Gallbladder cancer

Question 1

General prognosis

Answer 1

Highly lethal (advanced stage at diagnosis) but patients who’s GBC is discovered incidentally do better

Question 2

How most are diagnosed

Answer 2

Incidentally during lap chole for cholecystitis

Question 3

RF’s for gallbladder cancer

Answer 3

• gallstones
• salmonella
• porcelain gallstone
• gallbladder polyps
• PSC

Question 4

typical clinical presentation

Answer 4

asymptomatic

Question 5

appearance of GBC on CT

Answer 5

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

Question 6

polypoid definition

Answer 6

resembling a polyp

Question 7

Staging work up

Answer 7

• Cross sectional CT abdomen
• CT chest
• cholangriography not useful

Question 8

PET/CT for GBC?

Answer 8

Mixed data, so since mixed generally not done (false positives)

Question 9

Dominant histology

Answer 9

adenocarcinoma

Question 10

most common sites of mets

Answer 10

peritoneum and liver

Question 11

tumor markers?

Answer 11

CEA and CA19-9

Question 12

Management of early stage GBC

Answer 12

Surgery (but few patients, even if diagnosed incidentally have early-stage disease)

Question 13

Treatment of locoregional GBC

Answer 13

surgery with adjuvant chemo

Question 14

adjuvant chemo for locoregional

Answer 14

Capecitabine for 6 months per BILCAP trial

Question 15

In general how is approach to adjuvant therapy determined

Answer 15

• pattern of disease recurrence
  IF locoregional –> chemoRT makes more sense
  IF distant –> chemo makes more sense

Question 16

Typical recurrence pattern

Answer 16

IF margin-positive –> locoregional recurrence more common

IF complete resection –> both distant and local

Question 17

General chemo regimen type used for advanced GBC

Answer 17

Gem cis

Question 18

Locally advanced management in general

Answer 18

chemoradiotherapy (take advantage of radiation-sensitizing properties of certian chemotherapeutic agents)

Question 19

Preferred regimens in advanced GBC for good performance status

Answer 19

Gemcitabine based combination regimen (Gem-Cis, Gem-Capecitabine, GEMOX)

Question 20

Preferred regimens in advanced GBC for poor performance status

Answer 20

clinical trial vs. single agent

Question 21

Actionable mutations in biliary cancer?

Answer 21

FGFR2
NTRK
Others…

Question 22

What is the relationship between dMMR and immunotherapy

Answer 22

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

Question 23

T1a management

Answer 23

• cholecystectomy alone, no adjuvant treatment