis as they are likely to have advanced-stage disease.

Abdominal pain

Dyspepsia

Weight loss

Jaundice (yellowing of the skin and whites of the eyes).

Fever.

Nausea and vomiting.

Swelling in right upper abdomen.

Cancer Treatment

Risk Factors

Cholelithiasis is the most prevalent risk factor for gallbladder cancer, and the risk increases with stone size.
Calcification of the gallbladder wall (porcelain gallbladder
Anomalous pancreaticobiliary duct junction
Gallbladder polyps (>1 cm),
Chronic typhoid infection
Primary sclerosing cholangitis.

Cancer Treatment

Work up

Liver function tests

1-Ultrasonogram – Usually this the first investigation. Good quality ultrasound can detect gall bladder mass.

2-CECT or MRI –Triple phase contrast-enhanced CT scan or MRI scan is done to analyse the character of mass, association with surrounding structures, lymph node spread, and any distant metastasis.

3-PET CT scan is useful modality to detect any sprea to other parts of body.

Additional al workup like MRCP ( magnetic resonance cholangiography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP) to evaluate for hepatic and biliary invasion of tumor can be used before planning the treatment

Blood test-Liver function test, Tumor markers like Carcinoembryonic antigen (CEA) and CA 19-9 are not very specific markers for cancer gall bladder but useful for planning and follow up.

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Cancer Treatment

Treatment:

Depends on stage of presentation and general condition of the patient.
The initial goal of treatment is curative, to remove the gallbladder cancer, but when it spreads to other parts of body palliative treatment will be considered.

Surgery for Early-stage gallbladder cancer

Cholecystectomy(Removal of gall bladder): Done for early gallbladder cancer that is confined to the gallbladder.
Radical cholecystectomy:Gallbladder cancer that extends beyond the gallbladder and into the liver is sometimes treated with surgery to remove the gallbladder, as well as portions of the liver and bile ducts that surround the gallbladder. Along with this nearby lymph nodes are removed.

Chemotherapy

Chemotherapy is used after the surgery of gall bladder cancer to keep the cancer under control. For advanced cases when surgery is not possible chemotherapy is used to control the disease.

Radiation therapy

Radiation therapy is not very common treatment option for gall bladder cancer. Sometimes it is used along with chemotherapy to reduce the symptoms related to cancer.

Targeted therapy

Targeted therapy and immunotherapy might be an option for treating advanced gallbladder cancer.

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Prevention of Stomach Cancer

To reduce the risk of stomach cancer, you can:

Exercise regularly and keep your weight under control

Try to incorporate more fruits and vegetables into your diet each day

Reduce the intake of salty and smoked foods

Quit smoking

People with a family history of stomach cancer should undergo periodical testing and screening to detect cancer at the early stages

Do not delay seeking a medical consultant, when you start exhibiting symptoms.

Testing for Stomach cancer includes:

Once, you see a specialist, the following tests may be carried out:

A physical exam: A thorough physical examination will be carried out, after taking a detailed history of your symptoms.

Endoscopy: Usually upper gastrointestinal endoscopy i.e. UGI scopy is performed, wherein an endoscope a thin tube with a camera at its end will be inserted through your mouth into the oesophagus and stomach, to rule out any abnormal growth or ulceration.

Biopsy: A biopsy is performed at the time of UGI scopy to determine the type of stomach cancer.

Blood tests: Routine blood tests will be taken along with special tests to determine tumour marker levels eg. CEA, CA 19.9

CT scan: A CT scan of the chest, abdomen and pelvis is done to determine the stage of disease; which in turn help decide on the best treatment approaches for the patient.

PET CECT scan: A PET CT scan is recommended in advanced or recurrent cases to rule out the spread of cancer to other sites, eg lungs, liver, bone, etc.

Diagnostic laparoscopy and biopsy: In advanced cases, a diagnostic laparoscopy is done to document the spread of the disease, and a biopsy is also executed simultaneously.

Treatment for Stomach Cancer

Surgery:

Surgical procedures to remove cancer include:

Endoscopic Mucosal Resection (EMR)or Endoscopic submucosal dissection (ESD) uses an endoscope and special instruments to remove small early tumours present on the mucosal or submucosal layer.
Subtotal gastrectomy: In large-size malignant tumours, a part of the proximal or distal stomach is removed along with adjacent lymph nodes. The rest of the stomach is then anastomosed to the upper part of the small intestine (jejunum) to establish continuity for food passage and digestion.
Total gastrectomy:The whole of the stomach sometimes needs to be removed, depending upon the length of the stomach affected with cancer. In such cases, the oesophagal tube is connected directly to the small intestine (jejunum).
Bypass surgeries:In some advanced cases (stage IV), only bypass procedures are performed, like gastro-jejunostomy, to allow the patient to eat, during treatment.

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Chemotherapy:

Chemotherapy in the form of injections or tablets is suggested depending on the stage of the disease.

Adjuvant chemotherapy:This type of chemotherapy is given after surgery, usually, 6 cycles with each cycle having a duration of 2-3 weeks.
Neoadjuvant chemotherapy:This type of chemotherapy is given before surgery and is called neoadjuvant chemotherapy, consisting of 3 cycles with each cycle having a duration of 3 weeks, and, the remaining 3 cycles are given as adjuvant chemotherapy, after surgery.
Chemo-radiation:Chemo is recommended along with radiation therapy; called concurrent chemo-radiotherapy, which can be used as a neoadjuvant or adjuvant.
Intraperitoneal chemotherapy:This is a special form of chemotherapy delivered directly into the peritoneal (abdominal cavity) in patients with advanced stomach cancer. An intraperitoneal (IP) port system is introduced underneath the skin of the abdominal wall with a tubing passed into the abdominal cavity, under general anaesthesia. This new approach has been used successfully as neoadjuvant treatment also, especially in patients with peritoneally metastasised gastric cancer and has been shown to increase the chances of completely eliminating diseased cells with higher survival chances.

Radiation therapy:

Radiation therapy either alone or in combination with chemotherapy is recommended depending on the surgical histopathological report.

Targeted therapy:

Targeted therapy uses drugs to target specific proteins within the cancer cells, to eliminate them. For example, Trastuzumab targeting Her2neu protein in stomach cancer cells expressing Her2neu protein is suggested during treatment for stomach cancer.

Immunotherapy:

In advanced cases, biological therapy or immunotherapy is suggested as a treatment approach. Immunotherapy targets the cells, which affect the body’s immune response and helps the body in eradicating cancer cells.