Vesicle cancer: symptoms and treatment

Biliary cancer is rare and is usually diagnosed in advanced phases, with poor prognosis. Symptoms include jaundice, abdominal pain and weight loss. The treatment varies according to the stadium and includes surgery, chemotherapy and directed therapies.

Bile is a substance secreted by the liver that facilitates the digestion of fats. The bile ducts (intra and extrahepatic) and the gallbladder make up the biliary system, which is responsible for the drainage of bile from the liver to the small intestine in Vater’s blister.

Tumors that affect the biliary system are divided into three groups: bile duct tumors (intra and extrahepatic cholangiocarcinoma), gallbladder cancer, which is usually an adenocarcinoma, and the tumors of the váter ampoule (ampulomas).

They are a type of uncommon canceralthough the incidence of intrahepatic cholangiocarcinoma has increased in recent years in developed countries.

The prognosis, especially if it is diagnosed in a disseminated phase, is poor in the short term, which means that The perspectives of recovery or improvement would not be favorable.

What are the main risk factors

Some factors that seem to increase the probability of developing this type of cancer have been described:

• Age, female sex and obesity: They are more frequent in people over 65, in women and in obese people.
• The Biliary calculations or lithiasis They have been related to the development of this type of tumors. It is important to note that most people with biliary lithiasis do not develop cancer.
• The Chronic inflammation such as chronic cholecystitis and some infectionsas well as polyps in the gallbladder, they have also proposed as favorable causes of this type of cancer.

Most frequent symptoms

This type of tumors It does not usually give symptoms until they are found in advanced phasesso we could say that they are silent tumors.

One of the most frequent symptoms is jaundice (yellowish in leather and eyes), and is because the tumor obstructs the exit of the liver bile.

Other symptoms are abdominal pain and swelling, although they are very nonspecific and common to other diseases.

In advanced phases, lack of appetite and weight loss may also appear.

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How is the diagnosis performed?

The diagnosis begins with a medical evaluation and the performance of tests:

• Blood analysis to assess bilirubin levels, the liver function, and the CA 19.9 tumor marker which is the most frequently high, although it is not specific to this type of tumor.
• Image tests that evaluate the presence of a tumor in the bile duct and the degree of local affectation or distance: abdominal ultrasound, magnetic cholangio-resonance (NMR) to better define the local extension of the tumor and the Toracoabdominal TAC for distance extension.
• Tumor biopsy is not easy to perform, and in operable cases it is not always necessary before surgery.
• The molecular study of the tumor is of interest to assess future directed treatments.

With the aforementioned tests the extension of the tumor is evaluated to know if it is in an initial, locally advanced or metastatic (extension to other organs), since the treatments and the prognosis will vary.

Available treatments

The treatment depends on the cancer stadium, the general state of the patient and other factors. Biliary cancer can only be cured if it is diagnosed before dissemination to other organs. In cases of Advanced cancer The treatment is palliative focused on improving the patient’s quality of life and disease complications.

Initial phase tumors

Surgery is the only potentially curative treatment. It is usually complex and may include the removal of the liver, the gallbladder (cholecystectomy) and surrounding tissue and the local lymph nodes.

As a complementary treatment of surgery Chemotherapy is administered for six months to reduce the risk of a relapse. Sometimes radiotherapy can be considered, although evidence is not clear.

Advanced or disseminated phase tumors

They are treated with chemotherapy with the aim of extending survival. There are different types and chemotherapy schemes and can be combined with new treatments such as immunotherapy (if it has no contraindication), it increases the efficacy of treatment.

In recent years the molecular characteristics of these types of tumor have been studied. The most relevant are the IDH1, BRAF mutations, presence of microsatellites, fgfr2 mergers or her2 expansion, among others. At present, drugs are available to these different “therapeutic targets”, many times through clinical trials, which can improve the results of the treatment.

In Spain there are research programs at the state and international level that help in the progress of the treatment of this type of tumors.

What you should know …

• Malignant neoplasms of the bile duct comprise different tumors such as intrahepatic cholangiocarcinoma or gallbladder adenocarcinoma.
• They are rare tumors and that do not usually give symptoms in initial phases. The diagnosis usually occurs in advanced states, with a poor prognosis in the short term.
• The treatments go through surgery when the tumor is located, and by chemotherapy. Research studies of recent years have allowed developing treatments to molecular alterations with very favorable results.

Literature

• National Cancer Institute (NIH). Gallbladder Cancer Treatment (PDQ®) –Patient Version. Updated in December 2023. Available at: https://www.cancer.gov/types/gallbladder/patient/gallbladder-tratment-pdq
• Spanish Society of Medical Oncology (SEOM). Bile gallbladder cancer and bile ducts. Available at: https://seom.org/.