Robotic Surgery – Cancer, Hernia, Gallbladder Surgery

What is robot-assisted surgery?

Robot-assisted surgery is a type of minimally-invasive surgery completed through small incisions. The da Vinci surgical system uses high-definition, three-dimensional cameras that magnifies image 20 times coupled with specialized surgical tools that enable surgeons to operate with more precision and better control.

The robotic instruments have mechanical wrists that bend and rotate to mimic the movements of the human wrist thus allowing surgeons to make precise movements. Robotic software also negates the effect of surgeons’ hand tremors.

It is an effective minimally invasive alternative to both open surgery and laparoscopy. Surgeons undergo vigorous training with this system before being allowed to use it for surgery on patients. Moreover, there are many inbuilt safety checks in the system that decreases the chances of error. Patients can be rest assured knowing they’ll receive superior surgical care for the best possible outcome.

How robot-assisted surgery works ?

During robotic surgery, your surgeon inserts a tiny camera through a small incision in the surgical area. The camera sends a high-definition, 20 times magnified, 3D image of the surgical site to an external monitor in real-time.

Using computer-assisted technology that guides specialized surgical instruments, your surgeon directs the robot with better control, precision, and range of motion than is possible with traditional surgery. A support team assists the surgeon with other surgical tasks.  Thus the use of a robotic system makes difficult steps easier for the surgeon by providing a range of motion and more maneuverability in handling tissue and suturing.

Will the surgeon be with me in the operating room?

Many patients wonder who is operating on them: the robot or the surgeon.

Robot-assisted surgery is a system that enables surgeons to operate with precise, delicate motions by controlling the machine. The robot never makes decisions or performs incisions on its own — it only responds to your surgeon’s hand and finger movements.

Your surgeon is located at a console in the operating room near you and the experienced support staff, directing the procedure the entire time. The robot allows for greater precision than the human hand has on its own, and your surgeon is in charge the whole time.

Conditions that can be treated with robot-assisted surgery

The majority of gastrointestinal issues can be  addressed using robotic-assisted minimally invasive surgery, including:

  • Appendicitis
  • Hernias
  • Gallbladder disease and its cancer surgery
  • Gastroesophageal reflux disease (GERD)
  • Liver surgery
  • Surgery of the pancreas including surgery for cancer of the pancreas
  • Surgery for the colon and rectum including its cancers
  • Surgery for the esophagus, stomach, and intestine
  • Gastrointestinal and liver cancer surgery.

The benefits of robotic surgery

Robot-assisted surgery has many benefits. Patients experience these benefits both directly and indirectly. For example, because robot-assisted surgery is minimally invasive, a direct benefit to you is a shorter recovery time. And because the surgeon has better access to the operative area, an indirect benefit is a more precise surgery.

Other benefits include:

  • Smaller incisions
  • Greater range of motion and dexterity for the surgeon
  • High-resolution, the highly-magnified image of the operating field for better visualization during surgery
  • Shorter hospital stay
  • Lower risk of infection
  • Reduced risk of blood loss
  • Faster recovery with less pain
  • Minimal scarring
  • Better clinical outcomes

In addition, due to the enhanced control, flexibility, and precision that robot-assisted surgery offers, surgeons can complete complex or delicate procedures that may be difficult or impossible with traditional surgery.

Am I a candidate for robot-assisted surgery?

Although robotic surgery offers excellent outcomes for many patients, not everyone is a good candidate. The patient is recommended against robot-assisted surgery if:

  • You’re unable to have general anesthesia
  • You have significant scar tissue or other issues that prevent the cameras from visualizing the surgical area
  • You’ve been diagnosed with bleeding problems that put you at risk for surgery
  • You’re not a candidate for laparoscopic surgery

After a full evaluation of your condition and overall health, the surgical team in charge will determine if robot-assisted surgery is right for you.

What Are the Advantages of Robotic Surgery Over Laparoscopic Surgery

Robotic surgery is a minimally invasive surgical technique that uses a robotic arm to perform surgery.

