Gallbladder carcinoma

The Gallstone Elimination Report

Gallstone Elimination Manual by David Smith

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Gallstones. The incidence of gallbladder cancer is higher in patients with gallstones than in patients without stones {35}, and stones are present in over 80% of gallbladder carcinomas. The incidence of gallbladder carcinoma parallels that of gallstones, being more frequent in females and in certain ethnic groups, e.g. Native Americans, who have a high incidence of stones. Nevertheless, although gall stones are considered a risk factor, the overall incidence of carcinoma of the gallbladder in patients with cholelithiasis is less than 0.2%; this percentage varies with race, sex, and length of exposure to the stones {35}. While some authors have reported a correlation between gallstone size and the risk of cancer, others have not found such a correlation {35}. Abnormal choledochopancreatic junction. Data largely reported from Japan indicate an association between gallbladder cancer and an abnormal junction of the pancreatic and common bile ducts {1248}. Normally, the main pancreatic duct and the common bile duct unite within the sphincter to form the pancre-aticobiliary duct. The abnormal junction is defined as the union of the pancreatic and common bile ducts outside the wall of the duodenum beyond the influence of the sphincter of Oddi. As a result, pancreatic juice can reflux into the common bile duct, resulting in hyperplastic, meta-

Fig. 9.02 Carcinoma of the gallbladder involving the fundus (arrow). Bile ducts are normal.
Fig. 9.03 Hilar cholangiocarcinoma extending beyond both the right and left hepatic bile ducts (Klatskin type III) (arrows).
Papillary Adenocarcinoma Gallbladder
Fig. 9.04 Papillary adenocarcinoma, non-invasive. The tumour projects into the lumen, but does not invade the wall of the gallbladder.

plastic, and neoplastic changes in the gallbladder epithelium. Porcelain gallbladder. Diffuse calcification of the gallbladder wall (porcelain gallbladder) is associated with carcinoma in 10-25% of cases. Genetic susceptibility. As discussed above, carcinoma of the gallbladder is concentrated in certain racial and ethnic groups. Familial aggregation of gallbladder cancer has been recorded in the US and in other countries {35}.

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