Gall Bladder

Question 1

epidemiology and aetiology

Answer 1

gall stones
family history
incidences high in SA
smoking
obesity
70% female
risks can be altered as they are mainly due to lifestyle choices

Question 2

what is the most common pathology

Answer 2

adenocarcinoma (80%)

Question 3

what are the other pathological types

Answer 3

squamous cell
small cell
lymphoma
cholangiosarcoma (bile duct) - ONLY EVER 4 CASES

Question 4

what are the investigations

Answer 4

LFT: not fully reliable as the liver and kidney might be functioning normally
CA19-9 marker: levels will be high due to this being the tumour marker
CT/MRI
US

Question 5

what is the tumour marker

Answer 5

CA19-9

Question 6

what are the types of spread

Answer 6

local, blood, lymphatics
met spread is rare, it is a rare met sit too
M0 IS LIKELY

Question 7

where is local spread

Answer 7

bile duct, liver

Question 8

where is lymphatic spread

Answer 8

pancreatic-duodenal LN, pericholidodal/ cystic

Question 9

what are the treatment types

Answer 9

surgery, chemo, RT

Question 10

what is surgery for

Answer 10

unresectable tumours

Question 11

what chemo agents are used

Answer 11

gemitabine, cisplatin, 5-FU

Question 12

when is RT used

Answer 12

if the patient is pallative, aids in symptom control, due to late presentation

Question 13

what is the prognosis like

Answer 13

very poor, max survival rate is 3 years