Chapter 53: Biliary Tract- Carcinoma of the Gallbladder

Question 1

What is it?

Answer 1

Malignant neoplasm arising in the gallbladder, vast majority areadenocarcinoma (90%)

Question 2

What are the risk factors?

Answer 2

• Gallstones
• porcelain gallbladder
• cholecystenteric fistula

Question 3

What is a porcelain gallbladder?

Answer 3

Calcified gallbladder

Question 4

What percentage of patients with a porcelain gallbladder will have gallbladder cancer?

Answer 4

≈50% (20% to 60%)

Question 5

What is the incidence?

Answer 5

≈1% of all gallbladder specimens

Question 6

What are the symptoms?

Answer 6

• Biliary colic
• weight loss
• anorexia
• many patients are asymptomatic until late
• may present as acute cholecystitis

Question 7

What are the signs?

Answer 7

• Jaundice
  
  • from invasion of the common duct
  • or compression by involved pericholedochal lymph nodes
• RUQ mass
• palpable gallbladder (advanced disease)

Question 8

What are the diagnostic tests of choice?

Answer 8

Ultrasound, abdominal CT scan, ERCP

Question 9

What is the route of spread?

Answer 9

Contiguous spread to the liver is most common

Question 10

What is the management under the following conditions?Confined to mucosa

Answer 10

Cholecystectomy

Question 11

What is the management under the following conditions?Confined to muscularis/serosa

Answer 11

Radical cholecystectomy: cholecystectomy and wedge resection of overlying liver, and lymph node dissection ± chemotherapy/XRT

Question 12

What is the main complication of a lap chole for gallbladder cancer?

Answer 12

Trocar site tumor implants

(Note: If known preoperatively, perform open cholecystectomy)

Question 13

What is the prognosis for gallbladder cancer?

Answer 13

Dismal overall:

• <5%
• 5-year survival as most are unresectable at diagnosis
• T1 with cholecystectomy: 95% 5-year survival