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INTRODUCTION

Epidemiology

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Epidemiology
Gallbladder Cancer & Other Biliary Incidence: 11,980 (male: 5600; female: 6380. Estimated new cases for 2020 in the United States)
Deaths: Estimated 4090 in 2020 (male: 1700; female: 2390)
Median age: 71 years
Gallbladder cancer: Women are two to six times more likely to develop gallbladder cancer than men
Cholangiocarcinoma: Slightly more common in men

Siegel R et al. CA Cancer J Clin 2020;70:7–30

Surveillance, Epidemiology and End Results (SEER) Program. Available at: http://seer.cancer.gov [accessed April 6, 2020]

Work-up

  1. Early diagnosis of gallbladder or cholangiocellular carcinoma is nearly impossible or can be realized only 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 (Intrahepatic Cholangiocarcinoma)

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Five-Year Survival (Intrahepatic Cholangiocarcinoma)
AJCC 8th Edition Stage 5-Year Survival, % (95% CI)
Stage IA 90.0 (47.3–98.5)
Stage IB 50.6 (19.9–75.0)
Stage II 55.1 (34.5–71.7)
Stage IIIA 49.7 (16.6–76.2)
Stage IIIB 16.2 (9.5–24.5)
Spolverato G et al. J Surg Oncol 2017;115:696–703

Staging

Gallbladder Cancer

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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 ...

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