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{{Infobox medical condition (new)
{{Infobox medical condition (new)
| name = Gallbladder cancer
| name = Gallbladder cancer
| synonyms =
| synonyms =
| image = Illu pancrease.svg
| image = Illu pancrease.svg
| caption =
| caption =
| pronounce =
| pronounce =
| field = [[Oncology]]
| field = [[Gastroenterology]] [[Hepatology]] [[Oncology]]
|
|
| symptoms = [[Abdominal pain]], [[Bloating]], [[Fever]], Unexplained weight loss, [[Nausea]], [[Jaundice|Yellowing of the skin]], although some people may have no symptoms<ref>https://www.mayoclinic.org/diseases-conditions/gallbladder-cancer/symptoms-causes/syc-20353370</ref>
| symptoms = [[Abdominal pain]], [[Bloating]], [[Fever]], Unexplained weight loss, [[Nausea]], [[Jaundice|Yellowing of the skin]], although some people may have no symptoms<ref name="mayoclinic.org">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/gallbladder-cancer/symptoms-causes/syc-20353370|title = Gallbladder cancer - Symptoms and causes|website = [[Mayo Clinic]]}}</ref>
| complications = Cancer spreading to other parts of the body
| complications = Cancer spreading to other parts of the body
| onset = Above 65 years old<ref>https://www.cancer.org/cancer/gallbladder-cancer/causes-risks-prevention/risk-factors.html</ref>
| onset = Above 65 years old<ref>{{Cite web|url=https://www.cancer.org/cancer/gallbladder-cancer/causes-risks-prevention/risk-factors.html|title=Risk Factors for Gallbladder Cancer|website=www.cancer.org}}</ref>
| duration =
| duration =
| types = [[Adenocarcinoma]] (most common), [[Squamous cell carcinoma]] (more rare)<ref>https://www.cancerresearchuk.org/about-cancer/gallbladder-cancer/types</ref>
| types = [[Adenocarcinoma]] (most common), [[Squamous cell carcinoma]] (more rare)<ref>{{Cite web|url=https://www.cancerresearchuk.org/about-cancer/gallbladder-cancer/types|title = Types of gallbladder cancer &#124; Gallbladder cancer &#124; Cancer Research UK}}</ref>
| causes = Unknown<ref>https://www.mayoclinic.org/diseases-conditions/gallbladder-cancer/symptoms-causes/syc-20353370</ref>
| causes = Unknown<ref name="mayoclinic.org"/>
| risks = History of [[Gallstones]] and other [[Gallbladder diseases]]
| risks = History of [[Gallstones]] and other [[Gallbladder diseases]]
| diagnosis = Blood tests, medical imaging, examination of the [[Bile duct]]
| diagnosis = Blood tests, medical imaging, examination of the [[Bile duct]]
| differential = Other types of cancer in the [[Digestive system]]
| differential = Other types of cancer in the [[Digestive system]]
| prevention =
| prevention =
| treatment = [[Surgery]], [[Radiation therapy]], [[Chemotherapy]]<ref>https://www.mayoclinic.org/diseases-conditions/gallbladder-cancer/diagnosis-treatment/drc-20353374</ref>
| treatment = [[Surgery]], [[Radiation therapy]], [[Chemotherapy]]<ref>{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/gallbladder-cancer/diagnosis-treatment/drc-20353374|title = Gallbladder cancer - Diagnosis and treatment - Mayo Clinic|website = [[Mayo Clinic]]}}</ref>
| medication =
| medication =
| prognosis = [[Five-year survival rate]] ~19% (USA) (January, 2020)<ref>https://www.cancer.net/cancer-types/gallbladder-cancer/statistics</ref>
| prognosis = [[Five-year survival rate]] ~19% (USA) (January, 2020)<ref>{{Cite web|url=https://www.cancer.net/cancer-types/gallbladder-cancer/statistics|title = Gallbladder Cancer - Statistics|date = 25 June 2012}}</ref>
| frequency = ~3,700 cases per year (USA)<ref name="cebp.aacrjournals.org">{{Cite journal|url=https://cebp.aacrjournals.org/content/24/9/1319|doi = 10.1158/1055-9965.EPI-15-0199|title = Gallbladder Cancer Incidence and Mortality, United States 1999–2011|year = 2015|last1 = Henley|first1 = S. Jane|last2 = Weir|first2 = Hannah K.|last3 = Jim|first3 = Melissa A.|last4 = Watson|first4 = Meg|last5 = Richardson|first5 = Lisa C.|journal = Cancer Epidemiology, Biomarkers & Prevention|volume = 24|issue = 9|pages = 1319–1326|pmid = 26070529|s2cid = 886615}}</ref>
| frequency = ~3,700 cases per year (USA)<ref>https://cebp.aacrjournals.org/content/24/9/1319</ref>
| deaths = ~2,000 deaths per year (USA)<ref>https://cebp.aacrjournals.org/content/24/9/1319</ref>
| deaths = ~2,000 deaths per year (USA)<ref name="cebp.aacrjournals.org"/>
}}
}}
'''Gallbladder cancer''' is a relatively uncommon [[cancer]], with an incidence of fewer than 2 cases per 100,000 people per year in the United States.<ref>{{Cite web|url=https://www.cdc.gov/cancer/dcpc/research/articles/gallbladder.htm|title=CDC - Gallbladder Cancer Incidence and Death Rates|date=2018-09-27|website=www.cdc.gov|language=en-us|access-date=2018-12-10}}</ref> It is particularly common in central and South America, central and eastern Europe, Japan and northern India; it is also common in certain ethnic groups e.g. Native American Indians and Hispanics.<ref>{{cite journal |vauthors=Kapoor VK, McMichael AJ |title=Gallbladder cancer: an 'Indian' disease |journal=Natl Med J India |volume=16 |issue=4 |pages=209–13 |year=2003 |pmid=14606770 }}</ref> If it is diagnosed early enough, it can be cured by removing the [[gallbladder]], part of the [[liver]] and associated [[lymph node]]s. Most often it is found after [[symptoms]] such as [[abdominal]] pain, [[jaundice]] and vomiting occur, and it has spread to other [[Organ (anatomy)|organ]]s such as the liver.
'''Gallbladder cancer''' is a relatively uncommon [[cancer]], with an incidence of fewer than 2 cases per 100,000 people per year in the United States.<ref>{{Cite journal|url=https://www.cdc.gov/cancer/dcpc/research/articles/gallbladder.htm|title=CDC - Gallbladder Cancer Incidence and Death Rates|date=2018-09-27|journal=Cancer Epidemiology, Biomarkers & Prevention|volume=24|issue=9|pages=1319–1326|doi=10.1158/1055-9965.EPI-15-0199|language=en-us|access-date=2018-12-10|last1=Henley|first1=S. Jane|last2=Weir|first2=Hannah K.|last3=Jim|first3=Melissa A.|last4=Watson|first4=Meg|last5=Richardson|first5=Lisa C.|pmid=26070529|s2cid=886615}}</ref> It is particularly common in central and South America, central and eastern Europe, Japan and northern India; it is also common in certain ethnic groups e.g. Native American Indians and Hispanics.<ref>{{cite journal |vauthors=Kapoor VK, McMichael AJ |title=Gallbladder cancer: an 'Indian' disease |journal=Natl Med J India |volume=16 |issue=4 |pages=209–13 |year=2003 |pmid=14606770 }}</ref> If it is diagnosed early enough, it can be cured by removing the [[gallbladder]], part of the [[liver]] and associated [[lymph node]]s. Most often it is found after [[symptoms]] such as [[abdominal]] pain, [[jaundice]] and vomiting occur, and it has spread to other [[Organ (anatomy)|organ]]s such as the liver.


