Gallbladder carcinoma
Last reviewed: 23.04.2024
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Carcinoma of the gallbladder is rare. In 75% of cases it is combined with gallstones, in many cases - with cholecystitis. There are no convincing signs of an etiological relationship between these diseases. Any reason for the formation of gallstones predisposes to the development of a tumor.
The tumor especially often develops in a calcified ("porcelain") gallbladder. Papillomas of the gallbladder usually do not undergo malignant degeneration. The development of gallbladder carcinoma can be facilitated by ulcerative colitis. It is shown that an abnormal fusion of the pancreatic duct with a common bile duct at a distance of more than 15 mm from the duodenal papilla is combined with a gallbladder carcinoma and congenital cystic dilatation of the common bile duct. Throwing pancreatic juice can contribute to the development of this tumor.
In chronic typhoid paratyphoid infection of the gallbladder, the risk of carcinoma increases 167 times, which once again emphasizes the need for antibiotic therapy for chronic typhoid paratyphoid infection or for the implementation of planned cholecystectomy.
Papillary adenocarcinoma at first looks like a warty growth. It slowly grows until, in the form of a mushroom-like mass, it fills the entire gallbladder. With mucosal degeneration, the tumor grows faster, early metastasizes and is accompanied by gelatinous peritoneal carcinomatosis. Morphologically, squamous cell carcinoma and scirrus are isolated . Especially malignant in nature is anaplastic. More often the tumor concerns to differentiated adenocarcinomas and can be papillary.
The tumor usually develops from the mucosa of the bottom or neck, but due to its rapid growth, it is difficult to establish the initial location. Abundant lymphatic and venous outflow from the gallbladder leads to early metastasis in the regional lymph nodes, which is accompanied by cholestatic jaundice and dissemination. There is an invasion in the lodgment of the liver, possibly also germination in the duodenum, stomach and large intestine with the formation of fistula or compression of these organs.
Symptoms of gallbladder carcinoma. The elderly women of the white race are usually ill. They may be troubled by pain in the upper right quadrant of the abdomen, nausea, vomiting, weight loss and jaundice. Occasionally, carcinoma is occasionally detected by histological examination of the gallbladder tissue after cholecystectomy. During the operation, these minor changes may even go unnoticed.
At inspection it is possible to reveal dense, and sometimes and morbid volumetric education in the field of a cholic bubble.
In the blood serum, urine and feces when the bile ducts are compressed, the changes characteristic of cholestatic jaundice are revealed.
With liver biopsy, histological changes correspond to biliary obstruction, but do not indicate its cause, since this tumor is not characterized by metastasis to the liver.
When ultrasound examination (ultrasound) in the lumen of the gallbladder, a volume formation is visualized, which can completely fill the bubble. In the early stages, the gallbladder carcinoma is difficult to distinguish from the thickening of its wall, caused by acute or chronic cholecystitis.
Computed tomography (CT) in the area of the gallbladder can also reveal volumetric formation. Ultrasound and CT can diagnose gallbladder carcinoma in 60-70% of cases.
By the time the tumor is detected with ultrasound and CT, it is very likely that there are metastases, and the chances of its complete removal are small. The prevalence of the disease and its stage can be assessed using magnetic resonance imaging (MRI).
Endoscopic retrograde cholangiopancreatography (ERCPG) in a patient with jaundice allows the establishment of compression of the bile ducts. With angiography, the displacement of the hepatic and portal vessels is detected by a tumor.
The exact diagnosis before the operation can be established only in 50% of cases.
Treatment of gallbladder carcinoma
All patients with gallstones to prevent gallbladder carcinoma are advised to perform cholecystectomy. Such a tactic about such a widespread disease seems too radical, its consequence will be a large number of unjustified cholecystectomies.
The diagnosis of gallbladder carcinoma should not be an obstacle to laparotomy, although the results of surgical treatment are disappointing. Efforts have been made to perform a radical operation with liver resection, but the results were unsatisfactory. There was no increase in survival after radiotherapy.
Endoscopic or transcutaneous stenting of the bile ducts allows to eliminate their obstruction.
Prognosis for gallbladder carcinoma
The prognosis is unfavorable, since in most cases, at the time of diagnosis, the tumor is inoperable. At this time, 50% of patients already have distant metastases. The probability of prolonged survival exists only in those cases when the tumor is detected accidentally during cholecystectomy for gallstones (carcinoma in situ).
Survival after diagnosis is on average 3 months, and by the end of the first year, 14% of patients remain alive. With papillary and highly differentiated adenocarcinomas survival is higher than with tubular and undifferentiated. The results of radical interventions, including liver resection and radical lymphadenectomy, are contradictory; In some studies, the survival rate increased, but in others it did not.
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