What is te Gallbladder Tract Tumor?

Tumors seen in the gallbladder and tracts are usually malignant and eventually turn into cancer. Early diagnosis is quite difficult, as these types of cancer, which are in the top five among cancers of the digestive system, progress without symptoms. Although there are some symptoms of tumors in the gallbladder and pathways that are usually found by chance, they are detected too late. Gallbladder cancer and biliary tract cancer can be treated with surgery, as well as only radiation therapy and chemotherapy can be used in late diagnoses and advanced stages.

What are Gallbladder and Tracts Tumors?

The gallbladder is a digestive organ located adjacent to the liver. Bile removed by the liver is poured through the channels into the gallbladder and stored here for a while, and then transferred to the small intestine, where necessary. Tumors that occur in the gallbladder where gall is stored are gallbladder tumors (cancer), while tumors that occur in the biliary tract, consisting of channels extending from the liver to the small intestine, are called cholangiocarcinomas (biliary tract cancer).

The most common age group is the 70s. Gallbladder cancer is a more common type of cancer in women than in men. Because gallbladder cancer is a type of cancer that progresses very quickly, it is often not possible to diagnose it early.

Tumors that form in the biliary tract are rare, but are quite difficult to treat. Bile duct cancer, which accounts for 2% of all cancers, usually occurs over the age of 65. The incidence is low in people under the age of 40.

What Are The Types Of Biliary Tract Tumors?

There are types of tumors that form in the gallbladder pathways according to the area.

Intrahepatic Biliary Tract Cancer

This type of cancer, which occurs in the part of the bile ducts in the liver, is rare. Intrahepatic biliary tract cancer can sometimes be confused with liver cancer. However, treatment methods are usually the same.

Distal Biliary Tract Cancer

Distal, which develops in the bile duct close to the small intestine, accounts for 20% of bile duct cancers. Because of its distance to the liver, it is also known as bile duct cancer, which is not related to the liver.

Perihilar Biliary Tract Cancer

This cancer, also called “Hiler bile duct cancer” in medicine, occurs in the hilum region at the outlet of the liver. Perihilar biliary tract cancer is more common than other species.

Causes of Gallbladder and Tracts Tumors

Although the factors that cause tumors in the gallbladder and pathways are not known for sure, some factors that cause tumor cell formation can be listed as follows:

    • Gallstones
    • Gall bladder polyps
    • Choledoc cyst
    • Liver and biliary tract parasites
    • Cirrhosis
    • Caroli syndrome
    • Hepatitis B and Hepatitis C
    • Intestinal diseases such as ulcerative colitis and Crohn's disease
    • Obesity
    • Eld
    • Exposure to harmful chemicals
    • Smoking and alcohol consumption
    • Family history of similar diseases

Symptoms of Tumors in the Gallbladder and Its Pathways

Gallbladder and tract tumors, which usually occur at a later age, develop quickly and without symptoms in the early stages. When tumors begin to show symptoms, the common symptoms are as follows:

    • Jaundice
    • Bellyache
    • Nausea and vomiting
    • Unexplained weight loss
    • Weakness and fatigue
    • Itching on the skin
    • Digestive problems
    • White stool
    • Dark urine
    • Fever
    • Mass in the belly area

Diagnosis of Gallbladder and Tracts Tumors

When patients with complaints such as jaundice, vomiting, nausea caused by tumors in the gallbladder and tracts go to doctors, a physical examination is first performed and a family history is examined. But tumors in the gallbladder are unlikely to be understood by manual examination. For this reason, some tests and imaging techniques that are considered necessary are applied.

First, the patient is asked for some blood tests. These are the levels of bilirubin and other substances that are considered in blood tests. Ultrasound can check whether there is a tumor. CT (Computed Tomography) and MRI (magnetic resonance imaging) are used to diagnose the area in which the tumor is formed, whether it has spread, and its size. A biopsy is necessary for a definitive diagnosis. In a biopsy, a tissue sample is taken and sent for pathology analysis.

