| What are gall bladder carcinomas? | Second most common primary biliary malignancy, 5th most common malignancy of GI, dx at advanced stage (only 1/3 resectable at dx)
Prognosis is bad (5 year survival 0-10% and median of survival less than 6 months |
| What are risk factors for gall bladder carcinoma? | Anomalous union of pancreaticobiliary ductal system, carcinogens, cholangiocarcinoma, cholelithiasis, chronic salmonella typhi/paratyphi, IBD, intrahepatic biliary dysplasia, Lynch syndrome, PSC, porcelain gallbladder. |
| How is the clinical presentation of gallbladder carcinoma? | 47-78% incidentaloma during cholecystectomy (persumed benign disease) silent malignancy
Incidental diagnosed carcinomas are in lower stages than symptomatic ones
Common presentations are biliary/abdominal pain, jaundice secondary to direct invasion of biliary duct/metastasis to hepatoduodenal ligament, weight loss, abdominal distention.. |
| What are biology lab findings in case of gallbladder carcinoma? | 4ng/ml elevated CEA (specific (93%) but not sensitive (50%))
CA19-9 more sensitive but less specific (79% both) |
| How is the dx of gallbladder carcinoma? | abdominal US (sensitivity 85% and accuracy 80%), helical CT (more accurate than US) |
| How is the treatment of gallbladder carcinoma? | Surgery only curative therapy but only 15-47% are able to undergo therapy
Procedures include complete cholecystectomy, extended radical cholecystectomy (gallbladder + 2 cm bed lymphadenectomy + head of pancreas + hepatoduodenal ligament+ duodenum+celiac axis.)
Extended cholecystectomy w/hepatic (segmental or lobar ) resection/extensive para-aortic lymph node resection/ bile duct resection (pancreaticoduodenectomy)
Tumor removed via open surgery (not laparoscopic)
Unresectable Pt (chemotherapy w/gemitabine and cisplastin) |
| Give algorithm of TNM staging and actions. | . |
