gallbladder cancer reham khalilieh 4 th year medical student surgical round- shaare zedek medical...
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Gallbladder Cancer
Reham Khalilieh4th year Medical Student
Surgical Round- Shaare Zedek Medical Center, Jerusalem
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Anatomy (Reminder)
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Introduction and Epidemiology
^Uncommon ^Aggressive Malignancy
^Poor Prognosis
^Age ^Women > Men
^Caucasians > Blacks ^South American Countries, India, Pakistan, Japan
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Risk Factors
^Gallstone Disease- porcelain gallbladder ^Gallbladder Polyps
^Chronic Infection- Salmonella, Helicobacter ^Abnormal pancreaticobiliary duct junction
^Medications- Methyldopa, Isoniazid ^Carcinogen Exposure- oil, paper, radon
^Obesity ^Diabetes
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Abnormal pancreaticobiliary duct junction
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Pathogenesis and Staging
^Metaplasia-Dysplasia > CIS >Invasive Adenocarcinoma
^TNM staging system
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American Joint Committee on Cancer Staging of Gallbladder Carcinoma
Primary Tumor (T stage)T1Tumor invades lamina propria or muscle layer T1a: Tumor invades lamina propria
T1b: Tumor invades muscle layerT2Tumor invades perimuscular connective tissueT3Tumor perforates serosa or directly invades one adjacent organ (extension £2 cm into liver)T4Tumor extends ≥2 cm into liver and/or into two or more adjacentRegional Lymph Nodes (N Stage)N0No regional lymph node metastasisN1Metastasis in cystic ductal, pericholedochal, and/or hilar lymph nodesN2Metastasis in peripancreatic, periduodenal, periportal, celiac, and/or superior mesenteric lymph nodesDistant Metastasis (M Stage)M0No distant metastasisM1Distant metastasis
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TNM Stage Grouping
Stage I T1 N0 M0Stage II T2 N0 M0Stage III T3 N0 M0 or
T1-3 N1 M0Stage IVA T4 N0-2 M0Stage IVB T1-4 N0-2 M1
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Metastases ^GBC spreads via both lymphatic and venous vessels
^GBC frequently extend directly into the hepatic parenchyma
^Lymphatic spread: Calot's lymph node >> pericholedochal and hilar nodes >> peripancreatic, duodenal, periportal, celiac, superior mesenteric nodes
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Clinical Presentation ^Early invasive GBC are asymptomatic OR
cholelithiasis / cholecystitis like symptoms
^Symptomatic patients
^Duodenal Obstruction
^Rare symptoms
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Diagnosis ^US
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Diagnosis ^CT
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Treatment
^Gallbladder polyp
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Treatment cont.
^Gallbladder Cancer Following Cholecystectomy
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Treatment cont.
^Patients suspected of having GBC preoperatively
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Treatment cont.
^Patients with advanced disease at presentation
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Survival ^Overall survival of gallbladder cancer is less
than 15% ^T1a > Excellent prognosis
^T2 > 20-60% (5-year survival) ^T3 > less than 20%
^T4 > Months
^Patients with metastatic disease at presentation > 13 months
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THANK YOU!