Biliary Tumors.pptx
- 2. Gall Bladder Carcinoma • Carcinoma of the gallbladder is the most common malignancy of the extrahepatic biliary tract. • Gallbladder cancer is at least twice as common in women than in men; this gender disparity can be several-fold greater in regions of highest incidence. • The overwhelming majority of patients are diagnosed at an advanced, surgically unresectable, stage, and the mean 5-year survival for these patients remains at less than 10%.
- 3. Pathogenesis • The most important risk factor for gallbladder cancer (besides gender and ethnicity) is gallstones which are present in 95% of cases. • The common thread that ties gallstones or chronic infections together with gallbladder cancer is chronic inflammation.
- 4. Morphology • Carcinomas of the gallbladder shows two patterns of growth: infiltrating and exophytic. • The infiltrating pattern is more common and usually appears as a poorly defined area of diffuse mural thickening and induration. • Deep ulceration can cause direct penetration into the liver or fistula formation to adjacent viscera into which the neoplasm has grown. • These tumors are scirrhous and have a very firm consistency. • The exophytic pattern grows into the lumen as an irregular, cauliflower mass, but at the same time invades the underlying wall.
- 5. Cont. • Most carcinomas of the gallbladder are adenocarcinomas. • Some of the carcinomas are papillary in architecture and are well to moderately differentiated; others are infiltrative and poorly differentiated to undifferentiated. • About 5% are squamous cell carcinomas or have adenosquamous differentiation. • A minority may show carcinoid or a variety of mesenchymal features (carcinosarcoma). • Papillary tumors generally have a better prognosis than other tumors. • By the time these neoplasms are discovered, most have invaded the liver centrifugally, and many have extended to the cystic duct and adjacent bile ducts and portal-hepatic lymph nodes. The peritoneum, gastrointestinal tract, and lungs are common sites of seeding.
- 6. Clinical Features • Preoperative diagnosis of carcinoma of the gallbladder is the exception rather than the rule, occurring in fewer than 20% of patients. • Presenting symptoms are insidious and typically indistinguishable from those associated with cholelithiasis • abdominal pain, jaundice, anorexia, nausea and vomiting. • Early detection of the tumor may be possible in patients who develop a palpable gallbladder and acute cholecystitis before the extension of the tumor into adjacent structures, or when the carcinoma is an incidental finding during cholecystectomy for symptomatic gallstones. • Surgical resection, often including adjacent liver, is the only effective treatment, when possible, but chemotherapy regimens are also used.