GALLBLADDER CARCINOMA
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An overview on Gallbladder Carcinoma. Presented on the day of 23rd June at Binaytara foundation Cancer Center, Janakprdham, Nepal.
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GALLBLADDER CARCINOMA
- 1. Gallbladder Carcinoma Presented by: Dr. Rahul Shah Medical Officer, BTFCC 6/23/2021
- 2. 6/23/2021
- 3. OUTLINES • ANATOMY • INCIDENCE • RISK FACTORS • DISEASE PRESENTATION • DIAGNOSIS • TNM STAGING • TREATMENT • PROGNOSIA 6/23/2021
- 6. Relations • It lies in close proximity to the following structures: • Anteriorly and superiorly – inferior border of the liver and the anterior abdominal wall. • Posteriorly – transverse colon and the proximal duodenum. • Inferiorly – biliary tree and remaining parts of the duodenum. 6/23/2021
- 7. Anatomy Basics: Billiary Tree 6/23/2021
- 8. Blood Supply and Drainage 6/23/2021
- 9. Carcinomas of Gallbladder • 5th Most common GI malignancy in western world • 2-3:1 Female: Male • Commonest malignancy of biliary tree • Increasingly becoming a common problem in Nepal • 3rd Commonest GI malignancy in Nepal • Aggressive tumor • 5 year survival rate = 5% 6/23/2021
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- 12. Numbers at Glance: Nepal 6/23/2021
- 13. Risk Factors 6/23/2021 Adenomatous Polyp: warrant prophylactic cholecystectomy 10% : PSC+MASS of any size : prophylactic cholecystectomy
- 14. APBDU BP & PB TYPES PORCELIN GB 6/23/2021
- 15. SYMPTOMS Symptoms Proportion of patients RUQ pain 82% Weight loss 72% Anorexia 74% Nausea and vomiting 68% RUQ mass 65% Jaundice 44% Abdominal distention 30% Pruritus 20% Hematemesis 2% Melena 1% 6/23/2021
- 16. Diagnosis History/PE USG CT SCAN Blood analysis Tumor Markers MRCP Histopath 6/23/2021
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- 18. PATHOLOGY 6/23/2021 85% Adenocarcinoma 10% Anaplastic carcinoma 5% Squamous Cell carcinoma
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- 34. REFRENCES • SCHWARTZ’S PRINCIPLE OF SURGERY 10TH EDITION • SLEISENGER AND FORDTRAN’S GASTROINTESTINAL AND LIVER DISEASE 10TH EDITION • GLOBOCAN • NCCN GUIDELINES • CHEMOTHERAPY ADVISER 6/23/2021
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Editor's Notes
- Pear Shaped Sac, 7 to 10 cm long, 30-50 ml max 300ml Located in fossa in the interior surface of liver. A line from this fossa to the IVC divider liver to lobes GB: Fundus, Corpus (Body), Infindubulum and neck Fundus: 1-2cm beyond liver margin, has most of the smooth muscles Body: Elastic tissue, main stirage area, From Fundus to neck Neck: Funnel shaped, connects with cystic duct. Neck – the gallbladder tapers to become continuous with the cystic duct, leading into the biliary tree. The neck contains a mucosal fold, known as Hartmann’s Pouch. This is a common location for gallstones to become lodged, causing cholestasis. The GB is lined by the same peritoneal folding which covers the liver Lined by single, highly folded, tall columnar epithelium that contains cholesterol and fat globules Mucous secreted originates from tubule alveolar glands from mucosa lining the infundibulum and neck
- The biliary tree is a series of gastrointestinal ducts allowing newly synthesised bile from the liver to be concentrated and stored in the gallbladder (prior to release into the duodenum). Bile is initially secreted from hepatocytes and drains from both lobes of the liver via canaliculi, intralobular ducts and collecting ducts into the left and right hepatic ducts. These ducts amalgamate to form the common hepatic duct, which runs alongside the hepatic vein. As the common hepatic duct descends, it is joined by the cystic duct – which allows bile to flow in and out of the gallbladder for storage and release. At this point, the common hepatic duct and cystic duct combine to form the common bile duct. The common bile duct descends and passes posteriorly to the first part of the duodenum and head of the pancreas. Here, it is joined by the main pancreatic duct, forming the hepatopancreatic ampulla (commonly known as the ampulla of Vater) – which then empties into the duodenum via the major duodenal papilla. This papilla is regulated by a muscular valve, the sphincter of Oddi.
- The arterial supply to the gallbladder is via the cystic artery – a branch of the right hepatic artery (which itself is derived from the common hepatic artery, one of the three major branches of the coeliac trunk). Venous drainage of the neck of the gallbladder is via the cystic veins, which drain directly into the portal vein. Venous drainage of the fundus and body of the gallbladder flows into the hepatic sinusoids.
- 23 new cases 20 deaths
- It is relatively rare cancer worldwide; however it is the sixth cancer and second most common gastrointestinal tract cancer in Nepalese women. 21.5/100,000 in india Rare in western Europe and states
- Gallstones are found in 65% to 90% of patients with gallbladder carcinoma. Gallbladder carcinoma actually develops in only 1% to 3% of patients with cholelithiasis, and 20% of patients with gallbladder carcinoma do not have evidence of cholelithiasis. Therefore, a prophylactic cholecystectomy in an asymptomatic patient with gallstones to prevent gallbladder carcinoma cannot be recommended Although an increased risk of gallbladder carcinoma has been reported in patients with a porcelain gallbladder, the risk may be limited to patients with selective mucosal calcification (types II and III porcelain gallbladder) rather than those with diffuse mucosal calcification (type I) Adenomatous polyps of the gallbladder constitute another risk factor for gallbladder carcinoma (see Chapter 67). The risk correlates positively with the size, type, and growth rate of the polyps. Patients with polyps that are greater than 1 cm in size, sessile, and associated with gallstones, exhibit a rapid increase in size, demonstrate arterial flow on Doppler US, or are symptomatic are at increased risk of malignant transformation and warrant prophylactic cholecystectomy. Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), is the most common cause of hereditary colorectal (colon) cancer. People with Lynch syndrome are more likely to get colorectal cancer and other cancers, and at a younger age (before 50) PSC GB CA IN 20% CASES WITH PSC 40 TO 60 % MASSES IN Psc patient are mallignant
- * Markers as CA 19-9 >20U/ml have 79.4% sensitivity and 79.2% specific. CEA >4mcg/L is 93% specific but only 50% sensitive. USG >80% ACCURACY FOCAL THIKENING AND IRREGULARITY, NOT FOR STAGING
- ONLY SURGICAL IS CURABLE STAGE 1A: SIMPLE CHOLE STAGE IB AND IIl: EXTENDED CHOLECYSTECTOMY: WEDGE RESECTION OG GB BED+LN DISSECTION STAGE III AND IV: RADICAL RESECTION : EXTENDED RIGHT HEPATIC RESECTION, PANCREATODUODENECTOMY, RESECTION OF PORTAL VEIN PALLIATIVE: BILIODIGESTIVE BYPASS OR STENTS