The robotic arm is controlled by the surgeon, who sits at a console and uses a joystick to manipulate the arm. This allows the surgeon to perform surgery with greater precision and dexterity than is possible with laparoscopic surgery.

If you are considering robotic surgery, here are some things you can expect:

  1. You will be given general anesthesia, which will put you to sleep during the surgery.
  2. The surgeon will make a small incision in your abdomen and insert the robotic arm.
  3. The surgeon will then use the robotic arm to perform the surgery.
  4. The surgery will typically take less time than traditional open surgery.

You will likely be able to go home the same day or the next day after the surgery.

Overall, robotic surgery is a minimally invasive surgical technique that offers several advantages over laparoscopic surgery. If you are considering surgery, talk to your doctor about whether robotic surgery is a good option for you.

Advantages of Robotic Surgery

Here are some of the specific advantages of robotic surgery over laparoscopic surgery:

  1. Improved visualization: Robotic surgery provides the surgeon with a magnified, 3D view of the surgical site. This allows the surgeon to see more clearly and make more precise movements.
  2. Greater dexterity: The robotic arm has a greater range of motion than the human hand. This allows the surgeon to reach areas that would be difficult or impossible to access with laparoscopic surgery.
  3. Tremor-free movements: The robotic arm is tremor-free. This means that the surgeon can make very precise movements without the risk of shaking.

As a result of these advantages, robotic surgery has been shown to have several benefits over laparoscopic surgery, including:

  • Less pain: Robotic surgery is associated with less pain and a shorter recovery time.
  • Lower risk of complications: Robotic surgery is associated with a lower risk of complications.
  • Better cosmetic outcome: Robotic surgery is associated with a better cosmetic outcome.

However, it is important to note that robotic surgery is not always the best option for every patient. Some patients may be better suited for laparoscopic surgery or traditional open surgery. It is important to discuss your options with your doctor to determine which type of surgery is right for you.

Jaundice ( Peelia) – Symptoms Causes Treatment

Jaundice-Myths-And-Facts

Jaundice (peelia)- It’s yellowness of eyes and skin due to disturbance in metabolism of bilirubin.

Liver produces bile and then put it into intestine through a tract called biliary tract.

Any disturbance from making of bile and obstruction to its outflow will cause jaundice.

If one has this idea then one can really negate the myths prevalent in society about jaundice.

Myths and facts

  1. Jaundice will subside on its own.  Majority of jaundice do subside on its own as majority are due to infection but it’s for doctor to decide by testing as which type will subside on its own and which type require further treatment.
  2. We should not eat turmeric in jaundice.  It’s untrue. Turmeric does not do any harm to liver and does not increase jaundice.
  3. We should not eat certain foodstuffs in jaundice. – Untrue . One can eat all types of foodstuffs during jaundice. One should have good healthy diet during an episode of jaundice.
  4. Jaundice can be cured some spiritual leader by some herbal medicine. Majority of jaundice are self limiting so will cure even if you don’t take any medicine. So these types of jaundice get cured by any means and credit goes to spiritual leader.
  5. Jaundice can be transmitted from one person to another. Some type viral infection can be transmitted by sexual contact or sharing needle with infected person as seen with AIDS while another can spread by consuming food contaminated by infected person so infected person should maintain good hygiene to prevent further spread to its family members and friends.
  6. How can one prevent jaundice ?
    • Maintain good hygiene and have well cooked food.
    • Drink clean water.
    • Do not have unsafe sex.
    • Do not share syringes or needle.

What is treatment for jaundice?

Treatment of jaundice depends upon type of jaundice. For treatment purposes jaundice is divided into

  1. Medical jaundice- this type is primarily treated with medicines
  2. Surgical jaundice- It requires surgical intervention for its cure.

Medical jaundice arises usually due damage to cells of liver while surgical jaundice is caused by obstruction to flow of bile from liver to intestine. Liver function tests, Ultrasound abdomen, MRCP helps in classifying the jaundice. Your general physician/gastroenterologist/gastrosurgeon can help in diagnosing the type of jaundice based on these tests.

