Epidemiology of gallbladder cancer.
Gallbladder cancer is the most common biliary tract cancer. The highest incidence rates occur in Chile, which also has the highest mortality rates. This lethal gastrointestinal cancer has a predilection among adult women and older subjects of both sexes, and also among populations throughout central and Eastern Europe and certain racial groups, such as Native American Indians. Unfortunately, prospects are poor for preventing this form of cancer. [1]
Chronic inflammation and gallbladder cancer
Gallbladder cancer (GBC) is the most common biliary tract malignancy with an extremely poor prognosis. Epidemiological data have demonstrated that chronic inflammation resulting from infection of gallbladder or gallstones predispose individuals to GBC. Recent studies have begun to elucidate molecular mechanisms underlying the development of GBC in the setting of chronic inflammation. It is possible that persistently local inflammatory reactions may contribute to the development and progression of GBC through inducing genetic alterations, and subsequent promoting survival and proliferation of mutated sells, inhibiting apoptosis, stimulating angiogenesis and metastasis. This article reviews the current understanding of the involvement of chronic inflammation in gallbladder tumorigenesis. [2]
Gallbladder cancer worldwide: Geographical distribution and risk factors
Gallbladder cancer is a relatively rare neoplasm that shows, however, high incidence rates in certain world populations. The interplay of genetic susceptibility, lifestyle factors and infections in gallbladder carcinogenesis is still poorly understood. Age‐adjusted rates were calculated by cancer registry‐based data. Epidemiological studies on gallbladder cancer were selected through searches of literature, and relative risks were abstracted for major risk factors. The highest gallbladder cancer incidence rates worldwide were reported for women in Delhi, India (21.5/100,000), South Karachi, Pakistan (13.8/100,000) and Quito, Ecuador (12.9/100,000). High incidence was found in Korea and Japan and some central and eastern European countries. Female‐to‐male incidence ratios were generally around 3, but ranged from 1 in Far East Asia to over 5 in Spain and Colombia. History of gallstones was the strongest risk factor for gallbladder cancer, with a pooled relative risk (RR) of 4.9 [95% confidence interval (CI): 3.3–7.4]. Consistent associations were also present with obesity, multiparity and chronic infections like Salmonella typhi and S. paratyphi [pooled RR 4.8 (95% CI: 1.4–17.3)] and Helicobacter bilis and H. pylori [pooled RR 4.3 (95% CI: 2.1–8.8)]. Differences in incidence ratios point to variations in gallbladder cancer aetiology in different populations. Diagnosis of gallstones and removal of gallbladder currently represent the keystone to gallbladder cancer prevention, but interventions able to prevent obesity, cholecystitis and gallstone formation should be assessed. © 2006 Wiley‐Liss, Inc. [3]
Gemcitabine and Carboplatin in Inoperable, Loco-Regionally Advanced and Metastatic Gallbladder Cancer- A Study from Northern Indian Cancer Institute
Aims: The primary objective of this study was to determine the response rates of the gemcitabine and carboplatin combination chemotherapy in treatment naïve patients with inoperable gall bladder cancer. The secondary objectives were to evaluate the toxicity, progression free survival (PFS), and overall survival (OS).
Methodology: Treatment naïve patients with histologically proven inoperable gall bladder cancer treated with gemcitabine and carboplatin chemotherapy between February 2011 and December 2014 were included in this study. The dose of gemcitabine was 1 gm/m2 on day 1 and 8, and carboplatin [target AUC (area under the concentration versus time curve in mg/ml) of 5] on day 1, in a 21 day cycle. CT scan was used for response assessment.
Results: There were 32 men and 92 women with a median age of 59 years (range 26-75 years). Of the 124 patients, 9 (7.3%) patients achieved a complete response and 54 (43.5%) patients achieved a partial response for an overall response rate of 50.8%. The median PFS was 4.6 months [95% confidence interval (CI) 4–5.5 months], with 1-year survival rate of 20.2%. Common toxicity criteria (CTC) grade 3 anaemia was seen in 6 (4.8%) patients. Grade 3 and 4 neutropenia was observed in 11 (8.9%) and 4 (3.2%) patients respectively, whereas 9 (7.3%) patients experienced Grade 3 thrombocytopenia.
Conclusion: The combination of gemcitabine and carboplatin is active in advanced gall bladder carcinoma with mild toxicity. [4]
Gallbladder Carcinoma in Ghana: Histopathological Examination of Cholecystectomy Specimen
Objective: The aim of the study was to find out the incidence of gallbladder carcinoma in cholecystectomy specimen and the histological types from Korle-Bu Teaching Hospital, Ghana.
Methods: The study was a retrospective study using findings from 507 cholecystectomy specimen that were received at the Department of Pathology, Korle-Bu Teaching Hospital from 2006 – 2013.
Findings: Sixteen out of the 507 cholecystectomy specimen were malignant representing 3.15%. The commonest histological type of malignancy reported was adenocarcinoma, the mean age at presentation was 65.3 years (SD ±11.9 years) with the commonest clinical presentation being right hypochondrium pain.
Conclusion: The histopathological classification of gall bladder carcinoma in Ghanaian does not differ much from reported cases. [5]
Reference
[1] Eslick, G.D., 2010. Epidemiology of gallbladder cancer. Gastroenterology clinics of North America, 39(2), pp.307-30.
[2] Li, Y., Zhang, J. and Ma, H., 2014. Chronic inflammation and gallbladder cancer. Cancer letters, 345(2), pp.242-248.
[3] Randi, G., Franceschi, S. and La Vecchia, C., 2006. Gallbladder cancer worldwide: geographical distribution and risk factors. International journal of cancer, 118(7), pp.1591-1602.
[4] Talwar, V., Raina, S., Goel, V. and C. Doval, D. (2017) “Gemcitabine and Carboplatin in Inoperable, Loco-Regionally Advanced and Metastatic Gallbladder Cancer- A Study from Northern Indian Cancer Institute”, Journal of Advances in Medicine and Medical Research, 19(12), pp. 1-7. doi: 10.9734/BJMMR/2017/30843.
[5] Derkyi-Kwarteng, L., Ampomah Brown, A., P. Akakpo, K., Addae, E., Amoah, D., Diabor, E. and E. Quayson, S. (2016) “Gallbladder Carcinoma in Ghana: Histopathological Examination of Cholecystectomy Specimen”, Journal of Cancer and Tumor International, 3(4), pp. 1-4. doi: 10.9734/JCTI/2016/24468.