Maybe with a typical disease, cancer develops. Gallbladder cancer: symptoms, diagnosis, photo and video, treatment and forecast. Group of Symptoms

The gallbladder cancer refers to rarely encountered malignant tumors and is detected by about 2-8% of patients with cancer digestive organs. In almost 70-80% of cases, the tumor is adenocarcinoma and in rare cases refers to new types of neoplasms. Often, such a tumor process is combined with cancer damage and extrahepatic biliary tract.

Why does gallbladder cancer occur? What are the varieties of tumors of such localization? What are the symptoms of this tumor process? How is it diagnosed and treated? This article will give you answers to these and some other questions.

The cancer education is usually starting with the neck or bottom of the gallbladder. Later cancer captures bubble duct, cholel, liver, stomach and other nearby organs. In the gallbladder cancer, metastasis usually occurs in the liver, regional lymph nodes, ovaries, gland, peritoneum and pleura.

According to statistics, this is more often such a tumor, like gall cancer, arises against a background of long flowing or. Mostly the tumor appears in women over 50 years old. According to the observations of experts, the representatives of the beautiful floor 2-5 times more often sick with this cancer than men. Oncologists note that the tumor is often evolving in patients suffering from.

The reasons

Chronic cholecystitis, gallstone disease and other diseases of the hepatobiliary system are the risk factors for the development of gallbladder cancer.

The exact causes of the development of such tumors are still unknown. However, the observations of specialists show that mutations in the cells of the gallbladder are often provoked by the following factors:

a long course of gallway disease leading to constant injuries of the organ;
chronic cholecystitis and;
helicobacter infection;
adenomatous gallbladder polyps, the dimensions of which are more than 1 cm;
gallbladder cysts;
congenital polycystic or fibrosis of the liver;

Risk the risk of malignant gallbladder tumor is capable of the following predisposing factors:

Varieties of cancer tumors of gallbladder

In the overwhelming majority of cases, the cancer tumor is bile is adenocarcinoma. However, in some cases, the oncological process is caused by such types of malignant neoplasms:

plateLock carcalete cancer;
solid cancer;
mucous cancer;
skirrrozny cancer;
low-differentiated cancer.

All the above types of tumors have a high degree of malignancy and are prone to the early appearance of metastases.

First symptoms

On the early stages Tumor formation The disease does not manifest itself. In this period, education can be found randomly. For example, when conducting a patient survey about another disease, performing an operation to remove the gallbladder in calculous cholecystitis (after the histological analysis of tissues) or during preventive inspection.

As the tumor grows, the patient has the following nonspecific signs:

sensations of discomfort and gravity in the right hypochondrium;
periodic stupid stupid pain in the liver projection;
an increase in body temperature to subfebrile;
stool violations;
bloating;
general weakness;
deterioration of appetite;

In this period of the disease, the patient has no jaundice, and this stage is called the expensive. The duration of this period depends on the localization of the tumor and the degree of its influence on the bile ducts.

Approximately 10% of patients at this cancer stage show signs of migratory (Trusso syndrome). Such a state is manifested in different parts of the body phlebroids, which are poorly amenable to therapy.

Subsequent manifestations

With an increase in the malignant tumor in the sizes of the manifestation of the oncological process, the number of symptoms increases more pronounced. The patient develops jaundice and arises. Such symptoms are explained by germination of education in bile ducts or their compression tumor tissue. Because of this, bile stops normally entering the duodenum.

In addition to the jaundice and caused by a permanent skin, at this stage of development of the gallbladder cancer, the following complaints appear:

pronounced nausea;
vomiting;
dark color of urine;
bleaching kALOV MASS..

If due to the growth of the tumor, the blockage of bile ducts occurs, then the patient appears symptoms of empi or water and a bile, secondary biliary cirrhosis or cholangitis. After the lesion, the tumors of the liver tissue in the patient increases signs of hepatic insufficiency, manifested in severe lethargy, muscle weakness and slowdown in mental reactions. At the launched stages of the gallbladder cancer manifests itself ascitis, trouser carcroids and pronounced cachexia.

In rare cases, the symptoms of the gallbladder cancer are developing lightning and accompanied by intensive intoxication and sepsis.

Stages

Depending on the size of the tumor, the degree of its prevalence and the presence of metastases, specialists allocate the following gallbladder cancer stages:

0 - the tumor process is manifested only by the presence of cancer cells in the bustling bubble;
I A - Education germinates a mucous layer;
I b - the neoplasm sprouts the muscular layer;
II A - the tumor process applies to the peritoneum, lining organ, and connective tissues near the arranged organs;
II B - the neoplasm strikes regional lymph nodes and germinates in the muscles nearby internal organs;
III A - the tumor is distributed through visceral peritoneum to the neighboring body;
III B - tissue tissues affect lymph nodes and blood vessels of neighboring organs;
IV A - the tumor affects the main artery of a nearby organ;
IV B - the tumor applies to lymph nodes along large arterial vessels.

Diagnostics

Liver ultrasound is the most affordable diagnostic method, which allows you to detect a tumor.

Unfortunately, due to the long period of the asymptomatic flow of the gallbladder cancer, often (about 70% of cases) is diagnosed already at the started stages. Indicate the development of the tumor in this organ, a significant increase in liver, spleen and gallbladder in size, noted when examining the patient. In some cases in abdominal cavity Touch the infiltrate. The following data is characteristic of such a cancer process:

raising bilirubin levels;
an increase in alkaline phosphatase;
raising transaminases.

When analyzing blood to oncomarcresses, cancer antigen is detected 19-9.

For the detail of the clinical picture of the gallbladder cancer, the following studies are performed:

Ultrasound of the liver, gallbladder and abdominal organs - is used not only to identify neoplasms and metastases, but also when conducting aiming puncture biopsy of education tissues;
CT and - allow you to get the most deployed picture of the tumor process;
percutaneous christsechen cholangiography, retrograde cholangiopancrathyography and cholecintigraphy - are used to detail the manifestations of the neoplasm;
the aiming biopsy of the bile (sometimes and liver) is performed to obtain a sample of tumor tissues and determine its type by histological analysis;
- prescribed if suspicion of metastases.

Sometimes in the event of the need to clarify the operationality of this cancer process, diagnostic laparoscopy is performed.

Treatment

Tactics of treatment with a gallbladder cancer is determined by the type of cancer process:

localized cancer - the tumor is detected in the wall of the organ and can be deleted;
basic, recurrent or metastatic cancer - fabrics affected by a cancer process cannot be completely removed surgically.

