Comprehensive overview of Gall bladder carcinoma: diagnosis, staging and treatment

1. Ahmed Zeeneldin

2. Risk Factors
— Cholelithiasis is the most common
— chronic inflammation.
— Calcification
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3. Ahmed Zeeneldin 3

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5. Clinical picture and diagnosis
— Mimics biliary colic or chronic cholecystitis.
— incidental finding in 50% of cases
— at surgery or
— on pathology following cholecystectomy
— diagnosed at an advanced stage
— mass detected on ultrasound or jaundice
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6. GB CA US
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7. GB CA CT
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8. Pathology
— Adeno ca in
80%
— Early spread to
lymph node
and blood
steam
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9. Staging T1 T2 T3 T4
— M1: mets T1a lamina propria perimuscular serosa (and/or liver main portal vein or
T1b muscle layer connective tissue; and/or one other hepatic artery or
— N1: regional LN adjacent organ or
structure,
invades multiple
extrahepatic
—T
organs or
structures
GB staging Colon cancer staging
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10. OS
— Median OS Tis/0 T1 T2 T3 T4=III M1=IV
— (all): 10m
N0 0 IA IB IIA III IV
— 1-3: 12m
— 4: 6m
N1 IIB IIB IIB IIB III IV
— % year OS
— Stage OS% M1= IV IV IV IV IV IV
— 0 60 IV
— 1 40
— 2 15
— 3 5
— 4 1
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11. Treatment
— Surgery is the only curative
modality
— Scenarios:
— Preoperative suspicion
— Intraoperative dx
— Frozen section: cholecystectomy,
en bloc hepatic resection, and
lymphadenectomy with or
without bile duct excision.
— LNS: PH, GH, RD
— Celiac, PALN: irresectable
— Postopertive dx
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12. Treatment
— Postopertive (incidental) dx
on pathology review
— Reexploration yields residual
in 75%
— T1a with negative SM:
observe
— Otherwise:
— Exclude mets, local CT, MRI
— Surgical resection as before
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13. Adjuvant treatment
— T1a-b N0: no therapy
— Chem-oradiation: fluoropyrimidine
— fluoropyrimidine or gemcitabine chemotherapy
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14. Unresectable/metastatic disease
— Biopsy
— Relieve jaundice
— Unresectable: chemoradiation
— Metastatic: chemotherapy
— BSC
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16. Classification
— Intrahepatic
— Extrahepatic:
— Hilar (Klatskin):
commenest
— Extrahepatic proper:
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