Bile Duct

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Gallbladder cancer is unusual. About 400 people a year get the disease. Most are over 65. Cancer of the biliary tract has usually spread to the body when the disease is detected. Then there is treatment that can slow down and relieve the disease for some time but it cannot be rid of.

What is gallbladder cancer?

Gallbladder cancer means that you have a cancerous tumor somewhere in the biliary tract. The biliary tract begins in the liver and ends in the duodenum. The gallbladder is part of the biliary tract.

The disease usually spreads to lymph nodes located near the biliary tract and to the liver. It is unusual for metastases in other parts of the body. Metastases are the same as daughter tumors.

It is common for gallbladder cancer to spread at an early stage, before it has begun to produce symptoms. Then you can’t get rid of the disease.

All bile duct tumors are not cancer. There may be tumors that have not yet developed into cancer and even  benign tumors .

What is bile?

Bile is a liquid needed for digestion. It is formed in the liver and flows through the biliary tract to the gallbladder. It is stored there until food comes out of the stomach into the duodenum. Then the bile also runs into the duodenum. Here you can read more about the  digestive organs .

How does cancer occur?

The body consists of many billions of cells. The cells divide to form new cells so that the body can function. Sometimes it gets wrong when a cell divides. Usually, it does nothing or the cell can stop the error from spreading to more cells at the next cell division. But sometimes it doesn’t work. Then more and more altered cells can be formed for each cell division. Eventually, cancer cells can form and become a cancerous tumor. The cancer cells divide uncontrollably and do not die when they should.

Symptoms of biliary tract cancer

Initially, biliary tract cancer usually does not produce any symptoms, although sometimes jaundice can occur. The symptoms that come later may also be due to many other illnesses and disorders.

Jaundice early symptom in some

The first clear sign of biliary tract cancer may be the symptoms commonly called jaundice or icterus:

  • The urine becomes darker.
  • The whites of the eyes and the skin turn yellowish.
  • It can start to scratch the skin a lot.

Jaundice in cancer of the biliary tract is due to the fact that the cancerous tumor has become so large that it prevents the bile from flowing through the biliary tract. Then the bile dye bilirubin goes directly into the blood and causes the skin and eyes to turn yellowish and it starts to itch on the body.

For the most part, jaundice has completely different causes than gallbladder cancer, such as  gallstones  or hepatitis. Hepatitis is an inflammation of the liver caused by viruses.

Abdominal pain or discomfort or nausea

It can hurt or feel uncomfortable high up in the stomach. You may also feel ill. It is much more common for the symptoms to have causes other than cancer of the biliary tract.

Involuntary weight loss and decreased appetite

You can lose weight without knowing why. This may be because the cancer tumor prevents the body from absorbing nutrition properly. You may also lose the desire to eat. It is not known what this is due to.

Fatigue and fatigue

You may feel tired and powerless without knowing why. In bile duct cancer it may be due to the metabolism being affected.

Feeling tired and tired can have many causes other than cancer.

Fever and chills

You may have fever and chills. This may be because the cancer tumor prevents the bile from flowing into the intestine. Then bacteria can grow in the bile. It can lead to blood poisoning, which is also called sepsis .

When and where should I seek care?

If  you think you have biliary tract cancer, contact a  health care provider. You can contact many receptions by  logging in.

If it’s in a hurry

If you get yellow eye whites or yellowish skin at the same time as you get fever and chills, seek care at an emergency room.

Investigations and investigations

You can tell your doctor about your complaints and how long you have had them. The doctor also feels on the stomach.

Several of the symptoms of cancer of the biliary tract are the same as in many other diseases. Therefore, the investigation of your complaints may, for example, begin with the colon being x-rayed or the stomach being examined with  gastroscopy .

Ultrasound examination in jaundice

If you have jaundice, an  ultrasound examination  on the body can show if there is anything that prevents the bile from flowing between the liver and the duodenum. You need to be examined more if the doctor suspects that it is cancer.

Substances in the blood are examined

Blood tests  can show how the liver and biliary tract work or if there are tumor markers in the blood. Tumor markers are substances that may be more abundant in the blood in cancer but also in other diseases. The measurement value is helpful when the doctor is to make a diagnosis based on the examinations that have been done.

