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Risk Factorsó Cholelithiasis is the most commonó chronic inflammation.ó Calcification

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Clinical picture and diagnosisó Mimics biliary colic or chronic cholecystitis.ó incidental finding in 50% of cases ó at surgery or ó on pathology following cholecystectomy

ó diagnosed at an advanced stageó mass detected on ultrasound or jaundice

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GB CA US

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GB CA CT

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Pathology ó Adeno ca in

80%ó Early spread to

lymph node and blood steam

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Stagingó M1: metsó N1: regional LNó T

T1 T2 T3 T4

T1a lamina propriaT1b muscle layer

perimuscularconnective tissue;

serosa (and/or liver and/or one other adjacent organ or structure,

main portal vein or hepatic artery or invades multiple extrahepaticorgans or structures

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GB staging Colon cancer staging

OSó Median OS ó (all): 10mó 1-3: 12mó 4: 6m

ó % year OSó Stage OS%ó 0 60ó 1 40ó 2 15ó 3 5ó 4 1

Tis/0 T1 T2 T3 T4=III M1=IV

N0 0 IA IB IIA III IV

N1 IIB IIB IIB IIB III IV

M1=IV

IV IV IV IV IV IV

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Treatment ó Surgery is the only curative

modalityó Scenarios: ó Preoperative suspicionó Intraoperative dxó Frozen section: cholecystectomy,

en bloc hepatic resection, and lymphadenectomy with or without bile duct excision.

ó LNS: PH, GH, RDó Celiac, PALN: irresectable

ó Postopertive dx

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Treatment ó Postopertive (incidental) dx

on pathology reviewó Reexploration yields residual

in 75%ó T1a with negative SM:

observeó Otherwise: ó Exclude mets, local CT, MRIó Surgical resection as before

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Adjuvant treatmentó T1a-b N0: no therapyó Chem-oradiation: fluoropyrimidineó fluoropyrimidine or gemcitabine chemotherapy

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Unresectable/metastatic diseaseó Biopsyó Relieve jaundiceó Unresectable: chemoradiationó Metastatic: chemotherapyó BSC

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Classificationó Intrahepaticó Extrahepatic:ó Hilar (Klatskin):

commenestó Extrahepatic proper:

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