eMedicine Specialties > Oncology > Carcinomas of the Gastrointestinal Tract

Gallbladder Cancer: Follow-up

Author: Mary Denshaw-Burke, MD, FACP, Assistant Clinical Professor, Department of Medicine, Thomas Jefferson University School of Medicine; Program Director of Hematology/Oncology Fellowship, Education Coordinator for Oncology, Lankenau Hospital; Consulting Staff, Lankenau Hospital, Delaware County Memorial Hospital, Mercy Fitzgerald Hospital, Bryn Mawr Hospital, Taylor Hospital
Coauthor(s): Jessica B Katz, MD, PhD, FACP, Hematology/Oncology Fellowship, Lankenau Hospital; Churchman Fellow, Lankenau Institute of Medical Research; Andrew Scott Kennedy, MD, Co-Medical Director, Wake Radiology Oncology; David Van Echo, MD, Head, New Drug Development Program (Oncology), Professor, Departments of Medicine and Pharmacy, University of Maryland School of Medicine; Director of HarborView Cancer Center
Contributor Information and Disclosures

Updated: Jun 12, 2008

Follow-up

Further Outpatient Care

  • Because survival is usually very short in patients with advanced disease, close follow-up is essential to preserve the best quality of life. For patients with earlier stage disease who are treated with surgery and postoperative radiation therapy and chemotherapy, intermittent posttreatment imaging studies can be considered (particularly in the first few years).
  • Hospice referral is important early in the disease course for patients with metastatic disease because their survival is typically 6 months or less.

Deterrence/Prevention

  • Because a calcified (porcelain) gallbladder has up to a 25% incidence of associated gallbladder cancer, this is an indication for a cholecystectomy even in an asymptomatic patient.
  • A small percentage (<10%) of patients with gallbladder polyps are found to have underlying gallbladder cancer. The risk increases with age and the size of the polyp. A cholecystectomy should be considered if a gallbladder polyp greater than 1 cm in size is found in a patient older than 50 years.

Prognosis

Survival at 5 years is correlated with stage of disease at presentation. Only 10-20% of patients present with localized disease. The remainder present with regional or distant spread. According to the SEER registry on gallbladder cancer, the 5-year survival rates for localized, regional, and distant disease are approximately 40%, 15%, and less than 10%, respectively. The median survival for advanced disease is short (2-4 mo).

Miscellaneous

Medicolegal Pitfalls

  • Although pathologic review of all specimens removed from a patient is standard practice, careful examination of the gallbladder is indicated to rule out carcinoma in high-risk populations (calcified gallbladder, gallbladder polyps).
  • If laparoscopic or simple open cholecystectomy has been performed and cancer is discovered after the fact, additional surgery or adjuvant chemoradiation should be considered.
 


More on Gallbladder Cancer

Overview: Gallbladder Cancer
Differential Diagnoses & Workup: Gallbladder Cancer
Treatment & Medication: Gallbladder Cancer
Follow-up: Gallbladder Cancer
References
[ CLOSE WINDOW ]

References

  1. National Cancer Institute. Cancer Statistics. SEER Surveillance, Epidemiology, and End Results. Available at http://seer.cancer.gov/. Accessed 2008.

  2. Schottenfeld D and Fraumeni J. Cancer. Epidemiology and Prevention. 3rd. Oxford University Press; 2006:787-800.

  3. Lowenfels AB, Maisonneuve P, Boyle P, Zatonski WA. Epidemiology of gallbladder cancer. Hepatogastroenterology. May-Jun 1999;46(27):1529-32. [Medline].

  4. Bernstein CN, Blanchard JF, Kliewer E, Wajda A. Cancer risk in patients with inflammatory bowel disease: a population-based study. Cancer. Feb 15 2001;91(4):854-62. [Medline].

  5. Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer. Apr 1 2006;118(7):1591-602. [Medline].

  6. Matsukura N, Yokomuro S, Yamada S, Tajiri T, Sundo T, Hadama T, et al. Association between Helicobacter bilis in bile and biliary tract malignancies: H. bilis in bile from Japanese and Thai patients with benign and malignant diseases in the biliary tract. Jpn J Cancer Res. Jul 2002;93(7):842-7. [Medline].

  7. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. Apr 24 2003;348(17):1625-38. [Medline].

  8. Tsuchiya Y, Sato T, Kiyohara C, Yoshida K, Ogoshi K, Nakamura K. Genetic polymorphisms of cytochrome P450 1A1 and risk of gallbladder cancer. J Exp Clin Cancer Res. Mar 2002;21(1):119-24. [Medline].

  9. Singh MK, Pandey UB, Ghoshal UC, Srivenu I, Kapoor VK, Choudhuri G. Apolipoprotein B-100 XbaI gene polymorphism in gallbladder cancer. Hum Genet. Feb 2004;114(3):280-3. [Medline].

  10. Benjamin IS. Biliary cystic disease: the risk of cancer. J Hepatobiliary Pancreat Surg. 2003;10(5):335-9. [Medline].

  11. Hu B, Gong B, Zhou DY. Association of anomalous pancreaticobiliary ductal junction with gallbladder carcinoma in Chinese patients: an ERCP study. Gastrointest Endosc. Apr 2003;57(4):541-5. [Medline].

