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Abramson Cancer CenterNCI CANCERLIT® Search: Bile Duct and Gallbladder Cancer - June 2002
National Cancer Institute®
Last Modified: June 1, 2002
- Gallbladder polyps: epidemiology, natural history and management.
- Early gallbladder cancer.
- Intra-operative tube stenting, palliation for jaundice in carcinoma gall bladder.
- In primary sclerosing cholangitis, gallbladder polyps are frequently malignant.
- Should suspected early gallbladder cancer be treated laparoscopically?
- Mutation and altered expression of beta-catenin during gallbladder carcinogenesis.
- Gallbladder carcinoma: findings at MR imaging with MR cholangiopancreatography.
- Incidental finding of gallbladder carcinoma.
- [Therapy of gallbladder carcinoma. Experience of a central hospital]
- The value of laparoscopy in the management of ampullary, duodenal, and distal bile duct tumors.
- Number and size of stones in patients with asymptomatic and symptomatic gallstones and gallbladder carcinoma.
- [Adenomas of Vater's ampulla and of the duodenum. Presentation of diagnosis and therapy by endoscopic interventional and surgical methods]
Table of Contents
1
UI - 11930198
AU - Myers RP; Shaffer EA; Beck PL
TI -
Gallbladder polyps: epidemiology, natural history and management.
SO - Can J Gastroenterol 2002 Mar;16(3):187-94
AD - Division of Gastroenterology, University of Calgary, Calgary, Canada.
Polypoid lesions of the gallbladder affect approximately 5% of the adult
population. Most affected individuals are asymptomatic, and their
gallbladder polyps are detected during abdominal ultrasonography
performed for unrelated conditions. Although the majority of gallbladder
polyps are benign, most commonly cholesterol polyps, malignant
transformation is a concern. The differentiation of benign from
malignant lesions can be challenging. Several features, including
patient age, polyp size and number, and rapid growth of polyps, are
important discriminating features between benign and malignant polyps.
Based on the evidence highlighted in this review, the authors recommend
resection in symptomatic patients, as well as in asymptomatic
individuals over 50 years of age, or those whose polyps are solitary,
greater than 10 mm in diameter, or associated with gallstones or polyp
growth on serial ultrasonography. Novel imaging techniques, including
endoscopic ultrasonography and enhanced computed tomography, may aid in
the differential diagnosis of these lesions and permit expectant
management.
2
UI - 11848630
AU - Wagholikar GD; Behari A; Krishnani N; Kumar A; Sikora SS; Saxena R;
TI -
Kapoor VK
Early gallbladder cancer.
SO - J Am Coll Surg 2002 Feb;194(2):137-41
AD - Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate
Institute of Medical Sciences, Lucknow, India.
BACKGROUND: The majority of patients with gallbladder cancer (GBC) have
advanced disease at the time of diagnosis and are unresectable. Longterm
survival is usually seen in a subset of patients with early GBC
(EGBC)-cancer confined to the mucosa (pT1a) and muscularis (pT1b).
Management guidelines of EGBC are not yet defined and are controversial.
The purpose of this article is to evaluate the diagnostic aspects and
effects of resectional procedures on survival outcome in patients with
EGBC. STUDY DESIGN: EGBC was defined as cancer confined to the mucosa
(pT1a) or muscularis (pT1b) according to the TNM classification.
Clinicopathological details and survival data of 14 patients who had
EGBC were analyzed. There were 9 women and 5 men, with a mean age of 60
years. RESULTS: A definite preoperative diagnosis was possible in only
three patients and three patients were diagnosed at operation; the
majority of patients were diagnosed incidentally after cholecystectomy
for associated gallstones. Two patients underwent extended
cholecystectomy and 12 patients underwent simple cholecystectomy. Two
patients had pT1a and 12 had pT1b lesions. Mean (SD) survival was 71.5
(12.2) months and median survival was 42 months. There were five
treatment failures with locoregional recurrence and death; all with pT1b
tumors were treated by simple cholecystectomy. Cumulative 1-, 3-, and
5-year survival was 92%, 68%, and 68% respectively [corrected].
