Gall stones and carcinoma gall bladder

One hundred and fifty surgically resected gall bladder specimens were included in the study to evaluate the relationship between the prevalence of gall stones and histochemical alteration in sequential changes of metaplasia, dysplasia and neoplasia in gall bladder epithelium. Multiple sections were processed and stained with haematoxylin and eosin, Periodic acid Schiff's stain, Alcian blue (pH 2.5)/Periodic acid, Orcein/Alcian blue (pH 2.5) and Alcian Blue/Periodic acid/Potassium borohydride saponifications stains. Details of gall stones present were also noted. Prevalence of gall stones in gall bladders with metaplastic, dysplastic and neoplastic mucosal changes was significantly higher (P < 0.001) than those gall bladders which had no epithelial changes. Increase in sialomucin with a corresponding decrease in sulphomucin was observed from metaplasia to malignancy. Neutral mucin increased in metaplastic cells but was significantly reduced in neoplastic cells. Loss of O-acylation in sialmucin was also present in neoplastic cells. The histochemical changes suggest that chronic injury due to cholelithiasis induces appearance of neutral mucin positive metaplastic cells, which may further dedifferentiate to sialomucin containing dysplastic or neoplastic cells if the stimulation persists.

Small-cell carcinoma of the gallbladder: report of a case

We report herein the case of an 81-year-old woman in whom a mass in the gallbladder was revealed by an ultrasound examination conducted as part of a follow-up study for a silent gallstone. The mass showed evidence of invasion into the adjacent liver parenchyma. Under the tentative diagnosis of malignant neoplastic disease originating in the gallbladder, a cholecystectomy with partial hepatectomy was performed. Histological examination of the tumor confirmed a diagnosis of small-cell carcinoma of the gallbladder, which is considered to be a rare type of neoplasm.

Physical activity in the prevention and treatment of other morbid conditions and impairments associated with obesity: current evidence and research issues

PURPOSE

To evaluate the current status of knowledge concerning the effects of physical activity in the treatment and prevention of obesity- related problems, including cancers of the colon, breast, uterus, and prostate; gallstones; osteoarthritis; back pain; sleep apnea; reproductive abnormalities; and impaired health-related quality of life.

DESIGN

A Medline literature search on the effects of physical activity in the above conditions was conducted. Only studies with some measure of weight and a description of the type of physical activity were included.

RESULTS

No controlled randomized trials of exercise in the treatment of any of the studied conditions in obese patients were identified. Most of the epidemiologic studies reviewed were beset with severe methodological weaknesses. Most of the 18 studies on physical activity and colon cancer risk showed a protective effect that in some studies appeared to be greater than expected by weight loss alone. Some but not all studies of hormone-dependent cancers and gallstones showed a protective effect for physical activity. There were insufficient data on the role of exercise for the other morbid conditions studied.

CONCLUSION

The scarce data available on the role of physical activity in the prevention of obesity-related chronic conditions listed above suggest a protective role that needs to be examined further in studies with improved methodologies. Well-designed intervention trials are needed to assess the role of physical activity in the treatment and long-term outcome of obese patients with these co-morbid conditions.

Gallbladder carcinoma during laparoscopic cholecystectomy: is it associated with bad prognosis?

Laparoscopic cholecystectomy is the treatment of choice for gallstone disease. The ultrasonogram has failed for the early detection of gallbladder cancer, especially if inflammation (chronic or acute) is present. Incidental gallbladder could be an important cancer finding during laparoscopic cholecystectomy, due to the potential cancer cell dissemination during the procedure. In our Department, 6500 laparoscopic cholecystectomies have been performed in the last 5 years and in 15 cases (0.23%) gallbladder cancer was found during surgery or after histological examination of the resected gallbladder. In none of these 15 patients was pre-operative diagnosis of gallbladder carcinoma postulated. When re-evaluation of the pre-operative ultrasonograms was done, it was possible to observe signs suggesting the presence of neoplastic infiltration in 4 of them (28.6%). During videoscopic exploration, also in 4 patients, the suspicion of gallbladder cancer was noted. Laparoscopic cholecystectomy was completed in 9 patients. In 2 of them, in situ or mucosal invasion was demonstrated with a long survival. One patient presented recurrence at the biliary hilum 2,5 years after surgery. Six patients were re-operated and in 4 of them peritoneal or port site metastasis was found; all died early (4.5 month median survival). The other 2 patients were submitted to liver bed resection and lymph node dissection. These patients are free of cancer recurrence after 15 months of follow-up. Six patients were converted to open surgery, performing palliative procedures and died before the 12 month follow-up. The suspicion of pre-operative gallbladder cancer is generally unlikely to be confirmed based on ultrasonographic signs; but, in some cases with high suspicion, further investigation (TAC, tumor markers, etc.) must be indicated in order to avoid poor results. Laparoscopic cholecystectomy could be associated with bad prognosis, and then, when gallbladder cancer is suspected during the laparoscopic procedure, conversion to open surgery could be the best choice.