Investigations to diagnose and diagnose the disease

There are various ways to examine the obstacle in the biliary tract. If you have cancer, it is also important to chart where it grows and how it develops. It matters what kind of treatment you can get. Often contrast agents are needed to make the images as clear as possible. You may also need to submit cell samples or tissue samples. You may need to be examined in one or more ways:

Computer tomography or examination with magnetic camera

Examination with a  computer tomography  or  magnetic camera  can give an answer as to whether you have a cancerous tumor and whether it has spread. There is also a special kind of magnetic camera study called MRCP to examine the biliary tract. The studies are done with contrast agents.

ERCP – endoscope examination

The inside of the biliary tract can be examined with  ERCP technology . The examination is done with an endoscope. It is a flexible, hollow, tubular instrument that is inserted through the mouth. Before the examination  you are anesthetized  or given sedatives. You also get  local anesthesia  in the throat.

Ultrasound Endoscope – EUS

Endoscopy with ultrasound goes to much like ERCP, but makes it possible to examine both the outside and the inside of the biliary tract. The doctor can also examine, for example, nearby lymph nodes and see if there are liver metastases and take cell samples. Sometimes contrast agents are needed.

PTC

Examination with PTC technology means that the doctor inserts a needle through the skin, liver and into a biliary tract. There, the doctor injects contrast agents. Then the biliary tract is x-rayed. You are  anesthetized before the examination.

The investigation is conducted according to a standardized course of care

You will be examined according to a standardized course of care if the doctor suspects you may have biliary tract cancer.

Standardized care  is a way of organizing the investigation so that it goes as quickly as possible. Among other things, there are times set for the surveys you may need to do.

The doctor who writes the referral tells you why you should be investigated according to a standardized course of care, what it means and when you can be told if you have cancer or not.

It is often quick to get calls for examinations in a standardized course of care. It is good if you are clear about how the staff most safely reach you, so that you do not miss any time.

A group of specialists advise after the investigation

A group of different specialists advise on all people who have been diagnosed with biliary tract cancer. Your doctor will contact the specialists so that they can suggest the treatment that they believe will be best for you based on the examinations that have been done. Your doctor will tell you what the specialists suggest.

Treatment for the disease can be removed

Surgery is the only treatment that can remove the disease. You can be operated on so that you get rid of the cancerous tumor if it has not spread and if you feel well otherwise. Sometimes the operation is supplemented with cytostatic treatment.

Approximately one in five people can be offered an attempt at surgery. Sometimes it is only during the operation that the cancer has spread. Then the surgery is interrupted and you receive braking treatment instead.

Then the operation goes on

The operation often means that a fairly large portion of the liver must be removed. The cancer can spread to nearby lymph nodes and therefore they are also removed. Even a piece of the pancreas may need to be removed. The bile ducts that remain are linked to the intestine. The surgery is done either with peephole technique  or by a cut in the abdomen. You are anesthetized before surgery. What is removed is sent to the laboratory for analysis.

Preparatory examinations and treatment

Before an operation, careful preparation is needed. For example, the heart and lungs need to be examined so that the doctor can make sure your body is able to cope with the operation.

Sometimes you may need a preparatory treatment that allows the liver to grow so that there is enough left over it, although a large part should be removed during the cancer surgery. The treatment is called port vein embolism. It is done three to six weeks before the cancer surgery.

First  you sleep. Then the doctor inserts a narrow plastic tube into the vein that leads blood to the part of the liver to be removed. An agent is injected through the tube and clogs the vein. Then the hose is removed. It is common to be able to go home the day after treatment.

After a few weeks, you will be examined with a  computer tomography  or  magnetic camera  so that the doctor can see that the treatment has made the liver grow.

Talk to the doctor

You need to talk to the doctor a lot before making a decision about surgery so that you feel prepared and motivated. Both surgery and the time after surgery are demanding and there is a risk of various complications. There is also a risk that the disease will return, despite the operation.

Different how long you need to stay in the hospital

How long you need to stay in the hospital depends on how you feel and how big the operation was. Some may leave the hospital after four to five days. Others need to stay two to three weeks. Sometimes it starts to leak bile where you have been operated on. It usually ends by itself after a few days but you need to stay a little longer at the hospital. You also need to stay longer if you get a fever. Fever may be due to an infection. Then you get antibiotics.

Return visit after one month

Most people may come on an initial visit about a month after their stay in the hospital. The doctor is examining you. Sometimes an X-ray examination may be needed. You will know what the analysis shows of what was removed. This is important for continued treatment.

