Facultad en Ciencias Médicas - Capacitación en Inglés

EXAMEN FINAL MODELO

Alumno: ________________________ Legajo: __________ Fecha: _________

Gallbladder Cancer
Background: Cancers of the biliary tract include cholangiocarcinomas (cancers arising from the
5bile duct epithelium) and gallbladder cancers. Both types of biliary tract cancers are rare and have
an overall poor prognosis. They also both present difficulties in diagnosis. These diseases are often
discussed together and are co-mingled in therapeutic trials. However, this leads to significant
confusion. Despite some similarities, gallbladder cancer is a distinct clinical entity from
cholangiocarcinoma and will be discussed separately in this article.
10Pathophysiology: Gallbladder cancer arises in the setting of chronic inflammation. In the vast
majority of patients (>75%), the source of this chronic inflammation is gallstones. Other more
unusual causes of chronic inflammation are also associated with gallbladder cancer. These causes
include patients who suffer from chronic typhoid infections, abnormal pancreaticobiliary duct
junctions, inflammatory bowel disease, or polyposis coli.
15Chronic gallbladder inflammation is likely only part of the cause of the malignant transformation
which is seen in gallbladder cancer. Ingestion of certain medications (oral contraceptives, INH, and
methyldopa) as well as certain occupational chemical exposures may play a significant contributing
role. The role of various oncogenic mutations in gallbladder cancer is an area of active research.
Gallbladder cancer incidence increases with age and is more common in women.
20The tumor is usually located in the fundus of the gallbladder. Local spread through the gallbladder
wall can lead to direct liver invasion, or, if in the opposite direction, leads to transperitoneal spread
(20% of patients at presentation), with implants on the liver, on the bowel, and in the pelvis. Tumor
may also directly invade other adjacent organs such as the stomach, duodenum, colon, pancreas and
extrahepatic bile duct. At diagnosis, the gallbladder is often replaced or destroyed by the cancer,
25and approximately 50% of patients have regional lymph node metastases.
Mortality/Morbidity: Survival is correlated with staging based on the American Joint Committee
on Cancer tumor, node, metastases (TNM) staging system.
Patients with stage IA disease (T1N0M0) should be cured with a simple cholecystectomy. In
selected surgical series, patients with stage IB (T2N0M0) disease treated with extended
30cholecystectomy have a 5-year survival rate of 70-90%, and patients with stage IIB (T1-3N1M0)
treated with extended cholecystectomy have a 5-year survival of 45-60%. Stage III (T4, any N,M0)
gallbladder cancer is generally not surgically curable. The 1-year survival rate for advanced
gallbladder cancer is less than 5%. The median survival is 2-4 months.
The SEER ( Surveillance, Epidemiology and End Results ) registry from 1995-2001 shows 5-year
35survival rates for localized gallbladder cancer of approximately 40%. The 5-year survival rate for
regional disease is approximately 15%, and the 5-year survival rate for distant metastatic disease is
less than 10%

40A. READING COMPREHENSION

Answer these questions in Spanish.

1. ¿Cómo se origina la inflamación crónica de vesícula?

…………………………………………………………………………………………………………
45…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
 Facultad en Ciencias Médicas - Capacitación en Inglés
EXAMEN FINAL MODELO

2. ¿Qué otros factores pueden colaborar con la aparición del cáncer biliar?
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
5…………………………………………………………………………………………………………
3. ¿A dónde puede extenderse el cáncer?
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
10…………………………………………………………………………………………………………
4. ¿Cómo es el índice de sobrevida según el estadio de la enfermedad y el tratamiento recibido?
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
15…………………………………………………………………………………………………………

B. ENGLISH IN USE

1. Contextual References: What do these words refer to in the text?

20
They in line 3: ______________________________________
These diseases in line 3: ______________________________________
this in line 4 : ______________________________________
who in line 10: ______________________________________
25which in line 13 : ______________________________________

2. Noun Phrases: Translate these noun phrases into Spanish.

a. certain occupational chemical exposures: _____________________________________________

30________________________________________________________________________________

b.the setting of chronic inflammation: ________________________ _________________________

c. staging based on the American Joint Committee on Cancer tumor, node, metastases staging

system: _________________________________________________________________________

________________________________________________________________________________
 Facultad en Ciencias Médicas - Capacitación en Inglés
EXAMEN FINAL MODELO

d regional lymph node metastases: ____________________________________________________

e. Patients with stage IB disease treated with extended cholecystectomy: _____________________

________________________________________________________________________________

3. Verbs: Translate these verbs as they appear in the text.

5

Verb in the text Translation

PRESENT ( L. 3 )
WILL BE DISCUSSED (L. 6 )
IS SEEN (L. 13 )
MAY PLAY (L. 14 )
LEADS TO (L. 18 )
SHOULD BE CURED ( L 25 )

4. Find the following in the text and indicate the line numbers.
10
 Words derived from metastasis: ____________________________________________
 Connectors of contrast: ___________________________________
 An example of comparison: ________________________________
 Derived adjectives for these nouns: therapy: ________________ cure: ____________
15 chemistry: ______________

C. TRANSLATION: Translate the following text into Spanish.

20Calcium, bilirubin, and pigment gallstones

Bilirubin, a yellow pigment derived from the breakdown of heme, is actively secreted into bile by
liver cells. Most of the bilirubin in bile is in the form of glucuronide conjugates, which are quite
water soluble and stable, but a small proportion consists of unconjugated bilirubin. Unconjugated
25bilirubin, like fatty acids, phosphate, carbonate, and other anions, tends to form insoluble
precipitates with calcium. Calcium enters bile passively along with other electrolytes.
In situations of high heme turnover, such as chronic hemolysis or cirrhosis, unconjugated bilirubin
may be present in bile at higher than normal concentrations. Calcium bilirubinate may then
crystallize from solution and eventually form stones. Over time, various oxidations cause the
30bilirubin precipitates to take on a jet black color, and stones formed in this manner are termed black
pigment stones. Black pigment stones represent 10-20% of gallstones in the United States.
Bile normally is sterile, but, in some unusual circumstances (eg, above a biliary stricture), it may
become colonized with bacteria. The bacteria hydrolyze conjugated bilirubin, and the resulting
increase in unconjugated bilirubin may lead to precipitation of calcium bilirubinate crystals.
35Bacterial hydrolysis of lecithin leads to the release of fatty acids, which complex with calcium and
precipitate from solution. The resulting concretions are termed brown pigment stones.