Gallbladder Cancer

Gallbladder cancer
Specialty	General surgery, oncology
Symptoms	None, abdominal pain, yellowish skin, weight loss, vomiting[1]
Complications	Spread to other parts of the body[2]
Usual onset	>65 years old[3]
Types	Adenocarcinoma, squamous cell carcinoma[1]
Causes	Often unknown[4]
Risk factors	Inflammation of the gallbladder, salmonella typhi, isoniazid, radon, smoking, obesity, primary sclerosing cholangitis, inflammatory bowel disease[1]
Diagnostic method	Blood tests, medical imaging, biopsy[2]
Differential diagnosis	Cholecystitis, bile duct tumors[1]
Treatment	Surgery, chemotherapy, radiation therapy[1]
Prognosis	Five-year survival rate ~19% (US)[5]
Frequency	11,740 (2017 US)[1]
Deaths	3,830 (2017 US)[1]

Gallbladder cancer is a type of cancer that begins within the gallbladder.^[2] Symptoms may vary from none, to right sided abdominal pain, yellowish skin, weight loss, and vomiting.^[1] Complications may include spread to other organs such as the liver.^[2]

The cause is often unknown.^[4] Risk factors include gallstones, gallbladder polyps, and congenital biliary cysts, as these can result in inflammation of the gallbladder.^[1] Other risk factors include long-term infection by salmonella typhi, isoniazid, radon, smoking, obesity, primary sclerosing cholangitis, and inflammatory bowel disease.^[1] Diagnosis may be based on blood tests, medical imaging, and biopsy.^[2]

Early stage disease may be curable with surgery.^[1] In certain cases chemotherapy or radiation therapy may be used.^[1] The overall five year survival rate in the United States is 19%, though this varies from 62% for early disease to 2% if the cancer has spread to distant parts of the body.^[5]

Gallbladder cancer is a relatively uncommon, with fewer than 2 new cases per 100,000 people per year in the United States.^[6] Females are more commonly affected than males.^[2] Those affected are generally over the age of 65.^[3] It occurs more commonly in South America, India, Pakistan, Japan, and South Korea, with rates as high as 10 per 100,000 in Chile.^[1][7] It also affects certain ethnicities more frequently including Native Americans.^[1] It was first described in 1777 by Maximilian de Stoll.^[7]

Signs and symptoms[edit | edit source]

• Steady pain in the upper right abdomen
• Indigestion
• Dyspepsia (gas)
• Bilious vomit
• Weakness
• Loss of appetite
• Weight loss
• Jaundice and vomiting due to obstruction

Early symptoms mimic gallbladder inflammation due to gallstones. Later, the symptoms may be that of biliary and stomach obstruction.

Of note, Courvoisier's law states that in the presence of a palpably enlarged gallbladder which is nontender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones. This implicates possible malignancy of the gallbladder or pancreas, and the swelling is unlikely due to gallstones due to the chronic inflammation association with gallstones leading to a shrunken, non-distensible gallbladder. However, Ludwig Georg Courvoisier's original observations, published in Germany in 1890, were not originally cited as a law, and no mention of malignancy or pain (tenderness) was made. These points are commonly misquoted or confused in the medical literature.^[8]

Risk factors[edit | edit source]

• Gender— approximately twice as common in women than men, usually in seventh and eighth decades
• Obesity
• Chronic cholecystitis and cholelithiasis
• Primary sclerosing cholangitis^[9]
• Chronic typhoid infection of gallbladder; chronic Salmonella typhi carriers have 3 to 200 times higher risk of gallbladder cancer than non-carriers and 1–6% lifetime risk of development of cancer^[10]
• Various single nucleotide polymorphisms (SNPs) have been shown to be associated with gallbladder cancer; however, existing genetic studies in GBC susceptibility have so far been insufficient to confirm any association^[11]
• Gall bladder polyps^[12]
• Calcified gallbladder wall (porcelain gallbladder)^[12]
• Congenital abnormalities of the bile duct such as choledochal cyst^[12]

Diagnosis[edit | edit source]

Early diagnosis is not generally possible. People at high risk, such as women or Native Americans with gallstones, are evaluated closely. Transabdominal ultrasound, CT scan, endoscopic ultrasound, MRI, and MR cholangio-pancreatography (MRCP) can be used for diagnosis. A large number of gallbladder cancers are found incidentally in patients being evaluated for cholelithiasis, or gallstone formation, which is far more common.^[13] A biopsy is the only certain way to tell whether or not the tumorous growth is malignant.^[14]

• 

  Gallbladder adenocarcinoma lymphatic invasion histopathology

• 

  Incidentally discovered gallbladder cancer (adenocarcinoma) following a cholecystectomy.

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  Gallbladder adenocarcinoma histopathology

• 

  Gallbladder carcinoma

• 

  Gallbladder carcinoma on ultrasound

Differential diagnosis[edit | edit source]

Xanthogranulomatous cholecystitis (XGC) is a rare form of gallbladder disease which mimics gallbladder cancer although it is not cancerous.^[15][16] It was first discovered and reported in the medical literature in 1976 by J.J. McCoy, Jr., and colleagues.^[15][17]

Treatment[edit | edit source]

If detected early in a stage where it has not spread, gall bladder cancer can be treated by surgery. Surgery for gallbladder cancer is called radical cholecystectomy or extended cholecystectomy. It entails the removal of gall bladder along with adequate removal of its liver bed to the healthy tissue. The lymph nodes in the vicinity are also removed. Sometimes removal of a large part of the liver called hepatectomy is required to completely remove the tumor. The bile duct if involved also needs to be removed.^[12] However, with gallbladder cancer's extremely poor prognosis, most patients will die within a year of surgery. If surgery is not possible, endoscopic stenting or percutaneous transhepatic biliary drainage (PTBD) of the biliary tree can reduce jaundice and a stent in stomach may relieve vomiting. Chemotherapy and radiation may also be used with surgery. If gallbladder cancer is diagnosed after cholecystectomy for stone disease (incidental cancer), re-operation to remove part of liver and lymph nodes is required in most cases. When it is done as early as possible, patients have the best chance of long-term survival and even cure.^[18]

Epidemiology[edit | edit source]

Most tumors are adenocarcinomas, with a small percent being squamous cell carcinomas.

• Gallbladder cancer is relatively rare, affecting fewer than 5000 people in the United States per year^[19]
• Gallbladder cancer is more common in South American countries, Japan, and Israel; in Chile, gallbladder cancer is the fourth most common cause of cancer deaths.
• 5th most common gastrointestinal cancer
• Up to 5 times more common in women than men depending on population (e.g. 73% female in China^[20]
• The age adjusted incidence rates of gall bladder cancer is highest in Chile, followed by in the state of Assam in India^[21]

Prognosis[edit | edit source]

The prognosis still remains poor. The cancer commonly spreads to the liver, bile duct, stomach, and duodenum.

References[edit | edit source]

External links[edit | edit source]

Classification	ICD-10: C23–C24 ICD-9-CM: 156 MeSH: D005706 DiseasesDB: 30714

• U.S. National Cancer Institute Gallbladder Cancer Treatment (www.cancer.gov) Archived 2015-04-16 at the Wayback Machine