Gallbladder cancer or gallbladder carcinoma
Radiologically detection of gallbladder cancer- white and black arrows
What is gallbladder cancer ?
Gallbladder cancer is a malignancy that is affecting the gallbladder.
What cause gallbladder cancer and what is the associated factor ?
The cause of gallbladder cancer remains unknown however it is associated with strong association with gallbladder disease in 80% of patient. A porcelain bladed gallbladder ( due to chronic cholecystitis ) has an increase incidence of developing into malignancy. May also be associated with choledochal cysts and primary sclerosing cholangitis.
What is the epidemiology of gallbladder cancer ?
It is the fifth most common gastrointestinal malignancy most commonly affect people age more than 65 years of age. Female to male ratio is 2-3 :1.
How does gallbladder cancer present ?
It is usually discovered incidentally on investigation for gallstone disease. The patient may present with symptoms mimicking gallstone disease, right upper quadrant abdominal pain, nausea and vomiting. Other features include weight loss, anorexia, jaundice , abdominal distension and pruritus.
while examining the patient may present with right upper quadrant mass.
What is the pathology behind gallbladder cancer ?
90% are adenocarcinoma , 5% are squamous carcinomas and 5% is anaplastic carcinomas. They appear as gallbladder wall thickening and induration. Most common sites are at the fundus and neck of the gallbladder.
Spreads: Local direct invasion into the hepatic bed, lymphatic spread into the cystic nodes, hiatal nodes and then to the superior and posterior pancreaticoduodenal nodes and the periaortic nodes.Blood borne spreads via the portal vein to the liver.
How to investigate gallbladder cancer ?
Abdominal ultrasound scan : may shows gallbladder wall thickening or a mass filling the gallbladder , which would be suggestive of malignancy.
CT or MRI scan : show a mass in the region of gallbladder.
Arteriographic CT portogram ; Where contrast is injected into the superior mesenteric artery , allows accurate measurements of the extent of the disease and is resectability.
How to manage gallbladder carcinoma ?
Surgical : Simple cholecystectomy for tumours confined to the mucosa or sub mucosa. For tumours invading the muscularis , cholecystectomy with hepatic wedge resection, resection of the cystic duct and en bloc dissectio of regional lymph nodes in early stage disease. If pericholedochal nodes are involved the common bile duct maybe resected with restoration of biliary enteric continuity with a Roux- en - Y heapticojejunostomy. Surgery is inappopriate for advance disease.
Chemotherapy or radiotherapy ; Some agents have partial response (5 fluorouracil). Radiotherapy is also used.
Palliative : Most therapy is directed at symptomatic relief. Obstructive jaundice can be managed with endoscopic or percutaneous stenting. Pain relief is a prime concern, and may be helped by percutaneous coeliac nerve block or chemical splanchnicetomy.
What is the complication of gallbladder carcinoma ?
The complication of gallbladder carcinoma includes obstructive jaundice and pain from disease and biliary peritonitis, haemorrhage and ascending cholangitis.
What is the prognosis of gallbladder carcinoma ?
With the exception of case detected incidentally at cholecystectomy, prognosis is poor as many are detected late and are not amenable to surgical resection. Overall 5 years survival is less than 15 %
carcinoma of gallbladder
survival statistic for gallbladder cancer
What is gallbladder cancer and what is the treatment ?
Resection of gallbladder carcinoma
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