Gallbladder cancer overview: Difference between revisions
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==Classification== | ==Classification== | ||
Gallbladder [[cancer]] may be classified according to [[histology]] findings into various subtypes and are as follows [[Adenocarcinoma]], [[Papillary]] [[adenocarcinoma]], [[Mucinous]] adenocarcinoma, [[Signet ring cell carcinoma]], [[Adenosquamous carcinoma]], [[Squamous cell carcinoma]], [[Neuroendocrine]] [[carcinoma]], [[Small cell carcinoma]], [[undifferentiated]] carcinoma, spindle cell undifferentiated carcinoma, giant cell undifferentiated [[carcinoma]].It is understood that GBC is the result of persistent [[irritation]] of the gallbladder [[mucosa]] over a period of years which predispose to [[malignant]] transformation or act as an enhancer for [[Carcinogen|carcinogenic]] exposure.The primary mechanism involves [[cholelithiasis]] and resultant [[cholecystitis]] and appears to be the driving force in most areas of the arena.Chronically [[Inflammation|inflamed]] [[gallbladder]] may additionally express both pyloric gland and [[intestinal]] [[metaplasia]].But, fluke-infested gallbladders more commonly shows intestinal metaplasia and [[P53 (protein)|p53]] [[Mutation|mutations]] than sporadic gallbladder cancers.[[Dysplasia|Dysplastic]] lesions have [[molecular]] [[genetic]] proof that supports progression towards [[CIS]].There are also histologic and molecular differences in GBCs related to anomalous pancreaticobiliary duct junction and in the ones related to [[gallstones]], Providing further proof that two different pathogenetic pathways are involved.Less than 3% of early gallbladder carcinomas have [[adenomatous]] remnants, indicating this mechanism has less importance within the [[carcinogenic]] pathway.Around 80 t0 95% of [[biliary tract]] [[Cancer|cancers]] are gallbladder cancers.[[Epidemiology|Epidemiological]] research has recognized striking geographic and [[Ethnic group|ethnic]] difference. An excessive incidence in American Indians and Southeast Asia, but pretty low in the America and the arena.[[Gallstones]], [[Porcelain gallbladder]], [[Gallbladder polyp|Gallbladder polyps]], [[Primary sclerosing cholangitis]] (PSC) , | [[Gallbladder]] [[cancer]] may be classified according to [[histology]] findings into various subtypes and are as follows [[Adenocarcinoma]], [[Papillary]] [[adenocarcinoma]], [[Mucinous]] adenocarcinoma, [[Signet ring cell carcinoma]], [[Adenosquamous carcinoma]], [[Squamous cell carcinoma]], [[Neuroendocrine]] [[carcinoma]], [[Small cell carcinoma]], [[undifferentiated]] carcinoma, spindle cell undifferentiated carcinoma, giant cell undifferentiated [[carcinoma]].It is understood that GBC is the result of persistent [[irritation]] of the gallbladder [[mucosa]] over a period of years which predispose to [[malignant]] transformation or act as an enhancer for [[Carcinogen|carcinogenic]] exposure.The primary mechanism involves [[cholelithiasis]] and resultant [[cholecystitis]] and appears to be the driving force in most areas of the arena.Chronically [[Inflammation|inflamed]] [[gallbladder]] may additionally express both pyloric gland and [[intestinal]] [[metaplasia]].But, fluke-infested gallbladders more commonly shows intestinal metaplasia and [[P53 (protein)|p53]] [[Mutation|mutations]] than sporadic [[Gallbladder cancer|gallbladder cancers]].[[Dysplasia|Dysplastic]] lesions have [[molecular]] [[genetic]] proof that supports progression towards [[CIS]].There are also histologic and molecular differences in GBCs related to anomalous pancreaticobiliary duct junction and in the ones related to [[gallstones]], Providing further proof that two different pathogenetic pathways are involved.Less than 3% of early gallbladder carcinomas have [[adenomatous]] remnants, indicating this mechanism has less importance within the [[carcinogenic]] pathway.Around 80 t0 95% of [[biliary tract]] [[Cancer|cancers]] are gallbladder cancers.[[Epidemiology|Epidemiological]] research has recognized striking geographic and [[Ethnic group|ethnic]] difference. An excessive incidence in American Indians and Southeast Asia, but pretty low in the America and the arena.[[Gallstones]], [[Porcelain gallbladder]], [[Gallbladder polyp|Gallbladder polyps]], [[Primary sclerosing cholangitis]] (PSC) , chronic infection, congenital biliary cysts, pancreaticobiliary maljunction (PBM).There is no [[Screening test|screening]] recommended for [[gallbladder cancer]]. According to the National Comprehensive Cancer Network (NCCN) guidelines, gallbladder cancer may be diagnosed as an incidental finding in patients who undergo [[laparoscopic]] [[cholecystectomy]].[[Gallbladder cancer (patient information)|Gallbladder cancer]] must be differentiated from [[hepatitis]], [[gallstones]], [[cholecystitis]], [[peptic ulcer]], [[pancreatic cancer]] and [[pancreatitis]].Depending on the extent of the tumor at the time of [[diagnosis]], the prognosis may vary. However, the prognosis is generally regarded as poor.Most tumors are [[Adenocarcinoma|adenocarcinomas]], with a small percent being [[squamous cell]] carcinomas. The cancer commonly spreads to the [[liver]], [[pancreas]], [[stomach]] and [[duodenum]]. The survival rate depends on the extent of cancer at the time of diagnosis with [[gallbladder cancer]] and early detection is key for good [[prognosis]].According to the AJCC, there are 4 stages of [[gallbladder cancer]] based on the tumor [[Spread of the cancer|spread]].