Palliative Therapy for Gallbladder Cancer

Palliative care is treatment used to help control or reduce symptoms caused by cancer. It's not meant to cure the cancer.

If gallbladder cancer has spread too far to be removed by surgery, doctors may focus on palliative treatments. For instance, pain medicines and drugs to control nausea or itching might be used to help you feel better. Radiation and chemotherapy can also be used to help relieve problems caused by the tumor(s). Sometimes, surgery or other treatments are used to help you feel better or to help prevent problems the cancer might cause. Because gallbladder cancers tend to grow and spread quickly, doctors try to use palliative therapies that are less likely to have unpleasant short-term side effects, whenever possible. Your cancer care team will talk with you about the pros and cons of all the treatments that might help you

Here are some examples of procedures that might be used as part of palliative care for gallbladder cancer:

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 (yellowing of the skin and eyes) and other problems, like infection and liver failure. A small tube or a catheter can be put into the bile duct or the gallbladder to help the bile drain out.

• A stent is a small metal or plastic tube that's put through the blockage in the duct. It keeps the duct open to allow the bile to drain into the small intestine.
• A catheter is a thin, flexible tube that's put in through the skin over the abdomen (belly). One end of the tube is put into a bile duct and the other is outside the body. This allows the bile to drain into a bag. 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 can be done as part of a cholangiography procedure such as ERCP or PTC (see Tests for Gallbladder Cancer) or, in some cases, during surgery. They're often done to help relieve or prevent symptoms in 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 help reduce the risk of infection and gallbladder inflammation. It will also need to be replaced if it becomes clogged.

Biliary bypass

In people who are healthy enough, a surgery called biliary bypass is another option to allow bile to drain from the liver and gallbladder. There are different biliary bypass operations. Deciding which one to use depends on where the blockage is. In these procedures, the surgeon creates a bypass around the tumor blocking the bile duct by connecting part of the bile duct before the blockage with a part of the duct that lies past the blockage, or with the intestine itself. For instance:

• 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 using special long surgical tools put through several small holes made in the abdomen (belly). This is called 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're healthy enough to withstand it and that you talk with your doctor about the possible benefits and risks before you have the surgery.

Alcohol injection

To relieve pain, doctors may deaden the nerves that carry pain signals from the gallbladder and intestinal area to the brain by injecting these nerves with alcohol. This can be done during surgery or through a long, hollow needle that's guided into place with the help of a CT scan.