Carcinoma of the gallbladder - Disorders of the gallbladder

Carcinoma of the gallbladder

Definition

Carcinoma of the gallbladder is rare, but almost always associated with gallstones.

Age

Usually >70 years.

Sex

F > M (4:1)

Aetiology/pathophysiology

Unknown, but associated with gallstones and chronic cholecystitis. Histologically 90% of tumours are adenocarcinomas and 10% are squamous carcinomas.

Clinical features

Patients may have a history of gallstone disease. Invasion of the bile duct or porta hepatis leads to unremitting jaundice. A mass is often palpable in the right upper quadrant. Many tumours are detected following cholecystectomy for symptomatic gallstones. Direct invasion of local structures, especially the liver, is almost invariable at presentation. Spread via the lymphatics and blood occurs early.

Investigations

Ultrasound, percutaneous transhepatic cholangiography (PTC), CT scan.

Management

Surgical resection is often not feasible due to local spread and metastases. Sometimes aggressive segmental resection of the liver and regional lymph nodes is carried out. Once jaundice occurs, resection is not curative and palliation by stenting or surgical bypass is needed.

Prognosis

Five-year survival rate is <5%.