Gallbladder Cancer: Epidemiology, Diagnosis
WM Ali, Maneesh Kumar Bhardwaj*, SAA Rizvi and AZ Rab
Department of General Surgery, Jawaharlal Nehru Medical College and Hospital, India
Submission: August 17, 2018;Published: October 04, 2018
*Corresponding author: Maneesh Kumar Bhardwaj, Junior Resident, Department of General Surgery, Jawaharlal Nehru Medical College and Hospital AMU, India, Tel: ; Email: email@example.com
How to cite this article:WM Ali, Maneesh K B, SAA Rizvi, AZ Rab. Gallbladder Cancer: Epidemiology, Diagnosis and Treatment. Adv Res Gastroentero Hepatol. 2018; 11(1): 555802. DOI:10.19080/ARGH.2018.11.555802.
Gallbladder cancer is the most common malignancy of biliary tract. Gallbladder cancer incidence increases with advancing age. It occurs more commonly in females. The incidence rates are very high in Latin America and Asia. Its major risk factors include gallstone, chronic inflammation, primary sclerosing cholangitis, infections, gallbladder polyp etc. it usually presents with symptoms like yellowish discoloration of body, right upper abdominal pain, vomiting, lump in right upper abdomen etc. Investigation profiles include blood investigations and radiological tests like ultrasonography, computed tomography etc. ERCP (Endoscopic Retrograde Cholangiopancreatography) can be used as diagnostic and treatment modality. Treatments of gallbladder cancer include surgery, chemo-radiotherapy and palliative care. Forty-three patients of confirmed gallbladder cancer are included in this study. The main concern of our data analysis is to study epidemiology, diagnosis and treatment measures for gallbladder cancer.
World is facing a lot of problems in now a days. Among these, carcinomas are one of them. An estimated 169.3 million years of healthy life were lost globally because of cancer in 2008.1 About 1,688,780 new cases of cancer are expected to diagnose in year 2017 in US.2 Worldwide there will be 23.6 million new cases of cancer each year by 2030 (estimated) . In 2012, an estimated 8.2 million people died from cancer worldwide .
More than half of cancer deaths worldwide occurred in undeveloped countries . The risk of developing cancer in a person depends on factors, including age, genetics, lifestyle and exposure to risk factors . Alcohol, smoking, less physical activity, diet, infections, overweight and obesity are the important risk factors . Prevalence of different risk factors varies by region and country; this is partly why overall cancer incidence rates, and the most common types of cancer, also vary by region and country .
Among malignancies of the biliary tract, Gallbladder cancer is the most common accounting for about 80-95% of biliary tract cancers worldwide [3,5,6]. Gallbladder cancer ranks fifth among gastrointestinal cancers . The global rates for gallbladder cancer show differences, reaching epidemic levels for some regions and ethnicities [3,7]. Gallbladder cancer has a particularly high incidence in Chile, Japan, and northern India [3,5]. In the United States, gallbladder cancer accounts for only 0.5% of all gastrointestinal malignancies; less than 5,000 cases occur yearly
(1–2.5 per 100,000) . Among Chilean women, gallbladder cancer is the leading cause of cancer death, exceeding breast, lung, and cervical cancers [9,10]. Intermediate frequencies of 3.7–9.1 per 100,000 occur elsewhere in South Americans of Indian descent . Other high-risk regions include Eastern Europe (14/100,000 in Poland), northern India (as high as 21.5/100,000 for women from Delhi), south Pakistan (11.3/100,000), Israel (5/100,000), and Japan (7/100,000) . The incidence is rising in China and has doubled over the past 20 years in Shanghai . In these areas, gallbladder cancer is the most frequent gastrointestinal malignancy and a significant cause of death.
Every year in India there are about 800,000 new cases and 550,000 deaths per annum . Gallbladder cancer is the most common abdominal malignancy in the northern India . The Indian Council of Medical Research Cancer Registry has reported incidence rate of 4.5% in males and 10.1% in females per 100,000 populations in northern India .
This is a retrospective study done in Jawaharlal Nehru medical college. The patients included in study were those admitted during the 2016 to 2017. The size of study was the group of 43 patients. Patients were admitted to hospital. Following admission, their, clinical presentation, investigations and management were studied.
It was seen that majority of patients were of age 41-60 years.
It was found that 32 patients were female (female 74.5% and male
25.5%). Clinical presentations of patients were not very broad.
