Digestive Diseases and Sciences

, Volume 46, Issue 6, pp 1145–1151 | Cite as

Carcinoma of the Gallbladder

  • Manoj Pandey
  • Alok K. Pathak
  • Amitabh Gautam
  • Nakul C. Aryya
  • Vijay K. Shukla


Since the first description of the carcinoma of the gallbladder, about two centuries ago, this disease has evaded all attempts at early detection and a potential cure. There are only a few studies involving the Indian population, which has a high incidence of gallbladder cancer. Indians are ethnically and culturally different from their Western counterparts, for whom the incidence of this disease is comparatively low. The present study was conducted prospectively on 99 consecutive cases of carcinoma of the gallbladder of 736 patients with biliary diseases admitted to one surgical unit at the University Hospital. The staging, histological type, and grade were correlated with the clinical outcome. Abdominal pain (82.8%) and abdominal mass (73.7%) were the main presenting features. The diagnosis was obtained by ultrasonography (USG) in 93 of 99 cases and confirmed by fine-needle aspiration cytology (FNAC) in 70 patients. Ultrasonography, however, was found to be inadequate for accurate staging of the disease. Based on the TNM classification, 3 (3.0%), 12 (12.1%), 14 (14.1%), 12 (12.1%), and 58 (58.6%) patients had stage 0, I, II, III, and IV disease, with a corresponding mean survival of 28.3, 13.8, 7.5, 5.2, and 3.7 months, respectively. Carcinoma of the gallbladder is difficult to diagnose early due to its vague symptomatology. A high index of suspicion and health education seem to be the only answers available for early detection and improvement of survival.

