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Biliary Tract Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Hemant M. Kocher, Vincent S. Yip, Ajit T. Abraham
Gallstones are perhaps the single most important risk factor for gall bladder cancer, although the etiologic link is unclear. All the other risk factors associated with gallstone disease are also associated with gall bladder cancer, such as elevated body mass index, high caloric and carbohydrate intake, female sex, high parity and young age at first childbirth, and estrogen exposure. The association with gender varies with geography (female to male ratios can exceed 5:1 in northern India but are close to 1:1 in Korea and Japan) and ethnicity (female to male ratios are high in Hispanic whites and American Indians but not so among African Americans or Caucasians). Calcifications in the wall of gall bladder, such as porcelain gall bladder, may predispose to gall bladder cancer risk, especially in younger patients.107 Chronic Salmonella infection, which predisposes to gallstone formation, also predisposes to gall bladder cancer risk, perhaps due to chronic inflammation.108 Similarly, Helicobacter colonization has been suggested to predispose to gall bladder cancer, but these claims have not been substantiated by recent studies.109 Single, large (>1 cm) sessile polyps are more likely to be malignant.110,111 Environmental and dietary factors may also predispose to the disease; however, the causal evidence is weak.100,102,112
Gallbladder Cancer with Obstructive Jaundice and Periportal Lymph Node
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Arindam Mondal, Vikram A. Chaudhari, Manish S. Bhandare, Shailesh V. Shrikhande
Tissue diagnosis: In a clearly resectable, radiologically suspected gallbladder cancer, preoperative biopsy should not be performed as this aggressive cancer is known to spread across needle tracts. Suspected gallbladder cancer patients with locally advanced or metastatic disease would need tissue diagnosis before administration of neoadjuvant or palliative intent chemotherapy, respectively.
The Liver and the Biliary System
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Early presenting signs and symptoms of gallbladder cancer are similar to any gallbladder disease. Therefore, in most cases, the diagnosis of gallbladder cancer is not made clinically. Even at surgery, the diagnosis may be missed until the pathologist reports it. Radiological studies also do not differentiate between benign and malignant gallbladder disease. They only reveal a nonfunctioning gallbladder. If other anomalies are detected, it is due to the more advanced stages of the disease rather than accurate early diagnosis of the case. Sonography can detect some but again cannot differentiate between the carcinoma and a benign papillary lesion in the gallbladder. CT scanning will detect advanced cases but cannot differentiate between a thickened wall of the gallbladder due to tumor or due to a benign condition such as the inflammatory cases which are more common.
Emerging treatment strategies in hepatobiliary cancer
Published in Expert Review of Anticancer Therapy, 2023
Deniz Can Guven, Hasan Cagri Yildirim, Elvin Chalabiyev, Fatih Kus, Feride Yilmaz, Serkan Yasar, Arif Akyildiz, Burak Yasin Aktas, Suayib Yalcin, Omer Dizdar
Biliary tract cancers (BTC) include intrahepatic cholangiocarcinoma (iCCA), hilar cholangiocarcinoma, extrahepatic cholangiocarcinoma (eCCA), and gallbladder cancer (GBC) [1]. Although they are grouped together as biliary tract cancers, these four entities have distinct characteristics regarding the epidemiology, risk factors, tumor molecular characteristics and prognosis [2]. The gallbladder cancer is more frequent in women in advanced ages. Majority of the patients are incidentally diagnosed after cholecystectomies for benign reasons. Symptomatic patients with GBC tend to have poorer overall survival due to the higher frequency of local and vascular invasion, regional lymph node involvement, and distant metastases at the time of diagnosis [3]. Obesity, gallstones with chronic inflammation, calcified gallbladder (porcelain gallbladder), polyps of 1 cm and above, primary sclerosing cholangitis, and inflammatory bowel diseases are other risk factors [4]. The median overall survival rates for stage I–III and IV disease are 12.9 and 5.8 months, respectively [5]. The prognosis is poorer and the frequency of targetable alterations like fibroblast growth factor receptor (FGFR) and isocitrate dehydrogenase (IDH) gene mutations is lower in patients with GBC compared to iCCA [6].
Evaluation of gallstone classification and their diagnosis through serum parameters as emerging tools in treatment: a narrative review
Published in Postgraduate Medicine, 2022
Bhavna Sharma, Shubha Rani Sharma
Gallstones are associated with various risk factors which include age, gender, obesity and body fat allocation, quick weight loss, diet, physical activity, drugs, diabetes, and genetics. Gallstones may cause different health conditions like blockage of the digestive juices which can catalyze swelling of the gallbladder or cholecystitis which can lead to the destruction of the pancreas. Other conditions include Bouveret syndrome (blockage of the duodenum by gallstones), obstructive jaundice, pancreatitis, and gallstones ileus (blockage of the small bowel by gallstones) [4]. If left untreated, these stones can be life-threatening. It has been found that patients having gallstones are more prone to gallbladder cancer [5]. The symptoms of gallstones are also not definite, some of the gallstones remain as ‘silent gallstones’ but symptoms are noticed as complications develop. These include pain in the abdomen usually in the right upper part, vomiting, fever, nausea, indigestion, bloating, and jaundice [6].
Platinum-based chemotherapy in combination with PD-1/PD-L1 inhibitors: preclinical and clinical studies and mechanism of action
Published in Expert Opinion on Drug Delivery, 2021
Yingyan Xue, Song Gao, Jingxin Gou, Tian Yin, Haibing He, Yanjiao Wang, Yu Zhang, Xing Tang, Rong Wu
For HCC or BTC, a phase 2 study assessed the efficacy and safety of camrelizumab in combination with FOLFOX4 (fluorouracil, leucovorin, and oxaliplatin) or GEMOX (gemcitabine and oxaliplatin) in advanced HCC or BTC patients with no prior systemic treatment, respectively. Of 34 HCC patients, the overall ORR was 26.5%, with a DCR of 79.4%, a median TTR of 2.0 months, a not-reached median DOR, and a median PFS of 5.5 months [53]. Of 47 BTC patients, the overall ORR was 7.0%, with a DCR of 67.4%, a median TTR of 1.9 months, a median DOR of 5.3 months, and a not-reached median PFS [53]. Results show that the combination regimens may be promising first-line therapy in advanced HCC or BTC patients. Another phase 2 study explored the first-line therapy of camrelizumab combined with GEMOX in advanced BTC patients. In 26 evaluable patients, the overall ORR and DCR were 46.15% and 92.31%, and patients with gallbladder cancer had a higher ORR than those with cholangiocarcinoma (33.33% vs 66.64%) [54]. Results indicate that the combination regimen shows more efficacy in patients with gallbladder cancer.