American Medical Association Family Medical Guide - American Medical Association [526]
Cancer of the Gallbladder
Cancer of the gallbladder is an uncommon cancer that occurs more frequently in women than in men and in people who have gallstones (see page 793) or chronic inflammation of the gallbladder. The cancer has also been linked to obesity and to cigarette smoking. Because gallblader cancer often does not cause symptoms in the early stages, it frequently is found by chance during laparoscopic cholecystectomy (see page 795).
Symptoms
The symptoms of gallbladder cancer are similar to the symptoms of gallstones, including pain in the right side or in the upper abdomen. Frequently, gallbladder cancer causes no symptoms in the early stages. When symptoms develop, they can include persistent pain above the stomach, loss of weight, fever, or jaundice (yellowing of the skin and whites of the eyes; see page 785).
Diagnosis
If you have symptoms of gallbladder cancer, your doctor may order an imaging procedure such as ultrasound (see page 111), a CT scan (see page 112), or MRI (see page 113) to look for signs of cancer in the gallbladder and to help determine if it has spread to the common bile duct, nearby lymph nodes, or liver. You may also have angiography (see page 110), cholangiography, or ERCP (see page 796) to see if a tumor is blocking a blood vessel, the bile duct, or the pancreatic duct. However, because the gallbladder is hidden behind other organs, it can sometimes be difficult to make a diagnosis with imaging alone. A doctor may recommend laparoscopic surgery (see page 795) to remove tissue samples from the gallbladder and nearby organs for examination under a microscope for cancer cells (biopsy). The gallbladder may be removed at this time if a person has gallstones or another obvious gallbladder problem.
Treatment
The treatment for gallbladder cancer depends on the extent of the cancer, whether it has spread from the gallbladder, and the person’s general health. If gallbladder cancer has been found on a biopsy or during a laparoscopic cholecystectomy, the gallbladder will be removed through a larger incision in the abdomen to avoid releasing cancer cells into the abdominal cavity while removing the gallbladder. Part of the liver near the gallbladder and lymph nodes in the abdomen may also be removed.
Radiation therapy (see page 23) may be used alone or before or after surgery. Chemotherapy (see page 23) may be given in combination with radiation therapy to make cancer cells more sensitive to the radiation. These therapies are sometimes used to help shrink a tumor before surgery.
If your cancer is detected at a later stage, or if it recurs after treatment, your doctor may talk to you about participating in a clinical trial that evaluates experimental treatments for gallbladder cancer.
Acute Pancreatitis
Acute pancreatitis is a condition characterized by sudden, severe inflammation of the pancreas. Worldwide, about half of people who develop acute pancreatitis have gallstones. Most cases of acute pancreatitis in the United States are caused by alcohol abuse. Other possible causes include reactions to medications such as acetaminophen, sulfa drugs, thiazide diuretics, some antibiotics, zidovudine (an AIDS drug), or mercaptopurine (an immune-suppressing drug); a penetrating duodenal ulcer (see page 755); hyperparathyroidism (see page 904); or an abdominal injury. The condition can also result from pancreatic cancer (see page 800), elevated levels of triglycerides or calcium in the blood, or anatomical abnormalities.
Most people recover completely after their first attack of pancreatitis. The major danger is shock (see page 579), which can result from internal bleeding around the pancreas and can be fatal. Acute pancreatitis can sometimes lead to chronic, recurring