Staging by the AJCC TNM system is as follows:
- Stage I tumors include in situ disease confined to the gallbladder wall (T1a, not penetrating the muscularis) and also early disease (T1b, with invasion into the gallbladder muscularis).
- Stage II disease includes tumors with invasion into the perimuscular connective tissue.
- Stage III tumors extend up to 2 cm into the liver and may have regional node metastases.
- Stage IV tumors extend >2 cm into the liver and/or two or more adjacent organs and have more distant nodal spread or distant metastatic disease.for gallbladder cancer surgery in Bangalore
Diagnosis of gallbladder cancer.
Approximately one-third of these tumors are diagnosed incidentally during cholecystectomy, and cancer is found in 0.3% to 1% of all cholecystectomy specimens. Symptoms of stage I and II gallbladder cancer are often directly caused by gallstones rather than the cancer and include right upper quadrant pain in >80% of patients. Stage III and IV cancers present with jaundice due to bile duct obstruction and exhibit the signs and symptoms of advanced cancers, including weight loss, hepatomegaly and/or a palpable mass, and ascites. Ultrasound findings suggestive of gallbladder cancer may include thickening or irregularity of the gallbladder, or a polypoid mass. Porcelain gallbladder seen on diagnostic imaging carries a risk of cancer of approximately 25% for gallbladder cancer surgery in Bangalore.
Treatment of gallbladder cancer.
In situ disease confined to the gallbladder wall (stage I, T1a) is often identified after laparoscopic cholecystectomy for gallstone disease. Because the overall 5-year survival rate approaches 100%, cholecystectomy alone with negative resection margins (including the cystic duct margin) is adequate therapy.
Patients with a preoperative suspicion of gallbladder cancer should undergo open cholecystectomy, since port site recurrences and late peritoneal metastases (associated with bile spillage) have been reported even with in situ disease for gallbladder cancer surgery in Bangalore.
Early disease (stage I, T1b) may be treated by radical cholecystectomy that includes the gallbladder and the gallbladder bed of the liver.
Stage II or III disease with invasion through the muscularis of the gallbladder or the presence of lymph node metastases requires more radical resection. Depending on the extent of local invasion, extirpation may range from wedge resection of the liver adjacent to the gallbladder bed to resection of 75% of the liver. Due to the three-dimensional characteristics of the gallbladder fossa, hepatic wedge resection in this area is technically difficult and has the risk of entry into the tumor plane. Therefore, segmental liver resection (usually segments IV and V) is recommended. Dissection in continuity of the portal, paraduodenal, and hepatic artery lymph nodes should accompany the liver resection. Survival advantages have been demonstrated after radical resection. Because of the aggressive nature of this malignancy, adjuvant chemoradiation is often recommended, but no proof of efficacy is available.
Most gallbladder cancers have invaded the liver or extend into the porta hepatis before clinical diagnosis. Extensive liver involvement or discontiguous metastases preclude surgical resection as a reasonable option. Patients thus affected often are symptomatic, with pain, jaundice, nausea and vomiting, and weight loss. Jaundice may be palliated by percutaneous or endoscopically placed biliary stents. Duodenal obstruction can be surgically bypassed if present. Radiotherapy can decrease tumor bulk and temporarily relieve obstruction, but no survival benefits have been demonstrated. As with most malignancies of hepatobiliary origin, there are no effective chemotherapeutic agents for gallbladder cancer surgery in Bangalore.