Symptom control in advanced gallbladder cancer: pain, ascites and nutrition

Right upper quadrant and back pain from hilar and coeliac node involvement responds to opioid titration under the usual analgesic ladder. Neurolytic coeliac plexus block, tested in a 100-patient double-blind randomised trial in unresectable pancreatic cancer, lowered pain scores more than opioids alone (p 0.005) without changing opioid consumption, quality of life or survival; it is used for the same upper abdominal visceral pain in biliary cancer by extension, and can be done under endoscopic ultrasound or CT guidance. Malignant ascites from peritoneal spread is drained by paracentesis, and a tunnelled peritoneal catheter allows home drainage when taps are needed more than every few weeks; in a 94-patient series insertion succeeded in all, with catheter infection in 2 percent, leakage in 4 percent and occlusion in 2 percent, and median survival after insertion of 1.7 months, which places the procedure late in the illness. Cachexia and biliary obstruction both impair nutrition: fat malabsorption from obstructed bile flow and duodenal obstruction should be treated (stenting, pancreatic enzymes where indicated) before appetite stimulants are considered, and early integrated palliative care is the standard framework. UK care is delivered through hepatobiliary multidisciplinary teams with specialist palliative care referral; there is no gallbladder-specific supportive care trial.