8/30/2018 Gallbladder cancer - Wikipedia

Gallbladder cancer
Gallbladder cancer is a relatively uncommon cancer. It has
Gallbladder cancer
peculiar geographical distribution being common in central
and South America, central and eastern Europe, Japan and
northern India; it is also common in certain ethnic groups e.g.
Native American Indians and Hispanics.[1] If it is diagnosed
early enough, it can be cured by removing the gallbladder, part
of the liver and associated lymph nodes. Most often it is found
after symptoms such as abdominal pain, jaundice and
vomiting occur, and it has spread to other organs such as the
liver.

It is a rare cancer that is thought to be related to gallstones

building up, which also can lead to calcification of the
gallbladder, a condition known as porcelain gallbladder.
Porcelain gallbladder is also rare. Some studies indicate that
people with porcelain gallbladder have a high risk of
developing gallbladder cancer, but other studies question this.
The outlook is poor for recovery if the cancer is found after Specialty Oncology
symptoms have started to occur, with a 5-year survival rate
close to 3%.

Contents
Signs and symptoms
Risk factors
Diagnosis
Differential diagnosis
Treatment
Epidemiology
Prognosis
References
External links

Signs and symptoms

Steady pain in the upper right abdomen
Indigestion Dyspepsia (gas)
Bile (dark green color) in vomit.
Weakness
Loss of appetite
Weight loss
Jaundice and vomiting due to obstruction

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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 shunken, 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 missquoted or confused in the medical literature.[2]

Risk factors
Gender—approx. twice more common in women than men, usually in seventh and eighth decades.
Obesity increases the risk for gallbladder cancer.
Chronic cholecystitis and cholelithiasis.
Primary sclerosing cholangitis[3]
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.[4]
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.[5]

Diagnosis
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 biopsy is the only certain way to tell whether the tumorous
growth is malignant or not.[6]

Gallbladder Incidentally discovered Gallbladder

adenocarcinoma gallbladder cancer adenocarcinoma
lymphatic invasion (adenocarcinoma) histopathology
histopathology following a
cholecystectomy.

Differential diagnosis
Xanthogranulomatous cholecystitis (XGC) is a rare form of gallbladder disease which mimics gallbladder cancer
although it is not cancerous.[7][8] It was first discovered and reported in the medical literature in 1976 by J.J. McCoy,
Jr., and colleagues.[7][9]

Treatment

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The most common and most effective treatment is surgical removal of the gallbladder (cholecystectomy) with part of
liver and lymph node dissection. However, with gallbladder cancer's extremely poor prognosis, most patients will die
within a year of surgery. If surgery is not possible, endoscopic stenting 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), reoperation 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.[10]

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

Rare tumor, the U.S. incidence is 3 cases per 100,000 people each year
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 [11]).
The age adjusted incidence rates of gall bladder cancer is highest in Chile followed by In the state of Assam in
India[12]

Prognosis
The cancer commonly spreads to the liver, bile duct, stomach, and duodenum.

