Liver & Gall Bladder Cancer
Introduction :
Liver Cancer
Primary liver cancer is a life-threatening illness and one of the fastest growing cancer types. Most primary liver cancer is cancer in your liver and cancer in bile ducts in your liver.
Gall Bladder Cancer
Gallbladder cancer occurs when malignant (cancer) cells grow in your gallbladder. Your gallbladder is a pear-shaped organ in the upper right of your abdomen, just under your liver. It stores and delivers bile, a fluid your liver secretes to help you digest fats in foods you eat.
Gallbladder cancer begins in the innermost layer of your gallbladder, called the mucosal layer, and spreads outward.
Liver Cancer
When liver cancer is in its early stages, you might have no symptoms at all. Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC) have similar symptoms:
- A lump below your rib cage or pain on the right side of your abdomen, or pain near your right shoulder.
- Jaundice (a disease that causes skin and eyes to yellow).
- Unexplained weight loss, nausea, or loss of appetite.
- Fatigue.
- Dark-colored urine.
Gall Bladder Cancer
Gallbladder cancer is difficult to detect because symptoms don’t show up in the early stages. When symptoms appear, they’re similar to more common conditions, like gallstones or a blockage in a bile duct.
Symptoms include:
- Upper abdominal pain.
- Yellowed skin and yellowed whites of your eyes (jaundice).
- Lumps in your abdomen.
- Unexplained weight loss.
- Nausea and vomiting.
- Bloating.
- Fever.
Liver Cancer
Liver cancer happens when something affects healthy liver cells’ DNA. DNA carries the genes that tell our cells how to function. We all have genes that tell cells when to grow, multiply and die. For example, oncogenes help cells grow and divide. Other genes, called tumor suppressor genes, monitor cell activity, keeping cells from multiplying uncontrollably and making sure cells die when they’re supposed to die.
When our DNA mutates or changes, our cells get new instructions. In HCC, DNA changes turn on oncogenes and/or turn off tumor suppressor genes. For example, studies show cirrhosis related to hepatitis B virus (HBV) and hepatitis C virus (HCV) account for more than half of all HCC cases. When these viruses infect liver cells, they change cell DNA, turning healthy liver cells into cancerous cells.
Gall Bladder Cancer
Gallbladder cancer occurs when healthy cells become malignant cells that grow and multiply out of control. This can happen when there are changes, or mutations, in the genetic material that tells healthy cells how to behave. With gallbladder cancer, these genetic mutations occur over time (acquired). You don’t inherit them from your biological parents.
Gallbladder cancer is more common among certain groups, including people who are:
- Women or assigned female at birth.
- American Indian, Alaskan native or Mexican-American.
- Over age 65. (The average age at diagnosis is 72.)
Other risk factors include having:
- Gallstones or a history of gallstones.
- Gallbladder polyps.
- Chronic (long-term) gallbladder inflammation (cholecystitis).
- Chronic Salmonella typhi infection (the bacteria that causes typhoid).
- A build-up of calcium deposits in your gallbladder (porcelain gallbladder).
- Chronic inflammation in your bile ducts (primary sclerosing cholangitis).
- Cysts in your common bile duct (choledochal cysts).
- Obesity.
It’s also possible that smoking and exposure to certain chemicals used to create textiles and rubbers can increase your risk.
Liver Cancer
Your healthcare provider may suspect you have liver cancer if they find liver cancer signs and symptoms during your physical examination. They may order the following tests to learn more:
- Blood tests: Healthcare providers may do blood tests for cancer, such as a liver function test, to check on liver enzymes, proteins and other substances that show whether your liver is healthy or damaged. They may test for alfa-fetoprotein (AFP). High AFP levels may indicate liver cancer.
- Ultrasound (sonography): This test provides pictures of your soft tissue structures. Healthcare providers use ultrasound to look for liver tumors.
- Computed tomography (CT) scan: This special type of X-ray takes detailed images of your liver, providing information about liver tumor size and location.
- Magnetic resonance imaging (MRI): This test produces very clear images of your body using a large magnet, radio waves and a computer.
- Angiogram: This test helps healthcare providers examine your liver’s blood vessels. During this test, your healthcare provider injects dye into an artery so they can track blood vessel activity and look for blockages.
- Biopsy: Healthcare providers remove liver tissue to look for signs of cancer. Biopsies are the most reliable way to confirm a liver cancer diagnosis.
Gall Bladder Cancer
Because in gallbladder cancer, there are rarely signs or symptoms in the early stages, and those symptoms resemble other conditions, providers often diagnose gallbladder cancer late. They often discover it because you have gallstones or need your gallbladder removed.
If your provider suspects you might have gallbladder cancer, they’ll examine you and ask about your medical history. Then, they’ll perform tests.
Tests may include lab tests, imaging procedures and minor surgeries.
Lab tests
Lab tests detect substances in your blood that may be signs of cancer.
- Liver function test: Measures the levels of certain substances your liver releases, which may indicate that gallbladder cancer is affecting your liver.
- Carcinoembryonic antigen (CEA) assay: Measures the levels of CEA, a tumor marker released by both healthy and cancerous cells. High levels may be a sign of gallbladder cancer.
