Stents and surgery for advanced gallbladder cancer
This page tells you about surgery for advanced gallbladder cancer.
Surgery and stents for advanced gallbladder cancer
If you get jaundice, your doctor will suggest putting in a tube, called a stent, to stop the build up of bile that is causing your symptoms. This is generally a simple procedure that can be done with either a local anaesthetic or a sedative. In some situations, a blockage in the digestive system may also be relieved with a stent.
If the simpler procedures do not work for any reason, your doctor may suggest surgery to bypass the blockage and so relieve jaundice. Or you may need an operation to bypass a blockage in your digestive system caused by your cancer. These are both quite major operations.
If you are considering whether to have major surgery, you may want to talk this over with your close family and friends, as well as your doctor and nurse. No one can say how much you will benefit from the operation. But you may make a good recovery and feel better for longer with surgery.
Side effects from having a stent
The commonest side effect is soreness at the site where the needle went in. This should only last a day or two. Another possible side effect is infection. You may need to take antibiotics for a few days after your stent goes in to try to prevent infection.
You can view and print the quick guides for all the pages in the treating gallbladder cancer section.
Advanced gallbladder cancer can block bile from going into the bowel from the bile ducts and gallbladder. This causes jaundice - a build up of bile in the blood and other body tissues. It causes symptoms such as
- Yellowing of the eyes and skin
- Feeling or being sick
- Darkened urine
- Lethargy and tiredness
Your doctor will suggest putting a tube called a stent into the bile ducts to allow bile to flow into the bowel again. This is generally a simple procedure that you can have done with either a local anaesthetic or a sedative.
Sometimes, stents can also relieve blockages in the digestive system caused by gallbladder cancer. Your surgeon may be able to put the stent in endoscopically if it is near to your stomach or in the first part of your small bowel (the duodenum).
Sometimes a stent is not possible or doesn't work for some reason. In this case, your doctor may suggest surgery to bypass the blockage in your bile duct or digestive system and relieve the jaundice. This is quite a major operation.
If you are considering whether to have this type of major surgery, you may want to talk it over with your close family and friends. You can also talk to your doctor and nurses. No one can say exactly how much the operation will help you. It is likely to be quite a big operation just when you are feeling very low. But you may make a good recovery and feel better for longer if you do have the surgery.
There is more about these operations on the which surgery for gallbladder cancer page.
Instead of surgery, drug treatment can sometimes temporarily relieve a blockage in your digestive system.
A stent is a small tube that goes inside the bile duct or bowel to keep it open. Stents used to be made of plastic, but more often now they are made of an expandable wire mesh. The mesh may be open or covered with silicone. The newer stents are less likely to block, and if they do they can be unblocked or replaced more easily. A stent allows bile to drain into the small bowel and so relieves all the symptoms of jaundice. There are two ways of having a stent put in
- With an endoscope (endoscopically)
- With a needle and guide wire put through the skin (percutaneously)
For either of these procedures, you shouldn’t eat or drink for 6 hours beforehand. Your stomach and upper bowel will then be empty. You will have a sedative to relax you before the procedure starts. You will be drowsy and afterwards probably won’t remember much about it.
After you have had a sedative injection, the doctor puts a tube called an endoscope into your mouth and passes it down your throat to your stomach. The tube passes through to the beginning of the small bowel (your duodenum) and the opening of your bile duct. The doctor injects dye into the bile duct and uses an X-ray to see where the dye goes. They can see where the duct is blocked. The bile duct is then stretched open and the stent put in place.
Stents can also relieve a blockage in your digestive system, where the stomach meets the first part of the small bowel (the duodenum). The procedure is much the same as for having a bile duct stent.
This is sometimes called percutaneous transhepatic cholangiography which just means putting the stent in through the skin. You have a sedative and a local anaesthetic to numb the area where the needle is to be put in. Before the procedure begins, the radiologist takes an X-ray of your abdominal area with an overhead camera. This comes up on a screen that the doctor can watch while the procedure is being carried out.
After you have had your local anaesthetic, the doctor pushes a needle attached to a guide wire between two of your ribs on your right side. Your doctor can carefully guide the needle into position by watching the screen. A dye that shows up on X-ray is put through the needle. The doctor can see the position of the needle clearly because of the dye. The dye shows up the blockages in your bile duct system so that the doctor knows where the stent needs to go. Once the needle is in exactly the right place, the doctor feeds the stent along the guide wire and takes the needle out. The whole procedure usually takes about an hour.
For most people there are few side effects from having a stent put in, whichever way it is done. The most common effect is soreness at the place where the needle went in if the stent was put in through the skin. This should only last a day or two.
The liver has a very rich blood supply and sometimes bleeds a little after this procedure. If you have pain, swelling or bruising over the liver area, contact your doctor straight away. Another sign can be blood in your bowel movements. Bleeding from the liver can pass along the biliary tract and into the bowel. About 1 in 20 people (5%) have a bleeding blood vessel afterwards. If this happens to you, you may need further treatment to stop the bleeding and a blood transfusion to replace lost blood.
Another possible side effect is infection. To try to prevent infection, you may have antibiotics to take for a few days after your stent goes in. While you have a stent you are at risk of infection - bacteria from the gut can travel up the stent to the gallbladder. If you have signs of infection (high temperature and shivering) at any time while the stent is in place, you should contact your doctor straight away. You may need to go into hospital for antibiotic treatment.
A stent should keep your bile duct open and stop bile building up and causing jaundice. You should be able to see the jaundice reducing within a day or two of having your stent put in. Unfortunately, stents can become blocked after a few months. If this happens it is often possible to unblock or replace the stent.
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