Gallbladder carcinoma

Carcinoma of the gallbladder has an unusual geographic and demographic distribution being more common in Israel, Bolivia, Chile and in Southwestern native Americans in the United States. Chronic cholecystitis, choledochal cysts and significantly high body mass index are associated risk factors. Over 90% of gallbladder carcinomas are adenocarcinomas. Advanced local and regional disease usually is present at the time of diagnosis. P53 protein overexpression and p53 mutation may be related to increasing grade of cytologic atypia and to invasiveness. K-ras gene mutation occurs in both dysplasia and carcinomas. Ultrasonography, CT, MRI are diagnostic measures that can provide accurate staging information. Overall, the curative resection rates for gallbladder carcinoma range from 10% to 30%. During laparoscopic cholecystectomy, gallbladder cancer may be inadvertently discovered necessitating a more extensive resection. For those with unresectable disease, palliative surgical, endoscopic or radiologic bypass procedures can improve quality of life. Other approaches to the management of advanced tumors include combined radiation and chemotherapy and systemic chemotherapy.

The association between biliary tract cancers and cancers of other sites

OBJECTIVE

Cancers of the biliary tract, including cancers of the gallbladder and bile duct, generally carry a very poor prognosis. Little is known about their etiology. The pattern of co-occurrence of two cancers may give clues to shared etiological risk factors. We therefore investigated the association of biliary tract cancer with other cancers, especially with estrogen- and tobacco-related cancers.

METHODS

We used data from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. Associations between biliary tract cancer and other cancers were evaluated using the standardized incidence ratio as an estimate of the relative risk of a second primary malignancy.

RESULTS

Estrogen-related cancers of the breast and uterine corpus and smoking-related upper aerodigestive tract cancers were not associated with biliary tract cancer. The risk of gallbladder cancer was inversely related to the risk of prostate cancer in men, but positively related to the risk of cervical cancer in women.

CONCLUSIONS

This study suggests that smoking and estrogen exposure have minimal roles in the pathogenesis of biliary tract cancer. Our finding of an inverse relationship between prostate cancer and gallbladder cancer requires confirmation by further studies.

A case-control assessment of risk factors for gallbladder carcinoma

Gallbladder carcinoma is an uncommon, but highly fatal disease. Its symptoms frequently mirror those of gallstone disease, and in most instances, diagnosis is an incidental finding at surgery. While risk factors have been suggested for this cancer, many may in reality simply be a consequence of the older age of the population. This study is one of the few to approach this question by using a case-control study design comparing gallbladder carcinoma patients with a gallstone population, coupled with multivariate analysis to determine age-independent risk factors. Univariate analyses showed gallbladder carcinoma patients to be older than gallstone patients and to have many age-associated diseases. Following multiple regression adjustment for age, this disease was associated with female gender and with a previous history of gallstone symptoms. Carcinoma patients were less likely to have cholesterol gallstones in their gallbladders at surgery. A previous history of smoking was a substantial risk but of borderline statistical significance. Previous studies report associations that may be due to the older age of the gallbladder carcinoma patient. Our results show that after adjusting for age with multivariate analysis, gallbladder cancer subjects were predominantly female, more likely to report previous gallstone symptomology, and to smoke. While gallstones were not universally isolated from carcinoma patients at cholecystectomy, when present, they were less frequently classified as cholesterol gallstones based on visual inspection. Further cohort studies which target these populations will allow us to gain a more solid consensus on the risk factors for this disease.

What causes cancer gallbladder?: a review

Gallbladder cancer is a common malignancy of the biliary tract. It is the fifth common malignancy of the gastrointestinal tract in United States and third in Northern India. Despite such high prevalence, there is scanty published literature about this disease in indexed journals. Therefore, this article is intended to provide a brief overview of gallbladder cancer risk factors, based mainly on published evidence from analytical epidemiology and recent research findings of biologists and practising oncologists. Furthermore, an attempt has been made to establish an association between different causative factors and the occurrence of the disease.

