Gallbladder cancer: Deadly type killing more women than men

Former national women’s volleyball team star Janet Wanja, whose powerful sets thrilled fans for over a decade, lost her battle with gallbladder cancer at her Nairobi home while receiving palliative care last month.

The celebrated setter’s diagnosis came shortly after representing Kenya at the 2024 Paris Olympics, when she began experiencing severe abdominal pains that led her to seek medical attention. Despite immediate treatment, doctors discovered she was already battling Stage 4 gallbladder cancer. Her fight with the aggressive disease lasted just four months.

Dr Andrew Odmbohia, an oncologist and a gastrointestinal cancer specialist at Nairobi Hospital, says Wanja’s case highlights the devastating nature of this rare but increasingly common cancer.

“Gallbladder cancer was previously thought to be an uncommon problem. But now we are seeing more and more cases,” says Dr Odhiambo, who serves as the program director for the Medical Oncology Fellowship.

According to the latest Global Cancer Data, Kenya records approximately 500 documented cases annually, though experts believe the actual number could be significantly higher – possibly between 1,000 to 1,500 cases per year. This underestimation is partly due to the classification system that often groups gallbladder cancer with other biliary tract cancers.

The disease shows a clear demographic pattern, predominantly affecting women over 50 years old, who make up about 65 per cent of cases.

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However, Dr Odhiambo notes a concerning trend: “I’ve seen young patients as young as in their early 30s, and I’ve seen old patients even close to 90 years. So it affects people across the board, but it’s generally more common in women.”

Risk factors

The World Health Organisation (WHO) identifies several risk factors for gallbladder cancer, with obesity being a significant concern.

“It tends to affect women who have a larger body structure, implying that obesity and high levels of cholesterol could be contributing risk factors,” Dr Odhiambo explains.

Other risk factors include gallstones and possible aflatoxin exposure.

What makes gallbladder cancer particularly deadly is its silent progression. The National Cancer Institute of Kenya and the Ministry of Health have highlighted the challenges in early detection. The gallbladder’s location and size make early symptoms virtually non-existent.

“Being a very complex disease because the gallbladder is a tiny organ sitting under the liver that normally stores bile, when you have a small lump growing, usually there’s no pain,” Dr Odhiambo says.

The disease’s ability to masquerade as common ailments often leads to misdiagnosis. The oncologist further explains, many patients are initially treated for conditions like gallstones, malaria, amoeba, or typhoid, especially in rural areas where diagnostic facilities are limited. This delay in proper diagnosis often results in the cancer being discovered at stage 4, when treatment options are limited and survival rates are poor.

Diagnostic challenges are compounded by limited access to specialized care. Kenya faces a shortage of hepatobiliary surgeons – specialists trained to operate in this sensitive area.

The standard diagnostic process, the oncologist explains involves various imaging techniques, including ultrasound, CT scans, MRIs, and PET scans, which are not readily available in many parts of the country.

Treatment options vary by stage, but surgery remains the primary hope for early-stage cases. “Early cancers that have not spread, that can be removed by surgery, give you the best chance of cure,” he says.

However, with over 90 per cent of cases diagnosed at stage 4, most patients are too ill for aggressive treatment.

“The vast majority of gallbladder cancer cases—over 90 per cent—are diagnosed at stage four. At this advanced stage most patients are unfortunately not eligible for chemotherapy due to their compromised health status,” he says.

Patients typically suffer from persistent infections, bile leakage, and poor overall physical condition, making them too weak for treatment.

For those patients who maintain stable health, chemotherapy remains the primary treatment option.

“However, it’s worth noting that Kenya has been using essentially the same chemotherapy protocols for four decades.” The doctor adds.

Combination therapy

A promising development in the past five years has been the introduction of combination therapy, which pairs traditional chemotherapy with immunotherapy. While this treatment is now available in our country, its high cost remains a significant barrier, limiting its use to only a select number of patients.

“For patients with advanced gallbladder cancer, chemotherapy remains the primary treatment, though each case requires careful individual evaluation. It’s crucial to understand that most cases are diagnosed at a very late stage, significantly impacting survival rates,” explains the oncologist.

Dr Odhiambo further explains, some patients survive only a month, while others may live for three to six months. According to the oncologist, with treatment, some patients may survive up to a year. Reaching 18 months of survival is considered a notably positive outcome.

The Ministry of Health’s efforts to enhance awareness among primary healthcare workers and the general public are ongoing, but challenges persist. Gallbladder cancer has historically received less research attention and funding compared to more prominently studied cancers like breast cancer.

The doctor emphasizes, improving outcomes for gallbladder cancer requires a comprehensive, multi-centered approach. “The key starting point is raising awareness among both the public and primary healthcare workers, as this is essential for early detection,” he says.

A decade ago, the United States and Europe faced similar challenges. However, they achieved significant improvements in survival rates through strong patient advocacy groups and foundations that raised awareness about this rare cancer.