Gallbladder carcinoma

Gallbladder carcinoma is uncommon and mostly occurs in later life. 



Gallbladder cancer mostly originates in the glands lining the surface of the gallbladder and is an adenocarcinoma.



Gallstones are thought to be linked to the formation of cancer. 

Most are found at exploration and are not found preoperatively.

Is the most common and aggressive type of all biliary tract cancers.

Most common biliary malignancy and the fifth most common gastrointestinal malignancy.

Occurs in 2.5 per 100,000.

Approximately 5000 cases of gallbladder cancer diagnosed annually in the U.S.

Incident steadily increases with age.

Late stage diagnosis is increasing and early-stage diagnosis is decreasing.

Rates of gallbladder cancer have been decreasing in men since the 1970s, but the same is not true for women.

More common in women and more common in the white women.

Risk factors include being a woman, older age, obesity, poor diet, a personal or family history of gallstones and long-lasting infection and inflammation of the gallbladder.

Other risk factors for gallbladder carcinoma include:  large (>1 cm) gallbladder polyps and having a highly calcified porcelain gallbladder.

In Chile most common cancer in men and second most common cancer in women.

In American Indians in New Mexico, gallbladder cancer mortality rates are 8.9 for 100,000 surpassing those for breast and pancreatic cancers.

Gallbladder cancer is classified into four stages based on the depth of invasion into the gallbladder wall and extensive spread to surrounding organs and lymph nodes.

See gallbladder cancer staging.

The stage of the tumor is the strongest prognostic factor: five years survival rates are 60%, 39%, and 15% for patients with 0, I and Iii disease, respectively, whereas corresponding survival rates are only 5% and 1% for patients with stage III and IV disease, respectively.

Median survival in a retrospective analysis of 435 patients revealed a median overall survival of 10.3 months for an entire cohort of patients.

Curative resections are possible in only 20-40% of cases.

Often diagnosed at advanced page because of the aggressive nature of the malignancy as it can spread rapidly.

Late diagnosis attributed to clinical presentation that mimics biliary colic will chronic cholecystitis.

Not an uncommon finding for diagnosis to be incidental at the time of cholecystectomy for a benign gallbladder disease, or more frequently on pathological review following cholecystectomy for symptomatic cholelithiasis.

Only 10 – 15% of cases develop distant metastasis prior to locoregional recurrence, indicating that primary post-operative failure is locoregional.

Locoregional red4currence is the major cause of tumor related mortality.

Jaundice in a patient with gallbladder cancer is usually associated with the poor prognosis as the diagnosis is likely to be advanced, and there is a significantly lower disease specific survival at six months versus 16 months than in patients without jaundice.

Characterized by local and vascular invasion, regional lymph node metastases and distant metastases.

Associated with a shorter median survival time, shorter time to recurrence, and shortest survival duration after recurrence than hilar cholangiocarcinoma.

Only 5% of patients with gallbladder cancer survive 5 years.

Ultrasound, CT, or MRI of the chest, abdomen, and pelvis recommended to evaluate tumor penetration within the wall of the gallbladder and to determine the presence of nodal and distant metastases, and to detect extent of direct tumor invasion or other organs/biliary system or major vascular invasion.

PET scan may be useful to detect lymph node metastasis and and distant disease.

Patients with jaundice should have cholangiography to evaluate for hepatic and biliary invasion of tumor.

Noninvasive magnetic resonance cholangiography isvunknown preferred over endoscopic retrograde cholangiopancreatography or percutaneous trans hepatio cholangiography.

he will percutaneous transhepatic Karen geography.

The most prevalent risk factor is cholelithiasis with the presence of chronic inflammation in the gallbladder.

The risk increases with stone size.

Calcification of the gallbladder, a result of chronic inflammation of the gallbladder, is regarded as a risk factor.

The risk of developing gallbladder cancer in patients with gallbladder calcification is 6% compared with 1% of patients without gallbladder calcifications.

Other risk factors for gallbladder cancer include pancreaticoiliary duct junctions, gallbladder polyps, chronic typhoid infection, adenomyomatosis of the gallbladder, and inflammatory bowel disease.

Prophylactic cholecystectomy may be beneficial for patients who are at high risk of the developing a gallbladder cancer.

Simple cholecystectomy is an adequate treatment for mucosal gallbladder cancer.

Encountered in approximately 1.1% of laparoscopic cases.

Most patients have symptomatic cholelithiasis.

Frequent nausea, anorexia, abdominal pain and fatty food intolerance leads to incorrect diagnosis of benign biliary disease in as many as 50% of patients.

Associated with gallstone disease, advanced age, female sex, and genetics.

Open cholecystectomy is accepted primary therapy for T1N0M0 gallbladder cancer.

T1a tumors following a simple cholecystectomy has a long-term survival rate approaching 100%.

Complete resection with negative margins is the only therapy for the cure in patients with gallbladder cancer.

Optimal resection consists of cholecystectomy with a limited hepatic resection of segments IVB and V, and portal lymphadenectomy to encompass the tumor with negative margins.

Lymph node resection should include the porta hepatis, gastrohepatic ligament, and retro duodenal regions.

Cholecystectomy combined with hepatic resection and lymphadenectomy improve survival for patients with T2 or higher tumors, but no definite evidence exists for benefits of more radical resection over simple cholecystectomy for patients with T1b tumors.

Major liver resection and bile resection increase morbidly without improvement in survival.

Higher T and N stage, poor differentiation, and common bile duct involvement predict poor disease specific survival.

Major hepatic resection and common bile duct excision increase overall perioperative morbidity by 53% and are not associated with long-term survival.

Among patients with incidental finding of gallbladder cancer immediate resection rather than referral to a tertiary cancer center for radical resection is not associated with impaired survival.

Typically present with advanced disease and associated with a poor prognosis.

Advanced gallbladder cancer treated with gemcitabine and capecitabine associated with a 31% response rate, 42% stable disease and 14 month median survival.

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