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Carcinomagallbladder PDF
Carcinomagallbladder PDF
Objectives:
• Epidemiology
• Etiology
• Pathology and pathogenesis
• Clinical presentation
• diagnosis
• Treatment
• Prognosis
Epidemiology
• Old age
• Female
• Porcelain GB (10-25%)
• 60% - fundus
• 30% body
• 10% neck
• Tumor arising from neck and hartmanns pouch may infiltrate
the cystic duct and common bile duct make it clinically
indistinguishable form hilar bile ducts tumor
1. Infiltrative- m/c
2. Nodular
3. Combined nodular- infiltrative- m/c
4. Papillary
5. Combined papillary- infiltrative
• Infiltrative tumors cause thickening and indurations of GB wall
and extending to entire GB
• Also, most simple cholecystectomies for gallstone leave the serosa on the
liver side because the subserosal plane is the easiest for dissection.
4-posterior superior
pancreaticoduodenal, nodes on
the posterosuperior aspect of the
head of the
pancreas
5-hepatic artery, nodes
along the common or
proper hepatic artery
• Angiography
– Portal vein and hepatic artery encasement avoids
unneccesay laparotomy
• EUS
– Peripancreatic and periportal adenotpathy
– Needle bipdy can be performed
• Endoscopic and percutaneous cholangiographs
– GB cancer with obstructive jaundice- direct invasion or
compression of CHD or by pericholedochal LN
– Intraheptic bile ducts obstruction. High ALP
• Stage IVB
– N2 and or distance mets
– Uresectable
– Main portal vein, CHA if reseccted – confers
morbidity and mortality ares
Adjuvant therapies
• Adjuvant chemoradiotherapy after resection
• External beam or intraoperative radiation
therapy alone or in combination with 5FU-
decreasse local recurrence
• Data inadequate
palliation
• Goal- relief pain, manifestation of biliary
obstruction ( pruritis and cholangitis) and
bowel obstruction
• Endscopic stenting than surgical bypass in
weeks to month survival
• Palliative radiotherapy
• Regional intra- arterial chemotherapy
andchemoradiotherapy
• Gemcitabine plus cisplantin
outcome
Five year survival %
T1N0 39
T2N0 15
T3N0 12
• T1- 85-100%
– Morbidity--5-54%
– Mortality- 0-21%