In plain cancer, the following surgical techniques can be used to remove the tumor:

Cholecystectomy. The removal of the gallbladder can be done laparoscopically or by open access. Such operations can be carried out if the tumor process does not go beyond the organ.
Cholecystectomy with removal of a part of the liver. If the neoplasm applies to the liver tissue, then surgery cannot be limited only to the removal of the gallbladder and the surgeon has to excort part of the surrounding organ of bile ducts and liver tissues. With the III stage of cancer, such an operation can be complemented by pancreatododenectomy - removal of duodenum and pancreatic gland.

The feasibility of conducting chemotherapy and radiole treatment with a gallbladder cancer is determined individually for each patient. In some clinical cases, the patient is prescribed a combination of these additional methods of combating cancer tumor.

In the inoperable gallbladder cancer, the following techniques can be assigned to the patient:

Chemotherapy. Cyticostatics are used to destroy cancer cells, which can be administered systemically (in vein or muscle) or locally. For this, drugs such as cisplatin and fluorouracil are used.
Radiolic therapy. Exposure with a gallbladder cancer can be performed both remote and brachitherapy (introduction to the scope of the formation of a catheter or needle with radioisotope).
Hyperthermia. This technique involves the impact on the tumor of high temperatures, under the action of which the death of cancer cells occurs. In addition, this method of treatment makes tumor tissues are more sensitive to radiolochetically influence.
Radiation therapy with sensitizers. The essence of this method of irradiation is the preliminary administration of radio-axibilizers, which increase the sensitivity of the tumor to radiolochy therapy. Due to such a combination, more cancer cells die.

In some cases, palliative operations are performed in the inoperable cancer of the gallbladder, which contribute to the reduction of jaundice manifestations. For these purposes, the following types of interventions can be performed:

endoscopic stenting;
the imposition of the outer gall fistula with the help of a cheap puncture;
the imposition of cholecistegenic anastomoses, etc.

The gallbladder cancer is a malignant neoplasm that develops in the cavity of the internal organ or withdrawal ducts. It is considered quite rare pathology and in frequent cases is not developing independently, and against the background of another disease - a gall-eyed disease, dyskinesia or cholecystitis.

The gallbladder (LDP) is a "tank" used to maintain a specific secret that produces a liver. After that, it enters the duodenum, contributing to the accelerated cleavage of food and normalization of digestion.

Medical research has shown that malignant neoplasm in the body is diagnosed in 2-3 people per 100,000 population. In the main category of risk - women in the age group over 50 years old.

In order to detect oncological pathology in a timely manner and start therapy in the initial stages, it is necessary to know exactly how the cancerous defeat may manifest.

At the moment, doctors are not able to respond with maximum accuracy and confidence, for what reason the gallbladder cancer is developing.

Several factors are distinguished that can trigger the occurrence of oncological neoplasms:

genetics, hereditary tendency;
ulcerative colitis of nonspecific form;
glice invasion;
improper nutrition, regular use of smoked, pickled, oily, fried and sharp dishes;
frequent drinking of alcoholic beverages and tobacocco;
long stay in regions with adverse environmental conditions;
continuous contact with household chemicals containing carcinogenic and toxic substances;
working activities in harmful production associated with metal alloys or rubber manufacturing.

In addition, malignant neoplasm affecting the lap paths can develop against the background of other internal organs. The main causes of cancer become:

Cholelithiasis.
Bilyary cirrhosis.
Polycystrosis and liver fibrosis.
Cholant (inflammatory process in the liver).
Cholecystitis chronic type.
The presence of adenomatous polyps, the dimensions of which exceed 1-1.5 cm.

Cancer is most often found at the representatives of the fine sex. The doctors also note the connection of the oncological disease with age factors - most often the neoplasm is formed in patients in the age group of 45-65 years.

Symptomatics

This oncological disease is most often diagnosed completely by chance, in the process of prophylactic examination, in the treatment of cholecystitis or bile disease. As a rule, the first signs of malignant neoplasms are manifested in the later stages of the tumor, the initial stages of its formation are evident asymptomatic.

In later stages, the following symptoms are manifested:

feeling of gravity under the right edge;
stool disorders;
feeling of bitterness in the oral cavity;
regular attacks of vomiting and nausea;
a feeling of resolving in the stomach;
chronic fatigue, weakness;
a sharp decline in body weight.

With a given disease, which is in the launched stage, the person develops the jaundice syndrome. It is accompanied by the yellowing of the skin and eye scool, an increase in the size of the liver, frequent bits of nausea and vomiting, regular rashes and epidermis itching.

Also, the oncological disease is characterized by urine staining in darker, and the wheel masses in the brightest, even whisper shade.

The gallbladder cancer with metastases in the liver can be determined by characteristic symptoms of hepatic insufficiency - muscle weakness, lethargy, pallhenia of the skin, slowing down mental reactions. The patient's appetite deteriorates sharply, he begins to dramatically lose weight - weight loss can reach 10-12 kg per month.

Signs can be expressed in the form of regular headaches and dizziness, lethargy, fatigue, sleep disorders. Also, the patient can feel a seal in the field of right hypochondrium, attempts to prove his profits are accompanied by strong painful spasms.

This clinical picture It is general, the symptoms of the oncological disease depends on the shape and stage of the tumor and can differ significantly in each case.

Varieties and stages

With the gallbladder cancer, the metastasis paths are diverse. They are conditionally divided into several varieties:

hematogenic - the distribution of metastases through the circulatory system;
lymphogenic - metastasis by means of lymphatic vessels;
the defeat of nearby organs and tissues - pancreas, liver, thick and small intestine.

Metastasisation can develop both one and several paths. This process is often accompanied by the formation of secondary neoplasms.

The disease can occur in various forms, but in 80% of cases, the tumor is an adenocarcine - a malignant neoplasm consisting of ferrous tissues. It is ferrous cells first amazed by cancer elements, after which they penetrate other, healthy fabrics.

In addition to the adenocarcinoma, other varieties of malignant tumors are distinguished - fine-cell or flat-mellular cancer, lymphoma, melanoma, sarcoma.

The severity of the oncological disease depends on which stage of the cancer tumor is diagnosed in a patient.

