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home - Biliary - Biliary Cancers - Gallbladder Cancer Written by Dr Sebastian Zeki
Knowledge


Knows the epidemiology pathology and clinical presentation of bile
duct tumours

Can recognise the presentation of biliary tumours arising de novo or
in the context of PSC Can plan programme of investigations
including detailed staging

Understands treatment options including surgery chemotherapy and
endoscopic management

Skills
Aware of the treatment options including biliary drainage
chemotherapy radiotherapy photodynamic therapy or surgery

Understands rationale for selection of particular therapy in individual
patients

Awareness of the diagnostic modalities including CT MRI scanning
brush cytology intra ductal cholangioscopy and biopsy

Behaviours
Understands importance of multidisciplinary team of oncologist
surgeon radiologist histopathologist in decision making

Discusses cases with the specialist MDT

Gallbladder Cancer

Gallbladder cancer Clinical PresentationIt is usually asymptomatic.Patients can present with chol-ecystitis complex with weight loss.It can present with jaundice and symptoms of spread. Molecular Pathogeneses:Chronic irritation (bile from high gallstone areas is more mutagenic).Anomalous pancreaticobiliary duct junction- this is associated with k-ras and p53 mutations- different to gallstone related GBC- epithelial hyperplasia is the first lesion.It takes 15yrs for dysplasia-CIS- invasion progression. Histological featuresThey are usually adenocarcinomas.Macroscopically they are infiltrative, nodular, papillary or a combination.Papillary carcinomas have the most favorable prognosis.As no muscularis early invasion is common. Carcinogen exposure — Workers in the oil, paper, chemi-cal, shoe, textile, and cellulose acetate fiber manufacturing industries and radon exposed miners. Incidence of GBC if cholelithiasis=2%Risk high with larger gallstones and duration of gallstones Gallstones present in 70-90% Malignancy rate of 35% Porcelain Gallbladder Gallbladder polyps Larger ones can carry a focus of cancerNot usually inflammation related Salmonella: Chronic carriage - use gallstones as a nidus Helicobacter pylori: Impli-cated as H. P. cytokeratins and surface protein found in GBC Biliary cysts- usually risk of chol-angio rather than GBC Abnormal pancreaticobiliary duct junction Pancreatic duct inserts high up therefore get reflux and chronic irritationProhylactic cholecystectomy recommended Medications:Methyldopa/OCP/Isoniazid Resectable Unresectable Cholecystectomy + en bloc hepatic resection and lymphadenectomy +/- bile duct excision 5-FU based chemotx/RT orsupportive care Mets Biliary decompression/ Clinical trial/Gemcitabine and/or 5 FU based chemotx Post resection Consider 5FU or gem-citabine chemo +/- RT (except T1,N0) Image every 6 months for 2 years USS Poor sensitivity and specificity-Mural thickening or calcification,-Mass protruding into the lumen-Fixed mass in the gallbladder,-Gallbladder-liver interface loss-Direct liver infiltration.CT and MRI: Similar findings to USSMRI can distingiush benign from malignant polypsEndoscopic ultrasound — Good for TN staging and allows bile collection (70% sensitive for GBC diagnosis). EpidemiologyIt is the most common biliary tract cancer.GBC is the most common GI malignancy in both Southwestern Native Americans and in Mexican Americans.Geographical incidence is the same as that for gallstones.It is more common in elderly and females. Radiology Written by Dr Sebastian Zeki Staging — TNM or Nevin staging

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