Treatment with cytostatics

You may need treatment with cytostatics after surgery. Chemotherapy  is the cell-inhibiting drugs that reduce the risk that the disease will come back. You receive treatment at the hospital at regular intervals for six months. Between treatment sessions you can be at home. It varies from person to person how many treatment sessions are needed.

What can I do for myself?

The treatments can be stressful. You can cope better and recover faster if you take care of yourself so you feel as good as you can. Here are some things you can do that are of great importance:

Avoid alcohol and smoking

If you smoke or drink alcohol, try to refrain. It reduces the risk of complications when receiving treatment. There is help available if you need it. Talk to your doctor or contact nurse. Here you can read more about help and support for  quitting smoking before an operation.

Eat as well as you can

Try to get enough nutrition. You may need to eat frequently and even before going to bed to sleep. It can be difficult if you feel bad or get saturation feelings quickly. You can get dietary advice from a dietician. There are also medicines that can increase appetite and reduce nausea. Here you can read more about  food in cancer .

Physical activity

Touch yourself  as much as you can. It can also help if you feel very tired. It is common in cancer. You can get help from a physiotherapist or physiotherapist who can suggest exercises that are right for you.

Post-checks and risk of relapse

You may have relapse. This means that the gallbladder cancer will come back. Therefore, you may go on a return visit for a few years. It is different how long you need to go on a return visit. It is common to go more often in the beginning.

On the return visits you leave a  blood sample  and be examined with a  computer tomography  or  magnetic camera . You should also be informed if there is something special you need to think about and if there are any problems that may come up when you are finished. Feel free to ask if it is something you are wondering about.

Life after gallbladder cancer

About a month after the treatment, most people can continue with life almost like before the cancer. You can still be extra tired. Some body movements can be troublesome.

Life can feel different after treatment for cancer. You always have the experience of what you have been with. It can be painful periodically, but usually it gets better – although it can take time. Some feel vulnerable and worried long after treatment is over.

Sometimes contact with others in the same situation can feel empowering. The ideal association  Palema  is for you who have or have had gallbladder cancer or who are related.

Treatment if the disease cannot be removed

It is common for the disease to have already spread when it is detected. Then it can not get rid of. Most often, you cannot get rid of the disease if you have a relapse. Relapse means that the disease recurs after surgery.

Then you can instead get treatment that can slow down the cancer for a while and that relieves pain. It is called palliative care. The purpose of health care is that you should be able to have as good and active life as possible in every way, despite the illness.

Treatment that can curb the disease

Cytostatic therapy  can curb the disease for a limited time in about two out of three people. The treatment is demanding. Therefore, it depends on how you feel if you can get curative treatment with cytostatic drugs. Braking cytostatic treatment you get in hospital. Between treatment sessions, you do not have to be in the hospital.

Treatment that can relieve pain

When the disease is no longer curable, you receive treatment that relieves. On the Help and Support page   you can read more about what help you can get if you need psychological, existential or social support.

Here are examples of bodily problems you can get and what treatment is available:

Jaundice and itching

Jaundice can, among other things, cause it to start itching a lot on the body. This is because the cancerous tumor blocks the bile duct. Usually, it helps to get a small tube inserted into the bile duct. The tube is called a stent and allows the bile to drain into the duodenum as it should. The tube is inserted during an  ERCP examination . Another way to divert the bile is through an external drainage. This means that a thin plastic tube is inserted so that the bile can either run past the cancer tumor and into the duodenum or into a bag attached to the tube outside the stomach. External drainage is inserted during a PTC investigation. You can read more about PTC investigations in the Investigations and Investigations chapter.

It usually takes a few weeks before the jaundice disappears completely after the tube or outer drainage is inserted. Sometimes there will be a stop in the pipe or outer drainage. You notice it by becoming more yellow again, or getting a fever and chills which are signs of infection. Then you may need a new ERCP or PTC examination to replace or clean the pipe or outer drain.

Alcoholic liquor or a cold conditioner or a cool shower can relieve it if it continues to itch even if you have received a stent or an external drainage. Lubricate with moisturizing cream if you have dry skin. Medicines with antihistamines can relieve the itching if neither cream nor other agents help.

If you are in pain

There are many types of effective help if you are in pain. There are pain-relieving drugs in the form of tablets or patches where the medicine is taken up through the skin. Pain relief is also available as a drop directly into the blood.

Weight loss, nausea and constipation

The disease can cause you to lose your appetite and lose weight. You may feel sick and vomit. You may also have trouble with constipation.

