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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 2  |  Issue : 1  |  Page : 1-3

Gall Bladder Cancer: Audit of 150 Cases Managed at IGIMS, Patna


Department of G.I. Surgery, IGIMS, Patna, India

Date of Web Publication12-Feb-2016

Correspondence Address:
Manish Mandal
Addl. Prof. & H.O.D., G. I. Surgery, IGIMS, Patna Flat No.D-3/3, IGIMS, Patna, Bihar-800014
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


There is a marked increase in the incidence of gall bladder cancer (GBC) in recent times in India. There is no hospital based data or any registry system available for this cancer from Bihar. The present study aims to make a first insight into the pattern of GBC in Bihar during the year (2005-14). A retrospective study was carried out in the Department of G.I. Surgery at the Indira Gandhi Institute of Medical Sciences(I.G.I.M.S), Patna, Bihar, to study the pattern of GBC. The data obtained were analyzed for statistical significance by calculating the average value of the parameters followed by samplet-test. Most of the patients were from rural background with poor economic status.

Keywords: Cholelithiasis, Chronic Cholecystitis, Gall Bladder Cancer, Unresectable, CA19.9


How to cite this article:
Mandal M, Kumar S, Kumar K, Ranjan R, Kumar R, Prakash P, Anand U, Pankaj D. Gall Bladder Cancer: Audit of 150 Cases Managed at IGIMS, Patna. J Indira Gandhi Inst Med Sci 2016;2:1-3

How to cite this URL:
Mandal M, Kumar S, Kumar K, Ranjan R, Kumar R, Prakash P, Anand U, Pankaj D. Gall Bladder Cancer: Audit of 150 Cases Managed at IGIMS, Patna. J Indira Gandhi Inst Med Sci [serial online] 2016 [cited 2022 Oct 2];2:1-3. Available from: http://www.jigims.co.in/text.asp?2016/2/1/1/303359




  Introduction: Top


Gall bladder cancer, traditionally rare has been considered as an incurable disease with extremely poor prognosis. 150 patients were planned for operative procedure after proper investigation. In which there was an increasing trend in incidence of gall bladder carcinoma year wise. As Gall bladder carcinoma is a female predominant disease worldwide with ratio of 3:1(F: M).ln India ratio is 3.7:1. Gall bladder carcinoma disease has increasing incidence in between the age 40-60.

Only 10% of diagnosed cases of GBC are present with resectable disease in the outdoor. Here we have studied 150 patents who were Clinically, Biochemically and Radiologically having resectable disease. In our study, out of 150 patents 27 were unresectable disease on operation table. Our observation shows that there is great challenge for the medical professionals to diagnose the disease in curable stage.


  Materials and Method Top


This is a retrospective study which included radiologically resectable one hundred fifty (150) patients registered at IGIMS Patna with symptoms of Gall Bladder Cancer. They were operated for that in same Institute from 2005 to 2014.

Routine investigations were done including CECT WHOLE ABDOMEN, TUMOUR MARKER (CEA, CA19.).


  Exclusion Criteria - Top


  1. Patients having clinically metastatic disease
  2. Patents with gross Ascites
  3. Patient with jaundice due to Block at Porta.
  4. Patents medically unfitfor surgery
  5. Radiologically u n resectable disease



  Result Top


Year wise number of gall I bladder carcinoma
Figure 1: Increasing incidence of gall bladder carcinoma three to four times in the last ten years.

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  • Age Wise Distribution of Gall Bladder Carcinoma Top




Maximum number of cases are in between the age groupof30to60.


  • Sex Wise Distribution of Carcinoma Gall Bladder Top




Male: female ratio showing high female predominance of 1:4.3


  • Percentage of Resectable and Unresectable Disease Top


RESECTABLE & UNRESECTABLE




  Discussion: Top


Gall Bladder Cancer (GBC) was first described by De Stoll in 1777[19]. GBC is a rare neoplasm with marked ethnic, gender and geographical variations worldwide.. In India, it is mostly present in Gangetic belt of Uttar Pradesh, Bihar and West Bengal. The comparison of different population based cancer registries indicated that GBC was one of the commonest causes of cancer related mortality in women in northern and north-eastern states of India[2]. The reported incidence ranged from 21/1,00, 000 in Delhi to 2-3/1, 00, 0 00 in South India[3]. The association of GBC with gall stone is increased the risk from 4 to 7 times than those without gall stone[4]. It may be highlighted that chronic cholecystitis, Salmonella typhii infection, increased BMI, dietary and environmental factors like insecticides (D.D.T Spray) as some risk factors other than gall stone[1],[5],[6].

The non specific symptoms of the disease always remained a problem in the early diagnosis and treatment. This was always being confused with other gastrointestinal disease symptoms like abdominal pain, abdominal lump, anorexia, jaundice, nausea and vomiting. Sometimes patient presented with itching and pruritus simulating any skin disease. Blood serum alkaline phosphatase (ALP), serum glutamic pyruvic transaminase (SGPT), serum glutamic oxaloacetic transaminase (SGOT) and total bilirubin (TB) were found elevated in many cancers other than GBC[7],[8],[9],[10]. Abdominal Ultrasonography is the first and important radiological investigation to see the irregular wall thickening of gall bladder, liver infiltration and local lymph nodes enlargement. CECT abdomen is essential for staging and resectibility of gall bladder mass.

