Treatment principles and methods of gallbladder cancer

The treatment principles of gallbladder cancer are divided into limited resectable stage, limited unresectable stage and advanced stage, and the principles are different for each stage.

1. Limited resectable stage In this stage, the cancer is confined to the surface layer of the gallbladder (mucosal layer and submucosal layer). This limited stage of cancer is generally seen when the gallbladder is removed due to other problems.

(1) Standard treatment: Experts do not agree with the use of extended surgery for localized gallbladder cancer. Some research is ongoing, but most scholars would recommend: 1) removal of the gallbladder; 2) dissection of all lymph nodes that drain the lymphatic vessels in the area; 3) wedge resection of about 4 cm (1.5 inches) of superficial normal liver. This surgery is most likely to be a cancer-free treatment for the patient. If cancer is diagnosed after surgery, a second surgery should be considered. Patients who do have localized (surface layer) cancer can be closely observed. However, because the prognosis for cancer recurrence is poor, it is difficult to evaluate the invasive methods proposed above.

(2) The 5-year survival rate is approximately 80%. For patients whose cancer is very small but causes symptoms, the 5-year survival rate is slightly lower.

(3) Research trends: 1) There is no clear role for adjuvant chemotherapy. Although fluorouracil and mitomycin chemotherapy are often recommended, no studies have shown that they can increase the chance of cure. 2) Radiotherapy to the liver is often given after surgery, but it has not been proven to be effective. 3) Research on the combined use of 5-FU and radiotherapy after radical resection of the cancer is currently underway.

2. Limited unresectable stage: Although it is a localized mass, the tumor cannot be removed because it has spread to local lymph nodes or special parts of adjacent liver tissue.

(1) Standardized treatment: If there is no standardized treatment plan, patients should consider clinical trial treatment, which aims to prolong survival and alleviate tumor-related symptoms.

(2) The 2-year survival rate is less than 5%.

(3) Research trends: Research programs on combining radiotherapy with chemotherapy to enhance the therapeutic effect are underway.

3. Advanced cancer has metastasized to distant sites.

(l) Standardized treatment For advanced gallbladder cancer, it is currently believed that no standardized treatment will prolong the patient's survival. The commonly used method is a clinical trial of 5-fluorouracil or mitomycin monotherapy. Even if the tumor shrinks, the patient cannot benefit because of the adverse reactions of chemotherapy drugs and the usually very rapid regrowth of the tumor.

(2) The 2-year survival rate is less than 1%.

(3) Research trends: It can be confirmed that combined chemotherapy or new drugs are better than the currently used treatment methods for the treatment of advanced gallbladder cancer. However, since the adverse reactions are mostly greater than those caused by single-agent chemotherapy, this treatment should be used in clinical trial programs.