Null - Mutted elements, that is, cancer cells begin to actively affect healthy tissues of the organ.
First - Anomalous cells begin to merge among themselves, forming a small neoplasm in the cavity of the gallbladder or on the surface of its walls. Visually, the tumor has a large similarity with a polyp, but differs in intense growth.
Second - This stage is characterized by a rapid lesion of healthy organs, which most often protrudes the liver, pancreas, thick or small intestine.
The third - Stage of active metastasis, in which cancer cells on bleeding are spread throughout the body.
Fourth - The period of distribution of metastases into remote authorities.

The gallbladder cancer, the symptoms and the manifestation of which can be diverse, is considered one of the most severe oncological diseases, as it is characterized by rapid propagation in bile ducts, liver, lymphatic and blood vessels, stomach, duodenum and other digestive bodies.

At the initial stages of the development of the oncological tumor, it is good to be removed by operational intervention. SAME dangerous forms The gallbladder cancer is considered to be 3 and 4 stages of development.

Thanks to remote metastases, malignant neoplasm is considered incurable, the person dies for 1-5 years.

Diagnostic methods

At the initial stages of development, the disease is extremely difficult to diagnose. This is due to the fact that most often the oncological disease occurs completely asymptomatic, and the neoplasm is found already in the later, launched stages, with active metastasis.

To accurately diagnose, the doctor complaints complaints and visual inspection of the patient, paying particular attention to the color of the skin and eye scler.

Palpation of the right hypochondrium and the entire abdominal cavity is also held. For confirmation of cancer, the following analyzes and surveys are appointed:

generalized study of blood and urine;
ultrasound procedure;
radiography of the abdominal cavity;
magnetic resonance imaging;
cT scan;
angiography;
endoscopic retrograde cholangiopancratography.

One of the most accurate and efficient diagnostic methods is ultrasound. The procedure is completely painless, and its holding takes no more than 15-20 minutes.

But the study requires a certain preparation - the intestine must be released with the help of laxatives or purification enema. Ultrasound is held on an empty stomach, after which the patient takes a trial breakfast and the examination is repeated again.

For a trial breakfast, it is best to use 1-2 boiled chicken eggs, banana, a glass of sour cream or yogurt with a high fatness percentage. After 5 minutes, the ultrasound is reused.

Treatment

The choice of the method of treating oncology depends on many factors - the age of the patient, the overall state of its health, form and severity of the tumor. Operational intervention is considered the main method of therapy for oncological disease.

In case the cancer cells have a clear location location, a complete excision of the gallbladder is performed.

The main varieties of surgical treatment are:

cholecystectomy - the removal of the organ, which is carried out by extensive penetration or laparoscopy;
a partial type resection - excision of the organ at the same time as an affected area of \u200b\u200bthe liver;
pancreatododenectomy is an extremely complex operation in which the organ is removed with withdrawing ducts, digestive organs, pancreas, some lymphatic nodes.

Today, Pancreatododenectomy is extremely rare, since it is accompanied by numerous complications and a long period of recovery.

For the speedy restoration and normalization of the work of the biliary system, multivitamin complexes can be used, anti-inflammatory drugs and choleretic agents, which include Dragon Bile Pills.

Additional treatment methods:

Radiation therapy.
Chemotherapy.
Radiation therapy.

An effective addition to therapy for oncology is the use of drugs and biologically active additives, among which you can select the Dragon Bile pills.

These pills are a pharmacological preparation possess pronounced choleretic, painkillers, anti-inflammatory and diuretic properties. The drug is considered highly efficient with various diseases of the output channels, as well as the liver.

Popularity drug It is that pills are in their composition natural ingredients and vegetable extracts, so they are completely safe for use and do not cause addiction even after long-term use.

Forecasts of doctors

Forecast doctors oncological disease It depends on which stage the treatment of malignant neoplasms began. Cases of diagnosing oncology at its initial stages are considered as favorable at its initial stages, in which there are no metastases in healthy organs.

Survival for various degrees:

the first - five-year border of survival is overcome 75-80% of patients;
the second is 7-55%;
third - 3-25%;
third - 2-10%.

The most sad forecasts for patients who are diagnosed with a fourth degree disease. In such cases, it is not more than 7-8% of patients to live 1-5 years.

The cancer tumor in the bustling bubble is one of the most severe and dangerous oncological diseases with a high percentage of fatal outcomes. The diagnosis of malignant pathology in the early stages gives the patient hope for recovery and return to active, full-fledged life.

In the past few years, the number of people who have a gallbladder cancer have increased in oncology, which is associated with increasing incidence of gallstone disease, cholecystitis and hepatitis due to the high consumption of fats and alcohol. This pathology is most often observed in old age. The cancer tumor begins to develop in the wall of the gallbladder, hitting its mucous layer, and then extends to the outer layers of the organ and metastasizes into the liver, pancreas and abdominal organs. Therefore, this is an oncological disease is considered very malignant with unfavorable forecasts.

Description of the disease of the gallbladder

Gallbladder cancer – cancer tissue of the tissue of the organ, which is located in the fifth place in the frequency of occurrence after cancer of the gastrointestinal organs. Most often, the disease develops in the form of adenocarcinoma (80% of cases), can sometimes be papillar or flat-milk cancer. Most often, pathology develops in women by fifty years.

The cancer tumor is formed on the bottom of the bubble or in its neck. As the neoplasia is developed, it applies to the bile duct, and then the liver, stomach, duodenum and a fat intestine. Men may have the spread of neoplasm in ovaries.

In oncology, it is customary to allocate two types of cancer depending on the location of its location:

Localized cancer, which does not go beyond the organ and can be completely removed by the surgical method together with an affected bubble bubble. This type of tumor is observed only at the initial stages of development.
The inoperable cancer is characterized by metastasis the neoplasm in other organs and lymph nodes. In this case, the removal of the tumor is not possible.

Causes of disease development

In most cases, oncology develops with chronic cholecystitis or bile sickness. It is believed that the occurrence of the neoplasm is associated with injury to the mucous membrane of the organ as a result of moving the gallstones. Oncology may also appear due to the development of diseases such as cysts, polyps, salmonellosis, calcine or in the presence of bacteria Helicobacter.