It is a rare cancer that is thought to be related to gallstones building up, which also can lead to [[calcification]] of the gallbladder, a condition known as [[porcelain gallbladder]]. Porcelain gallbladder is also rare. Some studies indicate that people with porcelain gallbladder have a high risk of developing gallbladder cancer, but other studies question this. The outlook is poor for recovery if the cancer is found after symptoms have started to occur, with a 5-year survival rate close to 3%.
It is a rare cancer that is thought to be related to gallstones building up, which also can lead to [[calcification]] of the gallbladder, a condition known as [[porcelain gallbladder]]. Porcelain gallbladder is also rare. Some studies indicate that people with porcelain gallbladder have a high risk of developing gallbladder cancer, but other studies question this. The outlook is poor for recovery if the cancer is found after symptoms have started to occur, with a 5-year survival rate of close to 3%.{{cn|date=March 2022}}


==Signs and symptoms==
==Signs and symptoms==
*Steady pain in the upper right abdomen
* Steady pain in the upper right abdomen
*[[Indigestion]]
* [[Indigestion]] ([[dyspepsia]])
* [[Bile|Bilious]] vomit
*Dyspepsia (gas)
*[[Bile|Bilious]] vomit
* [[Weakness]]
* [[Loss of appetite]]
*[[Weakness (medical)|Weakness]]
*[[Loss of appetite]]
* [[Weight loss]]
⚫
* [[Jaundice]] and [[vomiting]] due to obstruction
*[[Weight loss]]
⚫
*[[Jaundice]] and [[vomiting]] due to obstruction


Early symptoms mimic gallbladder inflammation due to gallstones. Later, the symptoms may be that of [[bile duct|biliary]] and stomach obstruction.
Early symptoms mimic gallbladder inflammation due to gallstones. Later, the symptoms may be that of [[bile duct|biliary]] and stomach obstruction.{{cn|date=March 2022}}


Of note, [[Courvoisier's law]] states that in the presence of a palpably enlarged gallbladder which is nontender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones. This implicates possible malignancy of the gallbladder or pancreas, and the swelling is unlikely due to gallstones due to the chronic inflammation association with gallstones leading to a shrunken, non-distensible gallbladder. However, Ludwig Georg Courvoisier's original observations, published in Germany in 1890, were not originally cited as a law, and no mention of malignancy or pain (tenderness) was made. These points are commonly misquoted or confused in the medical literature.<ref>{{cite journal |last=Fitzgerald |first=J Edward F |author2=White Matthew J |author3=Lobo Dileep N |date=Apr 2009 |title=Courvoisier's gallbladder: law or sign? |journal=[[World Journal of Surgery]] |volume=33 |issue=4 |pages=886–91 |location = [[United States]]| issn = 0364-2313| pmid = 19190960 |doi = 10.1007/s00268-008-9908-y |s2cid=21799234 }}</ref>
Of note, [[Courvoisier's law]] states that in the presence of a palpably enlarged gallbladder which is nontender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones. This implicates possible malignancy of the gallbladder or pancreas, and the swelling is unlikely due to gallstones due to the chronic inflammation associated with gallstones leading to a shrunken, non-distensible gallbladder. However, the original observations of [[Ludwig Georg Courvoisier]], published in Germany in 1890, were not originally cited as a law, and no mention of malignancy or pain (tenderness) was made. These points are commonly misquoted or confused in the medical literature.<ref>{{cite journal |last=Fitzgerald |first=J Edward F |author2=White Matthew J |author3=Lobo Dileep N |date=Apr 2009 |title=Courvoisier's gallbladder: law or sign? |journal=[[World Journal of Surgery]] |volume=33 |issue=4 |pages=886–91 |location = [[United States]]| issn = 0364-2313| pmid = 19190960 |doi = 10.1007/s00268-008-9908-y |s2cid=21799234 }}</ref>


