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.
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Early stage :Polypoid mucosal mass.
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Late stage : Mass infiltrating GB fossa.
Staging or Grading Criteria.
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Stage 1: Carcinoma confined to mucosa.
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Stage 2: Carcinoma involves mucosa and muscularis.
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Stage 3: Carcinoma extends to serosa.
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Stage 4: Transmural involvement with positive nodes.
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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.
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Unfortunately most of the patients already have metastasis at point of diagnosis, so prognosis is very poor.
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1--year survival : 80%
5--year survival :1-5%.
Some common treatment includes but not limited to; Radical cholecystectomy and/or partial hepatectomy.
