The Gallbladder and Cancer

Gallbladder

What is Gallbladder?

The gallbladder is a pear-shaped organ that lies just below the liver in the right upper abdomen.

The gallbladder stores bile, a yellow, brown or greenish liquid made by the liver that aids in digestion of  fat.

When food is being broken down in the stomach and intestines, bile is released from the gallbladder through a tube called the common bile duct.

This tube( common bile duct) connects the gallbladder and liver to the duodenum, first part of the small intestine.

Gallbladder (Anatomy)

The wall of the gallbladder has 3 main layers of tissue.

1. Innermost Layer (Mucosal) 
2. Middle Layer (Muscularis) 
3. Outer Layer (Serosal )

Gallbladder cancer starts from the innermost layer and then subsequently spreads to the other layers. Gallbladder cancer is difficult to detect initially, primarily because there are no visible  symptoms. And when the symptoms emerge they are symptoms of various other problems and by then its too late.

Risk Factor(s )

• Porcelain gallbladder (Chronic gallbladder inflammation)
• Gall stone (Cholelithiasis)
• Gallbladder polyps
• Chronic salmonella infection
• Cyst in the bile duct
• Age
• Ethnicity
• Gender ( more prevalent among women’s)

Symptom(s)

• Abdominal pain
• Loss of appetite
• Nausea or vomiting
• Fever and bloating
• Jaundice

Treatment

• Mainly depends on the extent to which the cancer has spread.
• If surgery is still an option.
• If cancer has returned.
• General health and age of the patient.
• Gallbladder cancer can be cured only if it is found in early stages ( Stage 1 or Stage 2)  i.e before it has spread to other organs.

After the cancer has spread to other body parts, nothing much can be done. Palliative treatment remains the only option. Palliative care aims at improving the patient’s quality of life by controlling symptoms and complications as a result of disease and treatment.

I love you, Papa!

TARGET THERAPY in Gallbladder Cancer treatment

Gallbladder treatment, chemotherapy has been found to show limited or very less results. Researchers are coming up with a new line of treatment , known as TARGET THERAPY. These drugs are used in combinations of chemotherapy  drugs are now being tested for people with gallbladder cancer.

TARGET THERAPIES

These kind of therapies, are usually drugs or substances that targets the specific molecules in cancer cell growth. In contrast to the chemotherapy drugs, who act against cell division to stop their growth.

These drugs are target oriented and target parts of cancerous cells or  around their neighboring environments. Many of these new drugs target cells with specific changes in gene(s).

One such target are the tumor blood vessels. Gallbladder tumor require the new blood vessels to grow beyond a certain size. Such target drugs are said to really effective especially  in the treatment of Gallbladder cancer. For instance  Bevacizumab (Avastin®) and pazopanib (Votrient®) are examples of drugs that target blood vessel growth and are being studied for their use against gallbladder cancer.

Many other drugs have different targets For example, a protein, EGFR found in high amounts on certain types of cancer cell, is said to be helping the cancer cells in their growth. Drugs such as lapatinib (Tykerb®) and cetuximab (Erbitux®), are now being studied for  their usage in patients with gallbladder cancer,  along with chemotherapy and other targeted drugs.

Drugs such as MEK inhibitors, selumetinib and such as trametinib (Mekinist®) and, are also being studied for their use in the treatment of gallbladder cancer.

Courtesy: www.cancer.org

When you have CANCER?

Dealing with yourself,  is always easy. We say it all the time. "If it had been me…then it would be easy".

But when you are just told that you have CANCER. Various emotions float- scary, bad and very bad! You may be  disappointed and feel unfortunate. But it definitely brings out the lost emotion- Inner strength. You are a fighter and will not give up!

It is natural, to feel hopeless and low- when you know that you have cancer and may be just have few more months with your loved ones. You may feel that your life has just hit the rock bottom.

My father was to be operated, when by chance it was discovered that he had cancer. I was the first one to be told. But I wanted to hide from my father-just like he would have from me. After all now, it was my time to take care of him. However my mother could not control her emotions, so papa came to know about it.

He was shocked. He didn’t know what to say-just like we all din’t know how to react? But after 2 days, he spoke and said - it's  just like any other illness and he will get well. He was confident.

As time passed, he lost hope. And he somewhat made peace with his approaching death.

He openly acknowledged, he now wanted to die. I remember him feeling dejected just once- when he said, Why me? rest he was very hopeful throughout the treatment .

He making peace with his going away -I hated it and was really annoyed. According to him, he was making things easy for me. He wanted me to stop trying!And let him go. And now when I look back- he was suffering too much. The feeling that he was making my life "difficult" was taking over him and he felt it was "worthless"- eventually, he had to go!. 