==Risk factors==
==Risk factors==
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* [[Obesity]]
* [[Obesity]]
* Chronic [[cholecystitis]] and [[cholelithiasis]]
* Chronic [[cholecystitis]] and [[cholelithiasis]]
* [[Primary sclerosing cholangitis]]<ref name="Folseraas2016">{{cite journal|last1=Folseraas|first1=T|last2=Boberg|first2=KM|title=Cancer Risk and Surveillance in Primary Sclerosing Cholangitis|journal=Clinics in Liver Disease|date=February 2016|volume=20|issue=1|pages=79–98|doi=10.1016/j.cld.2015.08.014|pmid=26593292}}</ref>
* [[Primary sclerosing cholangitis]]<ref name="Folseraas2016">{{cite journal|last1=Folseraas|first1=T|last2=Boberg|first2=KM|title=Cancer Risk and Surveillance in Primary Sclerosing Cholangitis|journal=Clinics in Liver Disease|date=February 2016|volume=20|issue=1|pages=79–98|doi=10.1016/j.cld.2015.08.014|pmid=26593292}}</ref>
* Chronic [[typhoid]] infection of gallbladder; chronic [[Salmonella typhi]] carriers have 3 to 200 times higher risk of gallbladder cancer than non-carriers and 1–6% lifetime risk of development of cancer<ref name=Ferreccio2012>{{Cite book | doi = 10.1007/978-94-007-2585-0_5| chapter = Salmonella typhi and Gallbladder Cancer| title = Bacteria and Cancer| pages = 117–137| year = 2012| last1 = Ferreccio | first1 = C. | isbn = 978-94-007-2584-3}}</ref>
* Chronic [[typhoid]] infection of gallbladder; chronic [[Salmonella typhi]] carriers have 3 to 200 times higher risk of gallbladder cancer than non-carriers and 1–6% lifetime risk of development of cancer<ref name=Ferreccio2012>{{Cite book | doi = 10.1007/978-94-007-2585-0_5| chapter = Salmonella typhi and Gallbladder Cancer| title = Bacteria and Cancer| pages = 117–137| year = 2012| last1 = Ferreccio | first1 = C. | isbn = 978-94-007-2584-3}}</ref>
* Various single nucleotide polymorphisms (SNPs) have been shown to be associated with gallbladder cancer; however, existing genetic studies in GBC susceptibility have so far been insufficient to confirm any association<ref>Srivastava K, Srivastava A, Sharma KL, Mittal B. Candidate gene studies in gallbladder cancer: a systematic review and meta-analysis. Mutat Res. 2011 Jul–Oct;728(1–2):67–79.</ref>
* Various single nucleotide polymorphisms (SNPs) have been shown to be associated with gallbladder cancer; however, existing genetic studies in GBC susceptibility have so far been insufficient to confirm any association<ref>Srivastava K, Srivastava A, Sharma KL, Mittal B. Candidate gene studies in gallbladder cancer: a systematic review and meta-analysis. Mutat Res. 2011 Jul–Oct;728(1–2):67–79.</ref>
* Gallbladder polyps<ref name=":0">{{Cite web|title=Gallbladder Cancer: Symptoms, Causes & Treatment {{!}} Dr. Nikhil Agrawal|url=https://www.drnikhilagrawal.com/gallbladder_cancer|access-date=2020-10-11|website=Dr.Nikhil Agrawal|language=en}}</ref>
* Calcified gallbladder wall (porcelain gallbladder)<ref name=":0" />
* Congenital abnormalities of the bile duct such as choledochal cyst<ref name=":0" />


