Increase in Gallbladder Cancer Under 50: Causes and Treatments

Gallbladder cancer is the latest type of cancer on the rise in people under 50, alongside bowel, breast and lung cancer. Data from Cancer Research UK (CRUK) shows an 84 per cent increase in cases of gastrointestinal cancer among Britons aged 24 to 49 since the early 1990s. Although a significant increase in cases of the disease has been observed among Britons of all ages, the biggest growth compared to other age groups has been seen in young adults. World-renowned oncologists told MailOnline that although the reason for this increase in numbers is unclear, it is suspected the cause may be due to modern diets. Specifically, experts believe the answer may lie in the subtle changes that diets rich in ultra-processed foods cause in the trillions of bacteria found in our guts (microbiome). It has been widely proven that the risk of cancer increases with age, and most cases of the disease occur after the age of 50. However, experts pointed out that there was an alarming increase in early-onset cancers, medically defined as the incidence of the disease. below 50. According to Airc (Cancer Research Foundation), gallbladder tumors arise from glands in the mucosa of the organ of the same name, located in the innermost layer of the wall, causing it to thicken. The gallbladder or cholecyst is an organ located just below the liver, normally about 8-9 cm long and maximum 2-3 cm wide. Its main function is to store and concentrate bile, which is produced by the liver and is necessary for the digestion and absorption of fats. During digestion, the gallbladder contracts, causing bile to pass into the intestine through the last part of the bile duct, which is about 6 cm in size and connects the liver to the duodenum, the first part of the intestine after the stomach. in total. The gallbladder is connected to this main duct by another smaller duct called the cystic duct. As it progresses, the tumor mass develops in the internal cavity of the organ, but it can also expand outward, breaching the wall and invading surrounding organs (liver, duodenum, bile duct). The Italian Association of Cancer Registries (AIRTUM), in collaboration with, among others, the Italian Association of Medical Oncology (AIOM), in the report ‘Cancer Numbers in Italy 2022’, predicted a total of 5,400 new cases of gallbladder and biliary tract cancers in Italy for 2020. . Predictions for 2021 and 2022 are not yet available. In general, the estimates in this report are calculated through national-level projections of data collected by cancer registry centers at the regional level. These tumors are more common in women (estimated 3,000 new cases in Italy in 2020) than in men (2,400 new cases), and their incidence increases with age: it is almost negligible before the age of 40 and reaches highest values ​​over the age of 65. The report also highlights the difference in the incidence (number of new cases per year) of these tumors; this difference is higher for men and women in Southern Italy than in those in the North and Center. Gallbladder and bile duct cancers represent approximately 1.2 percent of total cancers diagnosed in men and 1.7 percent in women. The 5-year survival rate from diagnosis remains low; It stands at approximately 17 percent for men and 15 percent for women. According to Humanitas, cholangiocarcinoma is often asymptomatic in the early stages. In the case of intrahepatic cholangiocarcinoma, general symptoms such as the following may be present in the advanced stages of the tumor: – abdominal pain – weight loss – nausea – fatigue. Therefore, in 20-25% of cases, the diagnosis is made incidentally. In advanced stages of extrahepatic cholangiocarcinoma, the majority of patients present with painless jaundice (yellowing of the skin and sclera due to high bilirubin levels); Symptoms related to cholangitis, such as pain and fever, occur in only 10% of cases. There is no specific prevention strategy for gallbladder and bile duct cancers. But limiting preventable risk factors, such as being overweight, smoking, exposure to alcohol, and exposure to chemicals, may help reduce the likelihood of developing such tumors. Vaccination against hepatitis B virus may reduce the risk of developing cholangiocarcinoma. Although surgery is the main treatment for cholangiocarcinoma, approximately 70% of patients present with an advanced-stage tumor requiring systemic medical treatment at diagnosis. – Surgery: To date, only 1 in 4 patients diagnosed with cholangiocarcinoma can undergo surgery; However, results can be achieved with surgery if intervention is made while the tumor is at an early stage. – Chemotherapy: In many cases, precautionary chemotherapy may be indicated after the intervention and to improve the results and effects of the surgery. In cases of advanced disease, chemotherapy is the treatment of choice and may be associated with immunotherapy in the first line. – Immunotherapy: A recent study revealed that immunotherapy and chemotherapy are more effective in the first-line treatment of advanced disease. This combination will soon represent a new standard of treatment. – Target therapy: Recent clinical studies have shown the effectiveness of some molecularly targeted drugs for certain types of cholangiocarcinoma. While some of these drugs, unlike chemotherapeutics, are offered for use in clinical practice, some of them are available in research programs. – Radiotherapy: In patients where surgery is contraindicated, radiotherapy, especially stereotactic body radiotherapy, which can deliver high doses of radiation to the tumor in several sessions and reduce side effects, is considered an option. Stereotactic radiotherapy has been shown to provide excellent local control of the disease. However, since it is a local treatment, the combination of radiotherapy with systemic treatment becomes important.