Gradually he deteriorated- he spoke very less, and smiled very less. But there were certain things which I really want to share with people who are fighting cancer in some way- patient or family.

• Papa, never really gave up. He kept on trying till the end came. 
• He took active part in his own treatment.
• All  through the treatment, he was very tolerant-both at emotional and physical level.
• He was always hopeful and  kept faith.
• Lastly, he always said that he was fortunate to say good bye to all his loved ones.

To conclude, I will say-Its okay to cry, its okay to be silent or be angry. But don't give up. 

Dealing with cancer is very difficult especially when you know the result. But all you have to do keep trying. That’s what papa always said and true to his word- he kept trying. He lost the battle, but I am so proud of you papa!

Happy Makar Sakranti Papa!

When one of your parent has cancer

I still remember the most difficult time of my life was when papa, was detected with cancer. There was so much going on in my head. I was sad. I was anxious. I was scared. I was angry. I was completely lost. I wanted to ask so many questions. But whom to ask and what to ask? I was completely baffled

I became overemotional, I would cry at the drop of a hat. I would get irritated easily and was in constant frustrated mode. The next few days passed just like this. I was battling with myself. I wanted to help papa, but how ? when I was restless myself. I needed to calm myself.I needed to get over my thoughts to help my family and start with the treatment.

I visited this Cancer Hospital, and my thoughts took a drastic change. It was a hospital completely dedicated to people suffering from cancer. Thousands of people visiting daily from different parts of the world. Different cancer. Different pain. Different stories. At the same time, all of us were related. Cancer patient and families-we all were struggling and were dealing with our pain in our own way without saying anything to anyone.

When someone you love has cancer, things will definitely be different. And they become more painful when it is one of your parent. The first thing you need to do is to get hold of yourself and your wandering thoughts. It is important that you realize that for the next few months you will play a  very important role in building an environment that is not only motivational for your parent but also calm and peaceful for yourself and your family.

It is a tough time and you need to be strong for your loved ones. They need your support. Both at emotional and at mental level. Sometime even financially. 

For the parent-  who has just been diagnosed with cancer, it is the most sad phase of life. They can become irritated, and don't want to talk. Don't feel bad. Try to help them by distracting. You can do a lot of things to help, for instance 

• Try spending more time 
• Read a book of their choice
• Play music of their choice as long as they are comfortable
• You can treat them with luxuries
• Help them with their medication/treatment

As a child you always know what your parents really like, same way as they know what you like. You can find different ways to divert them from cancer. You can do all this, but only if you are in the right frame of mind. Create a support system for yourself. While you take care of your parent, don’t forget to take care of yourself. It’s okay to cry and let your emotions out. Don’t be guilty. It’s not you fault.

Taking care of yourself can make a big difference to the way you feel about yourself  as the caretaker and  your ability to perform these new roles and responsibilities in a more responsible manner.

Papa, miss you- It is easier said then done, but I tried and still trying!

Ignited Hopes

Papa was going, I wanted to try - try harder till the magic happens. I was reading extensively- books, websites or whatever I could find. My state of mind- would do anything to stop papa from going away. And then I came across this article about treatment through - Maple syrup and Baking Soda.

A person with stage 4 cancer had healed himself by this treatment . He not only cured himself completely but is now leading a normal and a happy life. My eyes brightened. My hopes were ignited once again.

This was it. The more I read about this treatment, the more convinced I was. This was magic potion that would heal papa. I don’t know how authentic it was, but I wanted papa to have it.  And as it is said, you don’t loose the battle until you give up.

I felt motivated. I was optimistic.

Maple Syrup- Baking Soda Treatment

The idea behind this treatment is maple syrup being sweet, targets cancer cells- which consume 15 times more glucose than normal cells and the baking soda with maple syrup enters into the cancer cells. Baking Soda being very alkaline in nature forces a rapid shift in pH killing the cancer cells. Thereby stopping the growth of cancerous cells and targeting the effected cells helps in healing.

3 portions of Maple Syrup (100%)

I portion of Baking Soda ( Aluminum free only)

To do this, the maple syrup must be heated to make it less viscous. Then the baking soda is added. Stir the mixture for 5 minutes until it is fully dissolved.

The normal recommended dose is 5 – 7 teaspoons per day for cancer patients. But entirely depends upon the patient's health and condition. I started with twice a day. Papa din’t like it, I can tell he hated it. But he kept faith in my faith and would drink it without any fuss or getting angry till he could. As time passed cancer reached his mouth and he couldn't  swallow. 