CONCLUSIONS: Simple cholecystectomy is an adequate treatment only for
mucosal GBC. Patients with pT1b tumors require extended cholecystectomy.
Incidental GBC extending up to the muscularis merits early reoperation
for completion of extended cholecystectomy, which offers the only chance
of cure.
3
UI - 12018544
AU - Puneet; Khanna R; Khanna AK
TI -
Intra-operative tube stenting, palliation for jaundice in carcinoma gall
bladder.
SO - J Indian Med Assoc 2001 Oct;99(10):584-6
AD - Department of Surgery, Institute of Medical Science, Banaras Hindu
University, Varanasi.
Majority of patients with advanced carcinoma gall bladder have
irresectable disease and require palliation for jaundice, pruritus and
cholangitis. These cases presenting with jaundice are usually high risk
cases to undergo any major surgical procedure like segment-III
hepaticodochojejunostomy. So intra-operative tube stenting was attempted
in 6 patients of carcinoma gall bladder but technically, it was possible
in 4 cases only. In 2 cases because of massive locoregional disease it
was not possible to cannulate the proximal part of the bile duct. The
distal end of the tube was passed either in the duodenum or proximal
part of the jejunum. Patients were followed up, showed good recovery
from jaundice and pruritus.
4
UI - 12014717
AU - Buckles DC; Lindor KD; Larusso NF; Petrovic LM; Gores GJ
TI -
In primary sclerosing cholangitis, gallbladder polyps are frequently
malignant.
SO - Am J Gastroenterol 2002 May;97(5):1138-42
AD - Division of Gastroenterology and Hepatology, Mayo Medical School,
Clinic, and Foundation, Rochester, Minnesota 55905, USA.
OBJECTIVE: The management of gallbladder polyps/masses in patients with
primary sclerosing cholangitis (PSC) (i.e., cholecystectomy vs
observation) remains problematic. Given the risk of biliary tract cancer
in PSC in the face of the benign nature of most gallbladder polyps in
the general population, our aim was to determine the prevalence of
gallbladder cancer in PSC patients with a gallbladder mass who had
undergone cholecystectomy. METHODS: The case records of all patients
with PSC undergoing a cholecystectomy at the Mayo Clinic between
1977-1999 were reviewed. RESULTS: Of the 102 patients with PSC who
underwent a cholecystectomy, 14 of 102 (13.7%) had a gallbladder mass.
In the subset of patients with gallbladder masses, eight of 14 (57%) had
adenocarcinomas (seven primary adenocarcinomas and one metastatic
cholangiocarcinoma); the other six had benign masses (five adenomas and
one cholesterol polyp). In those patients with benign masses, 33% had
associated epithelial cell dysplasia; in patients with primary
gallbladder cancers, 57% had associated dysplasia. The patients with
primary gallbladder adenocarcinoma had a favorable outcome after
cholecystectomy, with a 36-month survival of 66%. CONCLUSIONS: In
conclusion, gallbladder neoplasms in PSC patients are malignant in
approximately 40-60% of the cases. The presence of gallbladder
epithelial cell dysplasia suggests a dysplasia-carcinoma sequence in PSC
similar to that observed in ulcerative colitis. Consideration should be
given to performing a cholecystectomy in PSC patients with gallbladder
polyps. If a cholecystectomy is not performed, careful interval
follow-up is warranted.
5
UI - 11986018
AU - Weiland ST; Mahvi DM; Niederhuber JE; Heisey DM; Chicks DS; Rikkers LF
TI -
Should suspected early gallbladder cancer be treated laparoscopically?
SO - J Gastrointest Surg 2002 Jan-Feb;6(1):50-6; discussion 56-7
AD - Department of Surgery, Division of General Surgery, University of
Wisconsin-Madison, Madison, WI 53792, USA.
Early gallbladder cancer (EGC), defined as T1 and T2 disease, is
frequently curable when completely excised without bile spillage. The
objective of the present study was to determine what effect initial
laparoscopic cholecystectomy has on outcome in patients with EGC. Of 89
patients referred to our institution with gallbladder cancer over an
11-year period, 26 had undergone initial laparoscopic cholecystectomy.
