Gallbladder cancer overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
Overview
Classification
Gallbladder cancer may be classified according to histology findings into various subtypes and are as follows Adenocarcinoma, Papillary adenocarcinoma, Mucinous adenocarcinoma, Signet ring cell carcinoma, Adenosquamous carcinoma, Squamous cell carcinoma, Neuroendocrine carcinoma, Small cell carcinoma, Undifferentiated carcinoma, Spindle cell undifferentiated carcinoma, Gaint cell undifferentiated carcinoma.
Pathophysiology
It is understood that GBC is the result of persistent irritation of the gallbladder mucosa over a period of years which predispose to malignant transformation or act as an enhancer for carcinogenic exposure.The primary mechanism involves cholelithiasis and resultant cholecystitis and appears to be the driving force in most areas of the arena.Chronically inflamed gallbladder may additionally express both pyloric gland and intestinal metaplasia.But, fluke-infested gallbladders more commonly shows intestinal metaplasia and p53 mutations than sporadic gallbladder cancers.Dysplastic lesions have molecular genetic proof that supports progression towards CIS.There are also histologic and molecular differences in GBCs related to anomalous pancreaticobiliary duct junction and in the ones related to gallstones, Providing further proof that two different pathogenetic pathways are involved.Less than 3% of early gallbladder carcinomas have adenomatous remnants, indicating this mechanism has less importance within the carcinogenic pathway.
Epidemiology and Demographics
Around 80 t0 95% of biliary tract cancers are gallbladder cancers.Epidemiological research has recognized striking geographic and ethnic difference. An excessive incidence in American Indians and Southeast Asia, but pretty low in the America and the arena.
Risk factors
Gallstones, Porcelain gallbladder, Gallbladder polyps, Primary sclerosing cholangitis (PSC) , Chronic infection, Congenital biliary cysts, Pancreaticobiliary maljunction (PBM)
Screening
There is no screening recommended for gallbladder cancer. According to the National Comprehensive Cancer Network (NCCN) guidelines, gallbladder cancer may be diagnosed as an accidental finding in patients who undergo laparoscopic cholecystectomy.
Differential Diagnosis
Gallbladder cancer must be differentiated from hepatitis, gallstones, cholecystitis, peptic ulcer, pancreatic cancer and pancreatitis.
Natural history, Complications and prognosis
Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor.Most tumors are adenocarcinomas, with a small percent being squamous cell carcinomas. The cancer commonly spreads to the liver, pancreas, stomach and duodenum. The survival rate depends on the extent of cancer at the time of diagnosis with gallbladder cancer and Early detection is key for good prognosis.
Staging
According to the AJCC, there are 4 stages of gallbladder cancer based on the tumor spread.
History and symptoms
Symptoms of gallbladder cancer include jaundice, pain, fever, burping and weight loss.
Laboratory findings
Laboratory findings consistent with the diagnosis of gallbladder cancer include abnormal liver function tests and elevated CA 19-9 and CEA levels.
CT
On abdominal CT scan, gallbladder cancer appears as large heterogeneous mass with areas of necrosis.
MRI
MRI combined with magnetic resonance cholangiography may be helpful in the diagnosis of gallbladder cancer metastasis.
Other imaging findings
PET scan may be helpful in the diagnosis of gallbladder cancer.
Medical therapy
The therapy for gallbladder cancer depends largely on the disease progression and the stage of cancer.
Surgery
The mainstay of therapy for gallbladder cancer is surgery.
Palliative treatment
Palliative therapy in gallbladder cancer involves percutaneous transhepatic radiologic catheter bypass or endoscopically placed stents, standard external-beam radiation therapy, palliative surgery or standard chemotherapy.
Primary Prevention
Research suggests that lifestyle factors such as changes in diet, exercise, and maintenance of weight can influence the likelihood of an individual developing gallbladder cancer.