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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2015; 3(3): 231-244
Published online Mar 16, 2015. doi: 10.12998/wjcc.v3.i3.231
Gall bladder carcinoma: Aggressive malignancy with protean loco-regional and distant spread
Amit Nandan Dhar Dwivedi, Shivi Jain, Ruhi Dixit
Amit Nandan Dhar Dwivedi, Shivi Jain, Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, Uttar Pradesh, India
Ruhi Dixit, Department of General Surgery Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, Uttar Pradesh, India
Author contributions: Dwivedi AND contributed significantly in preparation collection of data writing and critically revising the manuscript; Jain S and Dixit R contributed in data analysis, collection and writing the manucript.
Conflict-of-interest: The authors declare no conflict-of-interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Amit Nandan Dhar Dwivedi, MD, Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Lanka Road, Varanasi-221005, Uttar Pradesh, India. amitnandan21@yahoo.com
Telephone: +91-542-2369024 Fax: +91-542-2311058
Received: July 11, 2014
Peer-review started: July 12, 2014
First decision: August 14, 2014
Revised: November 21, 2014
Accepted: December 16, 2014
Article in press: December 19, 2014
Published online: March 16, 2015
Abstract

The most common malignancy of biliary tract is gallbladder cancer (GBC) which is the third most common cancer in gastrointestinal tract. It is a lethal disease for most patients in spite of growing awareness and improved diagnostic techniques. GBC has a very poor prognosis and the 5 year survival rate is < 10%. Although etiology of the carcinoma of the gallbladder is still obscure, various factors have been implicated, cholelithiasis being the most frequent. The incidence of GBC worldwide is based on the gender, geography and ethnicity which suggest that both genetic and environmental factors can cause GBC. The major route of spread of gallbladder cancer (GC) is loco-regional rather than distant. It spreads by lymphatic, vascular, neural, intraperitoneal, and intraductal routes. Sonography is usually the most common imaging test to evaluate symptoms of biliary tract disease including suspected GC. With recent advances in imaging modalities like multi-detector computed tomography (CT) scanners, magnetic resonance imaging-positron emission tomography/CT diagnosis of gallbladder cancer has improved. Studies have also targeted molecular and genetic pathways. Treatment options have included extended and radical surgeries and adjuvant chemotherapy. This review article deals in detail with important aspects of carcinoma gallbladder and its manifestations and challenges. Role of various imaging modalities in characterization and accurate staging has been discussed. The loco-regional spread of this aggressive malignancy is dealt explicitly.

Keywords: Gallbladder cancer, Loco-regional and distant spread, Cholelithiasis, Imaging, Adenocarcinoma

Core tip: Gallbladder cancer is one of the most prevalent and lethal cancer of biliary tract with multi-factorial etiology. Cholelithiasis is the most common etiological factor. Adenocarcinoma is the most common histological type with loco-regional spread in majority of cases. Sonography is used widely as an initial screening tool and primary characterization of the tumor but it has a limited role in the diagnosis of early lesions. Thus, computed tomography and magnetic resonance imaging are used for complete morphologic characterization and staging of malignant gallbladder lesions and metastatic survey.