I have a friend with gallbladder cancer which has metastasized after surgery 9 months ago and six months of gemcitibine with oxalyplatin and when the cancer reappeared after that, she is now on Xeloda. She had gallstones over a 14 year history. No one ever suggested she have her gallbladder removed. Please do so for women friends with gallstones. In most countires, those with gallbladder are divided by gender, 3 women for each man. It really is more of a woman's disease than a man's. It is also a disease which is most lethal and observed in Chile, Mexico and amoung American Indians. For example, "Gallbladder cancer is the leading cause of cancer-related deaths for Chilean women (18 per 100,000)" in the Journal of Clinical Oncology, the Official Journal of the American Society of Clinical Oncology, October 20, 2005 Volume 23, No. 30, pages 7753-7754 by Jorge Gallardo, Betzabe Rubio, Luis Villanueva, Olga Barajas of the Oncologica Hospital Clinico Universidad de Chile; facultad de Clencias Quimicas y Farmaceuticas Universidad de Chile; Instituto Terapias Oncologicas Providencia, Santiago, Chile.
Gallstones appear to irritate tissue in the gallbladder which sets in motion a process of change in the irritated tissue which I think is called displasia and the end result of that change in the irritated tissue is or can be damage to the DNA of the cells of the ultimate tissue which damage leads to the cells being cancerous, no longer dying but no longer functional as gallbladder cells, but still gallbladder cells, regardless of where they might travel in the human body.
Humans do not need a gallbladder, which we use to store and distribute bile which I think is made in the liver and used to digest our food in our intestines. Surgery can create alternative ways for the bile to get to the intestines when the gallbladder is removed. Because women suffer gallbladder cancer so much more than men do, and since gallstones over a long period of time set in motion the change in tissue which leads to gallbladder cancer, it appears to me that there is an absolute duty of all doctors treating women with gallstones to graphically warn them of the risk of gallbladder cancer and of the benefit of removing the gallbladder early rather than later.
There are at least 13 types of types of cancer in the gallbladder cells, but the cancer has a better or worse prognosis in general depending on the type of cancer. These are listed at the National Cancer Institute web site. www.cancer.gov/cancertopics/pdq/treatment/gallbladder/HealthProfessional/page2. They are Carcinoma in situ, Adenocarcinoma, not otherwise specified (NOS), Papillary carcinoma, adenocarcinoma, intestinal type, mucinous carcinoma, clear cell adenocarcinoma, signet-ring cell carcinoma, adenosquamous carcinoma, squamous cell carcinoma, small cell (oat cell) carcinoma, undifferentiated carcinoma, carcinoma, NOS, and carcinosarcoma. These cancers are not unique to gallbladder. Why then is gallbladder cancer so lethal? I have no idea.
In response to the above referenced article, Jennifer J. Knox of the Princess Margaret Hospital, University health Network Toronto, ON, Cnada sent correspondence which appears in the same issue, immediately after that article, on pages 7754-7755 in which she described the gallbladder as an "orphan site" and that "As both gallbladder and bile duct cancers are relatively rare, neither have been studied enough to have an established chemotherapy standard of care." and "The time has come to establish a standard of care from which further studies can build and fine tune biliary cancer treatments." The two articles involve a debate over whether gallbladder cancer is so different from cancer in the bile duct, "biliary" cancer, that studies should not combine both and trials of treatments should separately measure treatments for gallbladder cancer from treatments for biliary cancer. Jennifer Knox wrote that : "I would argue that with the current level of knowledge, advancement of both sites would proceed more quickly from large, adequately powered, randomized trials that include both sites." She calls for such studies to stratify the study according to the "biliary tumor type". The primary article by Jorge Gallardo et al focuses on the fact that "gallbladder carcinoma is a "rappidly progressive disease" and "more aggressive disease than cholangiocarcinoma" and the "metastasis pattern, tumor localization, and other clinical parameters differe sufficiently to warrant further investigatiion into the molecular biology of these two different diseases, and to warrant different clinical trials."
Cancer is treated by surgery, radiation, chemotherapy, hormonal therapy and biologic immune therapies, but I do not know of any serious effort to treat gallbladder cancer with hormonal or biologic immune therapies. Both articles talk about using gemcitibine, either by iteself, or in combination with other chemos. The primary article argues that while combined chemos with gemcitibine may be indicated, the limited evidence is stronger in support of using gemcitibine alone to fight gallbladder cancer. There is also a discussion of using radiation therapy to supplement the chemo therapy. Why is there no hormonal therapy for gallbladder cancer or biliary cancer, when the leading way to stop breast cancer is Herceptin, a hormonal therapy which is based on cellular analysis of how estrogen triggers the growth of breast cancer cells and how some hormonal treatments such as Herceptin could trick breast cancer cells to treat the herceptin as estrogen, to receive it at its estrogen receptors which were then pluged and not turned on.
Why is there no comparable treatment of gallbladder cancer? What hormones or enzymes enable gallbladder cancer cells to divide? What other therapies are used for these 13 different types of cancer cells when they appear elsewhere in the body and are there hormonal treatments for any of those cells in other parts of the body which could work if used against gallbladder cancer?
What is it that is making the gallbladder cancer cell more aggressive and lethal than other cancer? What can we do now to help those with gallbladder cancer buy enough time until the industry adopts this "orphan site" and gives persons with gallbladder cancer world wide as good a chance as those with breast cancer to live their lives longer and healthier?
Is there a national or international or even a local foundation or organization advocating for this “orphan site”? Where is it and why is there so little progress?