==Diagnosis==
==Diagnosis==
Early diagnosis is not generally possible. People at high risk, such as women or Native Americans with gallstones, are evaluated closely. Transabdominal [[ultrasound]], [[CT scan]], endoscopic [[ultrasound]], [[MRI]], and MR cholangio-pancreatography (MRCP) can be used for diagnosis. A large number of gallbladder cancers are found incidentally in patients being evaluated for [[Gallstone|cholelithiasis]], or gallstone formation, which is far more common.<ref>{{Cite journal|last1=Duffy|first1=A.|last2=Capanu|first2=M.|last3=Abou-Alfa|first3=G. K.|last4=Huitzil|first4=D.|last5=Jarnagin|first5=W.|last6=Fong|first6=Y.|last7=D'Angelica|first7=M.|last8=Dematteo|first8=R. P.|last9=Blumgart|first9=L. H.|date=2008-12-01|title=Gallbladder cancer (GBC): 10-year experience at Memorial Sloan-Kettering Cancer Centre (MSKCC)|journal=Journal of Surgical Oncology|volume=98|issue=7|pages=485–489|doi=10.1002/jso.21141|issn=1096-9098|pmid=18802958}}</ref> A biopsy is the only certain way to tell whether or not the tumorous growth is malignant.<ref>{{cite web|url=http://cancerhelp.cancerresearchuk.org/type/gallbladder-cancer/diagnosis/tests-for-gallbladder-cancer|title=Tests for gallbladder cancer|last=|first=|date=|website=|publisher=Cancer Research UK|url-status=live|archive-url=https://web.archive.org/web/20111010001647/http://cancerhelp.cancerresearchuk.org/type/gallbladder-cancer/diagnosis/tests-for-gallbladder-cancer|archive-date=10 October 2011|accessdate=17 September 2012}}</ref>
Early diagnosis is not generally possible. People at high risk, such as women or Native Americans with gallstones, are evaluated closely. Transabdominal [[ultrasound]], [[CT scan]], endoscopic [[ultrasound]], [[MRI]], and MR cholangio-pancreatography (MRCP) can be used for diagnosis. A large number of gallbladder cancers are found incidentally in patients being evaluated for [[Gallstone|cholelithiasis]], or gallstone formation, which is far more common.<ref>{{Cite journal|last1=Duffy|first1=A.|last2=Capanu|first2=M.|last3=Abou-Alfa|first3=G. K.|last4=Huitzil|first4=D.|last5=Jarnagin|first5=W.|last6=Fong|first6=Y.|last7=D'Angelica|first7=M.|last8=Dematteo|first8=R. P.|last9=Blumgart|first9=L. H.|date=2008-12-01|title=Gallbladder cancer (GBC): 10-year experience at Memorial Sloan-Kettering Cancer Centre (MSKCC)|journal=Journal of Surgical Oncology|volume=98|issue=7|pages=485–489|doi=10.1002/jso.21141|issn=1096-9098|pmid=18802958|s2cid=43595860}}</ref> A biopsy is the only certain way to tell whether or not the tumorous growth is malignant.<ref>{{cite web|url=http://cancerhelp.cancerresearchuk.org/type/gallbladder-cancer/diagnosis/tests-for-gallbladder-cancer|title=Tests for gallbladder cancer|publisher=Cancer Research UK|url-status=live|archive-url=https://web.archive.org/web/20111010001647/http://cancerhelp.cancerresearchuk.org/type/gallbladder-cancer/diagnosis/tests-for-gallbladder-cancer|archive-date=10 October 2011|access-date=17 September 2012}}</ref>


<gallery mode="packed" widths="360px" heights="220">
<gallery>
File:Gallbladder adenocarcinoma (3) lymphatic invasion histopathology.jpg|Gallbladder adenocarcinoma lymphatic invasion histopathology
File:Gallbladder adenocarcinoma (3) lymphatic invasion histopathology.jpg|Gallbladder adenocarcinoma lymphatic invasion histopathology
File:Gallbladder adenocarcinoma (1) histopathology.jpg|Incidentally discovered gallbladder cancer ([[adenocarcinoma]]) following a [[cholecystectomy]].
File:Gallbladder adenocarcinoma (1) histopathology.jpg|Incidentally discovered gallbladder cancer ([[adenocarcinoma]]) following a [[cholecystectomy]].
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===Differential diagnosis===
===Differential diagnosis===
[[Xanthogranulomatous inflammation|Xanthogranulomatous]] cholecystitis (XGC) is a rare form of [[gallbladder disease]] which mimics gallbladder cancer although it is not cancerous.<ref name=Makino09>{{cite journal |vauthors=Makino I, Yamaguchi T, Sato N, Yasui T, Kita I |title=Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma with a false-positive result on fluorodeoxyglucose PET |journal=World J. Gastroenterol. |volume=15 |issue=29 |pages=3691–3 |date=August 2009 |pmid=19653352 |pmc=2721248 |doi=10.3748/wjg.15.3691}}</ref><ref name=Rao05>{{cite journal |vauthors=Rao RV, Kumar A, Sikora SS, Saxena R, Kapoor VK |title=Xanthogranulomatous cholecystitis: differentiation from associated gall bladder carcinoma |journal=Trop Gastroenterol |volume=26 |issue=1 |pages=31–3 |year=2005 |pmid=15974235 }}</ref> It was first discovered and reported in the medical literature in 1976 by J.J. McCoy, Jr., and colleagues.<ref name=Makino09/><ref name=McCoy76>{{cite journal |vauthors=McCoy JJ, Vila R, Petrossian G, McCall RA, Reddy KS |title=Xanthogranulomatous cholecystitis. Report of two cases |journal=J S C Med Assoc |volume=72 |issue=3 |pages=78–9 |date=March 1976 |pmid=1063276 }}</ref>
[[Xanthogranulomatous inflammation|Xanthogranulomatous]] cholecystitis (XGC) is a rare form of [[gallbladder disease]] which mimics gallbladder cancer although it is not cancerous.<ref name=Makino09>{{cite journal |vauthors=Makino I, Yamaguchi T, Sato N, Yasui T, Kita I |title=Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma with a false-positive result on fluorodeoxyglucose PET |journal=World J. Gastroenterol. |volume=15 |issue=29 |pages=3691–3 |date=August 2009 |pmid=19653352 |pmc=2721248 |doi=10.3748/wjg.15.3691 |doi-access=free }}</ref><ref name=Rao05>{{cite journal |vauthors=Rao RV, Kumar A, Sikora SS, Saxena R, Kapoor VK |title=Xanthogranulomatous cholecystitis: differentiation from associated gall bladder carcinoma |journal=Trop Gastroenterol |volume=26 |issue=1 |pages=31–3 |year=2005 |pmid=15974235 }}</ref> It was first discovered and reported in the medical literature in 1976 by J.J. McCoy Jr., and colleagues.<ref name=Makino09/><ref name=McCoy76>{{cite journal |vauthors=McCoy JJ, Vila R, Petrossian G, McCall RA, Reddy KS |title=Xanthogranulomatous cholecystitis. Report of two cases |journal=J S C Med Assoc |volume=72 |issue=3 |pages=78–9 |date=March 1976 |pmid=1063276 }}</ref>


