Palliative therapy for gallbladder cancer
Palliative therapy is treatment given to help control or reduce symptoms caused by advanced cancer. It does not try to cure the cancer. If the cancer has spread too far to be removed completely by surgery, doctors may advise palliative operations, radiation, chemotherapy, or other treatments to help make you feel better or to help prevent possible complications from the cancer. Because gallbladder cancers tend to advance quickly, doctors try to use palliative therapies that are less likely to affect a person’s quality of life, when possible.
Biliary stent or biliary catheter
If cancer is blocking a duct that carries bile from the gallbladder or liver to the small intestine, it can lead to jaundice and other problems. The doctor may insert a small tube (either a stent or a catheter) into the bile duct or the gallbladder to help the bile drain out. This may be done as part of a cholangiography procedure such as endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) (see “How is gallbladder cancer diagnosed?”) or, in some cases, during surgery.
- A stent is a small metal or plastic tube that keeps the duct open to allow the bile to drain into the small intestine.
- A catheter is a thin, flexible tube that drains into a bag outside the body through a small hole in the skin of the abdomen. The bag can be emptied when needed. If you have a catheter, your doctor or nurse will teach you how to care for it.
These procedures are often done to help relieve or prevent symptoms from more advanced cancers, but they can also be done to help relieve jaundice before potentially curative surgery is done. This helps lower the risk of complications from the surgery.
The stent or catheter may need to be replaced every few months to reduce the risk of it becoming blocked, which could lead to jaundice or gallbladder inflammation.
In people who are healthy enough, another option to allow bile to drain from the liver and gallbladder is to use surgery to create a new way for bile to get past the blockage in the bile ducts caused by the cancer.
There are several different biliary bypass operations, and the decision on which one to use is based on the location of the blockage.
- A choledochojejunostomy joins the common bile duct to the jejunum (the second part of the small intestine).
- A gastrojejunostomy (also known as a gastric bypass) joins the stomach directly to the jejunum.
- A hepaticojejunostomy joins the duct that carries bile from the liver to the jejunum.
Sometimes these operations can be done through several small holes made in the abdomen using special long surgical tools. This is known as laparoscopic or keyhole surgery.
A biliary bypass can often give longer-lasting relief than a stent, which might need to be cleaned out or replaced. Still, this can be a major operation, so it’s important that you are healthy enough to withstand it and that you talk with your doctor about the possible benefits and risks before you have the surgery.
To relieve pain, doctors may deaden the nerves that carry sensations of pain from the gallbladder and intestinal area to the brain by injecting these nerves with alcohol. This can be done during surgery or by guiding a long, hollow needle into place with the help of a CT scan.
Doctors can prescribe strong pain-relieving drugs if needed. Some people with cancer may be worried about taking narcotic drugs such as morphine for fear of being sleepy all the time or becoming addicted to them. But many people get very effective pain relief from these medicines without serious side effects. It’s very important to let your cancer care team know if you are having pain so that it can be treated effectively.
Pain medicines work best when they are taken on a regular schedule. They do not work as well if they are only used when the pain becomes severe. Several long-acting forms of morphine and other opioids are in pill form and only need be taken once or twice a day. There is even a long-acting patch that only needs to be applied every few days.
Common side effects of these drugs are nausea and feeling sleepy, which often get better over time. Constipation is a common side effect that does not get better on its own, so it needs to be treated. Most people on these drugs need to take laxatives daily.
Last Medical Review: 10/29/2014
Last Revised: 02/05/2016