Download - Gall bladder carcinoma
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Ahmed Zeeneldin
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Risk Factorsó Cholelithiasis is the most commonó chronic inflammation.ó Calcification
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Clinical picture and diagnosisó Mimics biliary colic or chronic cholecystitis.ó incidental finding in 50% of cases ó at surgery or ó on pathology following cholecystectomy
ó diagnosed at an advanced stageó mass detected on ultrasound or jaundice
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GB CA US
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GB CA CT
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Pathology ó Adeno ca in
80%ó Early spread to
lymph node and blood steam
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Stagingó M1: metsó N1: regional LNó T
T1 T2 T3 T4
T1a lamina propriaT1b muscle layer
perimuscularconnective tissue;
serosa (and/or liver and/or one other adjacent organ or structure,
main portal vein or hepatic artery or invades multiple extrahepaticorgans or structures
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GB staging Colon cancer staging
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OSó Median OS ó (all): 10mó 1-3: 12mó 4: 6m
ó % year OSó Stage OS%ó 0 60ó 1 40ó 2 15ó 3 5ó 4 1
Tis/0 T1 T2 T3 T4=III M1=IV
N0 0 IA IB IIA III IV
N1 IIB IIB IIB IIB III IV
M1=IV
IV IV IV IV IV IV
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Treatment ó Surgery is the only curative
modalityó Scenarios: ó Preoperative suspicionó Intraoperative dxó Frozen section: cholecystectomy,
en bloc hepatic resection, and lymphadenectomy with or without bile duct excision.
ó LNS: PH, GH, RDó Celiac, PALN: irresectable
ó Postopertive dx
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Treatment ó Postopertive (incidental) dx
on pathology reviewó Reexploration yields residual
in 75%ó T1a with negative SM:
observeó Otherwise: ó Exclude mets, local CT, MRIó Surgical resection as before
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Adjuvant treatmentó T1a-b N0: no therapyó Chem-oradiation: fluoropyrimidineó fluoropyrimidine or gemcitabine chemotherapy
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Unresectable/metastatic diseaseó Biopsyó Relieve jaundiceó Unresectable: chemoradiationó Metastatic: chemotherapyó BSC
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Classificationó Intrahepaticó Extrahepatic:ó Hilar (Klatskin):
commenestó Extrahepatic proper:
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