Chapter 3: Biliary: Gallbladder Cancer and Cholangiocarcinoma

Epidemiology

Work-up

1. Early diagnosis of gallbladder or cholangiocellular carcinoma is nearly impossible or can only be realized in exceptional cases

2. In a patient with specific clinical symptoms or ultrasound suspicion of biliary tract cancer, a spiral CT and chest x-ray should be performed

3. Medically fit, nonjaundiced patients whose disease appears potentially resectable may proceed directly to surgical exploration without needle biopsy to avoid tumor spread. Consider a laparoscopic evaluation before open surgery owing to the common occurrence of otherwise nonvisible metastatic spread to the peritoneum

4. If the potential to perform a resection remains uncertain and for those with jaundice, a more precise assessment of tumor extent and lymph node involvement should be obtained with MRCP ± MRA, which may help to rule out vascular invasion and anomalous anatomic findings for surgical planning

5. If it is obvious that a resection will not be possible or if distant metastases are present, fine-needle biopsy for tissue confirmation should be obtained

6. In nonresectable jaundiced patients, depending on the location of the biliary obstruction, a percutaneous transhepatic cholangiography (PTC) or an endoscopic retrograde cholangiography (ERC) should be considered to guide placement of a stent

Fong Y et al. Cancer of the liver and biliary tree. In: Principles and Practice of Oncology, 6th ed. Baltimore, MD: Lippincott Williams & Wilkins 2001:1162–1203

Pathology

Lazcano-Ponce EC et al. CA Cancer J Clin 2001;51:349–364

Nakeeb A et al. Ann Surg 1996;224:463–475

Five-Year Survival (Cholangiocarcinoma and Gallbladder Cancer)^✫

Staging