God had lost his magic wand.So magic didn’t happen….

Happy Diwali Papa!  

Chapter 4 - Visit to the hospital

Next day, 7 February 2012, we started early in the morning for the hospital. The hospital was in Parel and very far from the place, where I was staying. Besides I din’t wanted to be struck in the famous Mumbai traffic jam. We reached the hospital around 8:45am. It was early, still it was so crowded. gosh! whats wrong? why is it so crowded? Is it so crowded everyday, I wondered. Till few days ago, i rarely  heard the term “cancer" and barely came across any cancer patient(s). And today, I am standing in a room full of cancer patients. Why are they suffering from cancer? what is their fault? Is it their karma? I was thinking!.

Lost in my thoughts, I was trying to reason myself on behalf of those millions of people suffering from cancer and eventually dying sooner or later. As i struggled, i looked at my wrist watch. It was 930am, the counters were open for public dealing. I was the eleventh person in the queue. The lady at the counter asked me, what is the purpose of my visit? I wanted to scream and ask her why do people come to the cancer hospital?. Bringing my views to check,  i controlled, and said i am here for my father’s treatment. She said, deposit Rs10,000, and fill in the form(s), as she passed me a  bunch of papers. I said, what for? she said for the treatment. I said, the treatment hasn’t started. I haven’t met the doctor yet. She said this is the procedure. Reading my  expression(s), she suggested me to consult the doctor first.

Consult the doctor, I asked what is the difference between the two?. She said for consultation you have to just deposit Rs 1000 and meet the doctor. I took the form(s) and requested  for a pen. she flatly refused. I was shocked ( I like my Delhi, at least people are sensitive enough at a places like this). I asked papa to wait for me in the waiting lounge till I go outside and buy a pen. I filled the form(s), deposited the money, and went to two more counters( i don’t know for what, i was made to go from one counter to the other). After running from one counter to the other, finally i was given the file and a token to visit the doctor. It was 10am and i was informed, the doctor would not come before 1130am.Therefore i decided, to have a cup of coffee to restore my drained strength. Papa and I had coffee and settled ourselves  at the two seats in the back row of the waiting area.

230pm, papa’s name was called. We went inside, the doctor asked papa, his name and 1 or 2 more questions. He picked up the file, flipped through the pages, looked at papa and then shifted his gaze to me and then back to the file. He said, the treatment papa is receiving is the best and, I asked - he said  nothing. This is it !

Of course papa is getting the best treatment, and I don’t need a confirmation for that. I din’t know how to react. I mean a patient who is terminally ill,  travels 1500km, waits for 6hrs just sitting and not taking rest ( what he should be doing, actually),  and this is what he gets - 2 minutes and something we already know. The doctor din’t even had 5 minutes to spare. After seeing the file and knowing that the papa has very less time. He could have at least pretended to look concerned or may be talked for few more minutes and said some motivation words ( oh! i get it- i should have deposited 10, 000 rupees to get the doctor's attention and time, what a pity!, shameful!). But he din’t, he was one of those doctor who was just doing his job ( to get a fat paycheck at the end of the month, because he trapped those patients who had deposited the 10,000 rupees even before taking the treatment not wasting time on patients like papa who were just taking consultation) . 

I have always believed that people who are suffering and are in deep pain, may be will not heal by any medicine or treatment. But saying a few words of kindness will make them feel a lot better. Is being kind so difficult? Was I asking too much?  He was rude, Before coming here, I was so hopeful. And now, I was disappointed, I felt bad, I felt betrayed. I wanted to cry. But how can I? I have to be strong for my father, who had put his faith in me ( I am sorry, papa for letting you down, i wanted to say  but couldn't). Papa, realized this, he said,”I like Delhi better, I have you and "chutki beti”. Delhi is my home. I want to be home with my people. Let us go back！

We smiled( for each other)  and started walking towards the parking area.

Miss you Papa!

Chapter 4- Chemotherapy begins

After papa got admitted to the hospital. I was  impatient. I was restless. I wanted the treatment to start as soon as possible. The chemotherapy (chemo) to start as soon as possible as already so much time has been lost. I wanted some thing to  look forward too. I wanted a miracle to happen. I wanted to hope. As as the famous saying in hindi goes, a straw is enough to save the drowning person, for me chemotherapy was the straw. 

Most of us know that chemotherapy is a very painful process and for those who don’t know, chemotherapy- strong acids are injected in the body to stop the growth of cancer cells. These acids are injected through veins( intravenous) . The cycle includes sending poisonous chemicals into the body through very slim needles. And then flushing out the toxin from the body by sending another chemical(s). 

