Gallbladder Cancer

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Dr Thng Yongxian

MBBS

MMed

MRCS (IRE)

FRCSED

FAMS

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What Is Gallbladder Cancer?

Gallbladder cancer is a rare form of cancer that originates in the gallbladder, a small organ located beneath the liver that stores bile. Bile aids in digesting fats and is produced by the liver. This type of cancer often goes undetected in its early stages, making it challenging to diagnose quickly.

Causes and Risk Factors

While the precise cause of gallbladder cancer remains unclear, several risk factors have been identified.

Gallstones

The most significant risk factor for gallbladder cancer is the presence of gallstones, which are hard particles that form in the gallbladder due to imbalances in the substances that make up bile.

Gender and Age

Gallbladder cancer is more common in women than in men. The risk of developing this cancer may also increase with age, with most diagnoses occurring in people over the age of 70.

Obesity

Obesity is another risk factor for gallbladder cancer, potentially due to its role in the formation of gallstones and causing chronic inflammation of the gallbladder.

Chronic Gallbladder Inflammation

Chronic inflammation increases the risk of gallbladder cancer. Conditions such as primary sclerosing cholangitis and gallbladder polyps also contribute to chronic inflammation and, consequently, a higher cancer risk.

Family History and Genetics

A family history of gallbladder cancer increases a person’s risk. Certain genetic conditions and mutations may also predispose people to this type of cancer.

Symptoms

Symptoms usually may not appear until the cancer has advanced or spread to other body parts. When symptoms do occur, they may include:

  • Abdominal Pain: Pain, especially in the upper right abdomen, is one of the more common symptoms. This pain may extend to the back or right shoulder blade area.
  • Jaundice: Jaundice occurs when the liver can’t effectively process bilirubin, leading to the skin and the whites of the eyes looking yellow.
  • Nausea and Vomiting: These symptoms can arise from the general effects of cancer on the body, as well as specific disruptions caused by the gallbladder tumour affecting digestive processes.
  • Bloating: Patients may feel bloated or full if the tumour presses against the stomach or intestines.
  • Changes in Stool or Urine: Dark urine or light-coloured, smelly stools can be symptoms of gallbladder cancer, especially if the bile ducts are blocked.
  • Unexplained Weight Loss: Losing weight without trying may be a common symptom of gallbladder cancer.

Diagnosing Gallbladder Cancer

Diagnosing gallbladder cancer involves a series of steps and tests to confirm the presence of cancer and determine its stage, including:

Physical Examination

The initial step usually involves a physical exam, which includes checking for abnormalities in the abdomen, signs of jaundice, and other related symptoms.

Imaging Tests

Imaging tests can help to visualise the gallbladder and surrounding tissues.

  • Ultrasound: An ultrasound can detect gallstones, gallbladder thickening, and masses in the gallbladder.
  • Computed Tomography (CT) Scan: A CT scan provides detailed cross-sectional images of the body and can help identify the cancer’s location, size, and whether it has spread.
  • Magnetic Resonance Imaging (MRI): MRI can provide detailed images of soft tissues and is particularly useful in assessing whether the cancer has spread to the bile ducts or liver.
Biopsy

While a biopsy is important for confirming the diagnosis of gallbladder cancer, it is approached with caution due to risks such as bile spillage and potential dissemination of the disease. The decision to perform a biopsy is based on the results of imaging studies and the hepatopancreatobiliary specialist’s advice.

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Treatment Options

The treatment of gallbladder cancer depends on various factors, including the stage of the cancer, the patient’s overall health,  and the presence of symptoms.

Surgery

Surgery is the most effective treatment for gallbladder cancer if it is diagnosed at an early stage. The type of surgery depends on the cancer’s stage:

  • Cholecystectomy: Removal of the gallbladder is the most common surgery for early-stage gallbladder cancer.
  • Extended Cholecystectomy: This procedure involves removing the gallbladder, a portion of the liver around the gallbladder, and the lymph nodes in the area to ensure all cancer is removed.
  • Radical Gallbladder Resection: For more advanced cancers, this surgery may involve removing the gallbladder, a larger part of the liver, and possibly parts of other affected organs.
Chemotherapy

Chemotherapy uses drugs to kill cancer cells or slow their growth. It can be used before surgery to shrink a tumour, making it easier to remove or kill any remaining cancer cells after surgery.

Radiation Therapy

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It may be used in combination with surgery and chemotherapy, especially if the cancer has spread beyond the gallbladder or if surgery isn’t an option.

Palliative Care

Palliative care focuses on relieving the symptoms and stress of a serious illness. For advanced gallbladder cancer, palliative treatments include procedures to relieve blockages in the bile ducts that can cause jaundice, pain relief measures, and nutritional support.

Outlook and Survival Factors

Due to the difficulty of diagnosing gallbladder cancer at an early stage, many cases are advanced when discovered, which can affect the overall prognosis.