Sixteen of the 26 patients had T1 or T2 disease and are the subjects of
this report. These patients were reviewed retrospectively to assess
preoperative diagnosis, intraoperative bile spillage, and outcome
(recurrence and survival). In addition, the Western literature was
reviewed to determine the impact of initial laparoscopic cholecystectomy
on recurrence and survival of patients with EGC. Six patients had a
preoperative ultrasound consistent with a mass in the gallbladder wall.
Seven (44%) had documented bile spillage during the laparoscopic
cholecystectomy. T stage based on the laparoscopic cholecystectomy was
T1 (n = 1) and T2 (n = 15). Twelve patients underwent reexploration of
whom seven underwent further radical excision (gallbladder liver bed
resection and extensive lymphadenectomy). After a mean follow-up of 20.1
months (range 4 to 39 months), 69% of patients have had a recurrence or
died. Three patients had a port-site recurrence. Five (71%) of seven
patients with bile spillage at laparoscopic cholecystectomy have had a
recurrence or died of disease. A review of the Western literature on EGC
initially removed by laparoscopic cholecystectomy (including the present
series) yielded 21 patients with T1 and 42 patients with T2 disease.
One-year Kaplan-Meier survival (T1 = 89%, T2 = 71%) and 3-year
Kaplan-Meier survival (T1 = 47%, T2 = 40%) of these patients is worse
than prior reports for open cholecystectomy. An initial laparoscopic
cholecystectomy with its potential for bile spillage can convert
potentially curable EGC to incurable disease. Patients with preoperative
findings suspicious for gallbladder cancer should undergo open
exploration with intent to perform a radical cancer operation as a
primary procedure if the diagnosis is confirmed intraoperatively.
6
UI - 12023580
AU - Chang HJ; Jee CD; Kim WH
TI -
Mutation and altered expression of beta-catenin during gallbladder
carcinogenesis.
SO - Am J Surg Pathol 2002 Jun;26(6):758-66
AD - Department of Pathology, Seoul National University College of Medicine,
Korea.
Gallbladder carcinoma has two main morphologic developmental pathways: a
dysplasia-carcinoma sequence and an adenoma-carcinoma sequence.
beta-Catenin is a key regulator of the cadherin-mediated cell adhesion
system, and altered expression and mutation of beta-catenin have been
identified in many human malignancies. To clarify its role in
gallbladder carcinogenesis, we investigated mutation and
immunohistochemical expression of beta-catenin in adenomas, dysplasias,
and carcinomas. We classified adenomas according to the expression of
apomucins and cytokeratin and compared the mutational and expression
pattern among each type. beta-Catenin mutations were identified in 58%
(14 of 24) of the adenomas, and they were absent from all carcinomas (37
cases) and dysplasias (13 cases). Altered expression of beta-catenin,
such as nuclear or cytoplasmic expression and loss of membranous
expression, was also significantly higher in adenomas than in dysplasias
or carcinomas (p <0.001). Of the adenomas, papillary adenomas and
tubular adenomas of intestinal type showed infrequent beta-catenin
abnormality, which was similar to the carcinomas. The cytoplasmic and
nuclear expression of beta-catenin in carcinomas was correlated with
less aggressive tumor behavior; in particular, cytoplasmic expression
was associated with improved patient outcome (p = 0.028). Gallbladder
adenoma may be a heterogeneous entity, and the majority of adenomas are
not responsible for carcinoma progression.
7
UI - 12016370
AU - Schwartz LH; Black J; Fong Y; Jarnagin W; Blumgart L; Gruen D; Winston
TI -
C; Panicek DM
Gallbladder carcinoma: findings at MR imaging with MR
cholangiopancreatography.