carcinoma gallbladder neoplasm histology prognosis survival epidemiology 


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  1. 1.
    Shukla VK, Khandelwal C, Roy SK, Vaidya MP: Primary carcinoma of the gallbladder: A review of a 16–year period at the University Hospital. J Surg Oncol 28:32–35, 1985Google Scholar
  2. 2.
    Piehler JM, Crichlow RW: Primary carcinoma of the gallbladder. A collective review. Surg Gynecol Obstet 147:929–942, 1978Google Scholar
  3. 3.
    Hamrick RE, Liner FJ, Hastings PR, Cohn I Jr: Primary carcinoma of the gallbladder. Ann Surg 195:270–273, 1982Google Scholar
  4. 4.
    Strauch GO: Primary carcinoma of the gallbladder. Surgery 47:368–383, 1960Google Scholar
  5. 5.
    Thorbjarnarson B: Carcinoma of the gallbladder and acute cholecystitis. Ann Surg 151:241–244, 1960Google Scholar
  6. 6.
    Gerst PH: Primary carcinoma of the gallbladder: A thirty-year summary. Ann Surg 153:369–372, 1961Google Scholar
  7. 7.
    Glenn F: Gall stones without clinical symptoms [Editorial]. Ann Surg 145:143–144, 1957Google Scholar
  8. 8.
    Chao TC, Greager JA: Primary carcinoma of the gallbladder. J Surg Oncol 46:215–221, 1991Google Scholar
  9. 9.
    Balaroutsos C, Bastonnis E, Karamanakos P, Golematis B: Primary carcinoma of the gallbladder, analysis of 22 cases. Ann Surg 40:605–608, 1971Google Scholar
  10. 10.
    Kapoor VK, Pradeep R, Haribhakti SP, Sikora SS, Kaushik SP: Early carcinoma of the gallbladder: An elusive disease. J Surg Oncol 62:284–287, 1996Google Scholar
  11. 11.
    Soiva M, Aro K, Pamilo M, Palvansalo M, Suramo I, Taavitsainen M: Ultrasonography in carcinoma of the gallbladder. Acta Radiol 28:711–714, 1987Google Scholar
  12. 12.
    Palma LD, Rizzatto G, Pozzi-Mucelli RS, Bazzoccbi M: Grayscale ultrasonography in the evaluation of the carcinoma of the gallbladder. Br J Radiol 53:662–667, 1980Google Scholar
  13. 13.
    Itai Y, Araki T, Yoshikawa K, Furui S, Yashiro N, Tasaka A: Computed tomography of gallbladder carcinoma. Radiology 137:713–718, 1980Google Scholar
  14. 14.
    Yamaguchi K, Tsuneyoshi M: Subclinical gallbladder carcinoma. Am J Surg 163:382–386, 1992Google Scholar
  15. 15.
    Shirai Y, Yoshida K, Tsukada K, Muto T, Watanbe H: Early carcinoma of the gallbladder. Eur J Surg 158:545–548, 1992Google Scholar
  16. 16.
    Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Statist Assoc 53:457–481, 1958Google Scholar
  17. 17.
    Peto R, Peto J: Asymptotically efficient rank invariant test procedures. J Stat Soc 135:185–206, 1972Google Scholar
  18. 18.
    Nakayama F: Recent progress in the diagnosis and treatment of carcinoma of the gallbladder: Introduction. World J Surg 15:313–314, 1991Google Scholar
  19. 19.
    Diehl AK: Gall stone size and the risk of gallbladder cancer. JAMA 250:2323–2326, 1983Google Scholar
  20. 20.
    Waterhouse J, Muir C, Correa P, Powell J (eds): Cancer Incidence in Five Continents, Vol 3, IARC Publication No. 15. Lyon, IARC, 1976Google Scholar
  21. 21.
    Pandey M, Gautam A, Shukla VK: ABO and Rh blood groups in patients with cholelithiasis and carcinoma of the gallbladder. Br Med J 310:1639, 1995Google Scholar
  22. 22.
    Klamer TW, Max MH: Carcinoma of the gallbladder. Surg Gynecol Obstet 156:641–645, 1983Google Scholar
  23. 23.
    Shukla VK, Shukla PK, Pandey M, Rao BR, Roy SK: Lipid peroxidation products in bile from patients with carcinoma of the gallbladder. A preliminary study. J Surg Oncol 54:258–262, 1994Google Scholar
  24. 24.
    Pandey M, Khatri AK, Dubey SS, Gautam A, Shukla VK: Erythrocyte membrane fatty acid profile in patients with primary carcinoma of the gallbladder. J Surg Oncol 59:31–34, 1995Google Scholar
  25. 25.
    Pandey M, Shukla PK, Gautam A, Rao BR, Roy SK, Shukla VK: Increased peroxidation of PUFA: A possible link in the peroxidant pathogenesis of carcinoma of the gallbladder with cholelithiasis. Proc XVI Int Cancer Congress 3:2085–2088, 1994Google Scholar
  26. 26.
    Aldridge MC, Bismuth H: Gallbladder cancer: The polypcancer sequence. Br J Surg 77:363–364, 1990Google Scholar
