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Gall bladder cancer

Epidemiology.

Gallbladder cancer accounts for 2-8% of all malignant tumors and in frequency it takes 5-6 place among digestive tumors. Ill men relate to women in a ratio of 1:14. 90% of patients older than 60 years. For 100 planned cholecystectomies for chronic calculous cholecystitis, there is a histological finding of 3 cases of cancer in situ of the gallbladder.

Etiology:

The effect of carcinogenic factors:

• cholelithiasis,

• the effects of a combination of taurine with deoxycholic acid,

• contact with beta-naphthylamine and benzidine,

• the presence of an obligate precancer - adenomatous proliferating polyps.

Pathological anatomy.

Morphological forms of gallbladder cancer:

• adenocarcinoma,

• mucous cancer,

• scirrhotic cancer,

• anaplastic cancer,

• undifferentiated cancer.

Metastasis:

• lymphogenous - pericholedochal, pancreatoduodenal, paracaval lymph nodes;

• hematogenous - both lobes of the liver, omentum, peritoneum, ovaries in women.

TNM clinical classification:

T - primary tumor

TX - not enough data to evaluate the primary tumor

T0 - primary tumor is not determined

Tis - carcinoma in situ

T1 - the tumor grows into the basement membrane or muscle layer

T1a - the tumor grows into the basement membrane

T1b - the tumor grows into the muscle layer

T2 - the tumor grows into the peri-muscle connective tissue without spreading to the serous layer or liver

T3 - the tumor perforates the serous layer (visceral peritoneum) and / or directly grows in the liver and / or in one adjacent organ or structure, such as the stomach, duodenum, colon, pancreas, omentum or extrahepatic biliary tract

T4 - the tumor sprouts the main branch of the portal vein or hepatic artery or damage to two or more extrahepatic organs or structures

N - regional lymph nodes

Regional lymph nodes are the nodes of the cystic duct, common bile duct, liver portal, peripancreatic (only around the head), periduodenal, periportal, abdominal and superior mesenteric.

NX - not enough data to assess the status of regional lymph nodes

N0 - there are no signs of damage to regional lymph nodes

N1 - the presence of metastases in regional lymph nodes

M - distant metastases

MX - not enough data to determine distant metastases

M0 - distant metastases are not determined

M1 - distant metastases are present

pTNM pathomorphological classification:

Categories pT, pN, pM correspond to categories T, N, M.

pN0 - Material for histological examination after regional lymphadenectomy should include at least 3 lymph nodes.

G - histopathological gradation

G1 - high level of differentiation

G2 - average level of differentiation

G3 - low level of differentiation

G4 - undifferentiated tumor

Stage grouping

:

Clinical manifestations:

• dull pain in the right hypochondrium,

• subfibrillation,

• jaundice (appears on average 3 months after the first symptoms of the disease are detected),

• palpable tumor.

Diagnostics:

• ultrasound with puncture biopsy of the gallbladder or liver metastases,

• endoscopic retrograde pancreatocholangiography,

• computed tomography of the abdominal organs,

• laparoscopy,

• exclusion of distant metastases (X-ray examination of the lungs, mediastinum).


Gall bladder cancer before surgery can be established in 68% of cases.

Differential diagnosis:

• complicated forms of cholelithiasis,

• polyposis of the gallbladder.

Treatment:

1. Surgical treatment.

• The proportion of radical operations is only 32%. Radical surgery is performed at stages 1,2,3. The scope of the operation includes cholecystectomy with resection of the liver and skeletonization (lymphadenectomy) of the hepatoduodenal ligament. Local spread of the tumor involves a combined intervention with resection of nearby organs - the biliary tract, stomach, duodenum, colon, pancreas. The duration of such operations can be 12 hours.

• Palliative operations are performed at stages 3, 4 and include cytoreductive cholecystectomy with cryodestruction or electrocoagulation of the gallbladder bed.

• Symptomatic operations are performed at 4 stages and are aimed at the removal of bile in cases of obstructive jaundice.

2. Chemotherapeutic treatment is ineffective, use 5-FU, cisplatin, adriablastin, xeloda.

3. Radiation therapy.

Irradiation is carried out in a dose of 50-100 Gy fractionally 4 weeks after surgery. Combined radiation therapy is possible - external radiation therapy of SOD 50 Gy with the introduction of iridium-192 into the bile ducts by transhepatic drainage for a period of 21 to 100 hours.

Forecast.

5-year survival does not exceed 7%.

The average life expectancy of patients undergoing radiation therapy is 9 to 13 months.

The prognostic data on the survival of patients with gallbladder cancer presented by Japanese authors (2002) are significantly different from European ones.

So, at stages 1–2, one-year survival was achieved in 92%, 3-year-old in 90%, 5-year-old in 80%. At stage 3, one-year survival is 78%, 3-year-old is 44%, 5-year-old is 33%. Median survival is 22.4 months.

With T4N1M0, one-year survival is 52%, 3-year-old - 24%, 5-year-old - 17%. Median survival is 12 months.

With T4N1M1, one-year survival is 37%, 3-year-old - 7%, 5-year-old - 3%. The median survival is 6.6 months.

The median survival after palliative surgery is 4.7 months.

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Gall bladder cancer

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