Gallbladder cancer (GBC) is a relatively rare disease but it is the most prevalent malignancy of the biliary tract worldwide. The incidence rate is estimated to be < 3 per 100.000, but there are geographic, ethnic and gender-bound variations. There are high incidence rates in certain indigenous populations of North and South America, Central Europe and Northern India. Interestingly, these populations also have high incidences of cholesterol gallstone disease which is a major risk factor for developing GBC. The main risk factors for developing GB cancer include long standing gallstones, chronic biliary tract infections, female sex, large gallbladder polyps and anomalous pancreato-biliary duct junction.
Early diagnosis of GBC is difficult as symptoms are generally non-specific; the most common symptom is persistent right upper quadrant/epigastric pain (54-83%). Other symptoms include jaundice (10-46%), nausea and vomiting (15-43%), anorexia (4-41%) and weight loss (10-39%).
Presentation of GBC can be like biliary colic and acute or chronic cholecystitis. Therefore, GBC is often incidentally diagnosed after routine cholecystectomy for benign disease. Due to the combination of non-specific symptoms and a propensity for aggressive local dissemination, GBC is mostly diagnosed at an advanced disease stage, resulting in a poor prognosis with an overall 5-year survival of less than 5%. Other than resection of the tumour the treatment options are limited.
Radical resection of the gallbladder is the only curative treatment.
Cancer in the bile duct (cholangiocarcinoma)
Cancer can develop in any part of the bile duct (cholangiocarcinoma). When this is outside the liver the treatment is excision of the duct along with local lymph nodes as an extension of the Whipple’s procedure. When this is where the bile duct exits the liver
(Klatskin tumour) the surgery will involve a liver resection. When this is in the liver (peripheral cholangiocarcinoma) a liver resection is the treatment of choice. Postoperative chemotherapy is commonly used. When the cancer cannot be removed, bile drainage is re-established with the insertion of a stent through the narrowed bile duct and palliative chemotherapy may be offered