==Treatment==
==Treatment==
If detected early in a stage where it has not spread, gallbladder cancer can be treated by surgery. Surgery for gallbladder cancer is called radical [[cholecystectomy]] or extended cholecystectomy.<ref>{{cite web |url=https://www.lecturio.com/concepts/cholecystectomy-approaches-and-technique/| title=Cholecystectomy: Approaches and Technique|website=The Lecturio Medical Concept Library |access-date= 8 July 2021}}</ref>
The most common and most effective treatment is surgical removal of the gallbladder ([[cholecystectomy]]) with part of liver and [[lymph node]] dissection. However, with gallbladder cancer's extremely poor prognosis, most patients will die within a year of surgery. If surgery is not possible, endoscopic stenting of the biliary tree can reduce jaundice and a stent in stomach may relieve vomiting. [[Chemotherapy]] and [[radiation therapy|radiation]] may also be used with surgery. If gallbladder cancer is diagnosed after cholecystectomy for stone disease (incidental cancer), re-operation to remove part of liver and lymph nodes is required in most cases. When it is done as early as possible, patients have the best chance of long-term survival and even cure.<ref>{{cite journal |author=Kapoor VK |title=Incidental gallbladder cancer |journal=Am. J. Gastroenterol. |volume=96 |issue=3 |pages=627–9 |date=March 2001 |pmid=11280526 }}{{Dead link|date=March 2020}}</ref>
It entails the removal of gallbladder along with adequate removal of its liver bed to the healthy tissue. The [[lymph nodes]] in the vicinity are also removed. Sometimes removal of a large part of the liver called hepatectomy is required to completely remove the tumor. The bile duct if involved also needs to be removed.<ref name=":0" /> However, with gallbladder cancer's extremely poor prognosis, most patients will die within a year of surgery. If surgery is not possible, [[endoscopic stenting]] or percutaneous transhepatic biliary drainage (PTBD) of the biliary tree can reduce jaundice and a stent in the stomach may relieve vomiting. [[Chemotherapy]] and [[radiation therapy|radiation]] may also be used with surgery. If gallbladder cancer is diagnosed after cholecystectomy for stone disease (incidental cancer), re-operation to remove part of liver and lymph nodes is required in most cases. When it is done as early as possible, patients have the best chance of long-term survival and even cure.<ref>{{cite web |url=https://www.cancer.gov/types/gallbladder/patient/gallbladder-treatment-pdq| title=Gallbladder Cancer Treatment (PDQ®)–Patient Version|website=National Cancer Institute| date=24 March 2004|access-date= 8 July 2021}}</ref>


==Epidemiology==
==Epidemiology==
Most tumors are [[adenocarcinoma]]s, with a small percent being [[squamous cell]] carcinomas.
Most tumors are [[adenocarcinoma]]s, with a small percent being [[squamous cell]] carcinomas.
⚫
* Gallbladder cancer is relatively rare, affecting fewer than 5000 people in the United States per year<ref>{{Cite journal|last1=Carriaga|first1=M. T.|last2=Henson|first2=D. E.|date=1995-01-01|title=Liver, gallbladder, extrahepatic bile ducts, and pancreas|journal=Cancer|volume=75|issue=1 Suppl|pages=171–190|issn=0008-543X|pmid=8000995|doi=10.1002/1097-0142(19950101)75:1+<171::AID-CNCR2820751306>3.0.CO;2-2|doi-access=free}}{{Dead link|date=March 2020}}</ref>

⚫
* Gallbladder cancer is more common in South American countries, Japan, and Israel; in Chile, gallbladder cancer is the fourth most common cause of cancer deaths.
⚫
*Gallbladder cancer is relatively rare, affecting fewer than 5000 people in the United States per year<ref>{{Cite journal|last1=Carriaga|first1=M. T.|last2=Henson|first2=D. E.|date=1995-01-01|title=Liver, gallbladder, extrahepatic bile ducts, and pancreas|journal=Cancer|volume=75|issue=1 Suppl|pages=171–190|issn=0008-543X|pmid=8000995|doi=10.1002/1097-0142(19950101)75:1+<171::AID-CNCR2820751306>3.0.CO;2-2}}{{Dead link|date=March 2020}}</ref>
⚫
* 5th most common gastrointestinal cancer
⚫
*Gallbladder cancer is more common in South American countries, Japan, and Israel; in Chile, gallbladder cancer is the fourth most common cause of cancer deaths.
⚫
* Up to 5 times more common in women than men depending on population (e.g. 73% female in China) <ref name="cn">{{cite journal |vauthors=Hsing AW, Gao YT, Han TQ, etal |title=Gallstones and the risk of biliary tract cancer: a population-based study in China |journal=Br. J. Cancer |volume=97 |issue=11 |pages=1577–82 |date=December 2007 |pmid=18000509 |pmc=2360257 |doi=10.1038/sj.bjc.6604047 }}</ref>
⚫
*5th most common gastrointestinal cancer
⚫
* The age adjusted incidence rates of gallbladder cancer is highest in Chile, followed by in the state of Assam in India<ref>National Cancer Registry Programme (2013).Three-year report of population based cancer registries:2009-2011. NCDIR-ICMR, Bangalore.</ref>
⚫
*Up to 5 times more common in women than men depending on population (e.g. 73% female in China<ref name="cn">{{cite journal |vauthors=Hsing AW, Gao YT, Han TQ, etal |title=Gallstones and the risk of biliary tract cancer: a population-based study in China |journal=Br. J. Cancer |volume=97 |issue=11 |pages=1577–82 |date=December 2007 |pmid=18000509 |pmc=2360257 |doi=10.1038/sj.bjc.6604047 }}</ref>
⚫
* The age adjusted incidence rates of gall bladder cancer is highest in Chile, followed by in the state of Assam in India<ref>National Cancer Registry Programme (2013).Three-year report of population based cancer registries:2009-2011. NCDIR-ICMR, Bangalore.</ref>