AJCC Staging of Gallbladder cancer



USG guided FNAC may be needed for cytological confirmation for chemotherapy and for palliative metallic stenting to relieve the jaundice in case of Advance Gall Bladder Cancer. In case of resectable GBC, there is no need of cytological confirmation. Unfortunately, in a study area like ours, most often patients visit hospital only when the disease is in its advance stage and thus, they have a poor prognosis. There is lack of an ideal civil registration system in this part of South-East Asia to estimate the morbidity and mortality rates for a particular disease. The national level data sets[11],[12] showing incidence of gall bladder cancer made available have clearly missed the North Central part of India (including Bihar, north Madhya Pradesh, a few districts of Uttar Pradesh and Rajasthan), may be due to lack of availability of hospital based data and other reasons. The worst part is the predominance of gall bladder cancer in rural population, where medical facility is scarce, and who are either unaware of the extreme consequences or are too poor to afford the cost of diagnosis and treatment and hence, continue to suffer. The present study is first of its kind, reporting on the status of the disease in Bihar population especially in rural and semi-urban areas.


  Conclusion: Top


India has had the highest incidence of cancer gall bladder (21.5/ 1, 00, 000) in the world. The highest mortality rate of both women (16.6/1, 00, 000) and men (7.8/1, 00, 000) was also observed in India. In India, it is mostly present in Gangetic belt of Uttar Pradesh, Bihar and West Bengal20. As per our study, we had a F:M ratio similar to National Data with 3.7:1. Even after selecting radiologically resectable disease for Surgery, 20% were found unresectable during surgery. Extended Cholecystectomy is optimal surgery for GBC and Extended Cholecystectomy with Roux-En-Y Hepatico Jejunostomy is optimal surgery for locally advanced Carcinoma of Gall Bladder for Cystic Duct or Common Bile Duct involvement. Extended cholecystectomy with wedge resection of nearby single organ infiltration where only one organ is infiltrated. Protocol for follow up was six monthly for two years then yearly for next five years with radiological and biochemical investigation. In our study 80 % operated patients came regularly for two years and remaining 20% either lost to follow up or died. At the end of 5 years 30 % remain in study and others either lost to follow up or died. We still have to consider follow up for our recently operated cases.



 
  References Top

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Nervi F., Duarte I., Gomez G, Rodriguez G, Pino G D, Ferrerio O et. al. Frequency of gall bladder cancer in Chile, a high risk area. International Journal of Cancer. 1988; (41)657-660.  Back to cited text no. 4
    
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Wiwanitkit V, Teerasaksilp S, Paritpokee N. Biliary Alkaline Phosphatase Isoenzyme in Biliary Obstruction. SE Medical Journal 2006; 7(1): 1-5.  Back to cited text no. 9
    
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Saif M W, Alexander D, Wicox C M. Serum Alkaline Phosphatase Level as a Prognostic Tool in Colorectal Cancer: A Study of 105 patients. The Journal of Applied Research 2005; 5, (1): 88-95.  Back to cited text no. 10
    
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National Cancer Registry Programme, Consolidated reports of the population based cancer registries 1990-96, Indian Council of Medical Research, New Delhi, India, and August 2001.  Back to cited text no. 11
    
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Chaudhry K. Gall Bladdder- Indian Scenario. Indian Journal of Medical and Pediatric Oncology 2007; 28(2): 6-15.  Back to cited text no. 12
    
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Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: Geographical distribution and risk factors. International Journal of Cancer 2006:118,1591-1602.  Back to cited text no. 14
    
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Hsing AW, Sakoda LC, Rashid A, Chen J, Shen MC, Han TQet. al. Body size and the risk of biliary tract cancer: a population-based study in China. British Journal of Cancer 2008; 99,811 - 815.  Back to cited text no. 15
    
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Lazcano-Ponce EC, Miquel JF, Munoz N, Herrero R, Ferrecio C,Wistuba II, et al. Epidemiology and molecular pathology of gallbladder cancer. Ca Cancer Journal Clinical 2001; 51:349-364.  Back to cited text no. 16
    
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Strom BL, Soloway RD, Rios-Dalenz JL, Rodriguez-Martinez HA, West SL, Kinman JL, et al. Risk factors for gallbladder cancer. An international collaborative case-control study. Cancer 1995; 76:1747-1756.  Back to cited text no. 17
    
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Lai C L, Lam K C, Wong K P, Wu P C, Todd D. Clinical Features of Hepato- cellular Carcinoma : Review of 211 Patients in Hong Kong. Cancer 1981,47:2746-2755.  Back to cited text no. 18
    
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Introduction:
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