Chemotherapy causes more harm then doing good to the body. But i wanted to give it a try for myself- who was desperate and would do anything that will add few years to my hero- my father's life. For papa, who wanted to live. For my mother- his partner of 42 years. For my brothers, who looked up to papa as their idol.

I was informed about the side of effects of chemotherapy.  Reduction in blood platelets count, nausea, fever, mouth ulcer, diarrhea and hair loss. During his two cycles of chemotherapy , papa suffered all  of these except for that he never lost a single hair. In fact, in the final few weeks, he was so irritated by his hairs, owing to being bedridden now for months (Papa had beautiful silky straight hairs and  he always kept his hair nicely trimmed and well combed) that to pacify him, I had to trim his hairs.

The first chemo cycle lasted for 3 months, at the end of the 3 months a review was done, to find out about the improvement in papa's condition and to ascertain the extent to which the disease has  been  controlled or has spread. The first cycle was divided in to two parts. The first phase, papa had to be admitted to the hospital. He was supposed to stay in the hospital for 3- 4days. Papa was tied to the bed for as long as 56hrs with a needle in his arm. First the medicines and after a break of 10hrs, the toxins were flushed out. The only time he was allowed to leave the bed when he wanted to use the washroom.He hated it. I hated it too. It was painful for him and for me. But he believed in me and i believed in the doctors, who said it is important if you  want to prolong your father’s life ( Is their any other answer). 

The second  phase- lasted a day. We would come to the hospital in the morning, get the chemo done and leave by evening. Both phase(s) were carried out in the alternate weeks. 

Every morning the schedule was same in both the chemotherapy phase(s). Reach the hospital early in the morning, get the blood test(s) done. Wait for the reports and on the basis of the results, it was decided to go ahead for the chemotherapy. 

After every chemotherapy session, papa felt weak and exhausted. But he refused to give up. He tried to be as normal as he could be and do most of his daily chores by himself. As days turned in to weeks and weeks in to months, papa grew more weak and lost considerable weight. Chemotherapy has started taking its toll. I could see but was helpless and at the same time hopeful.

It is said, that the first chemotherapy cycle is the rosy period of the treatment and it turned out to be true. After 3 months reviews were done. The results of the first cycle said, the cancer that started from gall bladder has shown 20% decrease and no growth  was reported in the pancreatic region. Papa blushed. He smiled after almost 4 months. I felt relieved. Finally after months of sadness, we have a good news. 

It was my 6th wedding anniversary, and i could not have received a better gift then this - my father’s improving health.

To my father’s courage and never say die spirit. I am so proud of you papa!

Chapter 3 - Lesson learnt from Papa’s cancer journey

Papa's tryst with cancer began in Nov2012 ( that’s when we came to know about it). The diagnosis came as a shock. How can it be? How is it possible? A person so healthy, disciplined, health conscious. In the days followed, I began to realize that life will never be the same again.

Though papa, left us in October 2013. But we are still living in the nightmare. Though the pain papa was enduring might have come to end. But we are still suffering and the pain only grows! The pain of his absence.

Papa, still lives with us in his smile, calm, and the values he taught us. And I wish to keep him alive by living upto the values he taught us. Those 10months, of papa's cancer journey taught me many things. Few i am sharing here, so that nobody suffers like me.

If you are not feeling well for a long time, don’t ignore. Visit a doctor immediately.

Looking back, papa was showing symptoms for months- fatigue, loss of appetite, abdominal pain. They were all signs. He was visiting this doctor. The doctor kept on giving him medication for urinary infection. We took another opinion, the doctor suggested to take kidney Xray. But everything was all rite. 

But the symptoms persisted. We decided to have ultrasound of stomach. The doctor shared his doubts of presences of stones in the gall bladder.

The next step was to get the gall stones removed as early as possible. The operation  for removal of stones  was scheduled for 30th November 2012.  I was waiting outside the OT. The doctor came out within  5minutes and gave us the shock of our lives. Papa has Gall bladder Cancer Stage 4 Type B. He din’t have much time( in best scenario  9months) but he has to go.

Don’t feel guilty, try to make the most of the time, you have got

In the past few years, i was so busy with my daughter, husband and work that i hardly spent time with papa. After the diagnosis, which came as a major blow.I wanted to do so much and the time was very less. But i planned, started working on my to do list.

My brother had recently bought a new house in Mumbai, i wanted papa to see it. We went to Mumbai.
Though papa spent most of his time at home. But he saw my brother’s home and was very proud.We also went to a re-known hospital in Mumbai( Visit to the hospital turned out to be a complete sham) The doctors and hospital were money oriented. 

