What is the Purpose of the Gallbladder and Bile Duct in the human body?
The gallbladder is a small, pear-shaped pouch that sits underneath the liver. The gallbladder stores and concentrates bile, a dark-green or yellowish brown made by the liver that helps digest fats in the small intestine and in response to signals, the gallbladder contracts and squeezes the stored bile into the small intestine through a series of tubes called ducts.
Bile ducts transport bile from the liver and gallbladder through the pancreas to the duodenum, a part of the small intestine. Bile ducts within the liver join together to form one main bile duct outside the liver, which carries the bile to the small intestine. The main bile duct is called the common hepatic duct and it joins the gall bladder via the cystic duct; the combined duct is known as the common bile duct.
What happens when cancer develops in the Gallbladder and/or in the Bile Duct?
Gallbladder and bile duct cancers are rare malignancies that have variable incidence. In Nigeria, gallbladder cancer ranks number eight among all the gastrointestinal cancers seen.
Most primary gallbladder and bile duct cancers are adenocarcinomas; they are growths that begin in the mucus glands that line the insides of the gallbladder and bile duct.
Bile duct cancers also known as cholangiocarcinomas and can occur in the main bile duct outside liver (extrahepatic) or within the liver (intrahepatic). One in ten bile duct cancers develop as intrahepatic cancers in the small duct branches within the liver.
What are some symptoms of Gallbladder Cancer and Bile Duct Cancer?
Gallbladder and Bile duct cancer does not usually cause signs or symptoms until later in the course of the disease, when the cancer has spread to other organs, but sometimes symptoms can appear sooner and lead to an early diagnosis.
With bile duct cancer, the symptoms arise when the bile duct becomes obstructed. Such symptoms include:
- Jaundice; a condition in which the skin and the whites of the eyes become yellow, urine darkens, and the colour of the stool becomes lighter,
- Itching of the skin,
- Abdominal or belly pain,
- Loss of appetite/ weight loss,
- Nausea and vomiting,
Symptoms of Gallbladder Cancer include:
- Abdominal pain, particularly in the upper right position of the abdomen,
- Abdominal bloating,
- Unintentional weight loss,
What are the risk factors for developing Gallbladder Cancer and/or Bile Duct cancer?
Risk factors for gallbladder cancer include:
- Gallstones and inflammation: Gallstones are the greatest risk factors for gallbladder cancer and up to 90% of people diagnosed with gallbladder cancer also have gallstones and chronic inflammation of the gallbladder.
- Chronic or persistent typhoid infection: People who are chronically or persistently infected with Salmonella (causes Typhoid) are six times more likely to develop gallbladder cancer than those not infected.
- Gallbladder polyps: Polyps are growths that protrude from the gallbladder’s mucous membranes; they are sometimes precancerous and can progress into cancer.
- Porcelain Gallbladder: This occurs when the gallbladder becomes covered in calcium deposits, resembling porcelain ceramic.
- Family history
Risk factors for Bile Duct Cancer include:
- Ulcerative Colitis: This condition causes inflammation of the large intestine and is often associated with inflammation of bile duct.
- Biliary Parasites: Food or waterborne parasites in the bile duct increase the risk of developing cancer of the bile duct.
- Chronic Hepatitis C: Although this a common risk factor for liver cancer, it is also considered a risk factor for Bile Duct Cancer.
- Smoking: Intrahepatic bile duct cancer is more common along heavy smokers.
How do you diagnose Gallbladder and Bile Duct Cancers?
To confirm the diagnosis of Gallbladder and Bile Duct cancers, assess disease stage and plan the appropriate course of treatment, the patient will likely have or more of the following:
- Liver function tests
- Tumor Marker Tests
Some imaging techniques used to determine the exact size and location of the newly diagnosed gallbladder and bile duct tumours are as follows:
- Ultrasound Exam
- Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Angiographic Computer Tomography (CT) Scan
It is important to speak to your healthcare provider if you are experiencing any of the symptoms listed above, to determine the type of testing that will be done and after a diagnosis has been confirmed, the best treatment plan.