Causes of medical jaundice –

  1. Hepatitis – infectious or toxic
  2. Drug toxicity
  3. Damage to liver by abnormal deposition
  4. Defect in bilirubin metabolism
  5. Alcohol hepatitis
  6. Autoimmune hepatitis

Causes of surgical jaundice

  1. Stone in bile duct
  2. Gall bladder stone
  3. Tumor of gall bladder or bile duct
  4. Tumor of liver
  5. Liver cysts
  6. Liver abscesses

Except for stone in bile duct that is treated with ERCP, all other causes of surgical jaundice require surgical treatment. These cases are best treated by surgeon with knowledge and expertise in liver and biliary tract surgery.

Stomach Cancer

1. What are causes of stomach cancer?

Causes of stomach cancers are

  • Alcohol consumption
  • Smoking
  • Diet high in salt and processed meat and low in vegetables
  • Any previous stomach surgery
  • Conditions decreasing acid secretion in stomach
  • H.Pylori infection
  • Hereditary conditions like multiple polyps throughout GIT

2. What are the symptoms of stomach cancer?

  • Early satiety
  • Anemia
  • Recurrent Vomiting or blood in vomiting
  • Loss of appetite
  • Abdominal distension
  • Passing black-colored stools
  • Unexplained weight loss

3. Does cancer of stomach run in families?

Yes cancer of stomach can run in families especially in patient having multiple polyps
throughout gastrointestinal tract e.g, FAP, Lynch syndrome etc. first degree relatives of
these patient should undergo prophylactic screening endoscopy at young age.

4. How is stomach cancer diagnosed?

Stomach cancer is usually diagnosed by Imaging or endoscopy and biopsy. To establish
diagnosis endoscopy and biopsy is done. For staging purpose following investigations are
advised –

  • CECT Scan of abdomen
  • PET Scan of whole body
  • Endoscopic ultrasound

5. What is treatment of stomach cancer?

Treatment of stomach cancer depends upon stage of cancer and presentation of patient. In
case of patient who is unable to eat, surgery would be mainstay of treatment. While in patients with locally advanced disease chemoradiation followed by surgery is the treatment of choice. Surgery remain mainstay of treatment for stomach cancer.

6. What type of surgery is best for patient?

With advancement in technology and staplers stomach cancer is managed these days with
laparoscopy. Laparoscopy has been used widely for total or partial removal of stomach and
has been found to provide equal results with improved quality of life and early recovery in
these patients.
Robotic surgery is further advancement in surgical armamentarium that increases accuracy
of dissection thus improving results.

Liver cancer

Liver cancer is increasing day by day. Its probably due to increase in incidence of cirrhosis of liver that predisposes to liver cancer. Causes of cirrhosis of liver –

1. Alcohol
2. Viral hepatitis’
3. NASH – Non Alcoholic Steatohepatitis
4. Toxins
5. Autoimmune conditions- PBC, Autoimmune Hepatitis etc.

Above are main conditions that cause cirrhosis and predisposes to liver cancer. As the rate of obesity and Diabetes Mellitus is increasing all over world so is the rate of fatty liver and steatohepatitis (injury to liver) that predisposes to cirrhosis and thus liver cancer. So it becomes imperative for allpatients having above mentioned factors to be utmost careful in monitoring the progression of theirdisease to detect cancer at early stage.

FAQs

1. How can liver cancer be prevented?

Liver cancers can be prevented by keeping high risk patients under regular follow
with tumor markers and ultrasound examination. Patient at high risk of getting liver cancers
are mentioned above. So patients with above risk factors who have not progressed to
cirrhosis should be treated according to cause e.g; stopping alcohol, decreasing weight, good
control of diabetes, treating viral hepatitis etc.

2. What is peculiar about liver cancer and its treatment?

Liver cancers usually arise in patients with cirrhosis. This presents peculiar problem
as these patients have damaged liver in addition to tumor. Damaged liver further shrinks
treatment options for such patients. Moreover majority of these patients are unfit for any
form of treatment due to damaged liver. So treatment is tailored according to status of liver
disease and tumour size and location.