SO - J Comput Assist Tomogr 2002 May-Jun;26(3):405-10
AD - Department of Radiology, Memorial Sloan-Kettering Cancer Center, and
Weill Medical College of Cornell University, New York, New York 10021,
USA. schwart1@mskcc.org
PURPOSE: To describe magnetic resonance (MR) imaging and MR
cholangiopancreatography (MRCP) findings in gallbladder carcinoma, and
to correlate these findings with available surgical and biopsy
information. METHODS: Preoperative MR images (T1-weighted spin-echo,
T2-weighted fast spin-echo, single shot fast spin-echo, and dynamic
gadolinium-enhanced gradient echo) in 34 patients with gallbladder
carcinoma were retrospectively reviewed for appearance of the primary
neoplasm and for demonstration of hepatic, peritoneal, duodenal, and
nodal involvement. Imaging findings were then compared with surgical
findings (n = 19 patients) and histologic findings (n = 15 patients).
RESULTS: Gallbladder carcinoma manifested at MR imaging as focal
gallbladder wall thickening with an eccentric mass in 76% (26/34) of
cases. The most common types of regional spread demonstrated were direct
liver invasion in 91% (31/34), lymphadenopathy in 76% (26/34), and
biliary tract invasion in 62% (21/34). Sensitivity for direct hepatic
invasion was 100%, and was 92% for lymph node metastasis. CONCLUSION:
MRI and MRCP can provide information relevant to preoperative staging of
gallbladder carcinoma.
8
UI - 12040819
AU - Weinstein D; Herbert M; Bendet N; Sandbank J; Halevy A
TI -
Incidental finding of gallbladder carcinoma.
SO - Isr Med Assoc J 2002 May;4(5):334-6
AD - Department of Surgery B, Assaf Harofeh Medical Center, Zerifin, Israel.
BACKGROUND: Carcinoma of the gallbladder is diagnosed in 0.3-1.5% of all
cholecystectomy specimens. OBJECTIVES: To establish the overall rate of
gallbladder carcinoma and unexpected gallbladder carcinoma based on our
experience. METHODS: We retrospectively evaluated all consecutive
cholecystectomies performed in our ward during a 6 year period in order
to determine the incidence of gallbladder carcinoma and to identify
common characteristics of this particular group of patients. RESULTS: Of
the 1,697 cholecystectomies performed in our ward during the 6 years,
gallbladder carcinoma was diagnosed in six patients (0.35%) but was not
suspected prior to surgery in any of them. In accordance with the
literature, the occurrence in women (5/6) was higher than in men (1/6).
The mean age was 70 years (range 55-90). The most common symptom was
abdominal pain; the majority (5/6) had cholelithiasis, and the
pathologic report confirmed the diagnosis of adenocarcinoma in all six
patients. CONCLUSIONS: The overall incidence of unsuspected gallbladder
carcinoma in our series was 0.35%. We could not find any common
characteristics for this particular group of patients when compared to
patients with non-malignant pathology.
9
UI - 11974462
AU - Puhalla H; Bareck E; Scheithauer W; Ploner M; Stiglbauer W; Depisch D
TI -
[Therapy of gallbladder carcinoma. Experience of a central hospital]
SO - Chirurg 2002 Jan;73(1):50-6
AD - Chirurgische Abteilung, Allgemeines offentliches Krankenhaus, Wiener
Neustadt, Osterrreich.
INTRODUCTION: There are various options for the treatment of gallbladder
carcinoma; however, only radical resection offers a chance for prolonged
survival. METHODS: The aim of this study was to analyze retrospectively
patients suffering from gallbladder carcinoma in a central hospital in
Austria. From 1986 to 1999, 77 patients were treated in this surgical
department. The median age of the patients was 71.3 years. RESULTS: In
28 patients the cancer was resected and 22 persons underwent palliative
surgery. An explorative laparotomy was performed in 16 patients. Eleven
patients had no surgical therapy, 10 persons received gemcitabine or a
combination chemotherapy regimen consisting of leucoverin,
5-fluorouracil and mitomycin C. The median survival of patients without
chemotherapy following radical resection (n = 15) was 10.7 months (one
patient with metastatic cancer was excluded) and for patients with tumor
remaining margins (n = 8) 3.2 months (P = 0.023). Without chemotherapy
the median patient survival following palliative resection (n = 17) and
explorative laparotomy (n = 15) was 1.5 months and 2.1 months. The
median survival without surgical therapy was 1.6 months. Chemotherapy
was administered to four of the resected patients (median survival 16.5
months), in five patients following palliative surgery and in one
patient after explorative laparotomy (median survival 4.3 months) (P =
0.034). In a multivariate analysis, tumor resection (P = 0.034) and
tumor-free resection margins (P = 0.025) proved to be the most important
determinants for patient survival. CONCLUSION: Tumor resection is the
most important factor for a prolonged patient survival. Following
radical resection in an early tumor stage and combining this approach
with an established chemotherapy, patient survival could be increased
significantly.