Help against weight loss

A dietitian can give you dietary advice and make sure you get special nutritional drinks against weight loss. You can get nutritional solution that drips directly into your blood if you need it.

Help against nausea

There are medicines for nausea. The nausea may be due to the cancerous tumor compressing the duodenum so that the food cannot pass. Then the duodenum can be widened with a small tube, also called a stent. It is inserted using gastroscopy . It is also possible to perform an operation to transfer part of the intestine past the cancer tumor so that the food can pass.

Helps against constipation

If you get constipation, it may be because you need more fluid. It is good if you can drink more water and have the opportunity to move. Morphine or other morphine-like drugs can also cause you to become constipated. You should have access to laxative against constipation if you get morphine.

Fatigue – fatigue

You may feel very tired and that it does not help to rest. It is common in cancer and is called fatigue. Fatigue can have several causes. For example, you may have an infection or need more nutrition. You may also have  anemia . Then you can get iron medicine or a  blood transfusion  if needed. Fatigue can also be due to a  depression  that you need treatment for.

Physical activity can alleviate fatigue. Touch yourself  the way you can and do. Avoid resting for a long time. Rather rest several short moments.

Where can I get soothing care?

You can get soothing care at home or at a hospital, for example. It depends on what care you need and what you want yourself. You can read more in the text about  palliative care.

Be involved and influence your care

You have the right to be involved in your care as far as possible. The healthcare staff should tell you what treatment options are available. They should make sure you understand what the different options mean, what side effects are available and where you can get treatment. This way you can help decide on your treatment.

Ask questions if you don’t understand. You can also ask for information printed so that you can read it peacefully.

You can make a care plan together with the contact nurse, the doctor and other staff. The care plan should contain information that is important to you, such as contact information and how to get the  rehabilitation  you need. .

You can get a new medical assessment

You may get a  new medical assessment  from another doctor if you have a life-threatening or particularly serious illness. Obtaining another doctor’s assessment can help you, for example, if you are unsure of which treatment or treatment is best for you. 

Getting a cancer message

You can respond in many ways to a cancer message. It is common to need a lot of time to talk to your doctor and other healthcare professionals about what the message means. If possible, please let a relative accompany you. The related person can act as a support and help to remember what has been said.

In many hospitals, there are special nurses called contact nurses who should be especially accessible to the sick person and to the relatives. The contact nurse can provide support and also help with various practical things.

You can get help in several places

Talk to the contact nurse or the hospital’s curator if you feel anxious or have questions.

You can also contact, for example, the Cancer Counseling, the Cancer Foundation or a patient association. Palema is a patient association for people with cancer of the pancreas, liver or esophagus. There you can get in touch with one or more people who have their own experience with gallbladder cancer.

It is common for it to feel easier once treatment has begun and you know what is going to happen. 

Children need to know

A child under the age of 18 has the right to receive information and support based on his or her own needs if a close adult becomes ill. It is the responsibility of care. If you want to tell the child yourself about the disease, you can get help with what to say. Often it is good to make children as involved as possible, no matter how big or small they are. That doesn’t mean you have to tell everything.

Being related

It can feel difficult to be close to someone who is sick. It is common to want to support while you yourself have a strong concern and feel bad.

If you have people close to you, they can be a support. Often it will be easier for them to help you if you tell them how it feels. You can also talk to the contact nurse if you are close and need supportive calls.

You can get relief if you help take care of or support the sick person. You can also get support, for example in the form of calls or help with practical things.

What is the cause of gallbladder cancer?

There is no clear cause of gallbladder cancer, although there are things that can increase the risk. Here are some examples:

  • inflammation of the biliary tract, for example in the disease sclerosing cholangitis
  • chemicals and environmental toxins, such as dioxin
  • fluid-filled vesicles in the bile ducts called cysts and which one can have from birth.

Gallstones  can increase the risk of gallbladder cancer, but it is very uncommon to get gallbladder cancer due to gallstones.

Hepatitis B, hepatitis C, diabetes, obesity, smoking and alcohol may increase the risk of getting biliary tract cancer, but it has not been clarified.

Care that can reduce the risk of biliary tract cancer

Sclerosing cholangitis and cysts in the biliary tract can cause symptoms similar to biliary tract cancer. You may have regular check-ups if examinations of your symptoms show that you have sclerosing cholangitis.

Cysts causing symptoms may need surgery to reduce the risk of cancer.

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