==Prognosis==
==Prognosis==
The prognosis still remains poor. The cancer commonly spreads to the [[liver]], bile duct, [[stomach]], and [[duodenum]].<ref>{{cite journal |last1= Goetze |first1= T.O |date= 21 November 2015 |title= Gallbladder carcinoma: Prognostic factors and therapeutic options |journal= World Journal of Gastroenterology |volume= 21|issue= 43 |pages= 12211–12217 |doi= 10.3748/wjg.v21.i43.12211 | pmid= 26604631 |pmc= 4649107 |doi-access= free }}</ref>
{{expand section | date=January 2019}}

The prognosis still remains poor. The cancer commonly spreads to the [[liver]], bile duct, [[stomach]], and [[duodenum]].{{citation needed}}
==Research==
A better understanding of the biology of biliary tract cancers, including gallbladder cancer, is being achieved by advances in [[gene expression profiling|genomic profiling]].<ref name = Lamarca2018>Lamarca A, Barriuso J, McNamara MG, Valle JW. Biliary Tract Cancer: State of the Art and potential role of DNA Damage Repair. Cancer Treat Rev. 2018 Nov;70:168-177. doi: 10.1016/j.ctrv.2018.09.002. Epub 2018 Sep 8. PMID 30218788</ref> This research is providing insight into deficiencies in the tumor cell's ability to accurately [[DNA repair|repair damages in their own DNA]]. The tumors in about 25% of patients with biliary tract cancer have some form of DNA damage repair deficiency.<ref name = Lamarca2018/> Knowledge of such deficiencies can be exploited to potentially increase response to treatment strategies that are currently available such as [[chemotherapy]], [[radiotherapy]], or [[immunotherapy]].


==References==
==References==
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== External links ==
== External links ==
*[http://www.cancer.gov/cancertopics/pdq/treatment/gallbladder/Patient U.S. National Cancer Institute Gallbladder Cancer Treatment (www.cancer.gov)]
* [http://www.cancer.gov/cancertopics/pdq/treatment/gallbladder/Patient U.S. National Cancer Institute Gallbladder Cancer Treatment (www.cancer.gov)]
{{Medical resources
{{Medical resources
| DiseasesDB = 30714
| DiseasesDB = 30714
| ICD10 = {{ICD10|C|23||c|15}}–{{ICD10|C|24||c|15}}
| ICD10 = {{ICD10|C|23||c|15}}–{{ICD10|C|24||c|15}}
| ICD9 = {{ICD9|156}}
| ICD9 = {{ICD9|156}}
| ICDO =
| ICDO =
| OMIM =
| OMIM =
| MedlinePlus =
| MedlinePlus =
| eMedicineSubj =
| eMedicineSubj =
| eMedicineTopic =
| eMedicineTopic =
| MeshID = D005706
| MeshID = D005706
}}
}}


{{Digestive system neoplasia}}
{{Digestive system neoplasia}}
{{Authority control}}


[[Category:Digestive system neoplasia]]
[[Category:Digestive system neoplasia]]
[[Category:Gallbladder disorders]]
[[Category:Gallbladder disorders]]
[[Category:Articles containing video clips]]
[[Category:Articles containing video clips]]
[[Category:Cancer]]
[[Category:Types of cancer]]
[[Category:Types of cancer]]

Latest revision as of 15:54, 21 June 2024

Gallbladder cancer
SpecialtyGastroenterology Hepatology Oncology
SymptomsAbdominal pain, Bloating, Fever, Unexplained weight loss, Nausea, Yellowing of the skin, although some people may have no symptoms[1]
ComplicationsCancer spreading to other parts of the body
Usual onsetAbove 65 years old[2]
TypesAdenocarcinoma (most common), Squamous cell carcinoma (more rare)[3]
CausesUnknown[1]
Risk factorsHistory of Gallstones and other Gallbladder diseases
Diagnostic methodBlood tests, medical imaging, examination of the Bile duct
Differential diagnosisOther types of cancer in the Digestive system
TreatmentSurgery, Radiation therapy, Chemotherapy[4]
PrognosisFive-year survival rate ~19% (USA) (January, 2020)[5]
Frequency~3,700 cases per year (USA)[6]
Deaths~2,000 deaths per year (USA)[6]

Gallbladder cancer is a relatively uncommon cancer, with an incidence of fewer than 2 cases per 100,000 people per year in the United States.[7] It is particularly common in central and South America, central and eastern Europe, Japan and northern India; it is also common in certain ethnic groups e.g. Native American Indians and Hispanics.[8] If it is diagnosed early enough, it can be cured by removing the gallbladder, part of the liver and associated lymph nodes. Most often it is found after symptoms such as abdominal pain, jaundice and vomiting occur, and it has spread to other organs such as the liver.

