Enlarged lymph nodes
All around the gallbladder and throughout the abdomen there are plenty of lymph nodes. Those small bean-shaped glands are part of the lymphatic system. They help control infection by filtering the lymphatic fluid. They also remove anything not belonging to the body (bacteria or viruses).
But there is a twist: Those nodes are the first place cancer cells visit when they break away from a tumour. Most surgeons remove the nodes during cancer surgery to have them analysed by a pathologist. There are certain lymph nodes a doctor would look at if he is suspecting gallbladder cancer, especially the Virchow’s node and the Sister Mary Joseph’s nodes.
The Virchow’s node is a lymph node located in the area above the left clavicle. It is linked to the lymph vessels in the abdominal cavity. Doctors have a particular nickname for Virchow’s node: “the seat of the devil”. That is due to its apparent association with malignant disease. If a patient finds an enlarged, hard node, there is a strong possibility for the presence of gastric cancer in the abdomen. That indicates, besides, it has spread through the lymph vessels.
The Sister Mary Joseph’s nodes are rather uncommon, and appears when there’s umbilical metastasis. It is pretty impressive that Sister Joseph’s nodule appears as an early symptom of a malignoma (sometimes it is the only one). In most cases, the primary tumour remains occult. There are reports of patients with a few months history of a tender, painful nodule on the umbilicus area. Patients are apparently normal for the rest, but later cytologic examination confirmed the diagnosis of metastatic adenocarcinoma of the gallbladder.