References
1. Kapoor VK, McMichael AJ (2003). "Gallbladder cancer: an 'Indian' disease". Natl Med J India. 16 (4): 209–13.
PMID 14606770 (https://www.ncbi.nlm.nih.gov/pubmed/14606770).
2. Fitzgerald, J Edward F; White Matthew J; Lobo Dileep N (Apr 2009). "Courvoisier's gallbladder: law or sign?".
World journal of surgery. United States. 33 (4): 886–91. doi:10.1007/s00268-008-9908-y (https://doi.org/10.1007/s
00268-008-9908-y). ISSN 0364-2313 (https://www.worldcat.org/issn/0364-2313). PMID 19190960 (https://www.nc
bi.nlm.nih.gov/pubmed/19190960).
3. Folseraas, T; Boberg, KM (February 2016). "Cancer Risk and Surveillance in Primary Sclerosing Cholangitis".
Clinics in Liver Disease. 20 (1): 79-98. doi:10.1016/j.cld.2015.08.014 (https://doi.org/10.1016/j.cld.2015.08.014).
PMID 26593292 (https://www.ncbi.nlm.nih.gov/pubmed/26593292).
4. Ferreccio, C. (2012). "Salmonella typhi and Gallbladder Cancer". Bacteria and Cancer. p. 117. doi:10.1007/978-
94-007-2585-0_5 (https://doi.org/10.1007/978-94-007-2585-0_5). ISBN 978-94-007-2584-3.
5. Srivastava K, Srivastava A, Sharma KL, Mittal B. Candidate gene studies in gallbladder cancer: a systematic
review and meta-analysis. Mutat Res. 2011 Jul–Oct;728(1–2):67–79.
6. "Tests for gallbladder cancer" (http://cancerhelp.cancerresearchuk.org/type/gallbladder-cancer/diagnosis/tests-for-
gallbladder-cancer). Cancer Research UK. Retrieved 17 September 2012.
7. Makino I, Yamaguchi T, Sato N, Yasui T, Kita I (August 2009). "Xanthogranulomatous cholecystitis mimicking
gallbladder carcinoma with a false-positive result on fluorodeoxyglucose PET" (http://www.wjgnet.com/1007-9327/
full/v15/i29/3691.htm). World J. Gastroenterol. 15 (29): 3691–3. doi:10.3748/wjg.15.3691 (https://doi.org/10.3748/
wjg.15.3691). PMC 2721248 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721248)  . PMID 19653352 (http
s://www.ncbi.nlm.nih.gov/pubmed/19653352).
8. Rao RV, Kumar A, Sikora SS, Saxena R, Kapoor VK (2005). "Xanthogranulomatous cholecystitis: differentiation
from associated gall bladder carcinoma". Trop Gastroenterol. 26 (1): 31–3. PMID 15974235 (https://www.ncbi.nlm.
nih.gov/pubmed/15974235).
9. McCoy JJ, Vila R, Petrossian G, McCall RA, Reddy KS (March 1976). "Xanthogranulomatous cholecystitis.
Report of two cases". J S C Med Assoc. 72 (3): 78–9. PMID 1063276 (https://www.ncbi.nlm.nih.gov/pubmed/1063
276).

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10. Kapoor VK (March 2001). "Incidental gallbladder cancer". Am. J. Gastroenterol. 96 (3): 627–9. doi:10.1111/j.1572-
0241.2001.03597.x (https://doi.org/10.1111/j.1572-0241.2001.03597.x). PMID 11280526 (https://www.ncbi.nlm.ni
h.gov/pubmed/11280526).
11. Hsing AW, Gao YT, Han TQ, et al. (December 2007). "Gallstones and the risk of biliary tract cancer: a population-
based study in China" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2360257). Br. J. Cancer. 97 (11): 1577–82.
doi:10.1038/sj.bjc.6604047 (https://doi.org/10.1038/sj.bjc.6604047). PMC 2360257 (https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC2360257)  . PMID 18000509 (https://www.ncbi.nlm.nih.gov/pubmed/18000509).
12. National Cancer Registry Programme (2013).Three-year report of population based cancer registries:2009-2011.
NCDIR-ICMR, Bangalore.

External links
U.S. National Cancer Institute Gallbladder Cancer Treatment Classification ICD-10: C23 (htt D
(www.cancer.gov) (http://www.cancer.gov/cancertopics/pdq/treatment/gal p://apps.who.int/cla
lbladder/Patient)
ssifications/icd10/br
owse/2016/en#/C2
3)–C24 (http://apps.
who.int/classificatio
ns/icd10/browse/20
16/en#/C24) · ICD-
9-CM: 156 (http://w
ww.icd9data.com/g
etICD9Code.ashx?i
cd9=156) · MeSH:
D005706 (https://w
ww.nlm.nih.gov/cgi/
mesh/2015/MB_cg
i?field=uid&term=D
005706) ·
DiseasesDB:
30714 (http://www.d
iseasesdatabase.co
m/ddb30714.htm)

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