The epidemiology of gallbladder cancer: lifestyle related risk factors and limited surgical possibilities for prevention

Cancer of the gallbladder is a rare cancer with a poor prognosis. Most patients die within 1 year. The incidence shows large geographic variation and is higher in females and in certain ethnic groups. Gallstones are closely related to this type of cancer. Studying risk factors such as lifestyle is hampered by the generally small size of the case-series. Nevertheless, the studies conducted so far provide some indication that cigarette smoking, alcohol consumption, obesity and specific dietary habits might affect the risk. In women, reproductive history seems to affect the risk as well. Incidence may be lowered by identifying high risk groups and offering preventive measures. Although gallstones are associated with higher risk, most people with untreated gallstones are at low risk of developing the cancer. Moreover, the cancer occurs at such an old age that prophylactic removal of a stone-containing gallbladder is not an appropriate measure for the prevention of gallbladder cancer. Probably at a higher risk are those who are exposed to stones for longer periods. An indicator of duration of exposure is not presently available; whether stone size can be such an indicator in specific conditions and populations needs to be studied further.

Epidemiology of gallbladder cancer

Gallbladder cancer, although rare in most Caucasian populations, is among the most frequently observed cancers in native populations of North and South America, and in the Maori population of New Zealand. In all populations, there is a strong correlation between gallstones and gallbladder cancer: the risk of gallbladder cancer is approximately 4-5 times higher in patients with gallstones, than in patients without gallstones. In those populations where the onset of gallstone disease occurs in the first few decades, the risk is much higher. Obesity, which is also a risk factor for gallstones, increases the risk of gallbladder cancer, as does the consumption of diets high in fats and calories. Other risk factors, such as increased parity, also increase the frequency of gallbladder cancer, most probably explained by the association between gallstones and parity. Prophylactic cholecystectomy for asymptomatic gallstones cannot be justified for the control of gallbladder cancer, but the increasing frequency of this procedure in many countries, secondary to the widespread use of laparoscopic surgical techniques, will clearly lower the incidence and mortality rates for this lethal disease.

Height, weight and gastrointestinal cancer: a follow-up study in Norway

It has been suggested that components of our diet play an essential role in carcinogenesis. Anthropometric indices, such as body weight and height, have often been considered as measurements of prevailing diet and nutrition in childhood respectively. To investigate to what extent height and body weight are associated with the risk of gastrointestinal cancer, data from a Norwegian screening programme for tuberculosis were analysed. More than 1,100,000 individuals, aged 30-69 years at the time of examination, were included in the study. Body weight, expressed as Quetelet's index (QI), and height records were linked with vital status data from Statistics Norway and the Cancer Registry of Norway. The analysis shows that individuals in the first quintile of height had a lower relative risk than later quintiles for colon cancer, independent of sex and stage of disease at completion of follow-up. The association between height and rectal cancer is similar, but weaker. Men in the fifth quintile of QI have a relative risk of 1.39 for colon cancer, compared with the first quintile, and they also have a slightly elevated risk for rectal cancer. Among women, the pattern is unclear, but we observed a significant relationship between high QI and cancer of the gallbladder. Our results indicate that prevailing diet and living conditions in early life do play a role, and seem to support the hypothesis that anthropometric indices could be of importance as indirect markers for the risk of colon cancer and, to some extent, for cancer of the rectum and gallbladder.

European registry comparisons provide evidence of shared risk factors for renal, colon and gallbladder cancer development

In order to assess links between renal cell cancer (RCCs) and transitional cell cancers (TCCs) of the kidney and cancer development in other organs of the abdominal cavity, incidence data from the Cancer Incidence in Five Continents (Vol VII) were compared between various cancer registries in Europe. Significant correlations which persisted on partial analysis were observed between RCCs and carcinomas of the colon and gallbladder, as well as between the latter themselves. Kidney TCCs, in contrast, were associated with tumours of the urinary bladder. In addition, significant correlations between hepatocellular, but not cholangiocellular carcinomas, and gallbladder and colon cancers were observed. Data for pancreas and gallbladder neoplasms also correlated. Prostate cancer incidences, while positively linked to RCCs, negatively correlated with gallbladder rates. The results point to shared risk factors for RCCs and adenocarcinomas in a number of organs, suggesting a role for humoral agents. The present findings also underline the necessity of distinguishing between tumour types within organs in epidemiological investigations of causal influences.

