Gallbladder Cancer

Reham Khalilieh4th year Medical Student

Surgical Round- Shaare Zedek Medical Center, Jerusalem

Anatomy (Reminder)

Introduction and Epidemiology

^Uncommon ^Aggressive Malignancy

^Poor Prognosis

^Age ^Women > Men

^Caucasians > Blacks ^South American Countries, India, Pakistan, Japan

Risk Factors

^Gallstone Disease- porcelain gallbladder ^Gallbladder Polyps

^Chronic Infection- Salmonella, Helicobacter ^Abnormal pancreaticobiliary duct junction

^Medications- Methyldopa, Isoniazid ^Carcinogen Exposure- oil, paper, radon

^Obesity ^Diabetes

Abnormal pancreaticobiliary duct junction

Pathogenesis and Staging

^Metaplasia-Dysplasia > CIS >Invasive Adenocarcinoma

^TNM staging system

American Joint Committee on Cancer Staging of Gallbladder Carcinoma

Primary Tumor (T stage)T1Tumor invades lamina propria or muscle layer  T1a: Tumor invades lamina propria  

T1b: Tumor invades muscle layerT2Tumor invades perimuscular connective tissueT3Tumor perforates serosa or directly invades one adjacent organ (extension £2 cm into liver)T4Tumor extends ≥2 cm into liver and/or into two or more adjacentRegional Lymph Nodes (N Stage)N0No regional lymph node metastasisN1Metastasis in cystic ductal, pericholedochal, and/or hilar lymph nodesN2Metastasis in peripancreatic, periduodenal, periportal, celiac, and/or superior mesenteric lymph nodesDistant Metastasis (M Stage)M0No distant metastasisM1Distant metastasis

TNM Stage Grouping

Stage I T1 N0 M0Stage II T2 N0 M0Stage III T3 N0 M0 or 

T1-3 N1 M0Stage IVA T4 N0-2 M0Stage IVB T1-4 N0-2 M1

Metastases ^GBC spreads via both lymphatic and venous vessels

^GBC frequently extend directly into the hepatic parenchyma

^Lymphatic spread: Calot's lymph node >> pericholedochal and hilar nodes >> peripancreatic, duodenal, periportal, celiac, superior mesenteric nodes

Clinical Presentation ^Early invasive GBC are asymptomatic OR

cholelithiasis / cholecystitis like symptoms

^Symptomatic patients

^Duodenal Obstruction

^Rare symptoms

Diagnosis ^US

Diagnosis ^CT

Treatment

^Gallbladder polyp

Treatment cont.

^Gallbladder Cancer Following Cholecystectomy

Treatment cont.

^Patients suspected of having GBC preoperatively

Treatment cont.

^Patients with advanced disease at presentation

Survival ^Overall survival of gallbladder cancer is less

than 15% ^T1a > Excellent prognosis

^T2 > 20-60% (5-year survival) ^T3 > less than 20%

^T4 > Months

^Patients with metastatic disease at presentation > 13 months

THANK YOU!