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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
Gallbladder cancer is the fifth most common malignancy of the gastrointestinal tract. The cancer demonstrates marked geographic variations with the highest incidence reported in South America (Chile and Bolivia) and India. Gallbladder cancer is more common in women (4:1 ratio), and the main risk factors include gallstone disease, gallbladder polyps, and abnormal pancreaticobiliary duct junction. Gallbladder cancer is associated with low five-year survival rate. The poor prognosis is largely due to two factors: The absence of specific symptoms early in the course of the disease, and absence of a submucosa in the gallbladder permitting the cancer to invade deeper tissues with a high propensity for adjacent organ involvement and nodal spread, even for relatively small-sized tumors. On the flip side, around 50–70% of patients with gallbladder cancer are detected incidentally on histopathology following simple cholecystectomy for presumed benign conditions.
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.
Isoalantolactone suppresses gallbladder cancer progression via inhibiting the ERK signalling pathway
Published in Pharmaceutical Biology, 2023
Xingyu Lv, Yuqi Lin, Xi Zhu, Xiujun Cai
Gallbladder cancer usually originates in the epithelial cells of the biliary duct system (Shen et al. 2019; Mao et al. 2020; Chen et al. 2021). According to the Surveillance, Epidemiology, and End Results (SEER) program database, GBC has a poor prognosis, with a median survival time of less than 12 months and a 5-year overall survival (OS) rate of less than 5% (Hundal and Shaffer 2014; Cai et al. 2020; Mao et al. 2020). Surgery is currently the only treatment option, but most patients are diagnosed too late for surgery, as GBC onset and progression are usually asymptomatic at early stage (Roessler et al. 2021). If GBC has metastases at the time of diagnosis, surgery is usually not indicated and chemotherapy is the first choice of treatment (Baiu and Visser 2018). Although gemcitabine-based systemic chemotherapy offers a treatment option, only a few patients yield promising prognoses due to severe systemic toxicity and drug resistance (Azizi et al. 2021). Therefore, novel potential antitumour drugs need to be explored to improve the quality of life and OS of GBC patients.
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].
Risk-adjusted analysis of survival variability among hospitals treating biliary malignancy
Published in Journal of Chemotherapy, 2022
Margherita Rimini, Andrea Casadei-Gardini, Giovanni Brandi, Francesco Leone, Lorenzo Fornaro, Nicoletta Pella, Nicola Silvestris, Francesco Montagnani, Sara Lonardi, Eleonora Lai, Eva Galizia, Daniele Santini, Andrea Palloni, Roberto Filippi, Gianluca Masi, Giuseppe Aprile, Massimo Aglietta, Giorgio Frega, Elisabetta Fenocchio, Caterina Vivaldi, Maria Antonietta Satolli, Francesca Salani, Mario Scartozzi, Luca Faloppi, Antonio Pellino, Elisa Sperti, Valentina Burgio, Francesca Ratti, Luca Aldrighetti, Stefano Cascinu, Alessandro Cucchetti
Results from the multilevel mixed effect logistic regression are reported in Table 2. Male had 1.86 higher odds for mortality. Being treated for gallbladder cancer increased the odds by 1.81, in respect to all the other biliary malignancies. Additionally, higher the ECOG – PS higher the odds, being 2.39 for PS of 1 and 6.31 for PS 2. An increase on 1 logarithm of NLR, of CEA and of CA19-9 increased the odds for 9-month mortality of 3.33, 1.32 and 1.31, respectively. Finally, higher the haemoglobin lowers the odds and, conversely, higher the bilirubin higher the odds for mortality within 9 months. Of note, the treatment with gemcitabine plus platinum was not independently related to mortality at multivariable model. The model estimated that the residual variance observed in 9-month mortality was attributable for the 2.6% to the treating hospital.