Gallbladder Cancer Causes
Gallstones, Porcelain gallbladder, Age, Female Sex, Gallbladder polyps, Choledochal cyst are all risk factors for Gallbladder cancer
The most common symptom is pain localized to right upper abdomen. Anorexia and weight loss are common symptoms as seen in other cancer. Vomitting occur when it involve gastric antrum or pylorus or duodenum. Involvement of hilum can cause biliary obstruction leading to jaundice. This jaundice is called as surgical obstructive jaundice. It is painless and associated with dark colored urine and pale colored stools. Gallbladder cancer can involve hepatic flexure of colon then patient present with feature of large bowel obstruction like abdomen distension, non-passage of flatus and motion. Metastatic cancer present with abdomen distension in the form of ascites.
USG abdomen can show mass or focal thickening in the gallbladder. CECT abdomen is done to stage the tumor. FNAC is not done as it may risk the seedling of cancer cells in the needle tract. PET scan is done selectively
Treatment of Gallbladder Cancer
Gallbladder is situated on the inferior aspect of right lobe of liver adhered to it. Gallbladder is removed along with this part of liver to which it is adhered. Standard lyphadenectomy along with resection this whole procedure is called as radical cholecystectomy. Cystic duct margin is sent for frozen section intra-operatively and if it comes to be positive then common bile duct is also excised and then Roux-en-Y Hepatico-jejunostomy is performed. Extended right hepatectomy is done if tumor is located at the neck and involve right sided portal structures.
Role of staging laparoscopy
Staging Laparoscopy is the first step. It is done to look for metastatic deposits missed on CT scan. If metastatic deposits are seen on staging laparoscopy then biopsy is taken from the deposits and sent for frozen section and if these comes to be positive then definitive surgery is not done