Alerts and Notices
SynopsisGallbladder cancer is rare in the United States, with 1-2 cases per 100 000 population. It is most common in patients in their sixth to seventh decade, with a female predominance. In the United States, it is most common in individuals of Hispanic and Native American descent. Risk factors for development of gallbladder cancer are related to chronic gallbladder inflammation and include gallstone disease, porcelain gallbladder, gallbladder polyps, abnormalities in the choledochopancreatic junction, and chronic infections with Salmonella typhi and Helicobacter pylori.
Gallbladder cancer is often diagnosed in the following ways: malignancy found at the time of cholecystectomy, malignancy incidentally diagnosed on pathologic examination after simple cholecystectomy (approximately 50% of patients), malignancy suspected preoperatively because of symptoms, and malignancy found incidentally on imaging performed for another purpose.
Patients may be asymptomatic at the time of presentation or demonstrate nonspecific findings, including right upper quadrant pain. They may have typical symptoms of cholelithiasis in early disease or with advanced disease, and may present with anorexia, weight loss, and vomiting. Ninety percent of gallbladder neoplasms are adenocarcinoma with the remainder adenosquamous, squamous cell carcinoma, small cell neuroendocrine tumors, lymphoma, and sarcoma. Papillary carcinomas have the most favorable prognosis while adenocarcinomas may extend outside of the gallbladder and invade the liver as they grow. Prognosis is dependent on histologic type and the extent of invasive carcinomatous disease.
C23 – Malignant neoplasm of gallbladder
372140005 – Carcinoma of gallbladder
Differential Diagnosis & Pitfalls
- Biliary colic
- Acute cholecystitis
- Acute or chronic pancreatitis
- Acute coronary syndrome
- Hiatal hernia
- Esophageal spasm (see esophageal motility disorder)
- Malignancy (particularly esophageal, gastric, small bowel, pancreatic, liver)
- Zollinger-Ellison syndrome
- Acute hepatitis (eg, hepatitis A, B, C)
- Acute appendicitis
- Mesenteric ischemia (acute, chronic)
- Liver abscess (eg, pyogenic, amebic)
- Celiac disease
- Drug side effects (NSAIDs, alcohol, caffeine, antibiotics, corticosteroids, opiates, digoxin)
- Inflammatory bowel disease (ulcerative colitis, Crohn disease)
- Irritable bowel syndrome