Clinical study of 457 cholecystectomy cases in a private hospital

This is a retrospective study of 457 cases of cholecystectomized patients, who were admitted to Vichaiyut Hospital from 1970 to 1996. The ratio of male to female was 1:1.6 and the most common age range was 51-60 years, 45.3 per cent of patients were older than 60 years. Associated or underlying diseases were highly prevalent (81.6%). Diabetes mellitus, cardiovascular disease and liver disease were the three most common associated diseases. In acute cholecystitis the pathological findings were in accordance with clinical feature in only 46.2 per cent but in chronic or subsided cholecystitis pathology confirmed in 97.5 per cent. Carcinoma of the gallbladder was found in 0.9 per cent. Clinical diagnosis of cholecystitis was incorrect in 1.1 per cent. Multiple gallstones were found in 67.3 per cent, single stone in 23.5 per cent, sand stones in 2.1 per cent and acalculous cholecystitis in 7.1 per cent. Combined gallstones and CBD stones were found in 9.8 per cent. Enteric bacteria were isolated from the bile in 32.5 per cent and in acute cholecystitis similar organisms were isolated from both bile and blood cultures in 12.8 per cent. Morbidity rate of cholecystectomy was 7.6 per cent, the most common complication was perioperative infection in 3.5 per cent. It is interesting to find that atelectasis was recognized only in 2 out of 57 laparoscopic cholecystectomy. Mortality rate was low (0.66%).

Carcinoma of the gall-bladder

Carcinoma of the gall-bladder remains the fifth commonest gastrointestinal malignancy. Its associations, predisposing factors and epidemiology worldwide are reviewed in this article. The clinical presentation of carcinoma of the gall-bladder is frequently late, which accounts for the poor prognosis: this is also discussed. The use of relevant imaging techniques and aggressive management offer an improved outlook. These important aspects and others, such as the use of frozen section histology, the risks of trocar seeding and inadequate resection are mentioned.

Port site metastases from gallbladder cancer after laparoscopic cholecystectomy. Results of a Swedish survey and review of published reports

OBJECTIVE

To investigate the incidence of port site metastases from unsuspected gallbladder cancer after laparoscopic cholecystectomy.

DESIGN

Retrospective national multicentre study, 1991-94.

SETTING

All 8 university and 24 central hospital, Sweden.

SUBJECTS AND INTERVENTIONS

All 32 hospitals were interviewed by means of a written questionnaire. The registers of all Swedish Oncological Centres and the registers of the National Board of Health and Welfare were checked for reported cases of gallbladder cancer and surgical classification codes for cholecystectomy. To detect laparoscopic interventions incorrectly registered as open operations, all cholecystectomies registered as open were matched against the Swedish Registry of Laparoscopic Cholecystectomy for the years 1991-93 and all patients records for 1994 were scrutinised.

RESULTS

Replies were obtained from 30/32 clinics (94%) and 11976 laparoscopic cholecystectomies were done. Of 447 patients with verified gallbladder carcinoma 270 had their gallbladders removed, 55 (20%) laparoscopically. 9 of these (16%) developed port site metastases and 6 died from their disease at a median of 18 months (range 5-22). Two patients are alive, 54 and 45 months after cholecystectomy. One patient has been lost to follow-up.

CONCLUSIONS

Port site metastases from gallbladder cancer may be more common than previously thought. A laparoscopic procedure should not be done if cancer of the gallbladder is suspected.

Unexpected gallbladder cancer after laparoscopic cholecystectomy: an emerging problem? Reflections on four cases

Gallbladder cancer (GC) has been reported in 0.3-1.5% of cholecystectomies. Since the introduction of laparoscopic surgery, cholecystectomies have increased and occult GC may therefore be more frequent. Herein we analyze our own experience to determine whether there was an increase in GC. We also evaluate the risk factors for this outcome. Four patients with GC undiagnosed before surgery (four of 602 cases, or 0.66%) were submitted to laparoscopic cholecystectomy. The percentage in patients who underwent open surgery was 0.28% (two of 714 cases). Without reoperation, three patients died in the laparoscopic group and one is alive at 12 months. Trocar site metastasis was not observed. Although the percentage of GC (0.28% versus 0.66%) increased, the percentage is still in the referred average. Undiagnosed GC is on the increase. Examination of the gallbladder and a frozen section, if necessary, are recommended. Calcified gallbladders, age >70 years, a long history of stones, and a thickened gallbladder all represent significant risk factors.

