Makindo Medical Notes

Carcinoma of the gallbladder is a rare but aggressive cancer with a poor prognosis due to late detection. Risk factors include gallstones, chronic inflammation, and certain geographical or ethnic backgrounds. Early detection is key to improving outcomes, with surgery being the most effective treatment option. Preventative measures and regular monitoring for high-risk individuals can help reduce the incidence of this disease.

About

• Carcinoma of the gallbladder is a rare but highly aggressive form of cancer that originates in the gallbladder.

Aetiology

• Gallstones: Chronic inflammation from gallstones can lead to gallbladder cancer.
• Porcelain Gallbladder: Calcification of the gallbladder wall, significantly increasing cancer risk.
• Age and Gender: More prevalent in older adults, with higher incidence in females.
• Ethnicity and Geography: Higher rates in South America, India, and Japan.
• Chronic Inflammation: Conditions like chronic cholecystitis increase cancer risk.
• Gallbladder Polyps: Polyps larger than 1 cm are associated with a higher malignancy risk.

Pathology

• 90% of gallbladder cancers are adenocarcinomas.
• 10% are squamous cell carcinomas.
• Local spread to the liver and nearby tissues is common.

Clinical Presentation

• Abdominal pain, particularly in the upper right quadrant.
• Nausea and vomiting.
• Jaundice (yellowing of the skin and eyes).
• Unintended weight loss.
• Loss of appetite.
• Fever.
• Pale or clay-colored stools.

Investigations

• Imaging Studies: Ultrasound, CT scans, and MRI are commonly used to visualize the gallbladder and surrounding structures.
• Endoscopic Ultrasound (EUS): Provides detailed images and may be used to obtain biopsy samples.
• Biopsy: Tissue samples taken during imaging or surgery confirm the diagnosis.
• Tumour Markers: Blood tests for markers like CA 19-9 and CEA assist in diagnosis and monitoring.

Management

• Surgery: The primary treatment, including cholecystectomy (removal of the gallbladder) and, in advanced cases, resection of surrounding tissues and lymph nodes.
• Chemotherapy: Often administered post-surgery to reduce recurrence risk or in cases where surgery is not possible.
• Radiation Therapy: Used with surgery or chemotherapy, especially in advanced cases.
• Palliative Care: Focuses on symptom relief and improving quality of life for advanced-stage patients.