Gallbladder Carcinoma

Gallbladder carcinoma is a rare malignancy but represents almost 50% of all biliary tract cancer. Most tumors are adenocarcinomas, with squamous, adenosquamous, and neuroendocrine tumors being less common. Gallbladder neoplasms are more prevalent in women, with marked geographic variation in incidence. Most gallbladder tumors arise from the mucosal lining as the gallbladder lacks a submucosal layer and subsequently spread through the thin muscularis early in the disease course. Early symptoms may be similar to biliary colic or cholecystitis and might account for the late stage of diagnosis associated with this cancer. Consequently, tumors are often nonresectable at diagnosis.

Surgical resection is the treatment of choice, and not infrequently, a focus of early-stage carcinoma may be incidentally detected in patients undergoing cholecystectomy. In contrast to other biliary carcinomas, gallbladder carcinoma is associated with a higher rate of distant metastatic disease and may derive more benefit from chemotherapy. Chemotherapy is used in the adjuvant setting and palliative care. The overall prognosis is poor, with 5-year survival rates of <20%. Recent advances in studying the genetic drivers and molecular profile of these tumors have heralded the use of targeted agents, hopefully improving the prognosis of this disease.