There are risk factors that can provoke the appearance of pathology:

Inflammatory process and rock formation in a bustling bubble or biliary ways. The risk of developing a neoplasm increases in the presence of large-sized stones.
Note! Considerable number of people with gallbladder stones never have an oncological disease.
Calcino, in which the organ walls are covered with calcium overlaps, resulting in a so-called porcelain bubble.
Abdominal typhus, which develops as a result of the bacteria of Salmonella in the body. In this case, the risk of development of pathology increases six times.
The presence of cyst and polyps is more than one centimeter.
Obesity and long-term observance of the diet.
Effect of chemicals, carcinogens and toxins as a result of professional activities.
Harmful habits, low immunity.
Long stress and emotional stresses.
Hereditary predisposition.
Treatment of oncological pathologies of other organs.

Note! The risk of cancer development increases with several predisposing factors. In the presence of one of them, pathology may never develop.

Stages of development of oncology

Cancer bubbleproofing several stages of development:

The prediction stage is characterized by the location of the anomalous cells on the epithelium of the organ. Due to the influence of negative factors, they are transformed into cancer and begin to penetrate into the deep layers of the bubble.
The initial stage is caused by the formation of a cancer neoplasm, which penetrates the muscular layer of the organ. At this stage of development of pathology, complete recovery is possible, but in the absence of signs of cancer, the forecasts deteriorate.
The medium degree at which metastases in the liver and tissue are distributed, which are located nearby. Symptoms at this stage are pronounced, but are often ignored by patients.
The severe form of pathology is characterized by the propagation of cancer cells not only in neighboring organs, but also in lymph nodes. At this stage of cancer, most people become disabled.
The complicated degree of cancer is determined by the spread of metastases throughout the body. In this case, palliative treatment is prescribed in order to improve the quality of life of the cancer. With the fourth degree of cancer live long.

Symptoms and signs of gallbladder cancer

Gallbladder cancer can be different, most often they are similar to the signs of various organ pathologies. A person can feel painful syndrome in the right hypochondrium, which can be in the shoulder. If the blockage of gall duct occurred, jaundice develops, which is not accompanied by hepatic colic and increasing temperature. There is often an increase in the liver, in some cases a cancer can be patched in the abdomen. It may also lead to the development of cholangitis, secondary biliary liver cirrhosis.

With the growth of the neoplasm, such signs are manifested as weakness, a decrease in appetite, an increase in body temperature, nausea, changing the color of calm mass and urine, skin itching, yellowing of the skin and eye proteins. In advanced cases, a person develops anemia, an abdominal cavity, leukocytosis, hepatic insufficiency, slowdown in mental reactions, ascites, intoxication and sepsis.

Note! The gall cancer bubbles is slowly and unnoticed, so it is often diagnosed in the last stages. Very often oncological pathology is confused with cholelyaz. The first symptoms of the disease begins to show with the average degree of pathology.

In severe cases, liquid in the abdominal cavity begins to accumulate, so the stomach increases greatly in size. It becomes difficult for a person to breathe at rest. Sometimes the gallbladder cancer develops lightningry, while there is strong poisoning of the body and the development of sepsis, which represents a serious danger to life.

Diagnosing oncology

Since the disease proceeds asymptomatic, in gastroenterology, its diagnosis of late development stages is diagnosed when the operation is impossible. Such a phenomenon is observed in 70% of cases.

When contacting the medical establishment, the doctors of the clinic are inspected, as a result of which an increase in the gallbladder and abdomen is revealed. When palpation, the medic can reveal the neoplasm. The doctor also conducts a patient's survey for the severity of the symptoms of the disease, which makes it possible to determine the severity of pathology. Anamnesis of the disease and life of the patient and his relatives is studied further to identify the possible hereditary transmission of illness.

Laboratory diagnostic methods are then assigned: urine testing and blood, test for determining oncomarkers, coprogram. Analyzes show an increase in bilirubin, level of alkaline phosphatase and transminase. During the study, cancer-embryonic antigens are found in the blood.

The doctor also applies such diagnostic methods:

Ultrasound of the gallbladder and organs of the peritoneum.
MRI and CT to determine metastases, pathological sites, neoplasms of minor sizes.
Expressive christsechen cholangiography - a diagnostic method at which the state of the gallbladder and its ducts is determined. In this case, the patient is entered into the liver of a needle with a contrast, then it takes it with a bubble and ducts. Before using this method, drainage of bile is often carried out.
Liver biopsy with further cytological examination of the material.
Laparoscopy to determine the basis of the neoplasm in the organ.

Note! If a person has other gallbladder diseases, cancer can not be detected during diagnostics.

Treatment of an oncological disease

Methods for treating pathology depend on the form and size of the neoplasm. When the cancer is located in the walls of the organ used surgical method Treatment, which involves holding cholecystectomy. This operation is most often used at the first and second degree of cancer. In the process of surgical intervention, the gallbladder is removed and the nearest fabrics. If there is a tumor of the third and fourth stage, pinchedododegenectomy is possible and the removal of the right hepatic lobe, lymphatic vessels and surrounding tissues.

In the propagation of metastasis throughout the body, the operation is not carried out, in this case, palliative therapy is used to reduce the manifestation of symptoms. Treatment includes a combination of radiation and chemotherapy. Exposure can be used before and after surgical intervention to reduce the size of the neoplasm. This treatment method helps to prevent the propagation of cancer cell cancer cells. With radiation therapy, it is possible to use a special catheter, which is placed in the affected organ, as a result of which irradiation occurs inside the body. In some cases, doctors use radioensitizers - special preparations, which contribute to improved tumor sensitivity during radiation therapy.

Chemotherapy is appointed at the last stages of cancer development. It is used as palliative treatment To reduce the manifestations of symptoms of the disease and improve the quality of the life of the cancer. If the treatment does not help, doctors resort to liver transplant. This operation is quite complicated. After successful transplantation, the patient must stand under the supervision of a doctor for several years.

Note! Funds of traditional medicine can be used in a complex with the main type of treatment and only after discussion with the attending physician.

After the treatment of pathology, the diagnosis is repetition (restored), which was used to form a diagnosis and establishing the degree of development of the tumor. This is necessary in order for the doctor to make a decision on the continuation, shift or termination of therapy.

Prediction and prevention of pathology

During the diagnosis of oncological disease, the forecast depends on the form of a neoplasm and the degree of propagation of metastases. Pathology is well treated at the initial stages of development. At the last stage, the treatment is carried out palliative, the purpose of which is to improve the quality of life of the patient and eliminate pain syndrome. After treatment, there is a risk of recurrence. The forecast in this case will be bad. In the presence of an inoperable tumor, death occurs. For effective treatment With the help of surgical intervention in 40% of cases, people survive. Often the disease leads to disability due to the development of renal and liver failure, which provoke full exhaustion of the body.