Symptoms of patients were usually yellowish discoloration of
body (present in 13 cases), right upper abdominal pain (present
in 34 cases), vomiting (present in 7 cases), lump in right upper
abdomen (present in 5 cases), itching all over body (present in 1
case), anorexia (present in 5 cases). There were other symptoms
like backache, blood in urine, neck swelling which may be
associated with the metastasis of the tumor. Other nonspecific
symptoms seen were fever and nausea. Among these symptoms
most common was pain abdomen (seen in about 79% of cases)
followed by yellowish discoloration of eyes and body (seen in
about 30% of cases), vomiting (seen in about 16% of cases) lump
in right upper abdomen (seen in about 12% of cases).
On examination, most of patients were vitally stable and one of
the most important signs seen in these patients was icterus, which
was seen in 13 patients (30.2% of cases). Lymphadenopathy was
rarely seen (Table 1).
The patients were evaluated with blood investigations,
radiological investigations and pathological investigations.
Blood investigations were including haemogram, renal function
test, liver function test, prothrombin time, INR. Haemogram and
renal functions were usually normal and not reveal any specific
correlation. But decreased hemoglobin was seen in 17 cases.
Prothrombin time was prolonged in most of cases and INR was
also increased. Liver function test include total bilirubin, direct
bilirubin, alkaline phosphatase, alanine aminotransferase,
In 20 patients (48.5% cases), total bilirubin level was raised
and in most of these cases, direct bilirubin was raised up to the
more than 50%. Total bilirubin was raised up to 24 mg/dl. In most
of cases, total bilirubin was raised in between the range of 5 to
10 mg/dl. Among the all three enzymes included in liver function
tests, mostly alkaline phosphatase enzyme was associated with
raised level and was raised in 32 patients (74% cases). Alanine
aminotransferase enzyme was raised in 13 patients (30.2%
cases). Aspartate aminotransferase was seen raised in 12 patients
Radiological investigations done in each patient were
ultrasonography, chest X-ray and computed tomography. Initially
each patient has undergone ultrasonography, which usually
suggests a hypoechoic lesion in gall bladder with thickening of
gallbladder wall. Cholilithiasis was present in 20 patients (46.5%
cases), which suggests an important correlation between the
cholilithiasis and gall bladder cancer. Computed tomography
scan helps in knowing the involvement of fundus and body of
gallbladder. Lesion was having indistinct fat plane with adjacent
liver in about 43.7 % of cases. The most involved liver segment
was segment 5 (in 38.7%) followed by segment 4b (in 18.2%).
Periportal lymphadenopathy was seen in about 17.4% of cases
Pathological diagnosis was made by the FNAC only in
inoperable cases or where the diagnosis was suspected. FNAC
was not done in confirmed cases because of risk of spillage of
tumor cells along the track. Most of FNAC was suggestive of
After making the diagnosis and staging the disease, we managed
the patients. Management consisted of extended cholecystectomy,
chemotherapy, radiotherapy and palliative treatment. Extended
cholecystectomy was done in stage 1a, 1b and 2. In our study we
have done extended cholecystectomy in 8 cases and follow-up of
these patients done 3 monthly. In remaining cases, other mode of
treatment including chemotherapy, radiotherapy and palliative
treatment were given.
Sometime ERCP was also used in few patients as a palliative
mode of treatment. ERCP is an invasive procedure.
Gallbladder cancer is one of the cancers having good prognosis
with early diagnosis. It usually occurs in age group of 40-60 years.
It usually occurs in females. Gallbladder cancer presents with
symptoms like pain abdomen, yellowish discoloration of body and
eyes, lump abdomen, fever, vomiting and anuria. Symptoms usually
denote the late presentation of disease thereby bad prognosis
of disease. So, at the time of presentation, it is inoperable stage.
Important sign in these patients is the presence of icterus. Then
patient is investigated by liver function test, prothrombin time,
INR, ultrasonography, CT scan. In liver function test, elevated total
bilirubin with direct bilirubin is seen. Among enzymes, alkaline
transferase is most sensitive in these patients and is elevated in
high number of cases. Ultrasonography usually shows thickened
gallbladder wall with associated cholilithiasis. CT scan helps us
to stage the disease and making further plan of management.
Extended cholecystectomy is gold standard of treatment in early
stages of disease. Other mode of treatment includes chemoradiotherapy,
ERCP, pain management etc.
Gallbladder cancer is one of the major cancers among
all gastrointestinal cancers. And it tops the rank among the
hepatobiliary cancer in terms of incidence. But at present time,
incidence of gallbladder cancer has decreased may be because of
increased number of laparoscopic cholecystectomy done. Early
diagnosis of gallbladder cancer is very important for increasing
the survival of patient. Surgical and medical modalities are the
mainstay of treatment. Surgical treatment usually done in early
stage of disease. So, it is very important to diagnose early and
treatment of it to prevent the progression. And patient must
educate about it.