Ultrasonographic evidence of association of polyps and stones with gallbladder cancer

OBJECTIVE

The purpose of this study was to evaluate the level of gallbladder cancer risk associated with polyps and stones of the gallbladder by ultrasound examinations.

METHODS

We investigated abdominal ultrasonographic findings for gallstones and polyps of the gallbladder and the relationship of these findings to malignancy in 194,767 asymptomatic participants in health screening examinations.

RESULTS

Gallstones were detected in 7,985 participants (4.1%), at a prevalence of 5.3% in male and 4.5% in female participants. The prevalence was highest in the participants' seventh decade, followed by the sixth and the fifth decades, in both male and female participants. Polyps were found in 10,926 (5.6%), at a prevalence of 6.9% in the male and 4.5% in the female participants. In the male participants, prevalence was highest in the fourth decade, followed by the third and the fifth decades, whereas in the female participants it was highest in the fifth decade, followed by the fourth and third. High prevalence of polyps > or = 10 mm in diameter was found in the fifth to seventh decades in both sexes. Nineteen participants (0.01%) were diagnosed as having gallbladder cancer, and many of them were in the sixth or seventh decade in both sexes. Patients with stones showed a higher prevalence of gallbladder cancer. This difference was shown to be statistically significant by age-adjusted analysis (p < 0.01). The age distribution of the participants with polyps > or = 10 mm in diameter was correlated with that of patients diagnosed with gallbladder cancer. Furthermore, polyp incidence was significantly related to cancer by statistical analysis (p < 0.01).

CONCLUSION

These results suggest an association between gallstone or polyp of the gallbladder and increased risk of malignancy, implying that an etiological association may also exist.

Gallstones, cholecystectomy and risk of cancers of the liver, biliary tract and pancreas

To examine the association between gallstones and cholecystectomy, we conducted a nationwide population-based cohort study in Denmark. Patients with a discharge diagnosis of gallstones from 1977 to 1989 were identified from the Danish National Registry of Patients and followed up for cancer occurrence until death or the end of 1993 by record linkage to the Danish Cancer Registry. Included in the cohort were 60 176 patients, with 471 450 person-years of follow-up. Cancer risks were estimated by standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) stratified by years of follow-up and by cholecystectomy status. Among patients without cholecystectomy, the risks at 5 or more years of follow-up were significantly elevated for cancers of liver (SIR = 2.0, CI = 1.2-3.1) and gallbladder (SIR = 2.7, CI = 1.5-4.4) and near unity for cancers of extrahepatic bile duct (SIR = 1.1), ampulla of Vater (SIR = 1.0) and pancreas (SIR = 1.1). The excess risk of liver cancer was seen only among patients with a history of hepatic disease. Among cholecystectomy patients, the risks at 5 or more years of follow-up declined for cancers of liver (SIR = 1.1) and extrahepatic bile duct (SIR = 0.7), but were elevated for cancers of ampulla of Vater (SIR = 2.0, CI = 1.0-3.7) and pancreas (SIR = 1.3, CI = 1.1-1.6). These findings confirm that gallstone disease increases the risk of gallbladder cancer, whereas cholecystectomy appears to increase the risk of cancers of ampulla of Vater and pancreas. Further research is needed to clarify the carcinogenic risks associated with gallstones and cholecystectomy and to define the mechanisms involved.

Epidemiology of digestive tract cancers in India IV. Gall bladder and pancreas

Pancreatic cancer is a leading cause of cancer-related deaths in developed countries. Gall bladder cancer is very common in South American countries, around the Mediterranean and in Japan. A majority of patients with these cancers receive only palliative therapy in spite of recent advances in investigation and surgery. Their poor prognosis and increasing incidence in India necessitate a better epidemiologic approach towards their control. This review is based on epidemiological data, publications and abstracts from India. Population-based data reveal that the incidence of gall bladder cancer is very high in northern Indian cities (5-7 per 100,000 women) and low (0-0.7 per 100,000 women) in southern India. The distribution suggests a high-incidence region comprising Uttar Pradesh, Bihar, Orissa, West Bengal and Assam. The cancer is twice more common in women and is the leading cancer among digestive cancers in women in the northern Indian cities of Delhi and Bhopal. There are few analytical data to hypothesize why this geographical predisposition. The high incidence is also observed in north Indian immigrants to the United Kingdom. The incidence of pancreatic cancer is low (0.5-2.4 per 100,000 men and 0.2-1.8 per 100,000 women) in most parts of India. Somewhat higher rates are seen in the male urban populations of western and northern India. Studies from Kerala support an association between tropical pancreatitis and pancreatic cancer. Time trends reveal an increase in the incidence of gall bladder and pancreas cancers; the increase in the former is alarming. We estimate that the approximate annual cancer burden of India in 2001 would include 17,730 cases of gallbladder cancer and 14,230 of pancreatic cancer. Multi-center studies are needed to identify potentially preventable risk factors associated with gall bladder and pancreatic cancer in India.

