An overview of Ca Gall bladder management .ppt

Ca gall bladder

3. 
A rare disease but extremely variable A rare disease but extremely variable
by geographical region racial groupsby geographical region racial groups

Highest incidence in Chileans, Highest incidence in Chileans,
American Indians and in parts of American Indians and in parts of
northern India where it accounts for as northern India where it accounts for as
much as 9.1% of all gall bladder much as 9.1% of all gall bladder
disease.disease.

4. 
In west gall bladder cancer accounts In west gall bladder cancer accounts
for less than 1% of new cancer for less than 1% of new cancer
diagnosis diagnosis

6. 
Actual – unknown Actual – unknown

Predisposing factors-Predisposing factors-
Age – elderlyAge – elderly
G. Stone (10-25% of cases)G. Stone (10-25% of cases)
Chr. cholecystitisChr. cholecystitis

8. 
Histological types:Histological types:
Adenocarcnoma – commonest (90%)Adenocarcnoma – commonest (90%)
Squamous cell carcinoma – rare Squamous cell carcinoma – rare
Adeno-sqamous – rarestAdeno-sqamous – rarest

9. 
Spread:Spread:
Direct-Direct-
liverliver
adjacent organsadjacent organs
Lymphatic-Lymphatic-
lymph nodes in Callot’s trianglelymph nodes in Callot’s triangle
para-aortic (coeliac) L. nodespara-aortic (coeliac) L. nodes
Haematogenous-Haematogenous-
liverliver
distant metastasis - raredistant metastasis - rare

11. 
Mode of presentation:Mode of presentation:

AsymptomaticAsymptomatic – diagnosed during- – diagnosed during-
cholecystectomy for G. stonecholecystectomy for G. stone
routine histologyroutine histology

12. 
When the tumour obstructs cystic duct, the When the tumour obstructs cystic duct, the
patient presents with features of-patient presents with features of-
acute cholecystitis oracute cholecystitis or
Mucocele Mucocele

13. 
> 50% patients present with features > 50% patients present with features
of-of-
Obstructive jaundiceObstructive jaundice
Palpable mass in RHCPalpable mass in RHC

At the time of presentation majority of At the time of presentation majority of
tumours are advancedtumours are advanced

15. 
Ca pancreasCa pancreas

Cholangio-carcinomaCholangio-carcinoma

HepatomaHepatoma

Ca stomachCa stomach

Ca colonCa colon

17. 
U/S of HBSU/S of HBS

CT scan – if U/S is inconclusiveCT scan – if U/S is inconclusive

MRI – if CT inconclusiveMRI – if CT inconclusive

Image guided biopsyImage guided biopsy

Laparoscopic biopsyLaparoscopic biopsy

CA19-9 is elevated in 80% of patientsCA19-9 is elevated in 80% of patients

19. 
If diagnosed during chlecystectomy – If diagnosed during chlecystectomy – some some
advices resection of adjacent part of liveradvices resection of adjacent part of liver

In other cases – In other cases – only palliation by-only palliation by-
stenting if there is obst. jaundicestenting if there is obst. jaundice
chemotherapychemotherapy
pain killerpain killer

20. 
5 year survival5 year survival
2 – 5% overall 2 – 5% overall
50% if the tumour is confined to mucosa50% if the tumour is confined to mucosa

21. 21