India alone accounts for more than 10% of gallbladder cancers worldwide.
This makes India the world’s capital for gallbladder cancer. The
prevalence of the cancer is especially high in Uttar Pradesh and Bihar
and the eastern states while it is fairly less in Western and Southern
India. It is not really known what is the cause of the high incidence of
gallbladder cancer in these specific parts of India. Some studies have
shown a higher incidence of industrial waste and heavy metals in the
water in the Gangetic belt, which could be one of the causative agents
for the higher incidence of gallbladder cancers.
It is also interesting to know that 60- 80% of patients with gallbladder
cancers in India have concomitant gallstone disease. Longstanding
cholecystitis and gallstone disease. Maybe one of the contributing
factors to this cancer.
We are a tertiary referral center for gallbladder cancers and we find a
large number of patients where cancer has been incidentally detected in
the pathology specimen of cholecystectomy for gallstone disease.
It does hence important for radiologists to be aware and report any
abnormal thickening in the wall of the gallbladder in patients with
gallstone disease which could be suspicious for gallbladder cancer.
One should not hesitate in such situations to carry out a triple-phase CT
scan or an MRI to confirm or negate the possibility of gallbladder
cancer.
Outcomes of gallbladder cancer surgery are much better when
performed per primum rather than a revision surgery after the
gallbladder has been removed.
If a gallbladder cancer has been picked up upfront, the normal surgery
would include removal of the gallbladder with a wedge of the liver with
a margin of around 2 cm from segments 4B and 5 along with the complete
portal. Lymphadenectomy and the sampling of the cystic duct margin in
the frozen section.
If the cystic duct shows evidence of cancer, the bile duct also may need
to be resected.
Some patients with gallbladder cancer may need more major surgeries in
the form of a bi-segmental liver section or even a right hepatectomy.
A vast majority of gallbladder cancers are however inoperable because
they present to us in an advanced stage with metastases, either in the
liver or the peritoneum or extensive lymph nodes. Many of these patients
would then be eligible only for a palliative stenting if they are
jaundiced followed by chemotherapy.
In view of the poor outcomes of this cancer, it is important to diagnose
these cancers at an early stage so as to give these patients the best
chance for survival.
Gall
Bladder Cancer- What You Need To Know!