How is gallbladder cancer treated? Are radiotherapy and chemotherapy effective?

Author: Yang Zhiying, Chief Physician of China-Japan Friendship Hospital

Reviewer: Shi Wenzai, attending physician at Peking University International Hospital

The main treatment for gallbladder cancer is surgery, but the scope of surgery and the treatment effect are different for gallbladder cancer of different stages.

1. How to treat gallbladder cancer of different stages?

For early-stage gallbladder cancer, such as carcinoma in situ and T1a gallbladder cancer, that is, gallbladder cancer confined to the mucosa or submucosa, a simple cholecystectomy is sufficient to achieve a radical cure.

Figure 1 Original copyright image, no permission to reprint

For T1b gallbladder cancer, that is, gallbladder cancer that has invaded the muscular layer, it is not enough to simply perform a cholecystectomy because there may be lymph node metastasis and invasion of tissues within the liver.

At this time, a partial liver resection is needed, that is, the part of the liver adjacent to the gallbladder needs to be cut off, and lymph node dissection must be done at the same time. The lymph nodes near the hepatoduodenal ligament, hilar area, posterior and superior part of the pancreatic head, and common hepatic artery must be cleared out. Only in this way can a relatively radical cure be achieved.

In the T1b stage, if radical surgery is not performed, the five-year survival rate may be less than 10% or 20%, but with radical surgery, the five-year survival rate can be increased to 60%-70%. Therefore, such patients must undergo radical resection.

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In fact, this is also a problem that most patients encounter in the outpatient clinic are struggling with, especially when gallbladder cancer is discovered after surgery. That is, during laparoscopic cholecystectomy, T1b gallbladder cancer is accidentally discovered, which means it has reached the muscular layer stage. They are very confused about whether to have a second operation.

In fact, the guidelines and a lot of clinical evidence have given us the answer, that is, for such patients, if conditions permit, radical surgery must be performed. Only through radical surgery can the efficacy be improved.

In the T2 stage, which is the gallbladder cancer that has clearly invaded the muscular layer, and the T3 stage, which is the gallbladder cancer that has invaded the serosa, liver resection is required. Because the gallbladder is adjacent to the liver, it will infiltrate the liver, and this part of the liver must be removed. The resection methods include wedge resection of local resection, segment resection of 4b-5 segments, and even half liver resection.

Then, radical lymph node dissection is required. Of course, there is controversy about the extent of lymph node dissection. Some people think that it is enough to clear the lymph nodes in the hepatoduodenal ligament, beside the hepatic artery, and above the posterior pancreatic head. Some people say that it is more radical and the lymph nodes in the celiac trunk and behind the pancreatic head should also be cleared.

T2 and T3 gallbladder cancer must be radically resected to achieve a relatively better outcome. But generally speaking, the prognosis is not very optimistic. After radical surgery, the five-year survival rate of these patients is about 30%.

Figure 3 Original copyright image, no permission to reprint

For more advanced gallbladder cancer, such as enlarged para-aortic lymph nodes, enlarged lymph nodes around the celiac trunk, or distant metastasis, radical surgery will not have much impact on the long-term results and will only increase the patient's pain, so active surgery is no longer considered.

2. Can patients with gallbladder cancer still receive surgical treatment after liver metastasis occurs?

There are two situations:

One is local invasion, because the gallbladder and liver are connected, as the gallbladder tumor grows, it will inevitably invade the adjacent organs, the most common being the liver. For this type of direct invasion, we can also choose surgery, because direct invasion is only a local lesion and can be radically removed.

However, if gallbladder cancer metastasizes to the liver through the bloodstream, the liver metastases and gallbladder lesions are usually separate. Such hematogenous metastases are usually multiple and cannot be completely removed surgically, so there is no need for further surgery.

Therefore, there are two types of liver metastasis of gallbladder cancer: direct infiltration and hematogenous metastasis. After distinguishing these two situations, we can choose the appropriate treatment method.

3. Are chemotherapy and radiotherapy effective for patients with gallbladder cancer?

If gallbladder cancer cannot be radically removed, radiotherapy and chemotherapy are only palliative treatments. Usually, gallbladder cancer itself is not particularly sensitive to chemotherapy. If the primary tumor cannot be radically removed, chemotherapy can only relatively prolong survival.

Of course, if there is lymph node metastasis and the gallbladder cancer is in a higher stage, adding some chemotherapy after radical resection can improve the long-term efficacy. Data show that it can improve the long-term efficacy.

Radiotherapy is controversial now. If radical resection is performed, radiotherapy is not particularly meaningful. Of course, if resection is not possible, radiotherapy can relieve some symptoms locally and suppress them, but there is no good evidence to prove that it will definitely improve the long-term efficacy of patients.