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Gall bladder cancer
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.
The effect of carcinogenic factors:
• 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.
Morphological forms of gallbladder cancer:
• mucous cancer,
• scirrhotic cancer,
• anaplastic cancer,
• undifferentiated cancer.
• 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
• dull pain in the right hypochondrium,
• jaundice (appears on average 3 months after the first symptoms of the disease are detected),
• palpable tumor.
• ultrasound with puncture biopsy of the gallbladder or liver metastases,
• endoscopic retrograde pancreatocholangiography,
• computed tomography of the abdominal organs,
• exclusion of distant metastases (X-ray examination of the lungs, mediastinum).
Gall bladder cancer before surgery can be established in 68% of cases.
• complicated forms of cholelithiasis,
• polyposis of the gallbladder.
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.
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
- LESSON 6 TOPIC. Diseases of the liver, gallbladder, bile ducts, and pancreas
Motivational characteristic of the topic. Knowledge of the pathological manifestations of diseases and syndromes of the hepato-cholecystic-pancreatic zone is necessary for the successful assimilation of this human suffering in clinical departments. In the practical work of the doctor, this knowledge is necessary for the clinical anatomical analysis of sectional cases and liver biopsies. The general purpose of the lesson. Learn by morphological characteristics
- DISEASES OF THE LIVER, GALL BLADDER, BILENTAL TREATMENTS AND Pancreas
This chapter continues the presentation of the pathology of the digestive system. According to traditions, a number of diseases of the liver and biliary tract, despite their infectious etiology, are considered not in chapter 14, devoted to infections, but here. The same applies to diabetes mellitus, a description of which, for reasons of expediency, is included in this
- Gall bladder and bile ducts
As in many other organs and tissues, in the human liver, secretory processes are subordinated to a certain rhythm. Bile secretion prevails during the day, glycogen production prevails at night. The effect of a nightly decrease in the secretion of bile, which has a physiological basis, is enhanced even more with biliary dyskinesia (a violation of the coordinated work of the smooth muscles of the ducts and gallbladder, which has
- Liver, gall bladder and bile ducts
The liver of the newborn is relatively large, especially its left lobe, to which the spleen is adjacent. Cases of agenesis of the liver are rare, they are more often found to be underdeveloped. On the back or on the lower surface of the liver, you can sometimes see congenital notches, often located in the sagittal direction. If these depressions are significant, the liver is divided into additional lobes.
- Gall bladder (problems)
The gall bladder is a hollow organ that contains bile coming from the liver and prevents it from flowing into the intestine in between meals. During the digestion of food, the gallbladder opens and expels bile through the bile duct into the duodenum. Bile is necessary so that the intestines can absorb fats from food. Most common problem related
- Features of the gallbladder
The gall bladder is located under the right lobe of the liver and has a fusiform shape, its length reaches 3 cm. It acquires a typical pear-shaped form by 7 months, by 2 years reaches the edge of the liver. The main function of the gallbladder is the accumulation and secretion of hepatic bile. The bile of a child is different in composition from the bile of an adult. It has few bile acids, cholesterol, salts, a lot
Causes Impaired metabolism in the liver (bile is oversaturated with cholesterol). Overweight women get sick more often. One of the reasons is a sedentary lifestyle combined with errors in the diet (excess fat, fried, spicy and smoked foods, alcohol). In complex cases, cancer of the biliary tract and gall bladder can occur. Symptoms Soreness on palpation in the right
- Cholecystitis (inflammation of the gallbladder)