In order to prevent prevention, it is recommended to eliminate or weaken the effect of provoking factors. It is necessary to treat the diseases of the gastrointestinal bodies in time, to lead a healthy lifestyle, to eat correctly, engage in moderate exercise, follow your weight, as well as comply with safety rules when working with toxic substances and chemicals, periodically undergo a medical examination, treat chronic diseases.

The gallbladder is a small, hollow, pear-shaped organ located under the biscuits. It concentrates and preserves bile, liquid necessary to digest fats in the small intestine. When the gallbladder cancer is important in time to begin treatment, since the disease can proceed asymptomatic and often detected too late. Cancer can hit nearby organs and fabrics and cure the disease is much more complicated.

Malignant gallbladder tumors are a rather rare phenomenon, more often develop in women, in 7 out of 10 cases.

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Causes of gallbladder cancer

There are several risk factors associated with this type of oncology.

Like most types of malignant diseases, gallbladder cancer more often occurs in the elderly people.
The cancer tumors of the gallbladder in a family history increases the risk of the disease 5 times, especially if there is a genetic mutation, known as BRCA2.
Risk factors are the stones in the bustling bubble and the inflammatory process (cholecystitis). 8 out of 10 people with a gallbladder oncology diagnosed data disorders. According to research, the stones in the family history increase the risk of cancer.
Porcelain bubble - calcium deposition on the inner wall of the organ is one of the potential factors.
Primary sclerosing cholangitis (PSX) is a type of inflammation of bile ducts, may increase the likelihood of cancer.
Smoking and some industrial chemicals contain nitrosamines - chemicals, damaging DNA and increasing the risk of oncology.
Some of the pancreas anomalies and bile ducts increase the likelihood of this disease. These are congenital disorders along the bile duct, an abnormal compound of bile ducts and pancreas.
Polyps of the gallbladder - small growths that appear on the mucous membrane of the organ. The larger the size of the polyp, the higher the risk that it is transformed into malignant.
Overweight increases the likelihood of many types of oncology, including gallbladder cancer. Obesity means excess of more than 40% of the maximum desired weight according to a certain growth. Overweight causes a change in the hormonal balance in the body, which increases the risk of this type of oncology.
According to a number of studies, diabetes increases the likelihood of gallbladder cancer and bile duct tumors.
There are certain information about the fact that the diet affects the risk of developing this disease.
Ethnicity is one of the factors. The highest incidence rate of gallbladder cancer - in Northern India.
Salmonella infection increases the risk of this ailment. According to some studies, Helicobacter Pylori bacteria can also affect.

Signs and symptoms of gallbladder cancer

In the early stages, the disease does not cause any manifestations. When the disease is diagnosed, often it is over the limits of the primary hearth and affects the surrounding fabrics and organs.

Most of the symptoms of characters for late stages of the disease. It is worth knowing that other pathologies are also able to call these signs.

Abdominal pain may occur on the right side in the abdomen. Some people describe it as pulling. If the cancer or stones block the bulls, the pain will be acute.
Nausea is very common in the later stages of gallbladder cancer. It is easy to control with antiemetic drugs.
Jaundice means that the liver does not function properly. Among the symptoms note: the yellowing of the skin and proteins of the eyes; darkening of urine; White feces. Jaundice is associated with the accumulation of bile acid salts in the blood. Half people with a diagnosis of gallbladder cancer have jaundice - sign late stages Oncology. It is worth remembering that hepatitis is a more common cause of jaundice.
The expansion of the gallbladder occurs due to blocking the bile duct and filling the bile of the organ.
Another less common signs of the disease believes appetite, weight loss, constipation.

Types of gallbladder cancer

In 85 out of 100 cases of this disease, adenocarcinia is diagnosed. This type of cancer is developing in glandular cells producing mucus. Andencarcin is divided into papillary, non-fallallar and colloidal.

Less common types of gallbladder cancer include flat-cell, fine-cell and sarcoma.

Neuroendocrine tumors, lymphoma and mehanoma are observed among the rare types of gallbladder cancer.

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Diagnosis of gallbladder cancer in Israel

Oncologist collects anamnesis, polls about the symptoms. Inspect the patient, taking the abdomen for signs of increasing. Checks eye proteins and skin color on the symptom of yellowing. Inspect the lymph nodes in the neck and groin.

Depending on the results, the following types of surveys may be appointed:

Blood tests called liver samples. This series of tests that check the work of the liver and gallbladder. Also here includes an analysis on bilirubin, chemical in bile. A small amount of bilirubin in the blood is completely normal. But a high level, as a rule, means that there are problems with a bubble bubble or liver.
Ultrasound. If the tumor is found in a bustard bubble, with the help of ultrasound can be installed, whether the cancer on the walls of the organ spread.
CT will show the growth of the tumor inside the gallbladder and beside it, is the overall bile, lymph nodes or liver.

If scanning shows the abnormal regions around or inside the gallbladder can be carried out:

ERHPG - X-ray organ with the help of an endoscope (endoscopic retrograde cholangiopancopyography - ERCHP). The patient swallows a flexible tube, with the help of which the doctor examines the inner part of the small intestine and takes a biopsy from sites that look abnormally. This test shows a narrowing or blocking of bile ducts of the pancreas, it helps plan an operation. It takes from 30 minutes to 2 hours.
MRHPG - type of MRI of the gallbladder, pancreas and bile ducts. MRHP means magnetic resonance cholangiopancratography. The procedure requires preparation, in 2 hours it is necessary to stop eating and fluid. The MRHPG is less discomfort than ERCHP, does not require painkillers and other drugs, but does not allow to extract tissue samples.
Biopsy and fine game aspiration. Biopsy means taking the tissue sample and studying them using a microscope. This is the only way to determine whether the tumor is malignant. But if the doctor is absolutely confident based on the results of other tests that this cancer, biopsy is not needed. The gallbladder will be removed anyway.

If biopsy is needed, it can be performed in different ways: during laparoscopy with ERCHP, or using a thin game aspiration biopsy.

In order to control and further treatment of the gallbladder cancer, as well as for the inspiration biopsy, the doctor applies CT or ultrasound to direct the needle to the right place. Takes a sample of cells and sends it to the laboratory for further study. A tribe of the fabric from the liver or lymph nodes can be taken to find out if the tumor process was spread. After the biopsy of the gallbladder, the patient remains in the clinic for several hours or at night. This is necessary because there is a risk of bleeding.

