Carcinoma Gallbladder

Carcinoma of the gallbladder is the most common biliary tract malignancy in India and has among the highest incidence rates worldwide in certain Indian states — particularly Uttar Pradesh, Bihar, and the northern Gangetic plains. The aetiology is strongly linked to gallstone disease (chronic cholecystitis and mucosal irritation), with other risk factors including porcelain gallbladder, gallbladder polyps >1 cm (particularly sessile), anomalous pancreaticobiliary junction, typhoid carrier status, and exposure to industrial chemicals. Adenocarcinoma accounts for 98% of gallbladder cancers. Despite being potentially curable in early stages, the majority of cases are diagnosed at advanced, unresectable stages because early gallbladder cancer is often asymptomatic and incidentally detected in the pathology specimen after cholecystectomy.

Symptoms of gallbladder cancer are non-specific and overlap with benign gallbladder disease — right upper quadrant pain, nausea, and dyspepsia. Advanced disease presents with obstructive jaundice (due to hepatoduodenal ligament involvement), a palpable right upper quadrant mass, weight loss, and ascites. CA 19-9 and CEA are useful tumour markers but lack specificity. CT and MRI characterise the extent of hepatic invasion, ductal and vascular involvement, and lymph node status. Staging follows the AJCC TNM system: T1 (mucosa or muscularis propria), T2 (perimuscular connective tissue), T3 (perforates serosa or invades liver ≤2 cm), T4 (liver invasion >2 cm or portal vein/hepatic artery invasion).

Treatment is surgical when feasible. Incidental T1a gallbladder cancer (confined to mucosa) is adequately treated by simple cholecystectomy. T1b and T2 tumours require extended (radical) cholecystectomy — re-resection including a 2 cm margin of liver bed (segments IVb and V), plus regional lymphadenectomy of the hepatoduodenal ligament. T3/T4 tumours may require extended hepatectomy with bile duct excision and biliary reconstruction. Port-site excision is performed if prior laparoscopic cholecystectomy was performed without a retrieval bag. Adjuvant capecitabine chemotherapy is recommended after curative resection. For unresectable disease, gemcitabine-cisplatin with or without immunotherapy (durvalumab) represents the standard of care. Our multidisciplinary team offers expert oncological surgical management for all stages of gallbladder cancer.