From the Guidelines
Gallbladder cancer typically presents histopathologically as adenocarcinoma, which accounts for 85-90% of cases, characterized by malignant glandular structures, cellular atypia, and invasion through the gallbladder wall. The most common histopathological types of gallbladder cancer include:
- Adenocarcinoma
- Squamous cell carcinoma
- Adenosquamous carcinoma
- Small cell carcinoma
- Neuroendocrine tumors The treatment of gallbladder cancer depends on the stage at diagnosis, with simple cholecystectomy being sufficient for early-stage disease (T1a) and radical cholecystectomy with regional lymphadenectomy and possible liver resection recommended for more advanced disease (T1b and beyond) 1. For unresectable or metastatic disease, systemic chemotherapy with gemcitabine plus cisplatin is a standard first-line regimen, with alternative regimens including gemcitabine plus oxaliplatin or 5-fluorouracil-based combinations 1. It's worth noting that the prognosis remains poor, with 5-year survival rates of 5-15% overall, highlighting the importance of early detection and aggressive surgical management when possible 1. In terms of diagnosis, a combination of imaging studies such as US, MDCT, and MRCP, as well as histological diagnosis through ERCP, PTC, or EUS, are used to stage the disease and determine potential treatment options 1. A multidisciplinary team of experts, including experienced radiologists and surgeons, should review examination results to stage the disease and determine potential treatment options 1.
From the Research
Histopathology of Gallbladder Cancer
- The most common histological type of gallbladder cancer is adenocarcinoma (AC) 2
- Other rare histologic variants of gallbladder cancer include squamous cell carcinoma (SCC), adenosquamous carcinoma (ASC), and papillary carcinoma (PC) 2
- Adenocarcinoma accounts for approximately 90.6% of gallbladder cancer cases, while papillary carcinoma, adenosquamous carcinoma, and squamous cell carcinoma account for 3.8%, 3.6%, and 1.9% of cases, respectively 2
Treatment of Gallbladder Cancer
- Combination therapy with gemcitabine and cisplatin (GEMCIS) is a commonly used treatment for advanced gallbladder cancer 3, 4, 5, 6
- The addition of durvalumab to gemcitabine and cisplatin has shown promise in treating advanced gallbladder cancer 5, 6
- Maintenance therapy with capecitabine or S-1 after first-line treatment may be a reasonable option for patients with advanced gallbladder cancer 3
- Surgical resection is often performed in patients with early-stage gallbladder cancer, while systemic therapy is administered in patients with advanced disease 2
- The disease control rate for gemcitabine and cisplatin therapy in unresectable gallbladder cancer is approximately 59.5% 4