It is a rare cancer that is thought to be related to gallstones building up, which also can lead to calcification of the gallbladder, a condition known as porcelain gallbladder. Porcelain gallbladder is also rare. Some studies indicate that people with porcelain gallbladder have a high risk of developing gallbladder cancer, but other studies question this. The outlook is poor for recovery if the cancer is found after symptoms have started to occur, with a 5-year survival rate of close to 3%.[citation needed]

Signs and symptoms

[edit]

Early symptoms mimic gallbladder inflammation due to gallstones. Later, the symptoms may be that of biliary and stomach obstruction.[citation needed]

Of note, Courvoisier's law states that in the presence of a palpably enlarged gallbladder which is nontender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones. This implicates possible malignancy of the gallbladder or pancreas, and the swelling is unlikely due to gallstones due to the chronic inflammation associated with gallstones leading to a shrunken, non-distensible gallbladder. However, the original observations of Ludwig Georg Courvoisier, published in Germany in 1890, were not originally cited as a law, and no mention of malignancy or pain (tenderness) was made. These points are commonly misquoted or confused in the medical literature.[9]

Risk factors

[edit]
  • Gender— approximately twice as common in women than men, usually in seventh and eighth decades
  • Obesity
  • Chronic cholecystitis and cholelithiasis
  • Primary sclerosing cholangitis[10]
  • Chronic typhoid infection of gallbladder; chronic Salmonella typhi carriers have 3 to 200 times higher risk of gallbladder cancer than non-carriers and 1–6% lifetime risk of development of cancer[11]
  • Various single nucleotide polymorphisms (SNPs) have been shown to be associated with gallbladder cancer; however, existing genetic studies in GBC susceptibility have so far been insufficient to confirm any association[12]
  • Gallbladder polyps[13]
  • Calcified gallbladder wall (porcelain gallbladder)[13]
  • Congenital abnormalities of the bile duct such as choledochal cyst[13]

Diagnosis

[edit]

Early diagnosis is not generally possible. People at high risk, such as women or Native Americans with gallstones, are evaluated closely. Transabdominal ultrasound, CT scan, endoscopic ultrasound, MRI, and MR cholangio-pancreatography (MRCP) can be used for diagnosis. A large number of gallbladder cancers are found incidentally in patients being evaluated for cholelithiasis, or gallstone formation, which is far more common.[14] A biopsy is the only certain way to tell whether or not the tumorous growth is malignant.[15]

Differential diagnosis

[edit]

Xanthogranulomatous cholecystitis (XGC) is a rare form of gallbladder disease which mimics gallbladder cancer although it is not cancerous.[16][17] It was first discovered and reported in the medical literature in 1976 by J.J. McCoy Jr., and colleagues.[16][18]

Treatment

[edit]

If detected early in a stage where it has not spread, gallbladder cancer can be treated by surgery. Surgery for gallbladder cancer is called radical cholecystectomy or extended cholecystectomy.[19] It entails the removal of gallbladder along with adequate removal of its liver bed to the healthy tissue. The lymph nodes in the vicinity are also removed. Sometimes removal of a large part of the liver called hepatectomy is required to completely remove the tumor. The bile duct if involved also needs to be removed.[13] However, with gallbladder cancer's extremely poor prognosis, most patients will die within a year of surgery. If surgery is not possible, endoscopic stenting or percutaneous transhepatic biliary drainage (PTBD) of the biliary tree can reduce jaundice and a stent in the stomach may relieve vomiting. Chemotherapy and radiation may also be used with surgery. If gallbladder cancer is diagnosed after cholecystectomy for stone disease (incidental cancer), re-operation to remove part of liver and lymph nodes is required in most cases. When it is done as early as possible, patients have the best chance of long-term survival and even cure.[20]

Epidemiology

[edit]

Most tumors are adenocarcinomas, with a small percent being squamous cell carcinomas.

  • Gallbladder cancer is relatively rare, affecting fewer than 5000 people in the United States per year[21]
  • Gallbladder cancer is more common in South American countries, Japan, and Israel; in Chile, gallbladder cancer is the fourth most common cause of cancer deaths.
  • 5th most common gastrointestinal cancer
  • Up to 5 times more common in women than men depending on population (e.g. 73% female in China) [22]
  • The age adjusted incidence rates of gallbladder cancer is highest in Chile, followed by in the state of Assam in India[23]

Prognosis

[edit]

The prognosis still remains poor. The cancer commonly spreads to the liver, bile duct, stomach, and duodenum.[24]

Research

[edit]

A better understanding of the biology of biliary tract cancers, including gallbladder cancer, is being achieved by advances in genomic profiling.[25] This research is providing insight into deficiencies in the tumor cell's ability to accurately repair damages in their own DNA. The tumors in about 25% of patients with biliary tract cancer have some form of DNA damage repair deficiency.[25] Knowledge of such deficiencies can be exploited to potentially increase response to treatment strategies that are currently available such as chemotherapy, radiotherapy, or immunotherapy.

