Gall Bladder Cancer

Gall Bladder Cancer

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Definition

  • Gallbladder cancer is a relatively uncommon cancer. It has peculiar geographical distribution being common in central and South America, central and Eastern Europe, Japan and northern India; it is also common in certain ethnic groups e.g. Native American Indians and Hispanics.

Epidemiology and burden of Gall Bladder Cancer

 

  1. Gallbladder cancer is the 20th most common cancer in the world, with an estimated 178,100 new cases diagnosed in 2012. (http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/gallbladder-cancer-statistics)
  2. The highest gallbladder cancer incidence rates worldwide in 2006 are reported for women in Delhi, India (21.5/100,000), South Karachi, Pakistan (13.8/100,000) and Quito, Ecuador (12.9/100,000). (Int J Cancer.2006 Apr 1;118(7):1591-602)
  3. Gallbladder cancer, though generally considered rare, is the most common malignancy of the biliary tract, accounting for 80%–95% of biliary tract cancers. (Clin Epidemiol. 2014; 6: 99–109)
  4. Gallbladder cancer is not usually found until it has become advanced and causes symptoms. Only about 1 of 5 gallbladder cancers is found in the early stages, when the cancer has not yet spread beyond the gallbladder. (http://www.cancer.org/cancer/gallbladdercancer/detailedguide/gallbladder-key-statistics)

Treatment for Gall Bladder Cancer

  1. Gemcitabine combined with carboplatin has activity against advanced biliary tract cancers (BTCs) and are comparable to other gemcitabine-platinum or gemcitabine-fluoropyrimidine combinations in advanced BTCs. (HPB (Oxford).2010 Aug;12(6):418-26)
  2. Gem-based combination chemotherapy had significantly higher disease response rates [OR = 1.69, 95% confidence interval (CI): 1.17-2.43; P= 0.01], a longer progression-free survival (MD = 1.95, 95%CI: 0.90-3.00; P = 0.00) and a longer overall survival (MD = 1.85, 95%CI: 0.26-3.44; P = 0.02). (World J Gastroenterol. 2014 Dec 21; 20(47): 18001–18012)
  3. FOLFOX-4 is an effective and well-tolerated regimen as a second-line treatment in advanced gall bladder cancer patients. (Jpn J Clin Oncol.2016 Jan;46(1):57-62)
  4. Options for second-line systemic therapy include GEM-FU, FU-combo, GEM-P if not given in the first-line setting. (J Gastrointest Oncol. 2014 Dec; 5(6): 408–413)

Prevention of Gall Bladder Cancer

  1. After adjustment for age, education and body mass index, among women, ever tea drinkers had significantly reduced risks of biliary stones (OR = 0.73, 95% CI = 0.54-0.98) and gallbladder cancer (OR = 0.56, 95% CI = 0.38-0.83). (Int J Cancer.2006 Jun 15;118(12):3089-94)
  2. After controlling for age, sex, education, and biliary stone status, aspirin use has been found to be associated with a reduced risk of gallbladder cancer [odds ratio (OR), 0.37; 95% confidence interval (CI), 0.17-0.88]. (Cancer Epidemiol Biomarkers Prev.2005 May;14(5):1315-8)
  3. A significant reduction in gallbladder cancer risk was seen with the consumption of radish (OR 0.4; 95% CI 0.17-0.94), green chilli (OR 0.45; 95% CI 0.21-0.94) and sweet potato (OR 0.33; 95% CI 0.13-0.83) among vegetables, and mango (OR 0.4; 95% CI 0.16-0.99), orange (OR; 0.45; 95% CI 0.22-0.93), melon (OR 0.3; 95% CI 0.14-0.64) and papaya (OR 0.44; 95% 0.2-0.64) among fruits. (Eur J Cancer Prev.2002 Aug;11(4):365-8)
  4. Factors significantly associated with GBC are illiteracy [odds ratio (OR) 8.00], lower socioeconomic status (OR 2.45), parity more than 3 (OR 9.06), age at first pregnancy less than 20 years (OR 2.03), and the use of nonliquefied petroleum gas cooking fuel (OR 4.17). Higher vitamin C intake had a protective effect (OR 0.33). (Eur J Cancer Prev.2013 Sep;22(5):431-7)

Risk factors for Gall Bladder Cancer

  • Some of the important risk factors are: chemical exposure [odd ratios (OR): 7.0 (2.7-18.2)], family history of gallstones [OR: 5.3 (1.5-18.9)], tobacco [OR: 4.1 (1.8-9.7)], fried foods [OR: 3.1 (1.7-5.6)], joint family [OR: 3.2 (1.7-6.2)], long interval between meals [OR: 1.4 (1.2-1.6)]. (Int J Cancer.2013 Apr 1;132(7):1660-6)
  • Risk of gallbladder cancer is approximately 4-5 times higher in patients with gallstones, than in patients without gallstones. (1999 May-Jun;46(27):1529-32)
  • Age more than 55 years (OR – 7.27, p value- < 0.001), solitary stone (OR – 3.33, p value – 0.002) and stone of more than 1 cm (OR – 2.73, p value – 0.004) are found to be independent risk factors for development of gallbladder cancer. (World J Surg Oncol.2011 Dec 9;9:164)
  • Compared with non-diabetic individuals, both men and women with type 2 DM had an increased risk of gallbladder cancer. (Diabetes Metab Res Rev.2016 Jan;32(1):63-72)

Systematic reviews

  1. Candidate gene studies in gallbladder cancer: a systematic review and meta-analysis.more..
  2. Number of parity and the risk of gallbladder cancer: a systematic review.more..
  3. Adjuvant therapy in the treatment of gallbladder cancer: a meta-analysis.more..
  4. A systematic review of the safety and efficacy of hepatopancreatoduodenectomy for biliary and gallbladder cancers.more..

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