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Chapter 3: Biliary: Gallbladder Cancer and Cholangiocarcinoma

Tim Greten; Susanna Ulahannan; Werner Scheithauer

INTRODUCTION

Epidemiology

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Epidemiology
Gallbladder Cancer & Other Biliary Incidence: 10,650 (male: 4,960; female: 5,690. Estimated new cases for 2014 in the United States)
Deaths: Estimated 3,630 in 2014 (male: 1,610; female: 2,020)
Median age, cholangiocarcinoma: 65 years
Gallbladder: 7th decade
Gallbladder cancer: Women are two to six times more likely to develop gallbladder cancer than men
Cholangiocarcinoma: Slighlty more common in men

Siegel R et al. CA Cancer J Clin 2014;64:9–29

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

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Pathology
1. Gallbladder cancer (60%)
2. Cholangiocarcinoma (40%)
 Intrahepatic 10%
 Perihilar (Klatskin tumor) 40–60%
 Distal 20–30%
 Multifocal <10%
Histopathology
1. Adenocarcinoma Papillary, nodular, tubular, medullary 80–90%
2. Pleomorphic giant cell carcinoma >10%
3. Squamous cell carcinoma 5%
4. Mucoid carcinoma <1%
5. Anaplastic carcinoma <1%
6. Cystadenocarcinoma <1%
7. Clear cell carcinoma <1%
8. Other rare forms <1%

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)✫

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Five-Year Survival (Cholangiocarcinoma and Gallbladder Cancer)✫
Stage IA 85–100%
Stage IB 30–40% to 70–90%
Stage II 10–60%
Stage III 10–40%
Stage IV 0%

✫Statistics for gallbladder cancer not certain because few cases reported in the literature

Staging

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Staging
Gallbladder Cancer
Primary Tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor invades lamina propria or muscular layer
T1a Tumor invades lamina propria
T1b Tumor invades ...

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