Professional Documents
Culture Documents
DR AMOL KUMAR
DR HARI KISHAN
Epidemiology
-The incidence of Gall Bladder cancer is extremely
variable by geographic regions & racial-ethinic groups
-Incidence
-Highest- Chileans, Northeastern Europeans, Israelies,
American Indian & Americans of Mexican origin
-Intermediate- Japan
-Lowest- Black Zimbabweans Black Americans
& the People of Spain & India
- Sex- M:F::1:2-6
- Age - incidence ↑ with age, reaching its maximum in
the seventh decade of life
Risk Factors
-Cholelithiasis usually cholesterol type stones
-Anomalous pancriaticobiliary duct junction
-Chronic typhoid infection
-Inflammatory bowel diseases
-Porcelain gallbladder
- Chemicals like methyldopa oral contraceptives
isoniazid chemicals used in rubber industry
- Gall bladder Polyps
Etiology
-It is likely to be the chronic inflammation that
predisposes to neoplasia, regardless of the
cause of inflammation
-A higher concentration of free radical oxidation
products and a higher conc. Of sec.bile acids
Pathologic features
Ca gallbladder
Ca gallbladder
from a chronically
inflamed but benign gb
- Tumor to be disseminated
by cholicystectomy
Histopathological classification
MALIGNENT EPITHELIAL TUMORS MALIGNANT MESENCHYMAL
(99%) TUMORS
Adenocarcinoma Embryonal rhabdomyosarcoma
Well-differentiated Leiomyosarcoma
Papillary Malignant fibrous histiocytoma
Intestinal type Angiosarcoma
Pleomorphic giant cell Oat cell carcinoma
Poorly-differentiated, small cell
Signet ring cell
Clear cell
Colloid
With choriocarcinoma-like areas
Squamous
Adenosquamous
Oat cell carcinoma
TUMOUR BIOLOGY
Activation of
protoncogenes
Cell Tumor
Inactivation of
tumour
separessor genes
- Surgical-
T1diseases-
1. Most often presents after the gall bladder has already been removed by simple
colecystectomy for presumed gall stone disease.
2. Reviewed pathologic findings to ensure that margins are negative
3. Particular attention is paid to the cystic duct margin
-ve - no other therapy
- Margin <
+ve – common bile duct excision & biliary reconstruction
4. 5 years survival rate is 85% to 100%
Management contd.
T2 diseases-
-Chemotherapy
-CT – 5FU – based CT is usually given in conjunction with concurrent RT both in
the adjuvent and palliative settings
-Adriamycin, mitomycin cisplatin can have some role in management of Ca GB
PALLIATIVE MANAGEMENT
-The goal of palliation
-Relieve of pain, jaundice and bowel obstruction
-Prolongation of life
-Decisions on palliative treatment should take into account
the short survival of patients with non resectable gall
bladder cancer. Therefore all palliation treatment should be
simple as possible
PROPHYLACTIC CHOLECYSTECTOMY
-GB polyps > 10 mm size
-Porcelain GB
-High risk situation that serum CA 19-9 elevation and bile
cytology helpful in making a pre operative diagnosis of
carcinoma GB