ca Gall bladder

2. Dr Muhammad Asif Raza
MCPS-HPE

3.  70 year F presented with H/O multiple episodes of
pain RHC and anemia
 Managed in ER multiple times with analgesics and
send home on oral antibiotics
 Remained admitted in medical ward for anemia and
got multiple transfusions
 Usg abdomen showed suspected mass GB
 LFT/ RFT normal

4.  CECT Abdomen/Pelvis
 CECT Scan Chest normal
 CA 19-9 normal
 Mass GB fundus, no lympadenopathy, no mets in
abdomen/pelvis
 Stage T2-3 NoMo

5. •Relevant anatomy
• Introduction
• Epidemiology
• Etiology/Pathophysiology
• Presentation
• Workup
• Treatment
• Follow Up
Conclusion

10.  Gallbladder carcinoma was first described by
Maximilian Stoll in 1777
 G.B cancer is relatively uncommon but it is the 5th
most common GIT malignancy(worldwide)
 most frequent malignant tumor of the biliary tract
 90 % Adenocarcinomas.

11.  Adenomatous polyps
 Tubular adenomas
 Adenomyomatosis

12.  Incidence 1 to 23 per 100,000 worldwide
 The highest incidence is from the Indian-
Subcontinent including India and Pakistan 18-
23/100,000
 A relatively rare malignancy worldwide but second
commonest gastrointestinal cancer in Pakistani
women
 Most common cause of gastrointestinal cancer related
mortality in females in subcontinent

13.  Frequency of gallbladder cancer in Pakistan varies
between 6-7%
 Female to male ratio is 3:1
 Peak incidence is in 7th decade of life

14.  Gallstones are present in 60-90 % of GB cancer cases
(World wide)
 In Pakistan 98-100 % of cases of GC have gall stone
 Risk factors include
 Chronic inflammation and infection, Porcelain Gallbladder
 Typhoid carrier, Multiparity (>5)
 Adenomatous polyp ,Advanced age(>55 yr.)
 Presence of gallstone larger than 1-3cm.
 Anomalous pancreatobiliary junction
 Drugs :OCP, methyldopa

15.  Occupational exposure rubber, cigarette smoking
 Bile acid composition.
 Diet: low fiber, low calories.
 Excess body weight
 39-59% are associated with the K-ras mutation
 90% are associated with p53 mutation

16.  Asymptomatic
 Symptomatic Cholecystitis or biliary colic.
 Jaundice and anorexia are late features
 Palpable mass is a late sign
 Given this presentation, less than 50% of gallbladder
cancers are diagnosed preoperatively.
 Many are diagnosed incidentally in gallbladders
removed for biliary colic or cholecystitis.

17.  Ultrasonography
 findings that indicate possible malignancy
 – a thick gallbladder wall,
 – vascular polyp,
 – a mass projecting into the lumen or invading the
wall, multiple
 masses or a fixed mass in the gallbladder,
 – a porcelain gallbladder, and an extra-cholecystic
mass. Invasion of the liver can also be

19.  Computed tomography (CT) scan
 Asymmetrical wall thickening or gallbladder mass
with or without invasion into the liver.
 CT scanning of the chest, abdomen, and pelvis is a
common staging
 Positron emission tomography (PET) scanning has a
sensitivity of 75% and a specificity of 88%

21.  spreads via the lymphatic channels and venous
drainage
 Peritoneal metastasis common
 Due to adjacent location liver, bile duct, portal
 vein, hepatic artery, duodenum, and transverse
 colon involvement is common

28.  T2NoMo
 Stage II
 Radical Cholecystectomy with lymphadenectomy
done
 Post op course un eventful
 Discharged on day 5
 Histopathology pT2NoMo stage 2
 Planning for adjuvant chemo for 6 months

36.  STAGE 5 YEAR SURVIVAL RATE
 T1b 100% especially with Hepatectomy
 T2 50% to 77% after Radical cholecystectomy
 III and IV 25 % with extended resection
 Unresectable disease < 5% ( 1 year survival rate)

37.  Fluoropyrimidine-based chemo radiotherapy
 Single-agent chemotherapy with fluoropyrimidines
 Gemcitabine

38.  Never overlook anemia in old patient