Surgery for Gall Bladder Cancer

If you have gall bladder cancer, you have a tumour in the gall bladder, a small gland just behind the liver that usually produces bile. This fluid is released into the intestine to help digest fats in the food that you eat. Gall bladder cancer overall is quite rare but it is difficult to diagnose at a very early stage, so it tends to be discovered later, when treatments are not so effective.

Stages of Gall Bladder Cancer

One of the main treatments for gall bladder cancer is surgery to try to remove all of the cancerous tissue. If the cancer is at a relatively early stage, the tumour is only present in the gall bladder itself and removing this completely can remove virtually all of the cancer. Chemotherapy or radiotherapy may also be needed to mop up any cancer cells that have escaped into the blood and are in danger of setting up secondary cancers elsewhere in the body.

Later stage gall bladder cancers have spread out of the gall bladder itself and into the blood vessels, gall bladder duct and perhaps also into the surrounding tissues of the liver, intestine or stomach that are all nearby. It is more difficult to remove the cancer using surgery; chemotherapy or radiotherapy may then be used or can be done before surgery is attempted to try to increase the chances of success.

Surgery for Gall Bladder Cancer

The operation involved in removing the gall bladder is a fairly major procedure that always needs a general anaesthetic and a stay in hospital. The operation to take out the gall bladder is called a cholecystectomy and this can either be done by open abdomen surgery or using a keyhole technique that involves laparoscopy. The aim is to remove the gall bladder, the bile duct and all the nearby lymph nodes to try to remove the tumour and a good margin of healthy tissue all around it.

An Operation for Symptom Relief

Even if the cancer in the gall bladder cannot be removed by surgery and the primary treatment to try to reduce the size of the tumour involves chemotherapy and radiotherapy, an operation is often done to remove some of the worst of the symptoms caused by the growing tumour. Often tumour tissue blocks the bile duct, which cases the gall bladder to swell with bile, which can cause intense pain. Surgery to bypass the bile duct can help a lot – the operation is called a biliary bypass and involves cutting the bile duct at a point before the tumour, and then reconnecting the end of the duct with the intestine, so that the bile can drain away safely.

It is also possible to place a stent into the bile duct to prevent it from becoming blocked, and this can be linked to an internal catheter that also drains bile into the small intestine. If the blockage of the bile duct cannot be relieved be stenting or redirecting the duct, an operation called a percutaneous trans-hepatic biliary drainage can be performed. In this surgery, a new opening is made in the gall bladder and a stent and catheter is put in place that allows the bile to drain through the skin, and into a special collection bag that is worn outside the body.

Clinical Trials and Gall Bladder Cancer

Gall bladder can be a difficult cancer to treat but techniques are improving all the time. Many patients have surgery and are then treated by radiotherapy and chemotherapy, including with the new internal technique or with radiosensitisers. More clinical trials are ongoing to help refine even better treatments and most patients with gall bladder cancer are invited to enrol in a trial during the course of their therapy.