PGI study shows how undetected gallstones have spiked gallbladder cancer in India: What are risk factors?
'Unfortunately, India is now considered the gallbladder cancer capital of the world. Most patients present themselves in an advanced stage of the disease, often beyond the point where curative surgery can be offered. Early detection is challenging, as symptoms are non-specific and radiological evaluation can sometimes be misleading,' says Prof Usha Dutta, Head, Department of Gastroenterology, PGI and principal investigator of the study. The research was funded by the Indian Council of Medical Research (ICMR) to form Indian guidelines for prevention and therapies.
Once gallbladder cancer develops, it spreads rapidly, extending beyond the confines of the gallbladder and invading adjacent vital organs. This highlights the importance of understanding the risk factors and focussing on prevention as a more effective strategy.
Those who are obese, diabetic, physically inactive, have high blood cholesterol levels, are pregnant, or have chronic diarrhoea leading to bile salt loss are at an increased risk of developing gallbladder stones.
The gallbladder is a pear-shaped organ, approximately 30 ml in volume, located under the surface of the liver. The liver produces bile, which is stored in the gallbladder and is released in response to a fatty/protein-containing meal to help with nutrient absorption and excretion of waste products like bilirubin and cholesterol. When there is excess fat in the body, it produces extra bile. This then combines with cholesterol and bile salts to form crystals or gallstones. They can be single or multiple and may vary in shape and size.
Those at risk of gallbladder cancer are the 50-plus age group, women with a family history of gallbladder cancer, smokers, those with a porcelain gallbladder (where its walls become calcified) and patients with longstanding or large gallstones (greater than 2 cm) or with chronic infections such as typhoid and ulcers.
What are symptoms and why aren't they detected easily?
Many people with gallstones experience no symptoms because the stones do not obstruct the gallbladder or bile ducts. So they do not disrupt digestion or cause pain and sit silently. Advanced symptoms may include pain in the right upper abdomen or central upper abdomen, often radiating to the back. This pain typically occurs one to two hours after meals, is associated with nausea, and may be accompanied by vomitting. It can last between one and four hours and may subside with analgesics.
Once you have the kind of pain described above. Go for an ultrasound rather than rely on home remedies. Gallstones may slip out and enter the bile duct. This leads to inflammation of the bile duct, acute pancreatitis (inflammation of the pancreas) or persistent pain.
Patients with known gallstone history, irrespective of their symptom status, should seek medical evaluation, and an ultrasound examination should be performed to assess not only the nature of gallstones but also the gallbladder wall for thickening. This evaluation is crucial before surgery so that incidental gallbladder cancer, if present, can be identified and treated. Several causes for a thickened gallbladder wall need expert radiological evaluation, including a CT scan.
What about treatment?
Cholecystectomy, that is the removal of the gallbladder, should be performed by a trained surgeon. The surgery can be laparoscopic too, depending on the clinical condition of the patient. The excised gallbladder specimen must be examined by an experienced pathologist to detect presence of any early signs of cancer.
How to prevent silent gallstones and prevent gallbladder cancer?
Avoid prolonged fasting, eat frequent protein-rich meals and reduce fat intake. Exercise and keep body abdominal obesity at bay.
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