How does a tumor develop?
Most gallbladder tumors are adenocarcinomas that grow from the mucosa. Development is preceded by many years of chronic inflammation: stones constantly injure the wall, the mucous membrane is rebuilt, and areas of dysplasia appear, which can degenerate over time. The tumor most often occurs in the area of the bottom and body of the bladder, grows into the wall and quickly spreads to the adjacent liver tissue, since they are separated only by a thin layer. Hence the tendency to early spread to the liver, bile ducts and lymph nodes of the porta hepatis.
- Adenocarcinoma - the main histological type
- Precancerous changes in the mucosa during chronic inflammation
- Early germination in the liver bed
- Spread to the lymph nodes of the hilum of the liver
- Accidental discovery during removal of a bladder due to stones
Risk factors
The leading factor is long-term gallstone disease, especially with large stones and long-term chronic cholecystitis. The risk is increased by calcification of the bladder wall, large polyps, chronic infection of the biliary tract, and an anomaly in the connection of the bile and pancreatic ducts. The disease is more common in women and people over 60 years of age. It is important to understand the proportion: many people have stones, but bladder cancer rarely develops, so we are talking about an increased risk, not an inevitability, and prophylactic removal of the bladder is not done without indications.
- Gallstone disease, especially with large stones
- Chronic cholecystitis of long duration
- Gallbladder polyps from 10 mm and growing
- Calcified bladder wall
- Abnormal connection of the bile and pancreatic ducts
- Chronic biliary tract infection
- Age over 60 years, female, obesity
Symptoms
There are no specific early signs, and this is the main difficulty. A change in the usual picture should alert you: if instead of rare attacks a constant dull pain appears, your appetite has gone, weight loss has begun - a re-evaluation is needed. In later stages, the tumor blocks the bile ducts and causes obstructive jaundice with itching, dark urine and light-colored stool. Sometimes the disease first manifests itself as acute cholecystitis or is detected on ultrasound as a thickening of the wall, a fixed formation, or a polyp that has noticeably enlarged.
- Dull constant pain in the right hypochondrium
- Nausea, bitter taste in the mouth, loss of appetite
- Losing weight for no reason
- Jaundice, itchy skin
- Dark urine and discolored stool
- Palpable formation under the ribs on the right
- Fever without obvious infection
Survey
The first method remains ultrasound: it shows stones, thickening or unevenness of the wall, a formation in the lumen that does not shift when changing body position. If suspected, MSCT and MRI with contrast are prescribed - they evaluate growth into the liver, the condition of the ducts, lymph nodes and the presence of distant foci. Tumor markers CA 19-9 and CEA are auxiliary. The most important role is played by histological examination: the diagnosis is often made based on the removed bladder, so each bladder must be sent for analysis after surgery.
- Ultrasound of the liver and gallbladder
- MSCT of the abdominal cavity with contrast
- MRI with cholangiography
- Tumor markers CA 19-9 and CEA
- Liver tests, bilirubin, alkaline phosphatase
- Histological examination of the removed bladder
- Endoscopic ultrasound and biopsy if indicated
Treatment and prevention
Tactics depend on the depth of wall penetration. For the earliest tumors limited to the mucosa, standard removal of the gallbladder is sufficient. With deeper germination, an extended operation is performed: removal of the bladder along with a section of the liver and lymph nodes. If the tumor has spread widely, treatment is aimed at controlling the disease and quality of life: chemotherapy; for jaundice, stenting or drainage of the duct. Prevention comes down to timely treatment of gallstone disease in the presence of complaints and monitoring of polyps according to the rules determined by the doctor.
- Laparoscopic cholecystectomy at an early stage
- Extended surgery with resection of the liver bed and lymph node dissection
- Repeated surgery for a tumor found after planned removal
- Chemotherapy for advanced tumors
- Stenting or drainage of the duct for jaundice
- Observation of gallbladder polyps by ultrasound
- Mandatory histology of all removed blisters
