Current perspectives in gallbladder carcinoma

Abstract

shown an overall incidence of gallbladder carcinoma of 1-2% in patients with cholelithiasis. 7 ETIOLOGYNo single known factor has been identified to cause CaGB. Associations, predisposing and probable etiologic factors include cholelithiasis, polypoidal lesions of the gallbladder, genetic predisposition, chemical carcinogens, anatomical variations of pancreatico-biliary ductal system, infected bile, typhoid carrier-state and ulcerative colitis etc.The cause-and-effect relationship between gallstones and CaGB is not clear. Cholesterol stones, particularly of a large size (> 3 cm), are said to be intimately associated with CaGB. Chronic mechanical damage to the mucosa is believed to be a major promoting factor for this neoplastic transformation. 8 However, as the majority of CaGB are not squamous cell carcinomas, but are adenocarcinomas, malignant transformation in the gall- INTRODUCTIONThe prevalence of carcinoma in the gallbladder (CaGB) is greatly variable in different parts of the world. 1 In the United States Of America, Singapore and Nigeria, it is an uncommon cancer with an incidence of 2.5 per 100 000 population. In contrast, Chile has a much higher incidence of 7.5 per 100 000 population, especially in American Indian females. 2 The Indian Council of Medical Research Cancer Registry has recorded an incidence of 4.5 per 100 000 population in males and 10.1 per 100 000 population in females of northern parts of India, and 1.2 per 100 000 population in females of the southern parts of India. 3 The highest incidence of CaGB in India has been seen along the Ganges delta. 4 Gallstones associated with gallbladder carcinoma have been reported in 70-90% of patients with CaGB. Approximately 0.4% of all patients with gallstones have CaGB. 5 The risk of developing cancer among patients with untreated cholelithiasis has been estimated to be 0.2-0.5% over a 20-year period. 6 An autopsy study has REVIEW Current perspectives in gallbladder carcinoma SATYENDRA P KAUSHIK Department of General Surgery, Government Medical College and Hospital, Chandigarh, IndiaAbstract Carcinoma gallbladder (CaGB) is not a common malignancy in a large number of countries in the world, except Chile, Japan, some parts of India, and a few other regions. Lacunae exist even today in terms of understanding of its epidemiology, aetiopathogenesis, and in the early pick up of malignanacy, as well as in choosing the most appropriate treatment option for a given case. While Japanese surgeons have advocated radical resections for CaGB and have shown good outcome resulting in longterm survival, others have not felt convinced about the desirability of undertaking such morbid surgical procedures in all patients. Also, radical resections have not always resulted in a tumor-free state and a cure in a large percentage of cases. Under the circumstances, the clinician's mind is often confused as to the most beneficial option for that patient once curative resection is not possible. Palliation of the jaundice and/or gastric outlet obstruction relieves the sympto...

Expressão imuno-histoquímica e valor prognóstico da proteína p53 no carcinoma de vesícula biliar: estudo de 60 casos

“…A incidência do carcinoma de vesícula biliar varia amplamente nas diferentes partes do mundo (4,11,17) , sendo mais freqüente em alguns países da América Latina e na Índia. No Chile essa afecção encontra-se em terceiro lugar como causa de óbito quando comparada a todas as neoplasias, sendo a segunda entre os tumores do trato digestivo com uma elevada incidência de 13 por 100 mil habitantes.…”

“…Altas incidências também são relatadas em Israel, Polônia, México e Bolívia. Nos Estados Unidos é uma neoplasia incomum, com uma incidência de 1,1 por 100 mil habitantes para o sexo masculino e 2,2 para o sexo feminino (3,17,22,(32)(33)(34) . Em Porto Alegre, Brasil, é responsável por 3,09 óbitos por 100 mil habitantes (6) .…”

Role of morphology and immunohistochemistry in the diagnosis of cryptic and occult cancer of gall bladder

“…17,18 This is due to the fact that tumors detected on histopathology usually present early stage disease and patients get promptly referred for definitive surgery. Completion radical cholecystectomy is the standard treatment for incidental gall bladder carcinomas that are stage I b and beyond.…”

Resection After Neoadjuvant Chemotherapy in Advanced Carcinoma of the Gallbladder: a Retrospective Study

“…Despite advances in diagnosis and treatment of gall bladder, long term outcomes remain dismal. Surgery alone provides a reasonable probability of long term survival in patients with carcinoma of the gall bladder [6].…”