GB Cancer😍

GB Cancer

GB Cancer
GB Cancer

Risk Factors:

  • Note: Cholesterosis (Strawberry GB) is not a risk factor for GB cancer
  • Gallstones (90%)
  • Salmonella typhi carrier
  • Porcelain gallbladder
  • GB polyps → >1 cm in size, multiple
    • Risk factor for GB cancer
    • If single and < 1cm → Regular follow up (?every 2 months)
  • Abnormal Pancreaticobiliary Duct Junction (APBDJ):
    • Increased risk of GB cancer and cholangiocarcinoma.
  • Heavy metal contamination of water
  • Median survival: 6 months

Clinical Features:

  • Earliest sign: Non specific
    • abdominal pain, bloating, and changes in appetite.
    • Recurrent biliary colic
    • Cannot be distinguished from GB stones
  • Then: GB mass
  • Jaundice (late sign)

Management:

  • Investigations:
    • IOC: CECT (for staging).
    • PET-CT: IOC for staging.
  • Median Survival
    • 6 months
  • Stage-Based Treatment:
      • Stage
      Feature
      Rx
      T1a
      Above muscle layer
      Simple cholecystectomy
      T1b
      Involves muscle layer
      Radical/extended cholecystectomy
      T2, T3
      -
      1. Radical cholecystectomy

      2. Chemotherapy (Gemcitabine) ± radiotherapy
      T4
      Invades adjacent structures
      Gemcitabine chemotherapy →
      [Good response] →       Surgery
  • Radical Cholecystectomy (Surgical Removal):
    • Structures removed:
      • Gallbladder
      • Liver segments 4B & 5
      • Lymph nodes along hepatoduodenal ligament
      • Common Bile Duct (CBD) (if involved)

Lymph nodes

notion image
notion image
  • Minimum lymph nodes removed:
    • Breast: 10
    • Colorectal: 12
    • Esophagus: 15
    • Stomach: 16
    • GB: 6
    • Mnemonic:
      • Colorectal → Appi idan → 2 → 12
      • Eso → E → F → Five → 15
      • Sto → S → Six → Sixteen
      • Breast → 10/10 → 10
        • Gastric
        Gastric