ERCP (Endoscopic retrograde cholangio Pancreatography) is an another diagnostic method. In this method, which is more commonly used for the diagnosis of bile duct cancer, a small tube or catheter is inserted into the bile duct through the endoscope. In the percutaneous cholangiography method, which is accessed from the skin under the gallbladder with a dyed thin needle, the presence of a tumor in the gallbladder is checked in the imaging performed with the medicinal substance given from the vessels. As with many diagnostic methods, laparoscopy is also used to detect tumors in the gallbladder and its pathways. Imaging of the tumor is done by entering the abdominal area. PET scanning is the last of the methods used. In this scan, it can be understood which organs the tumor has metastasized to, as well as at what stage the cancer is at.

Stages of Gallbladder Cancer and Biliary Tract Cancer

Tumors found in the gallbladder and tracts have different stages. In these stages, the size, spread and region of the tumor can vary.

Stages Of Gallbladder Cancer

Stage 1: The tumor is located only on the inner surface of the gallbladder.

Stage 2: The tumor has spread to the muscular layer on the outer surface of the gallbladder.

Stage 3: The tumor has surrounded all the layers in the wall of the gallbladder.

Stage 4: The tumor clings to the bile ducts and lymph modules, metastasizing to the liver and other nearby organs.

Stages Of Biliary Tract Cancer

Intrahepatic Biliary Tract Cancer

Stage 1: The tumor is only in the bile ducts.

Stage 2: The tumor also developed in nearby vessels.

Stage 3: The tumor has developed in the part of the abdominal membrane that covers the liver. At this stage, the tumor can also develop in the intestine.

Stage 4a: The tumor has spread around the biliary tract. There may be cancer cells in the lymph nodes, but they are not seen in other remote areas.

Stage 4b: The tumor has metastasized to other areas and organs other than the biliary tract.

Distal Biliary Tract Cancer

Stage 1: The tumor is in the biliary tract.

Stage 2: The tumor has developed in the gallbladder, pancreas and small intestine and can spread to the lymph nodes.

Stage 3: The tumor is located in the aorta-carotid artery, which merges with the liver artery.

Stage 4: The tumor has spread to other nearby organs.

Perihilar Biliary Tract Cancer

Stage 1: The tumor is only in the bile ducts.

Stage 2: The tumor is in the adipose tissue around the biliary tract; it has also spread to the liver.

Stage 3a: The tumor can be seen in one of the main vessels.

Stage 3b: The size of the tumor varies. It has spread to the liver as well as to the lymph nodes.

Stage 4a: The tumor is in the liver channels. It also occurs in nearby lymph nodes.

Stage 4b: The tumor has spread to distant organs and lymph nodes.

Treatment of Gallbladder and Tracts Tumors

There are some factors that affect the treatment of these tumors. The stage of cancer, the location of the tumor, the age of the patient and other health problems, if any, are factors in deciding whether surgery is possible. Because both types of cancer are usually detected in advanced stages, surgery may not be possible in most cases. In such cases, treatments are applied to reduce the ailments caused by the patient. These include pain treatment, chemotherapy and radiotherapy.

If the gallbladder tumor is not at an advanced stage and allows surgery, the gallbladder and nearby lymph nodes can be removed using open or closed surgery methods. If the tumor has caused a blockage in the intestine, a by-pass is applied between the gallbladder and its path and the small intestine; if the tumor has blocked the bile duct, a stent is placed in the canal using the ERCP method. In cases where it is not possible to place stents in blocked channels, the bile ducts are emptied by entering the liver with a thin needle. After surgery, the patient can continue treatment with chemotherapy or radiation therapy.

In biliary tract cancer, only the cancerous area is removed if the tumor has spread regionally and is diagnosed at an early stage. Other bile ducts that remain in the liver are combined with small intestine channels to regulate bile flow. If the cancer has spread far, not regionally, the areas affected by the tumor and the biliary tract are completely removed. Whipple surgery, which requires discipline, is also the preferred method of this type of cancer. With this operation, along with the bile duct, part of the stomach and small intestine, the lymph nodes around the gallbladder and pancreas are also removed. As with gallbladder cancer surgery, if there is a blockage in the ducts, a stent can be inserted again. But in advanced and non-surgical stages, only radiotherapy and 5-FU-based chemoradiotherapy treatments are considered appropriate.

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