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gallbladder cancer

Etiology: (associated factors) 1) genetic predisposition 2) gallstones 3) gallbladder polyps 4) calcification of the gallbladder wall (porcelain gallbladder) 5) bile composition 6) environmental carcinogens 7) infections (Salmonella typhi) 8) drugs Epidemiology: 1) greatest incidence in patients > 65 years of age 2) female/male ratio is 3/1 3) most common biliary tract cancer, but still uncommon [3] - < 5000 cases yearly 4) highest incidence rates & mortality occur in Chile [3] Pathology: - commonly diagnosed at a late stage when prognosis is poor [2] Clinical manifestations: 1) may resemble biliary colic or cholecystitis 2) abdominal pain is the most common initial complaint - pattern of pain is variable 3) may be asymptomatic 4) nausea/vomiting 5) anorexia 6) weight loss 7) jaundice may occur 8) a palpable mass may be felt 9) ascites may occur Laboratory: 1) serum chemistries a) alkaline phosphatase may be elevated b) bilirubin may be elevated 2) tumor markers a) CEA may be elevated, but is not diagnostic b) CA 19-9 may be elevated, but is not diagnostic Radiology: 1) abdominal ultrasound a) thickening of gallbladder wall b) gallbladder mass c) calcification of gallbladder (porcelain gallbladder) 2) computed tomography 3) MRI cholangiopancreatography - ability to detect liver involvement - presence of regional lymph node & distant metastases - assessment of potential resectability Management: 1) surgical resection (cholecystectomy) a) only intervention that can result in a cure b) 80% of patients have unresectable disease at the time of cholecystectomy 2) chemotherapy does not improve survival 3) radiation does not significantly improve survival

Related

cholecystitis cholelithiasis (gallstones)

General

biliary carcinoma

References

  1. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  2. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17. American College of Physicians, Philadelphia 2009, 2012, 2015
  3. Eslick GD. Epidemiology of gallbladder cancer. Gastroenterol Clin North Am. 2010 Jun;39(2):307-30, ix PMID: 20478488
  4. National Cancer Institute Gallbladder Cancer - Health Professional version https://www.cancer.gov/types/gallbladder/hp