It is a relatively rare malignancy that affects more of the female population, with median incidence of about 73 years.
Etiology[edit | edit source]
Higher risk with cholelithiasis or calcified gallbladder, clear RF – ulcerative colitis (9-21 times higher risk). Other – primary sclerosing cholangitis, congenital duct anomalies and parasitic infections.
Clinical picture[edit | edit source]
Early stages are asymptomatic. Advanced stages have symptoms like other (benign) gallbladder diseases - pain in the right lower jaw, nausea, fatty diet intolerance, anorexia, weight loss and jaundice.
Physical finding[edit | edit source]
The most common sign of cancer is icterus. We can feel resistance in the right lower jaw, hepatomegaly, ascites may also be found. Non-specific symptoms - pain in the lower jaw, weight loss, pruritus, fever.
Diagnosis[edit | edit source]
Most are diagnosed at an advanced stage, the main detection methods are CT and US. ERCP is good for localizing biliary obstruction. cholangiocarcinoma can be diagnosed earlier than gallbladder cancer, due to obstruction and jaundice.
many cholangiocarcinomas are considered to be metastatic adenocarcinomas with unknown primary localization.
Histopathology[edit | edit source]
Adenocarcinomomas account for 85 % and squamous cell or mixed cancers for15 %. Rare – adenosquamous ca, leiomyosarcoma or mucoepidermoid ca.
Bile duct tumors account for 90% of adenocarcinomas.
Treatment[edit | edit source]
in 1–2 % we find cholecystectomy carcinoma (without previous diagnosis).
Surgical treatment[edit | edit source]
Surgical treatment is the basic treatment method of early stages, of the proximally located tumors, about 15–20 % are resectable, out of distally located up to 70 %. Resectability is assessed by CT or MRI. For the unresectable, it is important to palliatively bypass the obstruction (bypass, stent). Postoperatively, local recurrences are common - in gallbladder cancer up to 85 %, in bile ducts up to 25–40 %.
Radiotherapy[edit | edit source]
Radiotherapy can have a palliative effect, brachyradiotherapy is sometimes used in bile duct cancer
There is no evidence of efficacy of adjuvant radiotherapy or radiochemotherapy.
Chemotherapy[edit | edit source]
Chemotherapy is also used palliatively, mainly 5-FU.
Prognosis[edit | edit source]
- In the early stages, after a cholecystectomy, the 5-year survival rate is 80%,
- in growth, 5-year survival after surgery is 30%, in nodular involvement 15%,
- median survival after palliative care is 6 months.
Links[edit | edit source]
Related articles[edit | edit source]
Source[edit | edit source]
- BENEŠ, Jiří. Study materials [online]. ©2010. [cit. 16-06-10]. <http://jirben.wz.cz>.