10
UI - 11992798
AU - Brooks AD; Mallis MJ; Brennan MF; Conlon KC
TI -
The value of laparoscopy in the management of ampullary, duodenal, and
distal bile duct tumors.
SO - J Gastrointest Surg 2002 Mar-Apr;6(2):139-45; discussion 145-6
AD - Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York,
NY 10021, USA.
Laparoscopy identifies radiologically occult advanced disease in
patients with pancreatic adenocarcinoma. The value of laparoscopy in the
management of peri-ampullary tumors was determined. One hundred
forty-four patients with radiologically resectable nonpancreatic
adenocarcinoma, periampullary tumors were identified from a prospective
laparoscopic unresectability included histologically proved peritoneal
or hepatic metastases, distant nodal involvement, arterial involvement,
and local extension outside the resection field. Median age at operation
was 70 years (range 31 to 87 years) and 56% of the patients were men. An
adequate laparoscopy was performed in 134 cases (93%). Laparoscopy
identified 13 patients (10%) with unresectable disease. Of 121 patients
with laparoscopic resectable disease, 111 (92%) went on to subsequent
resection; CT correctly predicted resectability in 82%. Laparoscopy
spared 36% of unresectable patients a nontherapeutic laparotomy.
Patients with resectable disease were treated by pancreaticoduodenectomy
(n = 91, 76%), ampullectomy (n = 12, 10%), duodenal resection (n = 10,
9%), or bile duct excision (n = 6, 5%). The addition of diagnostic
laparoscopy to dynamic CT scanning in this selected patient population
identifies an additional 10% of patients with unresectable disease. We
believe that laparoscopy should be used in a selective manner for
preoperative staging of patients suspected of having nonpancreatic
periampullary tumors.
11
UI - 11992815
AU - Serra I; Diehl AK
TI -
Number and size of stones in patients with asymptomatic and symptomatic
gallstones and gallbladder carcinoma.
SO - J Gastrointest Surg 2002 Mar-Apr;6(2):272-3; discussion 273
12
UI - 11963497
AU - Hartenfels IM; Dukat A; Burg J; Hansen M; Jung M
TI -
[Adenomas of Vater's ampulla and of the duodenum. Presentation of
diagnosis and therapy by endoscopic interventional and surgical methods]
SO - Chirurg 2002 Mar;73(3):235-40
AD - St. Hildegardis-Krankenhaus, Abteilung fur Chirurgie, Hildegardstrasse
2, 55131 Mainz.
BACKGROUND: Adenoma of the ampulla of Vater and the duodenum are rare
tumors. The leading symptoms are unspecific; sometimes they are due to
the disturbances of the passage or erosion of the tumor. Early and
correct diagnosis and the appropriate therapy are of decisive importance
because these tumors are precancerous. PATIENTS AND METHODS: We report
the cases of seven patients with periampullary adenoma of the duodenum,
in one case with incorporation of the the distal bile duct. The
diagnostic steps and the surgical treatment are reported and discussed.
In achieving a definitive diagnosis, endoscopic retrograde
cholangiopancreatography is of paramount importance. Three patients
subsequently underwent partial pancreatoduodenectomy (Whipple's
procedure); in three patients transduodenal local tumor excision was
performed. Postoperative course was without complications in each case
and no operative mortality occurred. One patient was treated by
argon-coagulation. RESULTS: The histopathological examination showed a
tubular villous adenoma in six cases and in one case a villous adenoma
(ranging from low to high grade dysplasia). Because there is evidence of
an adenoma-carcinoma-sequence, radical surgical treatment is
recommended, even in adenoma with low grade dysplasia, in spite of the
absence of malignancy.
The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.
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