We celebrated my parents 42nd and last wedding anniversary. We went to Lansdowne. Papa stayed in the resort all through the trip. But in the early morning,he would sit in balcony.

After years,  me and my younger brother celebrated our birthdays with papa. He smiled, He clapped and blessed us.

I took papa to a hindi movie of his favorite actress- Deepika padukone, which he enjoyed.

5th October, it was papa’s 71st birthday, we wanted to make memories of a lifetime. We celebrated his last birthday with us. He had stopped eating completely except for a heap of pain killers thrice a day. 

It was 24th October, Karvachauth, Mom fasted, she got his favorite sweet. Cancer has reached to the mouth - the last stage.   He loved sweets, after months of not eating anything,  he had a small piece.

A day after,  Papa went away

Give time to the person to handle cancer in his/her own way.

I am very proud of my father. He tried his best to overcome the disease. Results were good in the first quarter of treatment. On 14th Feb2013, the results of his first cycle of treatment came. There was 20% improvement in his health. I smiled and went running to papa.  Now we had that silver lining that we have been looking for. We became hopeful. This was the last time i saw papa smiling.

Don't hesitate to show that you care

When some one you love has cancer. Show him that you care. Take active part in his care. In the months to come, papa’s health started to decline. Cancer has reached in bones. And his back bone became porous and crumbled. He became bedridden. All of us came around and took turns to be with papa.

The once so lively room, turned in a gloomy hospital room. Medicines, IVFluids, Injections, water bed, wheel chair replaced the furniture.

We all tried our best to smile for him and keep a positive attitude. Papa supported us too by believing in our faith. He happily went through chemotherapy, radiation therapy jus to make us happy. 

Don’t hesitate to say “I LOVE U”

Even after papa was diagnosed with cancer. His strength and the struggle to hold on to life was remarkable. He refused to give up.  The urge to live was so strong that it gives us inspiration till today. I would call myself fortunate to be able to spend time with him in his final day and tell him “ he was loved”. We all were with him on the night he passed away, 26th October2013.

Love you papa! You are the best!

Chapter 3 - The Doctor

When  looking for hospital, I had a difficult time in searching for the right hospital. It is very important to find the right hospital and equally important is to find the right doctor.  I have been to most of the hospital  and made a list solely on my experience.

Finding the right DOCTOR

Now that cancer has been diagnosed, you may be restless and feel that the treatment starts as soon as possible. You may want to rush.  But my suggestion is  choosing the  doctor carefully, will pay off in the year(s) to come. The bond you share with this person will probably last through treatment into long-term follow-up care. Though people have their own limitations and circumstances. But when i chose doctor for my father, i looked for the following criteria

• Doctor who had prior experience treating  Gall Bladder Cancer patients
• Doctor, who could be reached at any time of day and the hospital he practiced was near to my home.
• Doctor, with whom i was comfortable with in terms of sharing my worst concerns and issues and was free to ask silliest question. Basically i needed a person who can handle my emotional concerns with medical treatment
• Doctor/ hospital  was on panel ( Health Insurance Plan)

Based on the above criteria, i googled and gathered much information about this person. He was the head of the department. He was the right doctor. In his absence, his junior took over. The junior was a very warm person and a very dedicated doctor. Besides he was a very good person. I decided to retain him as papa's treating doctor. 

As time passed, a time came, when nothing much was left to do. The doctors' gave up.  

But i was not ready to give up. I wanted to fight. Fight and Win. I was adamant. I was desperate.The doctor suggested, I bring papa for radiation therapy.

I still went to the hospital for radiation therapy sessions with papa.  Not that these session would do wonder, but i wanted papa to have hope, even when he had none till his last breath. This  doctor still came to visit papa and always said " visit me when you get better". But papa never got better. And the day when papa became a star, i  messaged him to inform. He replied!

Thank you Doctor!

Cancer Hospitals in Delhi

Rajiv Gandhi Cancer Institute and Research Centre Action Cancer Hopital Institute of Liver and Biliary Sciences Dharmashila Cancer Hospital and Research Centre Manav Rakshak Cancer Hospitals Pvt Ltd Dr Krishnas Cancer Healer Center Delhi State Cancer Institute Institute Rotary Cancer Hospital Vardhaman mahavir medical college and Safdarjung hospital

Cancer Hopsitals in Gurgaon

Artemis Hospital

Medanta - The Medcity  Hospital

Fortis

Aarvy Hospital

Love you Papa!