References

[edit]
  1. ^ a b "Gallbladder cancer - Symptoms and causes". Mayo Clinic.
  2. ^ "Risk Factors for Gallbladder Cancer". www.cancer.org.
  3. ^ "Types of gallbladder cancer | Gallbladder cancer | Cancer Research UK".
  4. ^ "Gallbladder cancer - Diagnosis and treatment - Mayo Clinic". Mayo Clinic.
  5. ^ "Gallbladder Cancer - Statistics". 25 June 2012.
  6. ^ a b Henley, S. Jane; Weir, Hannah K.; Jim, Melissa A.; Watson, Meg; Richardson, Lisa C. (2015). "Gallbladder Cancer Incidence and Mortality, United States 1999–2011". Cancer Epidemiology, Biomarkers & Prevention. 24 (9): 1319–1326. doi:10.1158/1055-9965.EPI-15-0199. PMID 26070529. S2CID 886615.
  7. ^ Henley, S. Jane; Weir, Hannah K.; Jim, Melissa A.; Watson, Meg; Richardson, Lisa C. (2018-09-27). "CDC - Gallbladder Cancer Incidence and Death Rates". Cancer Epidemiology, Biomarkers & Prevention. 24 (9): 1319–1326. doi:10.1158/1055-9965.EPI-15-0199. PMID 26070529. S2CID 886615. Retrieved 2018-12-10.
  8. ^ Kapoor VK, McMichael AJ (2003). "Gallbladder cancer: an 'Indian' disease". Natl Med J India. 16 (4): 209–13. PMID 14606770.
  9. ^ Fitzgerald, J Edward F; White Matthew J; Lobo Dileep N (Apr 2009). "Courvoisier's gallbladder: law or sign?". World Journal of Surgery. 33 (4). United States: 886–91. doi:10.1007/s00268-008-9908-y. ISSN 0364-2313. PMID 19190960. S2CID 21799234.
  10. ^ Folseraas, T; Boberg, KM (February 2016). "Cancer Risk and Surveillance in Primary Sclerosing Cholangitis". Clinics in Liver Disease. 20 (1): 79–98. doi:10.1016/j.cld.2015.08.014. PMID 26593292.
  11. ^ Ferreccio, C. (2012). "Salmonella typhi and Gallbladder Cancer". Bacteria and Cancer. pp. 117–137. doi:10.1007/978-94-007-2585-0_5. ISBN 978-94-007-2584-3.
  12. ^ Srivastava K, Srivastava A, Sharma KL, Mittal B. Candidate gene studies in gallbladder cancer: a systematic review and meta-analysis. Mutat Res. 2011 Jul–Oct;728(1–2):67–79.
  13. ^ a b c d "Gallbladder Cancer: Symptoms, Causes & Treatment | Dr. Nikhil Agrawal". Dr.Nikhil Agrawal. Retrieved 2020-10-11.
  14. ^ Duffy, A.; Capanu, M.; Abou-Alfa, G. K.; Huitzil, D.; Jarnagin, W.; Fong, Y.; D'Angelica, M.; Dematteo, R. P.; Blumgart, L. H. (2008-12-01). "Gallbladder cancer (GBC): 10-year experience at Memorial Sloan-Kettering Cancer Centre (MSKCC)". Journal of Surgical Oncology. 98 (7): 485–489. doi:10.1002/jso.21141. ISSN 1096-9098. PMID 18802958. S2CID 43595860.
  15. ^ "Tests for gallbladder cancer". Cancer Research UK. Archived from the original on 10 October 2011. Retrieved 17 September 2012.
  16. ^ a b Makino I, Yamaguchi T, Sato N, Yasui T, Kita I (August 2009). "Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma with a false-positive result on fluorodeoxyglucose PET". World J. Gastroenterol. 15 (29): 3691–3. doi:10.3748/wjg.15.3691. PMC 2721248. PMID 19653352.
  17. ^ Rao RV, Kumar A, Sikora SS, Saxena R, Kapoor VK (2005). "Xanthogranulomatous cholecystitis: differentiation from associated gall bladder carcinoma". Trop Gastroenterol. 26 (1): 31–3. PMID 15974235.
  18. ^ McCoy JJ, Vila R, Petrossian G, McCall RA, Reddy KS (March 1976). "Xanthogranulomatous cholecystitis. Report of two cases". J S C Med Assoc. 72 (3): 78–9. PMID 1063276.
  19. ^ "Cholecystectomy: Approaches and Technique". The Lecturio Medical Concept Library. Retrieved 8 July 2021.
  20. ^ "Gallbladder Cancer Treatment (PDQ®)–Patient Version". National Cancer Institute. 24 March 2004. Retrieved 8 July 2021.
  21. ^ Carriaga, M. T.; Henson, D. E. (1995-01-01). "Liver, gallbladder, extrahepatic bile ducts, and pancreas". Cancer. 75 (1 Suppl): 171–190. doi:10.1002/1097-0142(19950101)75:1+<171::AID-CNCR2820751306>3.0.CO;2-2. ISSN 0008-543X. PMID 8000995.[dead link]
  22. ^ Hsing AW, Gao YT, Han TQ, et al. (December 2007). "Gallstones and the risk of biliary tract cancer: a population-based study in China". Br. J. Cancer. 97 (11): 1577–82. doi:10.1038/sj.bjc.6604047. PMC 2360257. PMID 18000509.
  23. ^ National Cancer Registry Programme (2013).Three-year report of population based cancer registries:2009-2011. NCDIR-ICMR, Bangalore.
  24. ^ Goetze, T.O (21 November 2015). "Gallbladder carcinoma: Prognostic factors and therapeutic options". World Journal of Gastroenterology. 21 (43): 12211–12217. doi:10.3748/wjg.v21.i43.12211. PMC 4649107. PMID 26604631.
  25. ^ a b Lamarca A, Barriuso J, McNamara MG, Valle JW. Biliary Tract Cancer: State of the Art and potential role of DNA Damage Repair. Cancer Treat Rev. 2018 Nov;70:168-177. doi: 10.1016/j.ctrv.2018.09.002. Epub 2018 Sep 8. PMID 30218788
[edit]
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