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Gallbladder cancer

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 From MayoClinic.com


Although just what causes gallbladder and bile duct cancers is unclear, scientists believe that bile may play a role. Bile is a bitter, yellow-green fluid produced in the cells of your liver. It's essential for the proper digestion of fats and is one of the main ways your body eliminates drugs, cholesterol and waste products of metabolism from your body.

Bile flows from your liver through a thin tube called the common hepatic duct and enters your gallbladder through another small tube (cystic duct).

Inside your gallbladder, water is extracted from the bile, making it highly concentrated. The bile is then stored in your gallbladder. When you eat, your gallbladder contracts and releases the bile into the common bile duct — a continuation of the hepatic and cystic ducts. The common bile duct then carries the bile to the upper part of your small intestine (duodenum), where it begins to help break down the fat in your food.

Gallbladder cancer

Healthy cells grow and divide in an orderly way. This process is controlled by DNA — the genetic material that contains the instructions for every chemical process in your body. When DNA is damaged, changes occur in these instructions. One result is that cells may begin to grow out of control and eventually form a mass of cells (a tumor).

Researchers believe that DNA in the cells of your biliary tract may sometimes be damaged by toxins that your liver routinely metabolizes. These toxins are released into bile so that they can be eliminated from your body. But if bile empties more slowly than usual, it increases the amount of time your gallbladder cells are exposed to cancer-causing substances (carcinogens).

Most gallbladder tumors develop in the cells lining the inner surface of the gallbladder (epithelial cells). These tumors are known as adenocarcinomas — a term that describes the way the cancer cells look when viewed under a microscope.

Gallbladder adenocarcinoma is highly invasive and can quickly penetrate deep into the gallbladder wall. The tumor becomes more threatening as it moves through layers of tissue from the inner surface to the outside of the gallbladder. Eventually it may involve nearby lymph nodes, obstruct the bile duct or invade nearby organs such as the liver. Cancer cells may also travel through the bloodstream to more remote parts of the body (metastasis).

Bile duct cancer (cholangiocarcinoma)

Cancer can develop in any part of the bile duct that stretches from your liver to your small intestine. Many tumors occur in the hepatic duct just as it leaves the liver. These are known as perihilar tumors. Other tumors may develop in the bile duct near the small intestine (distal tumors) or inside the liver itself (intrahepatic tumors).

The majority of bile duct cancers are adenocarcinomas that originate in the mucous glands lining the inside of the ducts. By the time these cancers are diagnosed, they often have spread to other tissues and organs.

Risk factors

Researchers have identified a number of factors that increase your risk of both gallbladder and bile duct tumors.

Gallbladder cancer

Gallstones — solid deposits of cholesterol or calcium salts that form in your gallbladder — are the single greatest risk factor for gallbladder cancer. Between 75 percent and 90 percent of people diagnosed with gallbladder cancer also have gallstones. Researchers speculate that gallstones may cause your gallbladder to release bile more slowly, which increases the amount of time cells are exposed to toxins. Even so, the vast majority of people with gallstones never develop gallbladder cancer.

Other risk factors include:

  • Age. The chances of developing gallbladder cancer increase as you get older. Most people who receive a diagnosis of gallbladder cancer are in their 60s or 70s.

  • Sex. Women are more than twice as likely to develop gallbladder cancer as men are. And women between 20 and 60 years of age are twice as likely to develop gallstones. That's because the female hormone estrogen causes more cholesterol — the main component of most gallstones — to be excreted in bile.

  • Bile duct abnormalities. The pancreatobiliary duct junction is the point where the common bile duct — which carries bile from your liver and gallbladder to your small intestine — joins the pancreatic duct — which carries digestive juices from your pancreas. In some people, these two ducts connect in a way that allows pancreas juices to back up into the bile duct, preventing bile from being quickly emptied into the small intestine. This may then irritate the cells lining the gallbladder and bile ducts, increasing the risk of cancer.

  • Gallbladder polyps. These are growths on the surface of your gallbladder. Many polyps are noncancerous (benign), but some larger polyps may contain cancerous (malignant) cells. If you have large polyps, your doctor may recommend an operation to remove your gallbladder.

  • Cigarette smoke. Tobacco smoke contains a number of chemicals that damage DNA. Smoking increases your risk of cardiovascular diseases as well as many types of cancer, including gallbladder cancer.

  • Hazardous chemicals. Studies have shown that people exposed to certain chemicals such as nitrosamines and azotoluene have an increased risk of developing gallbladder cancer.

  • Obesity. If you're very overweight — more than 20 percent to 30 percent over the average weight for your age, sex and height — you're at increased risk of gallbladder cancer.

  • Ethnicity. Indians have much higher rates of gallstones and gallbladder cancer than do members of other ethnic and racial groups.

Hormone replacement therapy (HRT) may also increase your risk of developing gallbladder cancer.

Bile duct cancer

Bile duct cancers are rare. These cancers occur about equally in men and women and often develop between the ages of 50 and 70. Other risk factors include:

  • Primary sclerosing cholangitis (PSC). This autoimmune disorder causes your immune system to attack your bile ducts. PCS creates scar tissue that narrows the bile ducts and prevents bile from reaching your intestines. Over time, repeated injury to bile duct tissue can increase the likelihood of developing cancer.

  • Ulcerative colitis. Another autoimmune disease, ulcerative colitis is characterized by severe bouts of bloody diarrhea with abdominal pain and cramping.

  • Congenital abnormalities of the bile ducts. These include choledochal cysts — a dilation or stretching of the common bile duct — and Caroli's disease — a dilation of the bile ducts within your liver (intrahepatic ducts). Over time bile that collects in these dilated spaces may seriously damage the duct lining.

  • Bile duct stones. Gallstones sometimes escape the gallbladder and enter the cystic duct, the common bile duct or, occasionally, the duct leading to your pancreas. These migrating stones can cause serious complications, including an increased chance of developing bile duct cancer.

  • Parasitic infections. These are primarily a concern in Asian countries. Parasitic infections generally occur when humans eat fish containing the cysts of certain flatworms. The worms migrate to the bile ducts, where they damage the duct lining.

  • Toxic materials. Thorium dioxide (Thorotrast), a dye once used in X-rays, can cause both liver and bile duct cancers. Although Thorotrast hasn't been used for more than 50 years, exposure to other toxic materials — including dioxin, nitrosamines and polychlorinated biphenyls (PCBs) — may increase your risk of bile duct cancer.

Gallbladder cancer > 1 > 2 > 3 > 4

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