- CA 19-9 assay: Measures the levels of the tumor marker CA 19-9 in your blood. High levels could indicate gallbladder or pancreatic cancer.
Imaging tests
Imaging tests allow healthcare providers to look for cancer and signs of cancer spread.
- Abdominal ultrasound: An imaging test that uses sound waves to create pictures of the organs within your abdomen. You may need additional imaging procedures, like a CT scan or MRI, if an ultrasound detects a mass that could be gallbladder cancer.
- CT (computed tomography) scan: A type of X-ray that takes detailed images of internal organs.
- MRI (magnetic resonance imaging): An imaging test that uses a magnet, radio waves and a computer to create pictures of the inside of your body.
- Endoscopic ultrasound: An ultrasound that uses a tube-like instrument called an endoscope to create pictures of your digestive tract.
- Endoscopic retrograde cholangiopancreatography (ERCP): An X-ray procedure that takes pictures of your bile ducts. Gallbladder cancer can cause these ducts to narrow.
Surgeries
Surgical procedures allow healthcare providers direct access to tissue that contains cancer cells.
- Biopsy: A healthcare provider removes a tissue sample and examines it under a microscope for cancer cells. A biopsy is the only way to confirm a gallbladder cancer diagnosis.
- Laparoscopy: A provider inserts a laparoscope (a thin, lighted tube) into your abdomen through a small incision (cut) to look at your gallbladder and nearby tissues. A laparoscopy can help your provider determine how much the cancer has spread.
Liver Cancer
Treatment of HCC includes surgery to remove part of your liver, liver transplantation and liver-directed treatments like hepatic arterial embolization and ablation. They may also use several types of chemotherapy, chemoembolization, radiation therapy, radioembolization, immunotherapy and targeted therapy.
Gall Bladder Cancer
Early-stage gallbladder cancer treatment
Early-stage gallbladder cancer that your provider can remove through surgery has the best treatment outcomes.
- Surgery: A healthcare provider called a surgical oncologist may remove your gallbladder and nearby tissue (cholecystectomy). If you have a simple cholecystectomy, the surgeon will only remove your gallbladder. With an extended cholecystectomy, the surgeon will remove other tissues with cancer cells, such as affected lymph nodes or part of your liver.
- Radiation therapy: This treatment uses a machine outside your body (EBRT) to direct radiation to your cancer. The radiation kills the cancer cells or slows tumor growth while minimizing damage to healthy cells. You may need this treatment after surgery to kill any remaining cancer cells. Radiation can also provide symptom relief.
- Chemotherapy: Chemotherapy uses drugs to kill cancer cells or stop them from multiplying. Like radiation, chemotherapy may help destroy any remaining cancer cells after surgery. Your provider may recommend chemotherapy treatments alongside radiation therapy.
Unrespectable, recurrent or metastatic gallbladder cancer treatment
Cancers that can’t be removed via surgery (unrespectable), have returned (recurrent) or spread (metastatic) aren’t curable. Treatments like radiation therapy and chemotherapy won’t eliminate the cancer, but they can improve your symptoms and extend your life. Similarly, while surgeries can’t remove the cancer, you may need procedures to relieve symptoms if tumors create blockages in your digestive tract.
You may be eligible to take part in a clinical trial. A clinical trial is a study that tests new treatments and new approaches to current treatments. Current treatments for gallbladder cancer being tested in clinical trials include:
- Targeted therapy: Treatment that targets cancer cells that carry certain gene mutations.
- Immunotherapy: Treatment that bolsters your immune system so it’s better able to identify and destroy cancer cells.
- Radiosensitizers: Treatment that makes cancer cells more sensitive to the effects of radiation therapy.
The stage wise 5-year survival percentages
Hepatocellular Carcinoma (Liver Cancer)
- Stage 1: ~35%
- Stage 2: ~25%
- Stage 3: ~15%
- Stage 4: ~5–10%
Gallbladder Cancer
- Stage 1: ~65%
- Stage 2: ~45%
- Stage 3: ~25%
- Stage 4: ~5–10%
Intrahepatic Cholangiocarcinoma (ICC)
- Stage 1: ~24–30%
- Stage 2: ~15–25%
- Stage 3: ~8–15%
- Stage 4: ~2–5%
Extrahepatic Cholangiocarcinoma (ECC)
- Stage 1: ~30–50%
- Stage 2: ~25–35%
- Stage 3: ~10–20%
- Stage 4: ~2–10%
Liver Cancer
While you can’t completely prevent liver cancer, you can do the following to lower your chances of getting liver cancer:
- Avoid behaviors that lead to cirrhosis.
- Reach or maintain a healthy weight.
- Get a hepatitis B vaccine. This vaccine is safe for nearly everyone. Ask your doctor about the hepatitis A vaccine.
- Avoid hepatitis C.
- If you have any liver disease, have diabetes, obesity or are a heavy drinker, ask your healthcare provider about liver cancer screenings.
- You can have very early-stage liver cancer without symptoms. Liver cancer screening is how healthcare providers monitor your liver’s health for signs of liver cancer. While there aren’t any standard liver cancer screening tests, your healthcare provider may recommend you have ultrasounds and blood tests every six months.
Gall Bladder Cancer
Gallbladder cancer can’t be prevented. You can do your best to avoid risk factors of gallbladder cancer.