3. Is there any medical treatment of liver cancer?

Mainstay of treatment is surgery. Medical treatment is offered to only those cases that
cannot be offered any surgery


4. How can liver cancers be treated?

Best way to treat liver cancer is by surgery. Surgery can be

  • Resecting tumor or tumor bearing liver
  • Liver transplantation

First option is feasible only in normal livers or in cirrhotic with small tumours. In patients
with cirrhosis best treatment option is liver transplant provided tumor load is within one specific
range. Liver transplantation takes care of diseased liver and tumor simultaneously and thus provides best chances of prolonged life.


In cases of tumor deemed unresectable or patient is unfit for transplant, interventional
radiology provides solution for tumor treatment by

A. Radiofrequency ablation that has same results as surgery in cirrhotics,
B. Tumor chemoembolization
C. Internal tumor radiation by TARE

5. Which specialist is best to treat liver cancer?

Before starting any treatment liver or liver transplant surgeon must be contacted. Liver
surgeon is best person to evaluate patients fitness and tumour resectability and can provide
tailored approach that is best suited for patient’s condition as mentioned above.

Esophagus Cancer

1. What are causes of esophagus cancer?

Risk factors for esophagus carcinoma are

  • Alcohol consumption
  • Smoking
  • Gastroesophageal reflux disease
  • Obesity
  • Barrett esophagus

2. What are types of esophagus cancer?

There are predominantly two types of esophagus cancers based on microscopic examination of tumor sample

  • Squamous cell carcinoma
  • Adenocarcinoma

Few other types of carcinoma can affect esophagus but are uncommon -e.g, smallcell carcinoma, neuroendocrine tumor, sarcomas etc.

3. What are symptoms of esophagus cancer?

Usual presenting symptoms are

  • Difficulty in swallowing
  • Stickiness of food while swallowing
  • Retrosternal discomfort
  • Pain chest
  • Chronic cough especially while swallowing
  • Weight loss
  • Hoarseness of voice

4. How can esophagus cancer be detected?

First line of investigation for diagnosis are

  • Barium swallow
  • Upper GI endoscopy and biopsy

These two tests not only provide us diagnosis but also tells us about location of tumor that will further decide future course of action for treatment. Biopsy provides us with tissue diagnosis regarding type of cancer as mentioned above.

5. What are tests to be done before starting any form of therapy?

After diagnosis staging investigation are required to grossly stage the disease and planfurther treatment

  • CT scan of chest and upper abdomen
  • Endoscopic ultrasound (EUS)
  • Whole body PET Scan
  • Bronchoscopy depending upon location of tumor

6. What is treatment of esophagus cancer?

Surgery has been mainstay of treatment for carcinoma esophagus. But long term survival was poor. With recent advent of few chemotherapeutic agents along with radiation the rapyhas really improved overall survival and outcomes. Even in patients with locally advanced disease chemoradiation has resulted in down staging of tumor and increased resection rate as well as survival rates. So now according to protocol patient usually under goes chemoradiation first followed by surgery.

7. What if the type of surgery done for esophageal cancer?

Esophagus cancer is treated by minimally invasive methods now. Thoraco- laparoscopi cresection of esophagus with reconstruction by stomach tube is method of choice for cancer of esophagus. Robotic surgery is further advancement in surgical armamentarium that increases safety of surgery and improves outcome. With minimally invasive methods side effects of surgery has been reduced to minimum and patient’s recovery is enhanced.

8. What are side effects of treatment of esophagus cancer?

The patient can have side effects due to radiation, chemotherapy or surgery. Side effects due tochemoradiation are

  • Nausea /vomiting
  • Difficulty in swallowing
  • Chest pain
  • Loss of appetite
  • Decreased cell counts
  • Mouth ulcers

Complications after surgery can be

  • Hoarseness of voice due to nerve injury- its usually temporary and recovers with time
  • Swallowing problems due to uncoordinated effects of swallowing reflex
  • Injury to trachea, blood vessels, thoracic duct (incidence has reduced considerablyafter using minimally invasive methods)
  • Lung complications (reduced significantly with laparoscopic approach)

Dr. Manmohan Singh Bedi

Specializing in surgery of Liver, Pancreas, gall bladder, biliary tree, esophagus, gastrointestinal, bariatric, and laparoscopic surgery.