If analyzes indicate a gallbladder cancer, further research may be needed to find out the degree of propagation of the tumor process. Most often, cancer strikes the liver - in 8 out of 10 people. It can also penetrate the lymph nodes in the abdominal cavity. For the treatment of gallbladder cancer, the following types of diagnostics can be carried out.

MRI more accurately displays soft tissues, compared to CT. The use of MRI with cholangiography can show the blocking of the bile stream to a tumor, as well as the propagation of cancer on a portal vein. If there is a metal in the body (for example, a pacemaker), this test is contraindicated.
Endoscopic ultrasound research involves an ultrasound scanner and an endoscope, helping to determine the stage of cancer, germination of the tumor process into the wall of the organ or distribution to the liver. All this facilitates the process of planning the operation.
Cholangiography explores bile ducts with a dye, x-ray and endoscope. The procedure lasts 30-60 minutes, with its help you can find out if there is a tumor in the bubble bubble, whether the duct blocked. If there is a blocking, a stent can be installed.

Laparoscopy is a small operation. Laparoscope, equipped with a camera and light, is introduced into the abdominal cavity through small cuts and are studied whether there are signs of oncology. With the help of Laparoscope, the surgeon has the opportunity to look inside the gallbladder. Laparoscopy helps in planning the operation and choosing other methods for the treatment of cancer treatment of gallbladder cancer. The procedure requires the use of general anesthesia, it will be necessary to hospitalize for the night. During its execution, biopsy can be carried out. If there are stones or inflammatory process in the gallbladder, the surgeon will immediately remove the organ. Such an operation is called cholecystectomy. The advantage of this type of treatment is a shorter period of recovery.

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Gallbladder Cancer Stage

Stages indicate the growth and distribution of the malignant process. Determination of the disease stage is necessary to select optimal option The treatment of gallbladder cancer.

A TNM system is used to classify the gallbladder cancer.

T - indicates the size and propagation of the tumor of the gallbladder.
N - on the defeat of lymphatic nodes.
M - on the penetration of the tumor process in other parts of the body.

According to this classification, 5 stages are distinguished - T1 - T4 and very early - called Tis or carcinoma in situ.

Tis (on-site cancer) - the tumor is located inside the organ. At this stage, the disease is diagnosed extremely rarely. It happens when the gallbladder is removed for other reasons, for example, due to the presence of stones.

T1 The tumor began to germinate into the wall of the gallbladder. The stage is divided into T1A and T1B. T1A indicates a damage to the connecting layer under the inner sheath of the organ wall, T1B - on the penetration of cancer in the muscular layer, located behind the connecting.
T2 The tumor is localized in the bustling bubble, but sprouted through the muscle layer in the following layer of connective tissue.
T3 The tumor went beyond the borders of the organ, spread to the liver or another closely located organ - stomach, intestines or pancreas.
T4 - cancer penetrated into a petrose vein or liver artery, gave secondary foci in two or more organs outside the liver.

There are three stages of lesion of lymph nodes with malignant gallbladder tumors

N0 -Limpatic nodes are healthy.
N1 - the tumor process affected one or several adjacent lymph nodes, for example, along the bile duct or the main arteries of the liver.
N 2 - Pathological cells spread to lymph nodes located on the gallbladder.

M indicates the penetration of the tumor process to other organs and tissues.

M0 - a malignant process did not affect the far organs or structures.
M1 - secondary foci arose in other organs, for example, in the brain or lungs.

The combination T, N and M give a complete description of the stage of the disease.

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Gallbladder cancer stage according to another classification

4 main stages are distinguished, some doctors also speak about stage 0.

Stage 0 or carcinoma in situ. This cancer at the earliest stage. Malignant cells are detected only in the layer of fabric, lining the gallbladder. There is a low risk of dissemination of the disease.

Stage 1. The earliest stage of invasive cancer. It means that the malignant process is located only in the inner layers, lining the tissues of the gallbladder. No penetration into the nearest fabrics or organs. Stage 1 is identical to T1, N0, M0 by TNM classification.

Stage 2. Cancer germinates through the muscular layer of the wall of the gallbladder in connect fabricfollowing him remains localized within the authority. Stage 2 corresponds to T2, N0, M0 by TNM.

Stage 3 is divided into 3a and 3B.

3A - Rosor's cancer through the walls of the gallbladder, there are no malignant cells in lymph nodes. Corresponds to 3, n0, m0.
3B - the tumor is located within the boundaries of the gallbladder or sprout through the outer layer and struck the nearest lymph nodes. Identical T1, T2 or T3, N1 or M0.

Stage 4 indicates a metastatic cancer, divided into 4a and 4B.

4A - the tumor process struck the artery leading to the liver, or spread to 2 or more organs outside the liver. Adhesive lymph nodes (T4, N0 or N1, M0) may be affected.

4B indicates cancer of any size that:

struck lymph nodes located on the gallbladder, but not penetrated into remote organs (any T, N2, M0);
gave metastases in structures or organs farther from the gallbladder (any T, any N, M1).

Simple staging system

Sometimes doctors use a simplified staging system to make a decision on which the treatment of gallbladder cancer is necessary. Stay three stages:

Localized gallbladder cancer (1 and 2) - the tumor is located within the borders of the gallbladder, can be removed by surgically.
The inoperable gallbladder cancer (3 and 4) - the malignant process spread beyond the primary tumor, cannot be removed operational. Sometimes it is possible to learn the tumor 3 of the stage.
Recurney - the disease returned after therapy. The secondary tumor may appear in the bustling bubble or in another area.

Prediction of the treatment of gallbladder cancer

The data of international statistics, intended for general guidelines are presented.

Unfortunately, the overall forecast for the gallbladder cancer is not very good. According to most medical articles, only 10 out of 100 people (10%) will live 5 years and more (5-10 survival). Basically depends on the stage of the disease. The diagnosis is often put in late steps when the disease cannot be cured.

Perspectives in stages - 5-year survival and more after diagnosed.

Stage 0 - for 80 out of 100 people (80%).
Stage 1 - for 50 out of 100 (50%). Some doctors believe that the removal of the nearest lymph nodes and some liver tissues during the operation will prevent recurrence - extended cholecyst setthomy is performed.
Stage 2 - for 25 out of 100 (25%).
Stage 3 and 4 meter 10 of 100 (10%).

