Gallbladder cancer

Malignancies of the biliary tract are uncommon in the United States, with approx 8000 cases reported annually nearly two-thirds of these cases arise in the gallbladder, while the remainder (cholangiocarcinoma) originate from the bile ducts and periampullary region. However, gallbladder cancer occurs in epidemic proportions in many South American and Asian countries, particularly affecting women. 

Gallbladder carcinoma is diagnosed approx 5000 times a year in the United States, making it the most common biliary tract cancer and fifth most common gastrointestinal tract cancer. Also, approx 4500 cases of bile duct cancer occur each year in the United States. Women are more commonly afflicted than men, with a female-to-male ratio of 2.7 1.0. The median age at presentation of gallbladder cancer is 73 yr. In addition, an incidence five to six times that in the general population is seen in southwestern Native Americans, Mexicans, Hispanics, and Alaskans. 

The risk of gallbladder cancer is higher in patients having cholelithiasis or a calcified gallbladder and typhoid carriers, while ulcerative colitis is a clear risk factor for bile duct cancer. Patients having ulcerative colitis have an incidence of bile duct cancer that is 9-21 times higher than that in the general population. 

Gallbladder cancer is staged primarily at the time of surgery. Specifically, the stage is determined by lymphatic involvement and extension to adjacent structures (Table 4). The 5-yr survival rate is 83% in patients having T1 lesion, and only 33% in patients having T3 lesions. In patients who have involvement of the lymph nodes or metastatic disease, the 5-yr survival rate ranges from 0-15%. 

The role of preoperative therapy for resectable disease remains ill defined. Local recurrence after curative resection of gallbladder cancer can be as high as 86% (70). Resected bile duct cancers have a rate of local recurrence of 25-40% (71). 

Fong Y. Aggressive therapy is warranted for gallbladder cancer. Cancer Invest 1998 16(1) 64—65. 

Bartlett DL, et al. Long-term results after resection for gallbladder cancer. Implications for staging and management. Ann Surg 1996 224(5) 639-646. 

Gabapentin has been used to treat morphine-induced myoclonus in a 54-year-old patient with gallbladder cancer (13). Effective pain control was maintained with morphine 300 mg, but after 24 hours the patient developed generalized muscular movements while asleep. Gabapentin 300 mg bd produced complete resolution of symptoms after 12 hours. In another case gabapentin 600 mg/day was used to treat a 1-month history of spontaneous jerking of both wrists after an increase in the dose of morphine to 120 mg/day the myoclonus disappeared over the next 24 hours (8,13). 

Ishii, H., Furuse, J., Yonemoto, N., Nagase, M., Yoshino, M., and Sato, T. (2004) Chemotherapy in the treatment of advanced gallbladder cancer. Oncology,... 

WANG, J.H., et.al., Antineoplastic effects of octreotide on human gallbladder cancer cells in vitro. World J. Gastroenterol. 10 (2004) 1043-1046. 

Deletion of pl6 gene is observed in half of the gallbladder cancers" 2i,429,430 jg reported to be associated... 

Roa I, Ibacache G, Roa J, et al. Gallstones and gallbladder cancer-volume and weight of gallstones are associated with gallbladder cancer a case-control study. J Surg Oncol. 2006 93 624-628. 

Kumar S. Infection as a risk factor for gallbladder cancer. / Surg Oncol. 2006 93 633-639. 

Quan ZW, Wu K, Wang J, et al. Association of p53, pl6, and vascular endothelial growth factor protein expressions with the prognosis and metastasis of gallbladder cancer. J Am Coll Surg. 2001 193 380-383. 

Mastrhara S, Kasuya K, Aoki T, et al. Relation between K-ras codon 12 mutation and p53 protein overexpression in gallbladder cancer and biliary ductal epithelia in patients with pancre-aticobiliary maljrmction. Pancreat Surg. 2000 7 198-205. 

Pandey, M. and Shukla, V.K. 2002. Diet and gallbladder cancer A case-control study. Eur. J. Cancer Prev. 11, 365 368. 

Srivastava A, Pandey SN, Choudhuri G, Mittal B (2008) Role of genetic variant A-204C of cholesterol la -hydroxylase (CYP7A1) in susceptibility to gallbladder cancer. Mol Genet Metab 94 83-89... 

Srivastava A, Choudhuri G, Mittal B (2010) CY-P7A1 (-204 A>C rs3808607 and -469 T>C rs3824260) promoter polymorphisms and risk of gallbladder cancer in North Indian population. Metab Clin Exp 59 767-773... 

The survival reported by numerous groups is comparable with that observed with other abdomi-nopelvic malignancy such as retroperitoneal and visceral sarcoma and liver metastases from colorectal cancer. The survival is far superior to that for some cancers that are routinely resected, such as pancreatic cancer, gallbladder cancer, and cholan-giocarcinoma. By analogy with other standard of practice management plans, the efficacy of these peritoneal carcinosis treatments and the morbidity and mortality are acceptable. 

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