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Gallbladder cancer is a cancer with low incidence and high mortality. While the cases of gall bladder cancer accounts for 1.2% of all cancer diagnoses, death because of it is 1.7% of all cancer deaths. By these figures we can see that gall bladder cancer is most deadly form of cancer. This is because only 1 of 10 gallbladder cancers is found in the early stages, and this cancer is very rapidly spreading kind of cancer; leading to poor survival rate. In this article we’ll understand the causes of gall bladder cancer and what is possible for its prevention.
Is India having high risk of gallbladder cancer?
India has about 10% of the global Gallbladder cancer. Incidence is high in North, North-East, Central and Eastern India, and low in South India. Gallbladder cancer risk is seven times higher in the north and north-eastern states as compared with the south. Gall bladder cancer incidence is rising. Gallbladder cancer causes as advised by most oncologists treatting gallbladder cancer are summerized in three risk groups.
Group 1 Risk Factors/ causes of gallbladder cancer: related to toxins in environment
- Ground water pollution: People living along Gangetic belt have 10 times higher risk than average risk of gall bladder cancer in India. Gangetic belt has many industrial regions with a high load of pollutants. People have exposure to environmental pollutants such as heavy metals and pesticides early in life.
- Soil and water contamination by industrial wastes, agricultural effluents and human sewage have been identified as potential risks for development of gall bladder cancer.
- Occupational risk hazards: workers in rubber plants or textile factories
- Tobacco exposure
- Coal/wood dust
- Hormone replacement therapy/ drugs: Post-menopausal women undergoing oral estrogen or estrogen-progesterone therapy are at increased risk of gallstones and gallbladder cancer. Drugs like methydopa, isoniazid are also mentioned as risk factors.
Group 2 Risk Factors: Related to personal risk factors
- Age: Older age beyond 50 years is more susceptible.
- More common in females than males.
- Genetic susceptibility: gall bladder cancer in India usually affects younger patients in the 5th and 6th decade which is a decade earlier than west.
- Obesity: cancer risk increased by 4% for each 1 kg/m2increase in BMI above 25 kg/m2. Diabetic individuals had 1.56 times more risk of gallbladder cancer.
- Lifestyle: weak association between dietary patterns such as consumption of fried food, the interval between meals >8 hours
- Primary sclerosis cholangitis (PSC): is an autoimmune disease and have high risk for gall bladder cancer.
- Bile Duct Cysts: biliary tract cancer, of which gallbladder cancer is the most common, occurs in 2.5-28% of those with biliary cysts.
- Anomalous junction of the pancreaticobiliary duct is a congenital malformation in which the pancreatic duct drains into the biliary tract outside the duodenal wall
- Alcohol
Group 3 Risk Factors: Related to gallbladder inflammation/ injury
- Gallstones are present in 80% of patients with gall bladder cancer. Stones leads to chronic injury in inner layers of gall bladder. Chronic irritation and infection from gall stones is an established risk factor for development of gall bladder cancer. Only a small fraction of around 1% gallstones leads to gall bladder cancer development. Risk is more in stone >3cm and multiple stones.
- Infection: chronic typhoid infection by Salmonella typhiand Helicobacter bilis infection.
- Gallbladder Polyp: cancer chances are more in >1cm polyp. There may rarely be risk for <1cm polyp to become cancerous.
Combination of environmental toxicity, gall bladder inflammation and personal risk are the key factors in gall bladder cancer development.
Prevention of gallbladder cancer:
While the gallbladder is a small organ unessential for life, adenocarcinoma of the gallbladder is a deadly and often untreatable cancer. It is such a rapidly spreading malignancy that often could not be diagnosed until advanced stages, when life expectancy is only in several months despite treatment. 75% of these cases are preventable. Possibles ways of gallbladder cancer prevention includes:
- Screening: there is no officially recommended screening for gall bladder cancer early detection.
- Ultrasound Imaging should be done for gall bladder polyp <1cm for at least 2 years to check their status with time.
- Those in high-risk areas and features of gall bladder inflammation should do surgery, but if not accepting treatment they may be advised ultrasound screening
- Primary sclerosing cholangitis
- Cholecystectomy surgery is advised for-
- strongly advised for gallbladder polyps 1cm or larger.
- For polpys < 1cm, but showing increase in size on followup ultrasound .
- Gall bladder mass in patients with primary sclerosing cholangitis
- Acute and chronic cholecystitis with gall stones should be treated with removal of gall bladder. Early detection and/or prophylactic treatment of gallstones in high risk individuals is also advised by some without any strong evidence.
- Porcelain gall bladder is condition with excess calcium deposits. Cholecystectomy is advised.
- Preventive steps: for prevention of gallbladder cancer as suggested by oncologist in Delhi NCR includes:
- Chronic infection treatment: Typhoid can be prevented with vaccine and can be treated with antibiotic. Helicobacter can also be treated antibiotics Good hygiene and sanitation is important for prevention
- Those with a history of gallstones or gallbladder polyps can practice secondary prevention by undergoing regular imaging of the gallbladder, biliary ducts, and pancreaticobiliary junction.
- Those with hereditary biliary cysts should seek surgical removal upon diagnosis, especially in infancy, as this decrease the risk of developing gallbladder cancer later in life.
- Early detection can likewise prove life-saving when it comes to gallbladder cancer.
- Screening: there is no officially recommended screening for gall bladder cancer early detection.