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Cancer
PREAMBLE
• the most common malignant tumour of the biliary
tract worldwide .
• It is also the most aggressive cancer of the biliary
tract with the shortest median survival from the
time of diagnosis.
• This poor prognosis is due, in part, to an
aggressive biologic behaviour and a lack of
sensitive screening tests for early detection -
resulting in delayed diagnosis and presentation at
an advanced stage.
C. H. E. Lai and W. Y. Lau, “Gallbladder cancer—a comprehensive review,” Surgeon, vol. 6, no. 2, pp. 101–110, 2008.
X. Zhu, T. S. Hong, A. F. Hezel, and D. A. Kooby, “Current management of gallbladder carcinoma,” The Oncologist, vol. 15, no. 2, pp. 168–181, 2010.
U. Dutta, “Gallbladder cancer: can newer insights improve the outcome?” Journal of Gastroenterology and Hepatology, vol. 27, no. 4, pp. 642–653, 2012.
INCIDENCE
Adapted from -Gallbladder Cancer in the 21st Century. Rani Kanthan, Jenna-Lynn Senger,
Shahid Ahmed, and Selliah Chandra Kanthan Journal of Oncology; Volume 2015 (2015),
RISK FACTORS
• Demographic factors:
(a)advanced age,
(b)female gender,
(c)obesity,
(d)geography: South American, Indian, Pakistani,
Japanese, and Korean,
(e)ethnicity: Caucasians, Southwestern Native
American, Mexican, and American Indians,
(f)genetic predisposition.
GEOGRAPHICAL VARIATION
GEOGRAPHICAL VARIATION
in Gall Stone Disease
RISK FACTORS
• Gallbladder pathologies/abnormalities:
(a)cholelithiasis, (Kaushik 2001; Rustagi and
Dasanu 2014)
(b)porcelain gallbladder, (Hundal and Schaffer
2014)
(c) gallbladder polyps,
(d)congenital biliary cysts *,
(e)pancreaticobiliary maljunction anomalies.
In Todani 's series of 154 cancers associated with bile duct cysts, 62 were in
the gall-bladder, 1 in the liver and 2 in the pancreas.*
RISK FACTORS
• Gallbladder pathologies/abnormalities:
The issue of microlithiasis
Gallbladder metaplastic changes appear to be
more frequent in cases of micro-lithiasis and seem
to be associated with a chronic thickening of the
gallbladder wall.
Further studies are needed to evaluate a possible
role of prophylactic cholecystectomy in this
population to prevent the long term evolution of
these early changes to cancerous lesions.
• Infections
(a)Liver flukes (R. Hundal and E. A. Shaffer
2014),
(b)Chronic Salmonella typhi and paratyphi
infections (Nath 1997; Shukla 2000; Randi
2006; Nagaraja 2014) and
(c)Helicobacter infection (Matsukura 2002;
Kobayashi 2005).
RISK FACTORS
• Exposures
(a)Ingestion of certain medications (eg, oral
contraceptives, INH, methyldopa) can increase the
risk of gallbladder cancer.
(b)Likewise, certain chemical exposures (eg,
pesticides, rubber, vinyl chloride) and
(c)Occupational exposures associated with working in
the textile, petroleum, paper mill, and shoemaking
industries increase the risk of gallbladder cancer.
(d) Smoking
(e)Exposures through
water pollution (organopesticides, eg,
dichlorodiphenyltrichloroethane and benzene
hexachloride);
heavy metals (eg, cadmium, chromium, lead); and
radiation exposure (eg, radon in miners) are associated with
gallbladder cancer.
PATHOGENESIS