Definition
Gallbladder cancer is the most common malignant lesion of the biliary tract, and is more common in women aged 50 to 70 years, with gallbladder stones combined in about 80% of cases. Possible predisposing factors include: porcelain gallbladder, gallbladder adenoma, abnormal biliopancreatic duct confluence, post-biliary jejunostomy, ulcerative colitis, etc. Gallbladder cancer mostly occurs in the body and bottom of the gallbladder, and adenocarcinoma is the most common pathology, followed by squamous epithelial cell carcinoma. Adenocarcinoma can be infiltrative or papillary type, and the former is more common.
Diagnosis
1.Clinical manifestations
1. There are no specific symptoms in early stage. There may be gallstone symptoms such as pain and discomfort in the right upper abdomen, anorexia and indigestion. When the above symptoms worsen, jaundice and weight loss should be highly suspected.
2.Signs are the same as gallstones and cholecystitis in the early stage, but jaundice may appear in the late stage, and hepatomegaly, right upper abdominal mass and ascites may appear when it invades the liver.
2.Auxiliary examination
1.Laboratory examination
Late stage jaundice may have corresponding liver function abnormalities.
Tumor marker tests: CEA, CA19-9, CA125, etc. can be elevated, but are not specific.
2.Imaging examination
1.B ultrasound is preferred, which can show uneven thickening of the gallbladder wall and intracavitary fixed masses, and can also observe gallstones, liver metastases, lymph node enlargement and bile duct obstruction and other lesions.
2.CT is better than B-ultrasound in qualitative aspect.
3.MRI and MRCP have greater diagnostic value in the case of bile duct obstruction.
4.ERCP has little early diagnostic value and is suitable for identifying occupying lesions in the common hepatic duct or common bile duct or collecting bile for cytological examination.
3.Other tests
Cytological examination: B ultrasound-guided percutaneous liver/gallbladder aspiration for bile extraction or fine needle aspiration biopsy.
3.Differential diagnosis
It must be distinguished from cholecystitis, gallbladder polyp-like lesions, and bile duct cancer.
Staging
Nevin staging
Stage I, cancerous tissue is limited to the mucosa of gallbladder.
Stage II, cancerous tissue invades the mucosa and muscle layer of the gallbladder.
In stage III, the cancer invades the whole wall of the gallbladder.
Stage IV, the cancer invades the whole wall of the gallbladder and is accompanied by lymph node metastasis.
Stage V, cancer invades the liver directly or with liver metastasis, or with metastasis to any organ.
Treatment
Surgery is the preferred treatment. Chemotherapy and radiation therapy are not effective.
Surgical treatment.
1.Surgical treatment of early-stage gallbladder cancer
Preoperatively diagnosed early-stage gallbladder cancer Nevin I and II, radical surgery for gallbladder cancer should be performed, including cholecystectomy, wedge resection of liver 2cm from gallbladder and lymph node dissection within hepatoduodenal ligament. If gallbladder cancer is accidentally found after cholecystectomy for benign disease, it is not necessary to operate again if it is Nevin stage I. If it is Nevin stage II, it is necessary to operate again to clear regional lymph nodes and wedge resection of liver.
2.Surgical treatment of middle and late stage gallbladder cancer
Expanded resection for intermediate and advanced gallbladder cancer includes clearing the lymph nodes of hepatoduodenal ligament, posterior superior pancreaticoduodenal lymph nodes, peri-abdominal artery lymph nodes, peri-abdominal aortic lymph nodes and peri-inferior vena cava lymph nodes while doing resection of middle lobe of liver, enlarged right half of liver or right trilobe of liver or adding pancreatic head duodenectomy.
For the surgical treatment of unresectable gallbladder cancer liver metastases, percutaneous ultrasound-guided anhydrous alcohol injection, intraoperative microwave curing of lesions, radiofrequency ablation, cryotherapy, etc. With obstructive jaundice, biliary-intestinal anastomosis is feasible, and if biliary-intestinal anastomosis is difficult, PTBD, external U-tube drainage, etc. are performed.
Prevention
For symptomatic patients, gallbladder stones >3cm in diameter, gallbladder polyps with single, >1cm in diameter or broad-based polyps, or clinically diagnosed adenomatous polyps, uneven thickening of gallbladder wall or more than 5mm, or porcelain gallbladder should be actively surgically removed to prevent gallbladder carcinogenesis.