  12. American Cancer Society. Key Statistics for Gallbladder Cancer. Available at http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_gall_bladder_cancer_68.asp?sitearea=.. Accessed March 29, 2008.

  13. American Joint Committee on Cancer. Staging Resources. AJCC Staging Resources. Available at http://www.cancerstaging.org/staging/index.html. Accessed 2008.

  14. Mohandas KM, Swaroop VS, Gullar SU, Dave UR, Jagannath P, DeSouza LJ. Diagnosis of malignant obstructive jaundice by bile cytology: results improved by dilating the bile duct strictures. Gastrointest Endosc. Mar-Apr 1994;40(2 Pt 1):150-4. [Medline].

  15. Gupta P, Chitalkar P, Sen A, et al. Combination of gemcite and cisplatin chemotherapy in unresectable gallbladder cancer. J Clin Oncol. ASCO Annual Meeting Proceedings (Post-Meeting Edition). 2007;25, No18s (June 20 Supplement):15166.

  16. Abdalla EK, Vauthey JN. Biliary tract cancer. Curr Opin Gastroenterol. Sep 2001;17(5):450-7. [Medline].

  17. American Cancer Society. Facts and Figures. Available at www.cancer.org/docroot/stt/stt_0.asp.. Accessed March 29, 2008.

  18. Bartlett DL, Ramanathan RK, Ben-Josef E. Cancer of the Biliary Tree. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. Cancer Principles and Practice of Oncology. 8th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2008:1156-86.

  19. Benson AB, Curley SA, Langnas AN. Hepatobiliary Cancers. NCCN Clinical Practice Guidelines in Oncology. 2005;1.

  20. Chang BB, Thomas MB, Wolff RA. Pancreatic Cancer and Hepatobiliary Malignancies. In: Kantarjian HM, Wolff RA, Koller CA. MD Anderson Manual of Medical Oncology. 2nd ed. New York, NY: McGraw-Hill Medical Publishing Division; 2006:383-393.

  21. Czito BG, Hurwitz HI, Clough RW, Tyler DS, Morse MA, Clary BM. Adjuvant external-beam radiotherapy with concurrent chemotherapy after resection of primary gallbladder carcinoma: a 23-year experience. Int J Radiat Oncol Biol Phys. Jul 15 2005;62(4):1030-4. [Medline].

  22. Dawes LG. Gallbladder cancer. Cancer Treat Res. 2001;109:145-55. [Medline].

  23. Dingle BH, Rumble RB, Brouwers MC,. The role of gemcitabine in the treatment of cholangiocarcinoma and gallbladder cancer: a systematic review. Can J Gastroenterol. Dec 2005;19(12):711-6. [Medline].

  24. Douglas HO, Tepper JE, Leichman L. Neoplasms of the Gallbladder. In: Holland JF, et al, eds. Cancer Medicine. 3rd ed. Philadelphia, Pa: Lea & Febiger; 1993:1448-1454.

  25. Doval DC, Sekhon JS, Gupta SK, Fuloria J, Shukla VK, Gupta S. A phase II study of gemcitabine and cisplatin in chemotherapy-naive, unresectable gall bladder cancer. Br J Cancer. Apr 19 2004;90(8):1516-20. [Medline].

  26. Gallardo JO, Rubio B, Fodor M, Orlandi L, Yanez M, Gamargo C. A phase II study of gemcitabine in gallbladder carcinoma. Ann Oncol. Oct 2001;12(10):1403-6. [Medline].

  27. Gunderson LL, Haddock MG, Foo ML, Todoroki T, Nagorney D. Conformal irradiation for hepatobiliary malignancies. Ann Oncol. 1999;10 Suppl 4:221-5. [Medline].

  28. Gunderson LL, Willett CG. Pancreas and Hepatobiliary Tract. In: Perez CA, Brady LW, eds. Principles and Practice of Radiation Oncology. 3rd ed. Philadelphia, Pa: Lippincott-Raven; 1997:1467-1488.

  29. Hawkins WG, DeMatteo RP, Jarnagin WR, Ben-Porat L, Blumgart LH, Fong Y. Jaundice predicts advanced disease and early mortality in patients with gallbladder cancer. Ann Surg Oncol. Mar 2004;11(3):310-5. [Medline].

  30. Houry S, Haccart V, Huguier M, Schlienger M. Gallbladder cancer: role of radiation therapy. Hepatogastroenterology. May-Jun 1999;46(27):1578-84. [Medline].

  31. Ito H, Matros E, Brooks DC, Osteen RT, Zinner MJ, Swanson RS, et al. Treatment outcomes associated with surgery for gallbladder cancer: a 20-year experience. J Gastrointest Surg. Feb 2004;8(2):183-90. [Medline].

  32. Knox JJ, Hedley D, Oza A, Feld R, Siu LL, Chen E. Combining gemcitabine and capecitabine in patients with advanced biliary cancer: a phase II trial. J Clin Oncol. Apr 1 2005;23(10):2332-8. [Medline].