Reliability of static data

There are no static information that will definitely say what happens. Each disease is unique, as well as the human body. For example, the same type of cancer can develop at different speeds from various people. Many individual factors may affect the treatment and forecast, you need to know about it.

Research results show that participation in clinical trials can improve the forecast.

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Handling cancer - relatively rare oncological pathology. It is diagnosed mainly in patients over 50 years old. The pathologies are subject to all departments of the gilitude system. In other words, the tumor can develop both in the liver channels and in the ducts outside the organ, for example, in the choleret. It is suitable for a horizontal bubble. There are characteristic symptoms for which the development of malignant education can be suspected. Noticing signs of illness, you need to consult a doctor. It will prescribe diagnostics and treatment of the tumor of yellow ducts in case of its detection.

The tumor affecting the horizontal duct is developing from its epithelial tissue. The disease is still known as the cholangiocellular carcinoma.

What is the main reason for the development of pathology, do not answer doctors. However, doctors identify some factors that, in their opinion, can provoke an oncological process.

Risks include:

Inflammatory processes in the gastrointestinal bodies ( gastrointestinal tract). It is noted that people who have been diagnosed with ulcerative colitis, Crohn's disease and other intestinal pathology of an inflammatory nature are more often subject to cancer. In the risk group, patients with inflammatory processes in gilted flows are also provided.
Congenital abnormal gilt ducts. Choledo, for example, may contain cysts and papillomas.
Contribute to cancerous processes can conduct x-ray diagnostics using a torch. This contrast agent represents a mixture of vinyl chloride and thorium dioxide.
Nutrition and availability harmful habits Like smoking, alcoholism, addiction to drugs.
Human immunodeficiency virus and hepatitis viral forms.
Age older than 65 years.

Sometimes the doctors diagnose the tumor in the gall ducts and in people without the risk factors described.

The classification of pathology involves the separation of tumors on malignant and benign.

To the latter refer to:

papillomas;

adenomy;
mixoma;
fibromo;
adenoma.

As a rule, they are formed at the bottom of the gulb bubble. At the initial stage of development, the manifestation of benign formations is insignificant, does not lead to violations of the body. As they grow, tumors begin to put pressure on neighboring organs, which causes certain unpleasant sensations.

Malignant tumors are diagnosed quite rarely, often, in the place of connecting the liver and bubble gall ducts.

For cancer education, slow growth and the possibility of metastasis is characterized.

Several types of malignant tumors are distinguished:

Epithelial.
Mesenchymal.
Mixed.

The neoplasm can occur in any part of the heated system. From the fact that the tumor depends on the treatment plan.

There are 2 types of disease:

cancer of an extra-eraine gall duct;
carcinoma of intravenous duct.

Handling ducts are partially located outside the liver, where they are more affected. Therefore, it is here that the conversion of tissues in malignant is most often. Anatomically disconnected channels can come close to and even grow together. This is the beginning of a tumor formation.

Cancer intrahedral gall ducts is diagnosed about 10% of all cases of oncology.

Under the term, the stage of cancer understand the size and dissemination of the neoplasm outside the place of its appearance (liver, horizontal bubble).

To determine the stage on which the cancer process is, doctors conduct a study of lymphatic nodes. This is due to the fact that it is through a lymphatic system and blood, cells of malignant education are capable of spreading in the body.

The following stages of the oncological process are distinguished:

A1. This is the designation for tumors identified exclusively within the limits of horizontal ducts.
IN 1. The tumor began to germinate in the walls of the organ. At the same time, adjacent tissues and lymph nodes are not yet amazed.

A2. There is a lesion of liver cells, a raging bubble or pancreas, as well as blood vessels.
IN 3. The tumor process affects the lymph nodes located nearby.
Stage 3. Pathology applies to the stomach, intestines and lymph nodes located in the abdominal cavity.
Cancer in gravel ducts in the 4 stages leads to the affect of light or other remote organs.

Sometimes after the treatment and offensive remission, cancer is able to appear again. This condition is called relapse.

At the initial stages of development in cancer, there are no symptoms. This is the deck of dear. Over time, a person starts to appear various clinical signs of the tumor. Symptoms depend on the location of education.

In practice, all patients with carcinoma violates the process of halch outflow, which is why mechanical jaundice develops.

Patients with grained duct cancer observes the yellowed of eye scool and skin cover. Urine darkens, and feces, on the contrary, becomes light.

In addition, people can disturb such symptoms:

permanent skin itching;
excessive weakness of the body;
painful sensations in the right hypochondrium;
lack of appetite, because of which the patient is much losing weight in weight.

During palpation of the right side, discomfort occurs. In this case, the doctor may mark an increase in the size of the gulb bubble, although it is impossible to identify the tumor itself.

In most cases, an increase in body temperature is not observed. However, with the development of stagnation of yellow or subsequent inflammatory process, hyperthermia is possible. In addition, the liver work is disturbed and intoxication of the body develops.

Any of the listed symptoms is characteristic not only for cancer developing in grying ducts. It confuses the doctors. First, they are usually examined on the yellow disease, cholecystitis, dyskinesia. Therefore, it is so important to consult a doctor at the first symptoms. The time to make the right diagnosis will take time.

When contacting the doctor, the patient should exactly describe the existing clinical manifestations.

At their foundation, a comprehensive examination will be prescribed, which is to carry out:

Laboratory tests. REA (oncofetal protein) and AFP (alpha-fetoprotein) in liquids allow you to reveal a possible malignant education.
Ultrasound (ultrasound examination) makes it possible to assess the state of the biliary system and determine the location of the neoplasm. It is necessary to conduct it on an empty stomach.
Computer tomography. It is considered the most informative when identifying tumor processes. In some cases, a contrast agent can be used.
Magnetic resonance tomography.
Spiral computer tomography.
Biopsy. In the area of \u200b\u200bthe amazed gorgeous duct, tissue samples are taken, which are investigated under the microscope.
Endoscopy. At the same time, a flexible tube with a camera is introduced through the esophagus.
Cholangioscopy.
Angiography. Used to examine the state of blood vessels located near the horizontal ducts.

Only on the basis of these comprehensive surveys, the doctor may diagnose the patient and determine the most effective therapy.

Harvest cancer treatment

The choice of the method of treatment with cancer in glamor ducts will depend on the degree of illness. The best carcinoma is to be treated at the initial stage, when the surrounding tissues are not yet amazed.

