Fact-sheet: Gallblaber carcinoma


Updated on 06/22/2020 at 10:11 AM

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Definition

Gallbladder cancer is a well-differentiated adenocarcinoma in 85% of cases

Risk factors:
- gallbladder lithiasis found in more than 70% of cases (calculous cancer)

- chronic cholecystitis with a calculus >2cm

- primary sclerosing cholangitis
- calcifications of the gallbladder wall (porcelain gallbladder)
- congenital anomalies such as choledochal cyst or anomalous biliopancreatic junction

- intra-gallbladder polyp

Female predominance (3/1)
Rapid lymph node extension
Possible metastases and peritoneal carcinomatosis.
Late diagnosis (poor prognosis, 5% 5-year survival)

Clinical features

Three circumstances of discovery:
- pathological finding after cholecystectomy performed for gallbladder lithiasis
- jaundice caused by direct involvement of the main bile duct or biliary confluence
- right upper quadrant pain and general health deterioration

Laboratory findings

Biological inflammatory syndrome or abnormal liver function tests depending on extent

Radiography

Not contributory

Ultrasound

Irregular +/- localized wall thickening (any localized wall thickening greater than 10 mm is highly suspicious for cancer)
+/- extension into the liver / lymph nodes / secondary lesions

Frequent extension to the adjacent liver because the superior border of the gallbladder is not covered by peritoneum, favoring contiguous spread

CT

- Two forms: Either localized thickening of the gallbladder wall, with variable, irregular enhancement after injection. Or a mass encompassing part of the gallbladder and extending variably into the adjacent liver or subhepatic space (+/- bile duct dilation) - A calcification within the mass corresponding to a macrolithiasis of the gallbladder is often visible - Signs of surgical unresectability: liver metastases, vascular involvement of the hepatic pedicle or of the main biliary confluence, peritoneal carcinomatosis, lymphadenopathy

MRI

Useful for morphological assessment of the bile ducts in jaundiced patients before palliative drainage.
Gallbladder cancer is hypointense on T1, mildly hyperintense on T2, and shows, as on CT, variable enhancement after contrast injection.

Vascular intervention

Palliative biliary drainage depending on extent

Nuclear medicine

Hypermetabolism

Management

Stage T1/T2: surgery (tumor confined to the gallbladder wall or with extra-parietal infiltration limited to adjacent connective tissue).
Otherwise: chemotherapy.

Classification

TNM 2018

T0No detectable primary tumorTisCarcinoma in situT1Tumor invading the lamina propria or the muscularisT1atumor invading the lamina propriaT1btumor invading the muscularisT2Tumor invading the perimuscular connective tissue without extension beyond the serosa or into the liverT2aTumor invading the perimuscular connective tissue on the hepatic side without extension to the serosaT2bTumor invading the perimuscular connective tissue on the hepatic side without extension into the liverT3Tumor perforating the serosa (visceral peritoneum) and/or directly invading the liver and/or one other adjacent organ or structure, for example, the stomach, duodenum, colon, pancreas, omentum, or extrahepatic bile ductsT4Tumor invading the main portal vein or hepatic artery, or two or more extrahepatic organs or structuresN - Regional lymph nodesNXRegional lymph nodes cannot be assessedN0No regional lymph node metastasisN11 to 3 metastatic regional lymph nodesN2≥ 4 metastatic regional lymph nodes

Differential diagnosis

Metastasis to gallbladder (melanoma++)