  33. Knox JJ, Hedley D, Oza A, Feld R, Siu LL, Chen E. Combining gemcitabine and capecitabine in patients with advanced biliary cancer: a phase II trial. J Clin Oncol. Apr 1 2005;23(10):2332-8. [Medline].

  34. Kresl JJ, Schild SE, Henning GT, Gunderson LL, Donohue J, Pitot H. Adjuvant external beam radiation therapy with concurrent chemotherapy in the management of gallbladder carcinoma. Int J Radiat Oncol Biol Phys. Jan 1 2002;52(1):167-75. [Medline].

  35. Lillemoe K, Kennedy AS, Picus J. Clinical Management of Carcinoma of the Biliary Tree. In: Kelsen, et al, eds. Principles and Practice of Gastrointestinal Oncology. 1. Philadelphia, Pa: JB Lippincott Co; 2000.

  36. Lotze MT, Flickinger JC, Carr BI. Hepatobiliary Neoplasms. In: Devita VT, Hellman S, Rosenberg SA, eds. Principles and Practice of Oncology. 4th ed. Philadelphia, Pa: JB Lippincott Co; 1993:883-907.

  37. Malik IA, Aziz Z, Zaidi SH, Sethuraman G. Gemcitabine and Cisplatin is a highly effective combination chemotherapy in patients with advanced cancer of the gallbladder. Am J Clin Oncol. Apr 2003;26(2):174-7. [Medline].

  38. Malka D, Boige V, Dromain C, Debaere T, Pocard M, Ducreux M. Biliary tract neoplasms: update 2003. Curr Opin Oncol. Jul 2004;16(4):364-71. [Medline].

  39. Stuver S, Trichopoulos D. Cancer of the Liver and Biliary Tract. In: Adami H, Hunter D, Trichopoulos D, eds. Textbook of Cancer Epidemiology. 2nd ed. New York, NY: Oxford University Press; 2008:308-332/12.

  40. Taner CB, Nagorney DM, Donohue JH. Surgical treatment of gallbladder cancer. J Gastrointest Surg. Jan 2004;8(1):83-9; discussion 89. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

biliary cancer, biliary tract cancer, cancer of the biliary tree, gallbladder cancer, gallstones, cholesterol gallstones, chronic typhoid infections, abnormal pancreaticobiliary duct junctions, inflammatory bowel disease, IBD, polyposis coli, cholangiocarcinomas, primary sclerosing cholangitis, ulcerative colitis, liver flukes, chronic Salmonella typhi and paratyphi infections, and Helicobacter infection, Gardner syndrome, neurofibromatosis type I, hereditary nonpolyposis colon cancer, obesity, oral contraceptives, INH, isoniazid, methyldopa, chemical exposures, pesticides, rubber, vinyl chloride, occupational exposures, textile worker, petroleum worker, paper mill worker, shoemaker, water pollution, organopesticides, dichlorodiphenyltrichloroethane, benzene hexachloride, heavy metals, cadmium, chromium, lead, radiation exposure, radon in miners, apolipoprotein B gene, cytochrome P450 1A1 gene, CYP1A1, abdominal pain

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Mary Denshaw-Burke, MD, FACP, Assistant Clinical Professor, Department of Medicine, Thomas Jefferson University School of Medicine; Program Director of Hematology/Oncology Fellowship, Education Coordinator for Oncology, Lankenau Hospital; Consulting Staff, Lankenau Hospital, Delaware County Memorial Hospital, Mercy Fitzgerald Hospital, Bryn Mawr Hospital, Taylor Hospital
Mary Denshaw-Burke, MD, FACP is a member of the following medical societies: American College of Physicians
Disclosure: Sharpe-Strumia Fund at Bryn Mawr  Grant/research funds Other

Coauthor(s)

Jessica B Katz, MD, PhD, FACP, Hematology/Oncology Fellowship, Lankenau Hospital; Churchman Fellow, Lankenau Institute of Medical Research
Jessica B Katz, MD, PhD, FACP is a member of the following medical societies: American College of Physicians and Phi Beta Kappa
Disclosure: Nothing to disclose.

Andrew Scott Kennedy, MD, Co-Medical Director, Wake Radiology Oncology
Andrew Scott Kennedy, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American Hepato-Pancreato-Biliary Association, American Society for Therapeutic Radiology and Oncology, American Society of Clinical Oncology, and Radiological Society of North America
Disclosure: Nothing to disclose.

David Van Echo, MD, Head, New Drug Development Program (Oncology), Professor, Departments of Medicine and Pharmacy, University of Maryland School of Medicine; Director of HarborView Cancer Center
Disclosure: Nothing to disclose.

Medical Editor

Michael Perry, MD, MS, MACP, Nellie B Smith Chair of Oncology, Professor, Department of Internal Medicine, Division of Hematology and Oncology, University of Missouri at Columbia/Ellis Fischel Cancer Center
Michael Perry, MD, MS, MACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Hematology, Missouri State Medical Association, Southern Association for Oncology, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Benjamin Movsas, MD, Vice-Chairman, Department of Radiation Oncology, Fox Chase Cancer Center
Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, and American Society for Therapeutic Radiology and Oncology
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Hematology and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.