In connection with the inaccessibility of some parts of the biliary system, the tumor is difficult to give in therapy. The main method of treatment is surgical removal Education. At the same time, disputes are conducted on the feasibility of using radiation or chemotherapy between doctors.

At the first stage of cancer, the patient is operating, during which the damaged dummy is removed. The channels not affected by pathology are directed directly into the intestine, which makes it possible to evacuate the boots normally.

In the second stage, the removal is also subject to the liver tissue, in which the tumor managed to penetrate. If cancer is spreading to neighboring organs, the surgeon will have to operate them.

This may be:

stomach;
pancreas;
horse bubble;
small intestine;
lymph nodes.

Sometimes the tumor is detected in place, access to which is impossible. In this case, the treatment will be aimed at facilitating the suffering of the patient. This also applies to cases when the oncological process managed to significantly spread to neighboring bodies.

In order to facilitate the condition of the patient, palliative operations are carried out. With their help provide a normal outflow of yellow. During the surgical intervention, the doctor creates the channels on which the liver secret will flow into the 12-risk. If it turns out to be blocked by the neoplasm, the stomach compound with a healthy intestinal area is carried out.

Effective is also considered to steanting the grained duct when a special tube is placed that contributes to the outflow of yellow. The method has the disadvantages. The stent has to be changed every 3 months, since the tube is clogged. The need for replacement is evidenced by the increase in body temperature and the occurrence of jaundice. After surgery, the patient is prescribed a course of antibacterial therapy.

With the inoperable form of cancer, the patient may require liver transplantation.

It is not easy to get a donor organ, so the operation is rare. Mostly for transplanting use part of the liver relative. The donor body can rejected the patient's body. Therefore, patients prescribe various drugs, including immunosuppressants.

They help liver to take care, but are able to cause various side effects, among which:

deterioration of the kidney function;
development of diabetes;
development of hypertension;

bone tissue strength;
hyperholesterolemia.

To destroy a cancer tumor in some cases use radiotherapy. It consists in exposure to the place where the neoplasm is a beam of radioactive rays. Radiation therapy is used as auxiliary treatment method to reduce the risk of relapse. Exposure and when the tumor cannot be removed or has very large sizes. This allows you to slow down the distribution of cancer.

Chemotherapy is used to destroy existing cancer cells and suppressing their growth. Treatment is prescribed if there is a relapse after surgery. Chemotherapeutic agent is also recommended in cases of detecting a non-cultural tumor. Another purpose is not removed during the operation plots of the neoplasm.

Chemotherapy products are able to destroy cancer cells, but at the same time cause intoxication of the entire body.

One of the most effective ways The treatment of the disease is photodynamic treatment. For this use special photosensitizing agents. The method is reduced to the exposure to the tumor of the light wave. It acts on the drug, causing a chemical reaction. Oxygen is released, capable of destroying the tumor. In the subsequent phagocytes produced by the immune system, they neutralize the dead malignant cells.

As a result of the use of photodynamic equipment, the destruction of blood vessels, according to which oxygen was delivered to the formation and nutrients. Left without them, the tumor is dying.

Some Israeli clinics offer:

Innovative target therapy. It is based on the action of special bioactive substances that can suppress the development of cancer cells. At the same time, such substances do not affect healthy fabrics.
Hyperthermic intraperitoneal cheemosphereship. During operation, cyticostatics preparations and high temperatures are applied. There is no invasive oncological process. The method showed its effectiveness even in patients with metastases.

Treatment of innovative methods is expensive, Russia is rarely applied. Patients have to undergo therapy abroad, paying procedures from his pocket, or using the means of benefactors.

Fitotherapists argue that extend the life of the patient when diagnosing cancer in his gall ducts, can be used folk Methods Treatment.

Decoration from the root of Khrena. A piece of underground part of the plant is crushed and poured with a glass of water. Then, you need to boil on slow heat for 10 minutes. After cooling, you can add a tablespoon of natural honey from buckwheat.

The radish juice is mixed with the same amount of natural honey. Twice a day before meals you need to drink a quarter of a cup of mixture.
Decoction of their cornflowers. To make it a tablespoon of raw materials poured with a glass of water and boil for 30 minutes on slow fire. After cooling, the decoction must be strain and drink twice a day for 20 milliliters. The duration of treatment is at least 50 days.
The dried immortals, St. John's wort and corn storks are taken on 1 tablespoon and mixed. The raw materials poured 0.5 liters of boiling water and insisted under the lid at least 3 hours. The finished infusion is filtered and accepted within a month twice a day for 1 cup.
Black Belen tincture. Two large spoons of plants are crushed and poured half liters of high-quality vodka. It is necessary to insist the drug for 2 weeks in a dark place. Drink a remedy for 2 drops in the morning before meal.
An alcohol acronite tincture has a similar effect. Prepare it exactly as well as a means of black whites. Take the tincture is needed according to the scheme. On the first day, 1 drop is dissolved in a tablespoon of pure water and drink before breakfast. Further, every day the dose needs to be increased by 1 drop until the dosage is 25 drops. After, you need to reduce it by 1 drop per day. Thus, the duration of the course of therapy is 50 days. After a small break, treatment is repeated.

ethnoscience It often offers to use to the treatment of cancer poisonous plants. It is possible to start their reception only after consulting with the attending physician. At the same time, it is necessary to strictly adhere to the appointed dosage.

Forecast for life

As with any oncological disease, the prediction for the patient depends on the stage of cancer, the age of the patient and the presence of associated pathologies. If we speak in general, the carcinoma of gall ducts doctors refer to neoplasms with a bad forecast.

Wherein:

When identifying pathology at an early stage, the patient will be able to live for another 3-5 years. However, to identify the disease at the very beginning of its development it is rare. This is mainly happening by chance when examining a relatively different disease.
In patients with diagnosis of gravel duct cancer, lifespan after the operation is about 1-2 years. The fact is that even radical treatment is not always effective. Operational interventions are accompanied by a risk for the patient. Often there are abscesses or sepsis, which worsen the forecast.
Without the operation, a person dies over the next 6 months.

Get rid of grain ducts, according to statistics, approximately 15% of patients are possible. Most of them discovered a tumor in the early stages.

Doctors insist on a timely examination of the body, when any unpleasant symptoms appear. Every year it is recommended to undergo a prophylactic ultrasound study of the abdominal cavity, which will also allow to identify pathology.