1 Comments:
I have a friend with gallbladder cancer which has metastasized after surgery 9 months ago and six months of gemcitibine with oxalyplatin and when the cancer reappeared after that, she is now on Xeloda. She had gallstones over a 14 year history. No one ever suggested she have her gallbladder removed. Please do so for women friends with gallstones. In most countires, those with gallbladder are divided by gender, 3 women for each man. It really is more of a woman's disease than a man's. It is also a disease which is most lethal and observed in Chile, Mexico and amoung American Indians. For example, "Gallbladder cancer is the leading cause of cancer-related deaths for Chilean women (18 per 100,000)" in the Journal of Clinical Oncology, the Official Journal of the American Society of Clinical Oncology, October 20, 2005 Volume 23, No. 30, pages 7753-7754 by Jorge Gallardo, Betzabe Rubio, Luis Villanueva, Olga Barajas of the Oncologica Hospital Clinico Universidad de Chile; facultad de Clencias Quimicas y Farmaceuticas Universidad de Chile; Instituto Terapias Oncologicas Providencia, Santiago, Chile.
Gallstones appear to irritate tissue in the gallbladder which sets in motion a process of change in the irritated tissue which I think is called displasia and the end result of that change in the irritated tissue is or can be damage to the DNA of the cells of the ultimate tissue which damage leads to the cells being cancerous, no longer dying but no longer functional as gallbladder cells, but still gallbladder cells, regardless of where they might travel in the human body.
Humans do not need a gallbladder, which we use to store and distribute bile which I think is made in the liver and used to digest our food in our intestines. Surgery can create alternative ways for the bile to get to the intestines when the gallbladder is removed. Because women suffer gallbladder cancer so much more than men do, and since gallstones over a long period of time set in motion the change in tissue which leads to gallbladder cancer, it appears to me that there is an absolute duty of all doctors treating women with gallstones to graphically warn them of the risk of gallbladder cancer and of the benefit of removing the gallbladder early rather than later.
There are at least 13 types of types of cancer in the gallbladder cells, but the cancer has a better or worse prognosis in general depending on the type of cancer.
These are listed at the National Cancer Institute web site. www.cancer.gov/cancertopics/pdq/treatment/gallbladder/HealthProfessional/page2. They are Carcinoma in situ, Adenocarcinoma, not otherwise specified (NOS), Papillary carcinoma, adenocarcinoma, intestinal type, mucinous carcinoma, clear cell adenocarcinoma, signet-ring cell carcinoma, adenosquamous carcinoma, squamous cell carcinoma, small cell (oat cell) carcinoma, undifferentiated carcinoma, carcinoma, NOS, and carcinosarcoma. These cancers are not unique to gallbladder. Why then is gallbladder cancer so lethal? I have no idea.
In response to the above referenced article, Jennifer J. Knox of the Princess Margaret Hospital, University health Network Toronto, ON, Cnada sent correspondence which appears in the same issue, immediately after that article, on pages 7754-7755 in which she described the gallbladder as an "orphan site" and that "As both gallbladder and bile duct cancers are relatively rare, neither have been studied enough to have an established chemotherapy standard of care." and "The time has come to establish a standard of care from which further studies can build and fine tune biliary cancer treatments." The two articles involve a debate over whether gallbladder cancer is so different from cancer in the bile duct, "biliary" cancer, that studies should not combine both and trials of treatments should separately measure treatments for gallbladder cancer from treatments for biliary cancer. Jennifer Knox wrote that : "I would argue that with the current level of knowledge, advancement of both sites would proceed more quickly from large, adequately powered, randomized trials that include both sites." She calls for such studies to stratify the study according to the "biliary tumor type". The primary article by Jorge Gallardo et al focuses on the fact that "gallbladder carcinoma is a "rappidly progressive disease" and "more aggressive disease than cholangiocarcinoma" and the "metastasis pattern, tumor localization, and other clinical parameters differe sufficiently to warrant further investigatiion into the molecular biology of these two different diseases, and to warrant different clinical trials."
Cancer is treated by surgery, radiation, chemotherapy, hormonal therapy and biologic immune therapies, but I do not know of any serious effort to treat gallbladder cancer with hormonal or biologic immune therapies. Both articles talk about using gemcitibine, either by iteself, or in combination with other chemos. The primary article argues that while combined chemos with gemcitibine may be indicated, the limited evidence is stronger in support of using gemcitibine alone to fight gallbladder cancer. There is also a discussion of using radiation therapy to supplement the chemo therapy. Why is there no hormonal therapy for gallbladder cancer or biliary cancer, when the leading way to stop breast cancer is Herceptin, a hormonal therapy which is based on cellular analysis of how estrogen triggers the growth of breast cancer cells and how some hormonal treatments such as Herceptin could trick breast cancer cells to treat the herceptin as estrogen, to receive it at its estrogen receptors which were then pluged and not turned on.
Why is there no comparable treatment of gallbladder cancer? What hormones or enzymes enable gallbladder cancer cells to divide? What other therapies are used for these 13 different types of cancer cells when they appear elsewhere in the body and are there hormonal treatments for any of those cells in other parts of the body which could work if used against gallbladder cancer?
What is it that is making the gallbladder cancer cell more aggressive and lethal than other cancer? What can we do now to help those with gallbladder cancer buy enough time until the industry adopts this "orphan site" and gives persons with gallbladder cancer world wide as good a chance as those with breast cancer to live their lives longer and healthier?
Is there a national or international or even a local foundation or organization advocating for this “orphan site”? Where is it and why is there so little progress?
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