Gallbladder cancer Flashcards
General prognosis
Highly lethal (advanced stage at diagnosis) but patients who’s GBC is discovered incidentally do better
How most are diagnosed
Incidentally during lap chole for cholecystitis
RF’s for gallbladder cancer
- gallstones
- salmonella
- porcelain gallstone
- gallbladder polyps
- PSC
typical clinical presentation
asymptomatic
appearance of GBC on CT
Polypoid mass protruding into the lumen or completely filling it, a focal or diffuse thickening of the gallbladder wall, or a mass in the gallbladder fossa
polypoid definition
resembling a polyp
Staging work up
- Cross sectional CT abdomen
- CT chest
- cholangriography not useful
PET/CT for GBC?
Mixed data, so since mixed generally not done (false positives)
Dominant histology
adenocarcinoma
most common sites of mets
peritoneum and liver
tumor markers?
CEA and CA19-9
Management of early stage GBC
Surgery (but few patients, even if diagnosed incidentally have early-stage disease)
Treatment of locoregional GBC
surgery with adjuvant chemo
adjuvant chemo for locoregional
Capecitabine for 6 months per BILCAP trial
In general how is approach to adjuvant therapy determined
- pattern of disease recurrence
IF locoregional –> chemoRT makes more sense
IF distant –> chemo makes more sense
Typical recurrence pattern
IF margin-positive –> locoregional recurrence more common
IF complete resection –> both distant and local
General chemo regimen type used for advanced GBC
Gem cis
Locally advanced management in general
chemoradiotherapy (take advantage of radiation-sensitizing properties of certian chemotherapeutic agents)
Preferred regimens in advanced GBC for good performance status
Gemcitabine based combination regimen (Gem-Cis, Gem-Capecitabine, GEMOX)
Preferred regimens in advanced GBC for poor performance status
clinical trial vs. single agent
Actionable mutations in biliary cancer?
FGFR2
NTRK
Others…
What is the relationship between dMMR and immunotherapy
Hypothesized that tumors lacking mismatch repair mechanism, harbor many more mutations (ie they are hypermutated) than do tumors of the same type without such mismatch repair defects, and that the neoantigens generated from mutations have the potential to be recognized as “non-self” immunogenic antigens
T1a management
- cholecystectomy alone, no adjuvant treatment