He specializes in dealing with both cancerous and non-cancerous diseases of the digestive system. He has been associated with many institutes of national and international fame. He has three fellowships to his credit. He was also awarded (delete) the best young investigator award at the international conference of Pancreas for his research work in Pancreatic surgery in 2011.

Gall Bladder Stone Treatment in Chandigarh Mohali

facts-about-gall-bladder-surgery

Gall bladder diseases are very common these days. These diseases range from innocuous gall stones to cancer of the gall bladder which has a very dismal prognosis. As a GASTROINTESTINAL SURGEON with HEPATOBILIARY experience we daily see cases from one extreme to another. The majority are simple gall stones and are managed at the periphery, however, what we receive are ones that are either left to be referred to as higher-level or are complicated ones. Many a times we also deal with cases that are operated elsewhere and become complicated and are then referred to us.

So today in this blog I would like to discuss gall bladder diseases with a special focus on stone diseases. The most commonly asked questions in the patient’s mind are

How are stones formed?

Bile is juice produced by the liver and stored in the gall bladder and released when food reaches the small intestine. It is composed of bile salts, and pigments, and they are kept in solution form by mixing with cholesterol. So any change that disturbs this proportion of each component required to keep these in solution form can result in the formation of stones. For example diet rich in fats can result in high cholesterol components and can result in stone formation.

How can we prevent formation of gall stones?

Gall stones are usually formed by a mismatch in the concentration of cholesterol and bile salts in bile. So a balanced diet that is low in fats can help in decreasing the chances of gall stone formation.

What are risks associated with gall stones?

Gall stones can cause pain by themselves. They can result in jaundice if a stone slips into bile duct. It can cause pancreatitis which can be mild or life-threatening. The gall bladder neck can be blocked by stone resulting in huge distension of the gall bladder thus causing pain and can result in pus formation in the gall bladder. Large stones in gall bladder are risk factors for cancer of gall bladder.

If they are not causing any trouble, should I undergo surgery?

These are called asymptomatic stones. Asymptomatic stones usually do not require surgery unless
a. Patient is having low immunity
b. The patient is living in a place where medical facilities are meager.
c. Patient is undergoing surgery of abdomen for some other reason
Relative indications are
i. Multiple small stones
ii. Diabetic patient
iii. Large stone

Can we just remove stones and leave gall bladder behind?

We have to remove the gall bladder as its functionally abnormal and stones would reform. Moreover cut on gall bladder heal very poorly.

Will removal of the gall bladder affect my digestion?

There is no effect on digestion if the gall bladder is removed. Body adapts to removal of gall bladder very well and digestion is not affected at all.

What are dietary restrictions after gall bladder surgery?

There is no dietary restriction and the patient can have a normal diet as before. Digestive system adapts well to removal of gall bladder and there is no effect on the digestion of food.

Is it major surgery?

Gall bladder removal surgery is performed by laparoscopy. It is successful in more than 99% of cases. Occasionally it is done by open surgery if anatomy is difficult or there is a risk of injury to important structures. But as the experience of the surgeon increases chances of conversion to open procedure decrease.

Is it very painful?

Laparoscopy surgery is done through small cuts made on your tummy ranging from 0.5-1 cm. these are small cuts and pain is minimum.

Should we undergo open or laparoscopic surgery?

That is to be decided by the surgeon operating upon you. As mentioned above large majority of procedures can be done by laparoscopy and needs open surgery only if surgery is difficult or in the presence of gall bladder cancer.

How long does it take to remove gall bladder?

Surgery is never about time. It is better to finish the procedure safely than quickly. It may take from 10 mintues to an hour depending upon anatomy.

What are the risks of surgery?