Causes: As a rule, the presence of stones in the gallbladder or its ducts. Pathological thickening of bile as a result of a viral infection, errors in diet, abnormal structure of the gallbladder, overweight, prolonged stressful situation, diseases of the gastrointestinal tract and liver. Symptoms Pain in the upper right abdomen, fever, fat intolerance, may be temporary
- Diseases of the biliary tract and gallbladder
Diseases of the biliary system are very common. Patients with this pathology in the general population are on average 2, and among women - almost 10 times more than patients with peptic ulcer disease. Among the numerous diseases of the biliary tract, it is advisable to single out mainly functional disorders (dyskinesias), inflammatory (cholecystitis), and metabolic (gallstone
- Extrahepatic bile duct cancer
Epidemiology. Extrahepatic biliary tract cancer occurs in 2.8-4.6% of all malignant tumors, the ratio of diseased men to women is 1.7-2: 1. 44% of patients are over 60 years old. In the structure of mortality from malignant tumors reaches 3%. On the share of extrahepatic bile duct cancer among malignant tumors of the hepatobiopancreatoduodenal zone
- Diseases of the gallbladder and biliary tract in children
Questions for repetition: 1. Duodenal sounding and its assessment. 2. The main pain points in the disease of the gallbladder and biliary tract. Test questions: 1. Biliary dyskinesia. Concept. Etiopathogenesis. Classification. 2. Clinical and diagnostic criteria for biliary dyskinesia: 2.1. hypermotor type 2.2. hypomotor type 3. Treatment of dyskinesia
- LIVER. Gallbladder
The liver (hepar) is the largest gland of the human body (Fig. 78). Its weight is about 1500 g. It performs several main functions: digestive, forms a protein, detoxifies, hematopoietic, carries out metabolism, etc. The liver is located in the right hypochondrium and in the epigastrium. In shape, it resembles a wedge, has an upper and lower surface. Upper (diaphragmatic)
- Diseases of the liver and gall bladder
With the development of possibilities for diagnosing diseases of internal organs, it was found that liver disease (hepatopathy) is much more common than previously thought, and that many vague signs of disease are based on hepatosis. Due to the importance and variety of functions, the liver is endowed with a natural ability for high regeneration. Therefore arising under the influence of different
- Nutrition for diabetes with diseases of the liver and gall bladder
Nutrition in the treatment of this disease should improve metabolic processes that are disturbed by diabetes and diseases of the liver and gall bladder. Products that improve liver function, enhance bile secretion, and help normalize intestinal activity are introduced into the diet of a diabetic. Foods that impede liver function are excluded from nutrition. It is recommended to include milk and
- Diseases of the liver, gallbladder and pancreas
DISEASES OF THE LIVER, GALL BLADDER AND Pancreas
- Nutrition for exacerbation of liver inflammation and acute gallbladder inflammation
Nutrition is recommended for patients with acute cholecystitis and hepatitis, chronic cholecystitis and hepatitis, liver cirrhosis with moderate liver failure, cholelithiasis, as well as with simultaneous damage to the liver and biliary tract, stomach and intestines. Food is cooked in water or steamed, wiped. Excluded foods that enhance fermentation and rotting in
- Recommended products for exacerbation of liver inflammation and acute gallbladder inflammation
Recommended: yesterday’s wheat bread; soups are prepared on a mucous broth with grated cereals, vegetables or on vegetable broths with finely chopped vegetables - potatoes, carrots, zucchini, pumpkin, boiled cereals - rice, semolina, oatmeal, noodles, and egg-milk mixture can be added to soups, which is prepared mix raw eggs with an equal volume of milk, and season
- Nutrition for patients with mild diabetes mellitus with diseases of the liver and gall bladder with normal body weight receiving sugar-lowering drugs (diet for 2500 calories)
PRODUCT SET FOR DAY Black bread 300 g. Potatoes 100 g. Vegetables 800 g. Buckwheat, oat or pearl barley 50 g. Meat (category II beef or chicken) 160 g. Meat broth 300 g. Egg white 2 pieces. Fat-free cottage cheese 200 g. Milk 600 g. Kefir or yogurt 200 g. Butter 25 g. Vegetable oil 25 g. Diet sausage 50 g. Sugar 20 g. EXAMPLES MENU DAY