  27. 27.
    Shukla VK, Tiwari SC, Roy SK: Biliary bile acids in cholelithiasis and carcinoma of the gallbladder. Eur J Cancer Prev 2:155–160, 1993Google Scholar
  28. 28.
    Silk YN, Douglass HO Jr, Nava HR, Driscoll DL, Tartarian G: Carcinoma of the gallbladder. The Rosewell Park experience. Ann Surg 210:751–757, 1989Google Scholar
  29. 29.
    Vaittinen E: Carcinoma of the gallbladder: A study of 390 cases diagnosed in Finland 1953-1967. Ann Chir Gynecol 168 (Suppl 59):1–81, 1970Google Scholar
  30. 30.
    Polk HC: Carcinoma and the calcified gallbladder. Gastroenterology 50:582–585, 1966Google Scholar
  31. 31.
    Hart J, Modan B, Shani M: Cholelithiasis in the etiology of gallbladder neoplasms. Lancet 1:1151–1153, 1971Google Scholar
  32. 32.
    Crade M, Taylor KJW, Rosenfield AT, deGraaf CS, Minihan P: Surgical and pathologic correlation of cholecystosonography and cholecystography. Am J Roentgenology 131:227–230, 1978Google Scholar
  33. 33.
    Chijiiwa K, Sumiyoshi K, Nakayama F: Impact of recent advances in hepatobiliary imaging techniques on the preoperative diagnosis of carcinoma of the gallbladder. World J Surg 15:322–327, 1991Google Scholar
  34. 34.
    Rossman MD, Friedman AC, Radecki PD, Caroline DF: MR imaging of gallbladder carcinoma. Am J Roentgenol 148:143–144, 1987Google Scholar
  35. 35.
    Shukla VK, Pandey M, Kumar M, Sood BP, Gupta A, Arrya NC, et al: Ultrasonography guided fine needle aspiration cytology of the malignant gallbladder masses. Acta Cytol 41:1654–1658, 1997Google Scholar
  36. 36.
    Nevin JE, Moran TJ, Kay S, King R: Carcinoma of the gallbladder: Staging, treatment and prognosis. Cancer 37:141–148, 1976Google Scholar
  37. 37.
    Bergdahl L: Gallbladder carcinoma first diagnosed at microscopic examination of gallbladders removed for presumed benign disease. Ann Surg 191:19–22, 1980Google Scholar
  38. 38.
    Wanebo HJ, Castle WN, Fechner RE: Is carcinoma of the gallbladder a curable lesion? Ann Surg 195:624–631, 1982Google Scholar
  39. 39.
    Wanebo HJ, Vezeridis MP: Carcinoma of the gall bladder. J Surg Oncol Suppl 3:134–139, 1993Google Scholar
  40. 40.
    Fahim RB, McDonald JR, Richards JC, Ferris DO: Carcinoma of the gallbladder. Study of its modes of spread. Ann Surg 156:114–124, 1962Google Scholar
  41. 41.
    Donohue JH, Nagorney DM, Grant CS, Tsushima K, Ilstrup DM, Adson MA: Carcinoma of the gallbladder. Does radical resection improve outcome? Arch Surg 125:237–241, 1990Google Scholar
  42. 42.
    Todoroki T, Iwasaki Y, Orii K, Otsuka M, Ohara K, Kawmoto T, et al: Resection combined with intra-operative radiotherapy (IORT) for stage IV (TNM) gallbladder carcinoma. World J Surg 15:357–366, 1991Google Scholar
  43. 43.
    Ouchi K, Suzaki M, Tominage T, Saijo S, Masuno S: Survival after surgery for cancer of the gallbladder. Br J Surg 81:1655–1657, 1994Google Scholar
  44. 44.
    Ogura Y, Mizumoto R, Isaji S, Kusuda T, Matsuda S, Tabata M: Radical operations for carcinoma of the gallbladder. Present status in Japan. World J Surg 15:337–343, 1991Google Scholar
  45. 45.
    Mishra NC, Jaiswal MSD, Singh RB, Das B: Intrahepatic arterial infusion of combination of mitomycin-C and 5–fluorouracil in treatment of primary and metastatic liver carcinoma. Cancer 39:1425–1429, 1977Google Scholar
  46. 46.
    Falkson G, MacIntyre JM, Moertel CG: Eastern Co-operative Oncology Group experience with chemotherapy for inoperable gallbladder and bile duct cancer. Cancer 54:965–969, 1984Google Scholar
  47. 47.
    Henson DE, Albores-Saavedra J, Corle D: Carcinoma of the gallbladder. Histologic type, stage of the disease, grade and survival rates. Cancer 70:1493–1497, 1992Google Scholar

Copyright information

© Plenum Publishing Corporation 2001

Authors and Affiliations

  • Manoj Pandey
    • 1
  • Alok K. Pathak
    • 1
  • Amitabh Gautam
    • 1
  • Nakul C. Aryya
    • 1
  • Vijay K. Shukla
    • 1
  1. 1.Department of Surgery, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia

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