gall bladder carcinoma

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

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  • 1. Ahmed Zeeneldin
  • 2. Risk Factors Cholelithiasis is the most common chronic inflammation. Calcification Ahmed Zeeneldin 2
  • 3. Ahmed Zeeneldin 3
  • 4. Ahmed Zeeneldin 4
  • 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 Ahmed Zeeneldin 5
  • 6. GB CA US Ahmed Zeeneldin 6
  • 7. GB CA CT Ahmed Zeeneldin 7
  • 8. Pathology Adeno ca in 80% Early spread to lymph node and blood steam Ahmed Zeeneldin 8
  • 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 extrahepaticT organs or structuresGB staging Colon cancer staging Ahmed Zeeneldin 9
  • 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 Ahmed Zeeneldin 10
  • 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 Ahmed Zeeneldin 11
  • 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 Ahmed Zeeneldin 12
  • 13. Adjuvant treatment T1a-b N0: no therapy Chem-oradiation: fluoropyrimidine fluoropyrimidine or gemcitabine chemotherapy Ahmed Zeeneldin 13
  • 14. Unresectable/metastatic disease Biopsy Relieve jaundice Unresectable: chemoradiation Metastatic: chemotherapy BSC Ahmed Zeeneldin 14
  • 15. Ahmed Zeeneldin 15
  • 16. Classification Intrahepatic Extrahepatic: Hilar (Klatskin): commenest Extrahepatic proper: Ahmed Zeeneldin 16