2. INCIDENCE
• Increases with age
• 2-6 times common in women
• Common among population in
– Western South America
– Northern India
– North American Indians
– Mexican Americans
4. APBDJ
• It is more common in Asian countries
• GB cancers with APBDJ
– Tend to occur at an younger age
– Lesser degree of female preponderance
– Asociated less often with cholelithiasis
– High prevalence of K-ras mutations & a late onset
of p-53 mutations
– High prevalence of premalignant epithelial
hyperplasia with a papillary or villous histology.
5. CANCER & CALCULI
• Gallstones are present in 70-90% of patients
diagnosed with GB cancer
• Only 0.5-3% of patients with cholelithiasis will
develop GB cancer
• Risk of GB cancer is increased with increasing
size & duration of cholelithiasis
10. USG
• Mural thickening
• Mural calcification
• GB mass >1 cm
• Loss of normal GB wall-liver interface
• Gall stones
• Polyps
11. CECT
• Mass protruding into the GB lumen
• Mass completely replacing the GB
• Focal or diffuse thickening of GB wall
• Presence or absence of distant metastasis
• Regional lymph node involvement
• Local invasion into liver & porta hepatis
12. STAGE 0 & 1A
• Carcinoma in situ & T1-cancer that doesnot
extend beyond the GB muscularis
– Simple cholecystectomy
13. STAGE 1B
• T2 lesion- invasion into perimuscular connective
tissue of GB
– Re-exploration revealed residual disease in 40-76%
– Regional lymphnode metastasis in 28-63%
• Exploration with en bloc resection of the GB with
2 cm of adjacent liver(non-anatomoic) with
regional lymphadenectomy of the hepatoduodenal
ligament
• En-bloc resection with anatomic resection of liver
segments 4b & 5
14. STAGE II
• T3 Lesion-locally advanced cancers that
perforate the GB serosa or directly involve the
liver or adjacent organ
• Hepatic resection encompassing segment 4b
& 5 or trisegmentectomy with adjacent organs
15. STAGE III & IV
• Unresectable
• Median survival with unresectable disease is
less than 6 months
• If detected intraoperatively
– Radio-opaque clips
– No data to support debulking cholecystectomy
16. PROGNOSIS
• 5-year survival rate is 5%
• Median survival 12 months(stage IA-III)
• Median survival 5.8 months(stage IV)
17. WHY POOR PROGNOSIS?
• Usually diagnosed at a late stage
• Aggressive nature
• Clinical presentation mimics that of biliary
colic/chronic cholecystitis
• Incidental diagnosis at surgery
• Incidental diagnosis after pathology report
18. SURVIVAL RATE
S.NO STAGE 5 YR.SURVIVAL RATE
1 I 60%
2 II 39%
3 III 15%
4 IV 1%
Median survival 12 months(stage IA-III)
Median survival 5.8 months(stage IV)
NCCN guidelines 2010