The National Cancer Data Base report on carcinoma of the gallbladder, 1989-1995

BACKGROUND

Reports utilizing data from the Commission on Cancer's National Cancer Data Base (NCDB) have previously contained evaluations of time trends for stage of disease at diagnosis, treatment, and survival for multiple tumor sites. Data collected from 1989, 1990, 1994, and 1995 for carcinoma of the gallbladder are presented herein.

METHODS

The data presented in this review were collected from hospital cancer registries from across the U.S. Seven calls for data yielded a total of 5,850,000 cases for the years 1985-1995, including 2574 gallbladder carcinoma cases from 1989-1990 and 2914 cases from 1994-1995 from hospital cancer registries across the U.S. These data represent approximately 8.8% and 8.4% of the estimated cases of liver and biliary track cancers diagnosed in the U.S. during the two respective time periods.

RESULTS

There were no changes in patient demographics between 1989-1990 and 1994-1995. Most gallbladder carcinoma patients were white women. The documentation of tumor stage improved noticeably between the two study periods. There was no increased frequency in the occurrence of early stage tumors between the two reporting times, an era that saw the development and widespread application of laparoscopic cholecystectomy. Treatment differed according to stage of disease. Surgery alone, particularly nonradical surgery, was performed more frequently in the initial treatment of gallbladder carcinoma. A large percentage of gallbladder carcinoma patients received no definitive therapeutic intervention because of the advanced stage of disease at presentation and the lack of effective treatments for these cancers. Multimodality treatment was utilized more often for young patients. Survival was closely related to tumor stage, with 60% 5-year survival for Stage 0 patients, 39% for Stage I patients, and 15% for Stage II patients, but only 5% for Stage III patients and 1% for Stage IV patients. Patient outcome was not demonstrably affected by more aggressive therapy, nor was an adverse effect in results seen in early stage cancers between 1989-1990 and 1994-1995.

CONCLUSIONS

The NCDB data are valuable in the evaluation of trends in malignant diseases, treatments, and patient survival. No substantial differences were apparent in the diagnosis, treatment, and survival of patients during this 7-year study period. The data do not support any adverse effect on outcome results with the introduction of laparoscopic cholecystectomy in the U.S.

[Acute cholecystitis and gallbladder neoplasms: the experience of 2215 cases]

The authors have retrospectively analysed 2215 surgical procedures for gallbladder stones. The global incidence of gallbladder neoplasm has been 5%. This rate rises to 11% considering female patients over 60 years old. In this group, a gallbladder carcinoma was contemporary present in 17.4% of acute cholecystitis. Cholecystectomy may be suggested in every patients with gallstones, even asymptomatic, particularly if some risk factors are present.

Gall bladder cancer in north eastern Libya

OBJECTIVE

Assessment of gall bladder cancer among cholecystectomy specimens.

DESIGN

Retrospective study of all cholecystectomy specimens coupled with data from clinical oncology department.

SETTING

Department of Pathology and Department of Clinical Oncology, Al Arab Medical University, Benghazi, Libya.

SUBJECT

Gall bladder cancer among cholecystectomies and the pattern of survival of these patients.

MATERIAL

Histopathology records available on all cholecystectomies performed between 1982 and 1997. Data available on staging and survival of cancer patients from clinical oncology upto 1996.

RESULTS

Eighty nine cases of gall bladder cancer were found out of 7352 cholecystectomies performed over a period of 16 years. It was found more commonly in females with a mean age of 58.1 years. It was also observed that the incidence in males above 60 years was almost equal to that of females. Gall bladder cancer when primarily detected by the pathologist in cholecystectomy specimens removed for symptomatic cholelithiasis, was mostly in stage I. Most of the patients in stage III-IV cancer died within one year whereas most of the stage I cancer patients survived more than two years.

CONCLUSION

Simple cholecystectomy is strongly advised in women above 50 years of age and in men above 60 years of age with symptomatic cholelithiasis.