Gallbladder cancer is an uncommon cancer in the United States. Only about 3,000 new cases of gallbladder cancer occur each year. In contrast to the USA, gallbladder cancer is common in some parts of the world such South America. For example, gall bladder cancer is the most common type of cancer affecting women in Chile. Gallbladder cancer is 7 to 10 times more common in women compared to men and its incidence increases with aging.
Gallstones: The most common risk factor for gall bladder cancer is the presence of gallstones.
Gallbladder polyps: Gallbladder polyps are also thought to be risk factors for gallbladder cancer. Because of the poor prognosis associated with gallbladder cancer, patients with gallbladder polyps should be carefully evaluated. We recommend surgery in all patients who are over the age of 50, have a gall bladder polyp that is greater than 1cm or if there are less than 3 gall bladder polyps in the gall bladder. If a patient elects not to have surgery then we would recommend six monthly follow up with ultrasound evaluation.
Diagnosis of gallbladder cancer:
The diagnosis of gall bladder cancer is made by presence of a mass in the gall bladder area on CT scanning. CT scanning also allows for evaluation of possible resectability of the cancer. If the cancer is confined to the gall bladder or locally invades the liver then surgical removal is an option and the patient requires further evaluation for this. Patients who have spread of the cancer outside the liver or have extensive liver involvement are not surgical candidates.
Treatment of Gallbladder cancer:
Treatment of gall bladder cancer requires a careful assessment of the stage of the disease, the extent of liver and lymph gland involvement and a careful evaluation for spread outside the liver and gall bladder. The surgical procedures are complex and technically demanding. Furthermore, the role of chemotherapy treatment and radiation therapy treatment is controversial and the type of treatment and its use varies from center to center.
Patients with gall bladder cancer should be treated in a tertiary cancer center that has some historical experience in treating patients with gall bladder cancer.Surgery for gallbladder cancer
Surgery to remove the gallbladder and surrounding liver tissue is the treatment of choice for patients who have early stage gallbladder cancer. This includes:
For patients with more advanced tumors surgical options need to be individualized and will depend on the extent of involvement of the liver, the general condition of the patient to tolerate a major operation and presence and extent of involvement of lymph glands by the tumor. Patients who do not qualify as surgical candidates should be evaluated for medical treatment with chemotherapy
Gallbladder cancer found at the time laparoscopic cholecystectomy
Because of the wide spread use of laparoscopic cholecystectomy, early stage gallbladder cancers are more frequently detected today after this procedure. Patients who are found to have gallbladder cancer after laparoscopic cholecystectomy should be evaluated for a second operation where radical removal of the cancer is performed.
Published studies have shown that up to half the patients will have recurrence in their gallbladder bed if a curative surgical procedure is not performed. The type surgery and extent of surgery will depend on the stage of gallbladder cancer detected in the laparoscopic cholecystectomy specimen.
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