From the Guidelines
Gallbladder cancer is a rare and often fatal malignancy that forms in the tissues of the gallbladder, typically beginning in the innermost layer and spreading outward, with risk factors including gallstones, although it has not been proved that gallstones are the cause 1.
Definition and Risk Factors
Gallbladder cancer is a type of cancer that originates in the gallbladder, a small organ located beneath the liver that stores bile. The median age of persons with gallbladder cancer is 73 years, and it is more common in females and individuals with a history of gallstones, although the exact relationship between gallstones and gallbladder cancer is not well understood 1. Other risk factors include obesity, chronic gallbladder inflammation, and certain genetic conditions.
Symptoms and Diagnosis
Symptoms of gallbladder cancer often do not appear until advanced stages and may include:
- Abdominal pain
- Nausea and vomiting
- Jaundice (yellowing of skin and eyes)
- Weight loss
- A mass in the abdomen Diagnosis usually involves imaging tests like ultrasound, CT scans, or MRI, followed by a biopsy to confirm the presence of cancer.
Treatment and Prognosis
Treatment of gallbladder cancer depends on the stage of the cancer but typically includes surgery to remove the gallbladder and possibly surrounding tissue. Advanced cases may require chemotherapy and radiation therapy. The prognosis varies based on how early the cancer is detected, with early-stage cancers having better outcomes than those diagnosed at later stages when the cancer has spread beyond the gallbladder. The potential effect of gallbladder cancer on decision making is significant, especially for patients with symptomatic gallstones, as cholecystectomy may be more advantageous in removing the threat of gallbladder cancer 1.
From the Research
Definition of Bladder Cancer
- Bladder cancer is a common malignancy in women and the fourth most common malignancy in men 2
- It ranges from unaggressive and usually noninvasive tumors to aggressive and invasive tumors with high disease-specific mortality 2
Causes and Risk Factors
- Advanced age, male sex, and cigarette smoking contribute to the development of bladder cancer 2
- Other risk factors for bladder cancer include irritative voiding symptoms and gross hematuria at any age 3
Symptoms and Diagnosis
- Bladder tumors can present with gross or microscopic hematuria, which is evaluated with cystoscopy and upper tract imaging depending on the degree of hematuria and risk of malignancy 2
- Transurethral resection of the bladder tumor (TURBT) allows for definitive diagnosis, staging, and primary treatment 3, 4
- Enhanced cystoscopy includes technology used to improve the detection of tumors and can reduce the risk of recurrence 2
Treatment Options
- Non-muscle-invasive tumors are treated with endoscopic resection and adjuvant intravesical therapy, depending on the risk classification 2
- Muscle-invasive disease is treated with radical cystectomy and urinary diversion or trimodal therapy with maximal endoscopic resection, radiosensitizing chemotherapy, and radiation 2
- Immunotherapy with checkpoint inhibitors, targeted therapies, and antibody-drug conjugates have become options for certain patients with various stages of disease 2
- Immediate post-transurethral resection of bladder tumor intravesical chemotherapy prevents non-muscle-invasive bladder cancer recurrences 5
Complications and Challenges
- Possible complications of TURBT include bleeding with bladder tamponade, extraperitoneal or intraperitoneal bladder perforation, and infections of the urogenital tract 4
- Patients with high-risk non-muscle invasive tumors that do not respond to adjuvant therapy with the standard-of-care immunotherapy, bacille Calmette-Guérin (BCG), constitute a challenging patient population to manage 2