Medical Care ,  Health & Wellness ,  Oncology (Cancer)

Large Gallstones Linked to Increased Risk of Gallbladder Cancer: Act Promptly for Effective Treatment

August 17, 2023

By Dr Thamarai Velan, Consultant General and Hepatobiliary Surgeon from Bukit Tinggi Medical Centre (BTMC)

Large Gallstones Linked to Increased Risk of Gallbladder Cancer: Act Promptly for Effective Treatment

Can gallstones be effectively treated by consuming apple cider vinegar or is it just a myth? It is noted that large gallstones can potentially lead to the development of gallbladder cancer.

In fact, individuals who frequently experience symptoms of gallstones are typically advised to undergo elective gallbladder surgery. However, for patients with gallstones who do not exhibit any symptoms, treatment is not necessary with a few exemptions such as gallbladder with large polyps and calcified gallbladder wall.

Gallstones refer to the formation of stones or concretion of sludge within the biliary system including the gallbladder or bile ducts. The shape, size, and colour of the stones can vary.

According to Dr Thamarai Velan, a consultant general and hepatobiliary surgeon at Bukit Tinggi Medical Centre (BTMC), gallstones are the most common disease affecting the biliary system.

Gallstones can be divided into cholesterol stones, mixed stones, and pigment stones. Cholesterol stones and mixed stones are often caused by a sedentary lifestyle.

"Black pigment stones are more common in patients with liver cirrhosis or blood disorders such as thalassemia or sickle cell anemia whereas the formation of brown pigment stones is due to bacterial infection in the bile duct."

"Generally, gallstones are more commonly found in women who are over the age of 40, had multiple pregnancies, lead a sedentary lifestyle, are obese, and prefer a high-fat diet intake."

"However, due to an unhealthy modern lifestyle, lack of exercise, inadequate water intake, and the rising number of individuals affected by obesity, this condition is becoming more prevalent among younger individuals. Currently, patients diagnosed with gallstones range from 25 and 40 of age."


Easily Confused with Gastric Problems

Dr Velan emphasised that the most common symptom of gallstones is biliary colic, characterised by upper right abdomen pain that can radiate to the tip of the right scapula.

"When individuals experience stomach pain or bloating, many tend to self-diagnose with gastric problems, especially if the symptoms subside after taking gastric medications, leading them to assume it is related to gastric pain."

However, he cautioned that in gallstone patients, the pain will return after a while, especially after consuming high-fat foods. This pain can persist for as short as 5 minutes or a few hours.

"If the pain reoccurs or becomes regular, it should not be disregarded as typical stomach pain, as it could be due to gallstones, heart conditions, or other upper abdominal condition."

 Furthermore, frequent belching after meals, feeling nauseous or experiencing the urge to vomit after consuming fatty foods are also common symptoms associated with gallstones.


Diagnosis Through Ultrasound Scanning

Dr Velan revealed that a simple and non-invasive technique, ultrasound examination, can be used to confirm the presence of gallstones.

Other diagnostic methods include computed tomography (CT) scans or more comprehensive magnetic resonance imaging (MRI) examinations.

"Besides imaging tests, blood tests can also be performed unless the bile duct is not obstructed, it becomes challenging to identify  any abnormalities in the blood especially Liver Function Test (LFT)."


Gallbladder Removal Surgery for a Permanent Solution to Gallstones

The presence of symptomatic gallstones signifies an issue with the gallbladder and therefore gallbladder surgery is necessary to eliminate the gallstones from the gallbladder.

Despite various remedies circulating online, such as consuming apple cider vinegar or green apples, Dr Velan believes that these remedies are ineffective as the gallstones tend to reoccur over time. And it only provides temporary relief.


All Symptomatic Patients Require Surgery

Not all patients with gallstones require surgery. "A small portion of patients with gallstones who experience symptoms will require surgery. “For those who are asymptomatic would only require regular ultrasound scans to monitor the growth of  the stones,," stressed Dr Velan. 

Gold Standard: Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the gold standard for treating gallstones.

The surgery typically lasts for about 45 minutes to one hour. Throughout the procedure, the surgeon utilises small incisions to insert a miniature camera and surgical instruments, enabling them to observe the abdomen and remove the gallbladder.

Gallbladder removal surgery is a safe procedure with a minimal risk of complications. While there are potential minor risks such as bleeding, infection, bile duct injury, or postprandial diarrhoea, the chances of experiencing these complications are exceedingly low when performed by an experienced surgeon.


Gallstones as a Risk Factor for Gallbladder Cancer

Dr Velan cautioned about the association between gallstones and an increased risk of gallbladder cancer especially if the gallstones is more than two centimeters.

"When the size of the stone reaches approximately two to three centimeters, chronic inflammation can lead to the malignant transformation of the gallbladder mucosa."

Larger Stones and Older Age Increase the Risk of Malignant Transformation

The probability of developing gallbladder cancer increases with larger stones and older age, particularly after reaching the age of 50.

However, Dr Velan emphasised that only a very small portion of patients with gallstones disease will develop cancer. Generally, symptoms of cancer transformation include more frequent upper abdominal pain, discomfort, and weight loss.

To determine if cancer cells have spread to nearby organs such as the pancreas, bile duct, or lymph nodes, doctors employ diagnostic tools like computed tomography (CT) scans, endoscopic ultrasound (EUS), and other examinations. The treatment options depend on the stage of gallbladder cancer. In cases of early-stage cancer, gallbladder removal alone is usually sufficient. In advanced stages, a radical gallbladder operation may be required, involving the resection of adjacent parts of the liver. 

However, for cases deemed not suitable for operation, palliative care is provided, often involving biliary stenting to alleviate pain and jaundice.


Maintaining a Healthy Lifestyle to Prevent Gallstones

"While enjoying life, it is crucial to practice moderation. Limit the consumption of excessive high-fat and greasy foods, engage in regular physical activity, maintain a consistent sleep routine, stay adequately hydrated , and undergo regular physical check-ups." He advised not to rely solely on blood tests and stressed the importance of undergoing ultrasound scans at regular interval.

On follow up ultrasound, if there is an increase in size or the onset of symptoms, immediate medical advice should be sought for appropriate treatment.

To mitigate the risk of developing gallbladder cancer, he advised individuals above the age of 40 to undergo regular ultrasound scans. If polyps are detected and the size is more than one centimeter, it is advisable to undergo surgical removal as they pose as a risk factor for gallbladder cancer.


Dr. Thamarai Velan
General Surgery
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