Gallbladder carcinoma
| Classification according to ICD-10 | |
|---|---|
| C23 | Malignant neoplasm of the gallbladder |
| ICD-10 online (WHO version 2019) | |
The gallbladder carcinoma is one of the malignant tumors of the biliary tract system . This also includes the following tumors:
- Tumors of the distal biliary tract
- Papilla vateri tumors (i.e. tumors of the mouth of the bile duct into the duodenum)
- Tumors of the biliary tract near the hilum, so-called Klatskin tumors (i.e. in the biliary tract that emerges directly from the liver)
Risk factors
Genuine gallbladder polyps larger than 0.5 cm and a so-called "porcelain gallbladder" (i.e. a gallbladder whose wall is completely fibrosed and calcified due to chronic inflammatory processes) are considered risk factors for developing gallbladder cancer . The risk here is 20–60%. In these cases, the gallbladder should be removed to prevent cancer.
Gallstones larger than 3 cm cause a 10-fold increased risk of cancer.
Another risk factor is the colonization of the gall bladder with salmonella in permanent salmonella excretors.
Epidemiology
Tumors of the biliary tract are generally rare in western industrialized countries and occur most frequently around the age of 70. They are the fifth most common tumors of the gastrointestinal tract. Women get sick two to three times more often than men. In Mexico , gallbladder cancer accounts for around a fifth of all malignancies.
anatomy
The mouth, stomach, small intestine and large intestine as well as liver, gallbladder and pancreas make up the digestive tract. The gallbladder is connected to the liver and duodenum by the bile ducts and acts as a reservoir for bile. These, and in particular the bile acids they contain, are required to digest the fats ingested with food. A tumor of the gallbladder, v. a. but the bile ducts block the outflow of bile, leading to symptoms such as jaundice (jaundice), discoloration of stool, and dark urine. The cause of the disease is still unclear. However, the risk of chronic inflammation of the gallbladder due to gallstones is increased.
Symptoms
- Loss of appetite
- Weight loss
- nausea
- Vomit
- Pain in the upper right abdomen
- Intolerance to high-fat foods
- Jaundice (a yellow discoloration of the skin and yellow eyes caused by the pigment of bile (bilirubin) deposited in the body)
- Itching of the skin
The physical exam may reveal a hardened area in the abdomen, an enlarged liver, jaundice, fever, and a distended abdomen.
Diagnosis
Symptoms only appear in the advanced stages of the disease. A painless jaundice (jaundice) can point the way. Carcinoma of the gallbladder is found by chance in around 1% of gallbladder operations. If a gallbladder carcinoma is clinically suspected, the following examinations are indicated:
- Sonography of the abdomen
- an ERCP (= representation of the biliary tract and gall bladder via an endoscope )
- Laboratory and tumor markers
- Endoscopic ultrasound (rarely useful, e.g. for papillary carcinoma )
- Computed tomography of the abdomen
- Biopsy if primary surgical removal is not sought and histological differentiation makes sense.
The classification is based on the WHO tumor divisions.
histology
Histologically, 90% of the cases are adenocarcinomas. The most common subtypes are adenocarcinomas of tubular or papillary appearance. Slime formation is common.
therapy
The therapy of gallbladder carcinoma is a domain of surgery , because only it allows healing in the early stages of the disease. However, in an advanced stage, an operation is no longer curative.
The endoscopy allows a simple and rapid treatment of symptoms such as jaundice by an insert of a Gallenwegstents (see also stent ).
The chemotherapy currently plays a minor role.
A radiation therapy is not generally recommended, although there are promising work on it.
forecast
The prognosis for gallbladder carcinoma is unfavorable because the tumors usually only cause symptoms in an advanced stage. As a result, the tumor can usually no longer be completely removed by surgery. The five-year survival rate for patients is around 6-7%. The mean survival time after diagnosis is around four to five months. If the carcinoma has been completely removed, the 5-year survival rate is 10–60%.
Aftercare
Overall, the prognosis is poor. There is no way of cure for a recurrence. Follow-up care is then based on the clinical picture and the symptoms.
literature
- Caspary Sahm: Gastroenterological Oncology. 2nd edition 2003, ISBN 3-7945-2255-9 .
Individual evidence
- ↑ Federal Statistical Office for Cancer of the Gallbladder and Biliary Tract PDF, 221 kB accessed on April 10, 2017.
- ↑ a b c P. Schirmacher, W. Jochum, H. Denk: Gallbladder and extrahepatic biliary tract in W. Böcker, H. Denk, Ph. U. Heitz, H. Moch: Pathologie , 4th edition, Munich, 20908 p. 826f.
case report gallbladder carcinoma pT4, N0, Mx, G3, stage IVa in a 65-year-old patient (PDF; 189 kB)
