Carcinoma of the Gall Bladder: A Prospective Study in a Tertiary Hospital of Bombay, India 692-695
Kishan Prasad H.L.
Asst. Professor, Department of Pathology,
K.S. Hegde Medical Academy of Nitte University,
Deralakatte, Mangalore, Karnataka, India.
Phone: 09480503190; E-mail: firstname.lastname@example.org
Introduction: Despite the pre-operative procedures, gall bladder carcinoma is commonly detected intraoperatively or on histopathological examination after cholecystectomy. The prevalence of gall bladder carcinoma is highly variable across the world and it remains the most common malignancy of the biliary tract worldwide. Very high incidence rates are found in northern India and Chile. Gall bladder cancer has been frequently referred as a lethal and incurable disease. Despite the advances in medical imaging, most of the cases (70-80%) of gall bladder cancer are only discovered incidentally on histopathological examination after cholecystectomy which is performed for presumed benign biliary disease. Therefore, the morphological studies have had a significant impact on the diagnosis of this cancer, thus lowering the number of cases that could be under diagnosed and guiding the extent of the surgical resection. Although the subject of gall bladder cancer has been well explored, there is relative paucity of clinicopathological studies on this topic.
Objective: To analyze the demographics, the clinical presentation and the diagnostic modalities in patients with gall bladder carcinoma and to assess the various treatment modalities which have been offered and their results.
Methods: This prospective study was carried out on patients with carcinoma of the gall bladder, who were admitted in a tertiary hospital, Bombay, between 2004 to 2007. After taking the informed consent of the patients, their detailed clinical history which was related to their demographics and their clinical manifestations was taken. Various diagnostic modalities and their TNM staging and treatment were analyzed. All the patients who presented with features which were suggestive of biliary diseases were evaluated by using abdominal ultrasonography and CT, but only those with a confirmatory diagnosis of carcinoma by CT or histopathology were included in the study.
Results: A total of 50 patients were included in the study, with a male:female ratio of 1:2.3. Their ages ranged from 25 to 80 years, with a mean of 54years. Many (34) patients were from the northern states. A lump in the right hypochondrium was seen in 28 patients (56%). It was also noted that 14 patients had presented with obstructive jaundice. Ultrasound and CT revealed a locally advanced disease status in a majority of the cases. Many (90%) cases had associated gall stones. A majority (92%) were in stage IV as was found by TNM staging. Two were identified as incidental findings following cholecystectomy. A majority of the cases were managed with palliative gastrojejunostomy, ERCP stenting and chemoradiotherapy. The cases of early cancer had a better 2 year survival, whereas many of the advanced cases had poor survival rates.
Conclusion: Early detection contributes to a higher survival rate. The prognosis of gall bladder cancer is thus poor, mainly because of the delayed presentation. Besides other factors, TNM staging remains the most imperative prognostic factor which affects the survival. It is desirable to search for any factor which can be linked to gall bladder cancer or which can help in the diagnosis of the disease in the early stages, thus making surgical intervention possible so that it can ultimately result in a good prognosis. Moreover, to positively affect the outcome of the patients in the advanced stage of the disease, newer cancer treatment strategies need to be adopted.