Apart from anaesthesia risk that depends upon general condition of patient gall bladder surgery carries minimum risk. Still there is a small but real risk of bleeding, injury to bile duct or injury to bowel.

How long does it take to recover and get back to normal life?

Gall bladder surgery is usually done as daycare surgery and the patient is send home same evening of surgery. The patient is up about a Few hours after surgery and starts his normal routine within a few days of surgery.

How does the experience of the surgeon matter in gall bladder surgery?

The experienced surgeon has fewer conversion rate and the chances of complication are less. Surgeon experienced in hepatobiliary or gastrointestinal surgery can handle the majority of complications on table and can provide better outcome in difficult cases.

Why some people are unsatisfied after gall bladder surgery?

Gallstones can cause abdominal pain, bloating, or discomfort after food intake and the complications listed above. Symptoms such as indigestion, heartburn, constipation and increased frequency of stools are very common in the general population and are not related to gallstones. Mostly when the patients / treating doctors try to correlate these symptoms with gallstones it leads to unhappiness as these symptoms may not get relieved by the removal of the gall bladder. So proper patient selection and counseling can help avoid the unsatisfied patient.

Liver Cancer Treatment Surgery Chandigarh

What are the symptoms of liver cancer?

Symptoms of liver cancer vary widely and may include

  • Fatigue
  • Jaundice (yellowness of the skin)
  • Pain
  • Easy bruising or bleeding
  • Swelling of abdomen
  • Weight loss.

    • What are the risk factors for liver cancer?

    • Viral hepatitis such as hepatitis B and C
    • Regular alcohol consumption
    • Cirrhosis – cirrhosis due to any cause increases the risk of liver cancer
    • Diabetes – It can result in fatty liver disease and thus leading to hepatitis and predisposes to cancer.
    • Non alcoholic fatty liver disease – it can lead to inflammation of liver cell thus predisposing to formation of cancer.
    • Hereditary conditions like hemochromatosis( iron deposition in liver), Wilson disease ( copper deposition in liver)
    • Aflatoxins – consumption of food product infected with fungus producing aflatoxins can also produce liver cancer

    How can liver cancer be prevented?

    Prevention is very important when it comes to a disease like liver cancer. The underlying cause of liver cancer is often liver inflammation and the development of a condition called Cirrhosis.  In addition to avoidance of drugs and alcohol, infection (such as Hepatitis B or C) and obesity can contribute to the development of liver cancer.

    Steps to minimize these risks include

    • Vaccination against hepatitis B for those at risk,
    • Prompt treatment for patients infected with hepatitis C,
    • Maintaining a healthy weight through diet and exercise.
    • Avoidance of alcohol
    • Good control of diabetes.

    How is liver cancer detected?

    Patients diagnosed at an earlier stage have better outcomes. There are many strategies that are used to detect liver cancer, including.

  • Frequent imaging studies (ultrasound, computed tomography scan, magnetic resonance imagining) in high risk patients.
  •  Routine physical exams with blood testing in high risk patients.

    • Several researchers are looking to find the one blood test that will help identify liver cancer much sooner. Until that time, we continue to remain vigilant and screen with a variety of methods to try to catch this disease as early as possible.

    Are fatty liver disease and liver cancer related?

    Fatty liver disease progressing onto non-alcoholic fatty liver disease(NAFLD) and non-alcoholic steatohepatitis(NASH) can result in cirrhosis of the liver. Cirrhosis of the liver predisposes the patient to liver cancer. The fatty liver itself does not predispose a patient to cancer however if it is controlled at an early stage before it progresses onto cirrhosis then the risk of liver cancer is negligible.

    What is the optimal treatment of liver cancers?

    In general, the basic approach of any cancer therapy can also apply to liver cancer. The treatment of the local disease. In liver cancer, we often address the local disease with:

  • Surgery (removal of the tumor) – treatment of choice for patients
    without cirrhosis of the liver.
  • Liver transplantation – it is the treatment of choice in patients with
    cirrhosis provided tumor size and number criteria are met. It takes
    care of cirrhosis of the liver also.
  • Radiation therapy
  • Local ablation of the tumor by radiofrequency
  • Catheter-directed chemotherapy or embolization.