[[Symptom|Symptoms]] of gallbladder cancer include [[jaundice]], [[pain]], [[fever]], [[burping]] and [[weight loss]].Laboratory findings consistent with the diagnosis of gallbladder [[cancer]] include abnormal [[liver function tests]] and elevated [[CA 19-9]] and [[CEA]] levels.On [[Abdomen|abdominal]] [[Computed tomography|CT]] scan, [[gallbladder cancer]] appears as large [[heterogeneous]] [[mass]] with areas of [[necrosis]].[[Palliative therapy]] in [[gallbladder cancer]]<nowiki/>involves [[percutaneous]] transhepatic radiologic [[catheter]] bypass or endoscopically placed [[Stent|stents]], standard external-beam [[radiation]] therapy, [[palliative]] surgery or standard [[chemotherapy]].Research suggests that lifestyle factors such as changes in [[Diet (nutrition)|diet]], [[exercise]], and maintenance of weight can influence the likelihood of an individual developing [[gallbladder cancer]].Research suggests that lifestyle factors such as changes in [[Diet (nutrition)|diet]], [[exercise]], and maintenance of weight can influence the likelihood of an individual developing [[gallbladder cancer]]. | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
[[Category:Oncology]] | [[Category:Oncology]] | ||
Revision as of 15:54, 10 January 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
Overview
Classification
Gallbladder cancer may be classified according to histology findings into various subtypes and are as follows Adenocarcinoma, Papillary adenocarcinoma, Mucinous adenocarcinoma, Signet ring cell carcinoma, Adenosquamous carcinoma, Squamous cell carcinoma, Neuroendocrine carcinoma, Small cell carcinoma, undifferentiated carcinoma, spindle cell undifferentiated carcinoma, giant cell undifferentiated carcinoma.It is understood that GBC is the result of persistent irritation of the gallbladder mucosa over a period of years which predispose to malignant transformation or act as an enhancer for carcinogenic exposure.The primary mechanism involves cholelithiasis and resultant cholecystitis and appears to be the driving force in most areas of the arena.Chronically inflamed gallbladder may additionally express both pyloric gland and intestinal metaplasia.But, fluke-infested gallbladders more commonly shows intestinal metaplasia and p53 mutations than sporadic gallbladder cancers.Dysplastic lesions have molecular genetic proof that supports progression towards CIS.There are also histologic and molecular differences in GBCs related to anomalous pancreaticobiliary duct junction and in the ones related to gallstones, Providing further proof that two different pathogenetic pathways are involved.Less than 3% of early gallbladder carcinomas have adenomatous remnants, indicating this mechanism has less importance within the carcinogenic pathway.Around 80 t0 95% of biliary tract cancers are gallbladder cancers.Epidemiological research has recognized striking geographic and ethnic difference. An excessive incidence in American Indians and Southeast Asia, but pretty low in the America and the arena.Gallstones, Porcelain gallbladder, Gallbladder polyps, Primary sclerosing cholangitis (PSC) , chronic infection, congenital biliary cysts, pancreaticobiliary maljunction (PBM).There is no screening recommended for gallbladder cancer. According to the National Comprehensive Cancer Network (NCCN) guidelines, gallbladder cancer may be diagnosed as an incidental finding in patients who undergo laparoscopic cholecystectomy.Gallbladder cancer must be differentiated from hepatitis, gallstones, cholecystitis, peptic ulcer, pancreatic cancer and pancreatitis.Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor.Most tumors are adenocarcinomas, with a small percent being squamous cell carcinomas. The cancer commonly spreads to the liver, pancreas, stomach and duodenum. The survival rate depends on the extent of cancer at the time of diagnosis with gallbladder cancer and early detection is key for good prognosis.According to the AJCC, there are 4 stages of gallbladder cancer based on the tumor spread.Symptoms of gallbladder cancer include jaundice, pain, fever, burping and weight loss.Laboratory findings consistent with the diagnosis of gallbladder cancer include abnormal liver function tests and elevated CA 19-9 and CEA levels.On abdominal CT scan, gallbladder cancer appears as large heterogeneous mass with areas of necrosis.Palliative therapy in gallbladder cancerinvolves percutaneous transhepatic radiologic catheter bypass or endoscopically placed stents, standard external-beam radiation therapy, palliative surgery or standard chemotherapy.Research suggests that lifestyle factors such as changes in diet, exercise, and maintenance of weight can influence the likelihood of an individual developing gallbladder cancer.Research suggests that lifestyle factors such as changes in diet, exercise, and maintenance of weight can influence the likelihood of an individual developing gallbladder cancer.