Factors affecting the prognosis include:

  • Stage of the Cancer: Early-stage gallbladder cancer has a more favourable prognosis compared to advanced stages, where cancer has spread to distant organs.
  • Response to Treatment: Patients who respond well to chemotherapy or radiation therapy may have a better prognosis.
  • Surgical Outcomes: The ability to completely remove the cancer through surgery significantly improves the prognosis. In cases where the cancer is too advanced to be fully removed, treatment focuses on symptom relief and prolonging life.
  • Overall Health: The patient’s overall health, including the presence of other medical conditions, can influence the outcome.
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Dr Thng Yongxian

MBBS (SG)

MMed (Surg)

MRCS (Ire)

FRCSEd (Gen)

FAMS (Surg)

Dr Thng Yongxian is a dual fellowship-trained Hepatopancreatobiliary & General Surgeon who has performed over 6000 surgical procedures.

  • Bachelor of Medicine & Bachelor of Surgery,
    National University of Singapore
  • Membership of the Royal College of Surgeons, Ireland
  • Master of Medicine, General Surgery, Singapore
  • Fellow of the Royal College of Surgeons, Edinburgh
  • Fellow of the Academy of Medicine, Singapore

He pursued his subspecialty training in Hepatopancreatobiliary surgery first in the Department of Hepatopancreatobiliary Surgery, Singapore General Hospital. Following this, he completed a clinical fellowship in Minimally Invasive Hepatopancreatobiliary Surgery at Seoul National University Hospital in Bundang, South Korea.

Dr Thng set up and pioneered the Minimally invasive surgery program for his hospital in complex liver and pancreas cases. His surgeries were featured on live national television. His surgical videos have also been presented at international surgical conferences. He also pioneered the use of capsule colonoscopy for colorectal screening.

Dr Thng has served on various committees at hospital, cluster and ministry level. Dr Thng served as a member of the Ministry of Health (MOH) Laparoscopic cholecystectomy Clinician workgroup for value-driven care (VDC).

Patient Reviews

I cannot possibly express how grateful I am for the compassionate care received by Dr Thng during my hospitalization. I was 20 hours away from flying back to the USA after a long work trip, and homesick already when diagnosed with acute appendicitis and a UTI. To say that I was nervous to undergo surgery so far away from home, friends and family is an understatement. He was expedient, attentive and thorough. He even took the time to text and call my husband back home multiple times to update him on my status. His infectious laugh, sense of humor and kindness helped to sooth my own frazzled nerves. I am so appreciative to have had Dr Thng as my surgeon.

Ms Tina Hunter

I was diagnosed for ampullory cancer in 2021. I am very thankful to Dr. Thng Yongxian who kept me calm when revealing the report to me. I really felt like God sent his angel to speak to me.He helped me overcome the operation. Dr. Thng said 3 things that I needed to do before the operation....Stay positive, exercise n eat well, have faith in God. He even gave me his handphone number incase I need to consult him when home. Indeed the 8 hrs operation was a success n I am able to write this testimonial, living a normal life. Finally, its still God who works all things good for those who love Him... Romans 8:28.

Mdm Tang K H

I recently underwent gallbladder stone removal surgery performed by Dr. Thng, and I am impressed with the quality of care I received during this process. Dr. Thng demonstrated exceptional professionalism and expertise throughout my entire experience. From the initial consultation to the post-operative care, Dr. Thng explained the procedure in great details, answered all my questions, and alleviated my concerns and ensuring that I fully understood each step of the process. His compassionate and caring demeanor put me at ease, making me feel confident in his abilities. The outcome of the procedure was beyond my expectations. Dr. Thng successfully removed all my 3 gallstones, and I experienced a smooth recovery process. I am grateful for his expertise and the care I received under his supervision. Overall, my experience with Dr. Thng was exceptional. I highly recommend him for his professionalism, compassion, and outstanding surgical skills. Thank you, Dr. Thng for your excellent care.

Mr Low LT

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    Nexus Surgical @ Mt. Alvernia

    820 Thomson Road, #06-05 ,Singapore 574623

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    Frequently Asked Questions (FAQ)

    How does the type of gallbladder cancer affect treatment options?

    The primary type of gallbladder cancer, adenocarcinoma, typically responds to a combination of surgery, chemotherapy, and radiation. Other rare types, such as squamous cell carcinoma or sarcoma of the gallbladder, may require different treatment approaches due to their distinct growth patterns and behaviours.

    What are the latest advancements in gallbladder cancer treatment?

    Recent advancements in the treatment of gallbladder cancer include targeted therapy, which focuses on specific molecules and signalling pathways to stop cancer growth. Immunotherapy, which uses the body’s immune system to fight cancer, is also being explored in clinical trials.

    Is it possible to live without a gallbladder, and what are the long-term effects?

    Yes, it is possible to live without a gallbladder. The liver continues to produce bile, which flows directly into the small intestine, rather than being stored in the gallbladder. Most people do not experience significant long-term effects, although some may have temporary digestive issues.

    How can lifestyle changes reduce the risk of gallbladder cancer?

    Maintaining a healthy weight, adopting a diet low in fat and high in fibre, and managing underlying health conditions such as gallstones and chronic gallbladder inflammation can help reduce the risk of gallbladder cancer.

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