Gallbladder Cancer

Gallbladder Carcinoma

Definition: Malignant Epithelial neoplasm arising from gallbladder mucosa.

Epidemiology: Though uncommon, GB carcinoma is the 5th most common GI cancer, and the most common primary biliary cancer. 75% of the population affected are older women >60 years of age with long standing cholecystolithiasis. F:M ratio=4:1.

Etiology: Porcelain gallbladder, chronic cholecystitis, and long standing cholelithiasis predisposes to GB carcinoma.

Pathology: 90% of GB carcinoma are adenocarcinoma and the rest 10% are squamous cell carcinoma.
..
Early stage :Polypoid mucosal mass.
..
Late stage : Mass infiltrating GB fossa.

---

Staging or Grading Criteria.
....
Stage 1: Carcinoma confined to mucosa.
.....
Stage 2: Carcinoma involves mucosa and muscularis.
.....
Stage 3: Carcinoma extends to serosa.
.......
Stage 4: Transmural involvement with positive nodes.
........
Stage 5: Liver or distant metastasis.

---

Clinical Signs & Symptoms.
RUQ pain, Weight loss, Jaundice, elevated bilirubin levels and alkaline phosphatase, biliary obstruction.

---

Ultrasound Findings.

• Intraluminal moderately echogenic gallbladder mass >1cm.
  ......
• Asymmetric GB wall thickening and/or destruction of GB wall.
  .......
• Mass infiltrating GB fossa.
  .......
• Presence of Gall stones 70-90% in GB carcinoma cases.
  .......
• Regional metastatic lymphadenopathy (early stage of disease).
  .......
• Liver metastasis.
  .......
• Biliary obstruction /dilatation, tumour extension to hepatic confluence, extrinsic compression by enlarged regional lymph nodes.
  ........
• Color Doppler will show hyper-vascularity within the mass.

---

Differential Diagnosis.

• GB polyps, GB Adenomyomatosis, Xanthogranulomatous Cholecystitis, Chronic cholecystitis, and metastatic disease to GB fossa.

---

Treatment and Prognosis.
......
Unfortunately most of the patients already have metastasis at point of diagnosis, so prognosis is very poor.
.......
1--year survival : 80%
5--year survival :1-5%.
Some common treatment includes but not limited to; Radical cholecystectomy and/or partial hepatectomy.