Gallbladder carcinoma

Gallbladder carcinoma is rare. In 75% of cases, it is combined with gallstones, in many cases - with cholecystitis. There are no convincing signs of an etiological connection between these diseases. Any cause of gallstone formation predisposes to the development of a tumor.

The tumor most often develops in calcified ("porcelain") gallbladder. Gallbladder papillomas usually do not undergo malignant transformation. Nonspecific ulcerative colitis may contribute to the development of gallbladder carcinoma. It has been shown that abnormal fusion of the pancreatic duct with the common bile duct at a distance of more than 15 mm from the duodenal papilla is combined with gallbladder carcinoma and congenital cystic dilation of the common bile duct. Reflux of pancreatic juice may contribute to the development of this tumor.

In chronic typhoid-paratyphoid infection of the gallbladder, the risk of developing carcinoma increases by 167 times, which once again emphasizes the need for antibiotic therapy for chronic typhoid-paratyphoid infection or performing a planned cholecystectomy.

Papillary adenocarcinoma initially appears as a warty growth. It grows slowly until it fills the entire gallbladder as a mushroom-shaped mass. In mucous degeneration, the tumor grows faster, metastasizes early, and is accompanied by gelatinous carcinomatosis of the peritoneum. Morphologically, squamous cell carcinoma and scirrhus are distinguished. The anaplastic type is especially malignant . More often, the tumor is a differentiated adenocarcinoma and can be papillary.

The tumor usually develops from the mucous membrane of the fundus or neck, but due to its rapid growth, it is difficult to establish the original location. Abundant lymphatic and venous outflow from the gallbladder leads to early metastasis to regional lymph nodes, which is accompanied by cholestatic jaundice and dissemination. Invasion into the liver bed occurs, and it is also possible to grow into the duodenum, stomach, and colon with the formation of a fistula or compression of these organs.

Symptoms of gallbladder carcinoma.The disease usually affects older white women. They may present with pain in the right upper quadrant of the abdomen, nausea, vomiting, weight loss, and jaundice. Sometimes carcinoma is accidentally discovered during histological examination of gallbladder tissue after cholecystectomy. These minor changes may even go unnoticed during surgery.

During examination, a dense and sometimes painful volumetric formation in the area of the gallbladder can be detected.

In the blood serum, urine and feces, when the bile ducts are compressed, changes characteristic of cholestatic jaundice are revealed.

In liver biopsy, histological changes are consistent with biliary obstruction, but do not indicate its cause, since this tumor does not typically metastasize to the liver.

Ultrasound examination (US) reveals a volumetric formation in the lumen of the gallbladder that can completely fill the bladder. In the early stages, gallbladder carcinoma is difficult to distinguish from thickening of its wall caused by acute or chronic cholecystitis.

Computed tomography (CT) may also reveal a volumetric formation in the gallbladder area. Ultrasound and CT allow diagnosing gallbladder carcinoma in 60-70% of cases.

By the time the tumor is detected by ultrasound and CT, it is highly likely that it has metastasized, and the chances of completely removing it are low. The extent of the disease and its stage can be assessed using magnetic resonance imaging (MRI).

Endoscopic retrograde cholangiopancreatography (ERCP) in a patient with jaundice allows us to establish compression of the bile ducts. Angiography reveals displacement of the hepatic and portal vessels by the tumor.

An accurate diagnosis can be established before surgery only in 50% of cases.

Treatment ofgallbladder carcinoma

All patients with gallstones are recommended to undergo cholecystectomy to prevent gallbladder carcinoma. This tactic seems too radical for such a widespread disease and will result in a large number of unnecessary cholecystectomies.

The diagnosis of gallbladder carcinoma should not be an obstacle to laparotomy, although the results of surgical treatment are disappointing. Radical surgery with liver resection has been attempted, but the results were unsatisfactory. No increase in survival was noted after radiation therapy.

Endoscopic or percutaneous stenting of the bile ducts can eliminate their obstruction.

Prognosis forgallbladder carcinoma

The prognosis is unfavorable, since in most cases the tumor is inoperable by the time the diagnosis is made. By this time, 50% of patients already have distant metastases. The probability of long-term survival exists only in cases where the tumor is discovered accidentally during cholecystectomy for gallstones (carcinoma in situ).

Survival after diagnosis averages 3 months, with 14% of patients still alive by the end of the first year. Papillary and well-differentiated adenocarcinomas have a higher survival rate than tubular and undifferentiated adenocarcinomas. Results of radical interventions, including liver resection and radical lymphadenectomy, are controversial; in some studies, survival was increased, while in others, it was not.

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