Cancer of a gall bladder
Cancer of a gall bladder – a malignant tumor (the adenocarcinoma or planocellular cancer is more often) tissues of a gall bladder. Cancer of a gall bladder proceeds with pains in the right podreberye, nausea, vomiting, loss of body weight, jaundice. At diagnosis of cancer of gall bladder data of ultrasonography, a puncture of a gall bladder, the cholecystography, KT, MRT, RHPG, diagnostic laparoscopy are considered. For the purpose of radical cancer therapy of a gall bladder carrying out a holetsistektomiya, resection of the right share of a liver, sometimes – pankreatoduodenektomiya is necessary.
Cancer of a gall bladder
Cancer of a gall bladder meets in 2-8% of observations. In gastroenterology, among malignant new growths of bodies there is a GIT, cancer of a gall bladder takes the fifth place. Tumoral process in a gall bladder comes to light mainly at women 50 years are more senior. On morphological type primary cancer of a gall bladder to 70-80% is presented by an adenocarcinoma of various differentiation, to the others – planocellular or papillary cancer.
Tumoral growth usually begins in the field of a bottom of a bubble or its neck; further also the puzyrny channel, a liver, adjacent anatomical structures (a stomach, a duodenum, a large intestine) extends on . Cancer of a gall bladder is often combined with cancer of extra hepatic bilious ways. Metastasis of cancer of gall bladder most often occurs in regionarny lymph nodes, a liver, a peritoneum, an epiploon, ovaries, a pleura.
Reasons of cancer of gall bladder
Two thirds of cases of cancer of gall bladder develop against the background of the long previous course of cholelithiasis or chronic cholecystitis. Most often the tumor arises in a calcific gall bladder. It is considered that carcinogenesis is promoted by traumatizing a mucous layer of a bubble the moving gallstones.
Carry polyps and cysts of a gall bladder to the background diseases contributing to developing of cancer of gall bladder, , salmonellosis, a helikobakterny infection. The smokers, people having obesity, abusing alcohol, contacting to chemical carcinogens, eating mainly greasy and fried food enter into group of the increased risk on development of cancer of gall bladder.
Classification of cancer of gall bladder
Clinical classification by the TNM system allocates the following stages of cancer of gall bladder.
- Tis – preinvazivny cancer of a gall bladder
- T1 – germination by a tumor mucous (T1a) or a muscular layer (T1b) of a wall of a gall bladder
- T2 – an invasion of a wall of a gall bladder up to a serous layer; infiltration in a liver is absent
- TZ – germination by a tumor of a serous cover with distribution on a visceral peritoneum or a liver (depth of an invasion is up to 2 cm)
- T4 – an invasion in a liver on depth more than 2 cm or germination in other bodies (a stomach, a 12-perstny gut, an obodochny gut, an epiploon, a pancreas, extra hepatic bilious ways).
- N0 - metastatic damage of regionarny lymph nodes is not defined
- N1 – is available damage of lymph nodes of the general and okolopuzyrny bilious channel or gate of a liver
- N2 – metastasises in lymph nodes of a 12-perstny gut, head of a pancreas, a vorotny vein, the top mezenterialny or chrevny arteries.
- M0 - the remote metastasises do not come to light
- M1 - are defined the remote metastasises of cancer of gall bladder.
Symptoms of cancer of gall bladder
At early stages cancer of a gall bladder develops asymptomatically. Most often locally-spread cancer of a gall bladder is a casual histologic find at a holetsistektomiya concerning kalkulezny cholecystitis.
In process of increase in education low-specific manifestations appear: weakness, a loss of appetite, periodically arising dull ache in the right podreberye and an epigastriya, weight loss, temperature increase of a body to subfebrilny values. Further jaundice, nausea, vomiting, a skin itch joins, coloring changes the calla (brightens) and urine (darkens). At obstruction dropsy or an empiyema of a gall bladder arises a tumor of bilious channels, holangit, secondary biliarny cirrhosis.
Involvement of a liver in tumoral process is followed by increase of symptoms of a liver failure - slackness, an adinamiya, delay of mental reactions. In late stages of cancer of gall bladder at patients comes to light peritoneums, ascites, a kakheksiya. In rare instances the clinic of cancer of gall bladder is developed immediately and proceeds with the phenomena of the hardest intoxication, sepsis.
Diagnosis of cancer of gall bladder
In view of a long bessimptomnost of cancer of gall bladder and low-specificity of its manifestations prior to 70% of cases are diagnosed already in late inoperable stages. At a palpation of a stomach the gepatomegaliya, the increased gall bladder, a splenomegaliya, sometimes - infiltrate in an abdominal cavity is defined. Serve as characteristic changes of biochemical tests increase in values of bilirubin of blood, , the level of alkaline phosphatase. Specific laboratory test on cancer of a gall bladder is definition in marker blood - a cancer anti-gene 19-9 (SA 19-9).
Ultrasonography of a liver and gall bladder reveals increase in the sizes of bodies, a thickening and uneven density of walls of a bubble, additional echo signals in its gleam etc. At primary cancer of a gall bladder in a liver metastasises can be defined. In doubtful cases resort to an aim chreskozhny biopsy of a gall bladder or a biopsy of a liver with the subsequent morphological verification of material. For clarification of interest of other bodies expanded ultrasonography of an abdominal cavity is carried out.
For the purpose of the specifying tool diagnostics the cholecystography, a chreskozhny chrespechenochny holangiografiya, a retrograde holangiopankreatografiya, KT and MRT, a holestsintigrafiya can be applied. For the purpose of definition of operability of cancer of gall bladder in some cases carrying out a diagnostic laparoscopy is shown.
Cancer therapy of a gall bladder
Radical cancer therapy of a gall bladder assumes early surgical intervention. At locally-spread cancer of a gall bladder (T1-T2) the simple or expanded holetsistektomiya can serve as adequate volume. In need of removal of bilious channels imposing of a gepatikoyeyunoanastamoz is made. At the T3 stage the volume of surgery will include a holetsistektomiya, a resection of the right share of a liver, according to indications - a pankreatoduodenektomiya.
In case of inoperable cancer of a gall bladder the palliative interventions directed to reduction of jaundice are carried out. They can include a rekanalization of channels (endoscopic stenting), imposing of holetsistodigestivny anastomoz, imposing of external bilious fistula by a chrespechenochny puncture, etc. After surgical interventions, and also at nerezektabelny cancer of a gall bladder also the chemotherapy is applied beam.
Forecast and prevention of cancer of gall bladder
The remote forecast at cancer of a gall bladder in general is adverse as the disease is in most cases diagnosed late enough. The failure is observed at identification of the remote metastasises, impossibility of radical removal of a tumor. Results of survival after radical interventions are contradictory: there are 12-40% of patients given about 5-year survival.
Prevention of cancer of gall bladder is elimination and weakening of action of risk factors: timely treatment of ZhKB, refusal of unhealthy habits and food, sufficient physical activity, maintenance of optimum weight, etc.
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