Gallbladder cancer

1. Gallbladder Cancer
Mohammad Saraireh
School of Nursing
The Hashemite University
2021/2022

2. Introduction:
 Gallbladder cancer (GBC) is an uncommon but highly fatal
malignancy
 The fifth most common cancer of the gastrointestinal(GI) tract
 The majority are diagnosed incidentally in patients undergoing
exploration for cholelithiasis
 The poor prognosis associated with GBC is thought to be related to
advanced stage at diagnosis, which is due both to the anatomic
position of the gallbladder, and the vagueness and non-specificity of
symptoms
 Women develop gallbladder cancer 5 times more often than men,
similar to the incidence of gallstones.

3. Incidence and Prevalence :

4. Risk factors
 Female sex
 Age
 Postmenopausal status
 Cigarette smoking
 Overweight and obesity
 Gallbllader stones
 More than 90% of individuals with gallbladder cancer have
coexistent chronic cholecystitis (inflamed gallbladder) and
cholelithiasis (gallstones).
 Patients having gallstones greater than 3 cm have 10 times greater
risk of developing gallbladder cancer. It is presumed that the large
gallstones have been present for a long period of time, causing chronic
irritation of the gallbladder wall and thus predisposing it to the
development of carcinoma

5. Risk factors
 in a case-control study from Shanghai that included 368
patients with GBC and 959 healthy controls, individuals with
symptomatic gallbladder disease (gallstones or self-reported
cholecystitis) were 34-fold more likely to develop GBC
 Hsing AW, Gao YT, Han TQ, et al. Gallstones and the risk of biliary tract cancer: a population-based study
in China. Br J Cancer 2007; 97:1577.

6. Risk factors
 Typhoid carriers have an increased risk of gallbladder and bile
duct cancer. The higher incidence of gallbladder cancer in
chronic typhoid carriers is also thought to result from chronic
irritation and degradation of bile acids

7. Pathophysiology
 It is hypothesized that chronic irritation
of the gallbladder mucosa over a
period of years may predispose to
malignant transformation or act as a
promoter for carcinogenic exposure or
genetic predisposition

8. Pathophysiology

9. Screening
 At present there is no effective screening
method for gallbladder cancer, as it is a rare
tumor that is often confused with other biliary
cancers. The presenting symptoms of
gallbladder cancer usually occur with
advanced disease, making early detection
almost impossible.

10. CLINICAL MANIFESTATIONS
 Patients with early invasive GBC are most often
asymptomatic, or they have nonspecific symptoms that
mimic or are due to cholelithiasis or cholecystitis
 GBC may be diagnosed preoperatively, intraoperatively at
the time of surgical exploration for abdominal symptoms
attributable to another disease process, or postoperatively
upon examination of the gallbladder specimen, typically
removed for cholecystectomy due to symptomatic
cholelithiasis
 Among symptomatic patients, the most common complaint
is pain, followed by anorexia, nausea, or vomiting. The
symptoms of advanced GBC often differ from usual biliary
colic and are more suggestive of malignant disease (eg,
malaise, weight loss).

11. Diagnosis
 Ultrasound — The usual initial diagnostic study for presumed-
benign gallstone-related disease is US. Many patients with an
incidental GBC are found retrospectively to have had suspicious
US findings
 CT is less helpful in distinguishing benign from malignant polyps
,By contrast, dynamic MRI and MRCP can help to differentiate
benign from malignant gallbladder lesions and provide information
as to disease extent
 Magnetic resonance cholangiopancreatography (MRCP) is a
non-invasive imaging technique to visualize the intra and
extrahepatic biliary tree and pancreatic ductal system.

12. Magnetic resonance cholangiopancreatography
(MRCP)

13. Diagnosis
 Laboratory studies — Laboratory studies are generally
nondiagnostic; an elevated alkaline phosphatase or serum bilirubin
may be related to bile duct obstruction. Serum tumor markers such
as carcinoembryonic antigen (CEA) or carbohydrate antigen 19-9
(CA 19-9, also called cancer antigen 19-9) are often elevated, but
they are not diagnostically useful because they lack specificity and
sensitivity
 HISTOLOGY:
 The majority (close to 90 percent) are adenocarcinomas, although
other histologic types are occasionally found, including
adenosquamous or squamous cell carcinoma

14. STAGING

15. THERAPEUTIC APPROACHES
 Surgery
 Although fewer than 50% of cancers of the gallbladder are
resectable, the most effective treatment for this form of cancer is
resection of the primary tumor and areas where it has locally invaded
 Cholecystectomy is the primary treatment for stage I gallbladder
carcinoma. Many gallbladder cancers are found incidentally at the
time of elective cholecystectomy
 When the cancer involves deeper layers of the gallbladder wall, A
radical or extended cholecystectomy has been recommended in the
hopes of improving survival. The extended procedure consists of a
cholecystectomy with a wide resection of the liver around the
gallbladder bed and a major lymph node dissection

16. THERAPEUTIC APPROACHES AND
 Palliative therapy
 Most therapies for gallbladder cancer are palliative. Palliative
management for gallbladder cancer is directed at the relief of
jaundice, treatment of sepsis, and palliation of pain. The majority of
gallbladder tumors are unable to be resected with negative margins
 Nonoperative management. Many individuals with gallbladder
cancer will have obstructive jaundice, which can be relieved and
managed with an endoscopic biliary stent or percutaneous
transhepatic biliary stent.
 Chemotherapy
 Chemotherapy agents for the treatment of gallbladder cancer have
been limited due to poor tumor response
 SYMPTOM MANAGEMENT AND SUPPORTIVE CARE

17. THERAPEUTIC APPROACHES AND
 Radiotherapy
 The benefit of adjuvant radiation therapy
(RT) or combination chemoradiotherapy
after resection of GBC has not been tested
in randomized controlled trials. However,
impressions of a survival advantage have
been reported in many retrospective reports
in which either RT alone or
chemoradiotherapy was administered

18. 5-year relative survival rates for
gallbladder cancer Source: ACS

19. Post-treatment surveillance
There are no data to support aggressive post-
treatment surveillance. We monitor patients
closely with liver function tests and tumor
markers (carcinoembryonic antigen [CEA] and
cancer antigen 19-9 [CA 19-9]) every three to
four months for the first two years after
surgery, followed by every six months for one
more year. We perform reimaging only as
clinically indicated

20. Complications
Primary
- Obstructive jaundice
- liver abscess
- liver failure
Secondary
- Ascites
- Poor Nutritional intake
- Intra-abdominal spread of tumor can cause
pain and palpable or visible tumor