    • Are herbal medicines recommended to treat liver cancer?

    The term ‘herbal medicine’ can represent thousands of compounds. Unfortunately, most are not rigorously tested or regulated by the companies that produce them, so real evidence of any benefit is not known. In fact, they may have harmful side effects that one comes to know only after using them.

    Should I be worried if I have a cyst on my liver?

    There is often nothing to worry about with simple cysts in the liver. They can be quite common. When we find cysts that are growing, we will often take extra care to ensure that

    • There is not an associated tumor causing the growth
    • That cyst is not causing problems.

    This is often discussed over time with your hepatologist and/or liver surgeon who can help in differentiating malignant ( cancerous) cysts from nonmalignant ones.

    What should I do if some lesion is found in the liver on a regular check-up?

    Lesions in the liver on ultrasound can be of many types

    Non-cancerous

    • Hemangioma ( abnormal formation of blood vessels)
    • Abscess ( pus collection in liver)
    • Granulomas in liver- because of TB , Sarcoidosis etc.
    • Cysts of liver – that can be simple cyst or hydatid cysts ( worm infestation)

    Cancerous

    • Primary liver cancer
    • Metastatic tumor from some other organ- liver is most common site of spread of tumors from other abdominal organs.
    • Neuroendocrine tumor of liver
    • Malignant cysts of liver

    A hepatologist or liver surgeon can help you in guiding you towards diagnosis and treatment by carrying out relevant investigations.

    If a parent had/has liver cancer, are their children at greater risk of getting it?

    In some cases, yes, a parent with liver cancer can raise your personal risk e.g in hereditary disease as Hemochromatosis, or Wilson’s disease. However, this is not true for the majority of patients. It’s always good to talk to your primary care doctor about your concerns or questions.

    Gall bladder Cancer

    1. What are causes of gall bladder cancer?

    Known causative factors for gall bladder cancer are

    • Gall Stones
    • Gall bladder Polyps
    • Porclein gall bladder
    • Obesity
    • Old age
    • Choledochal cyst
    • Abnormalities of union of bile and pancreatic duct
    • Primary sclerosing cholangitis
    • Ethnicity
    • People residing in high-risk area eg., Chile, along plains of river Ganges etc.

    2. What are signs and symptoms of gall bladder cancer?

    Gall bladder cancer can present with very non-specific signs and symptoms. Majority times it is
    detected incidentally on imaging. Patient may present with

    • Pain
    • Jaundice
    • Loss of weight
    • Loss of appetite
    • Distension of abdomen

    3. How can gall bladder cancer be detected?

    Gall bladder cancer usually are detected on imaging. Ultrasound abdomen is first lie of
    investigation that can show irregular thickening of gall baldder wall. These findings are
    confirmed by multiphasic CECT abdomen that can show condition of gall bladder and
    surrounding enlarged lymph nodes.

    4. Are gall bladder polyps cancerous?

    Small gall bladder polyps are non cancerous. Any polyp larger than 1 cm in size harbour
    higher chances of malignancy and is an indication of surgery.

    5. How can gall bladder cancer be prevented?

    Gall bladder cancer cannot be prevented . There are no ways by which gallbladder cancer can be prevented except for prophylactic cholecystectomy in area of high endemicity eg., Chile ,
    where prophylactic cholecystectomy had been shown to decrease incident of gall bladder
    cancer.

    6. What is treatment of gall bladder cancer?

    Main treatment of gall bladder cancer is surgery is it is feasible. Complete resection of gall
    bladder cancer is the only chance of providing long term survival. Usually majority of patients
    present with advanced disease that cannot be resected and can be offered palliative treatment
    only. Resectability if usually assessed best by liver/gastrointestinal surgeon who is experienced
    in liver surgery. Assessment by liver surgeon can make advanced disease resectable by proper
    planning with help of interventional radiologist. Chemotherapy has a role in pallative setting or
    after resection of tumor by surgery.