Gallbladder and Biliary Duct Biliary System Cancer

The Gallstone Elimination Report

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DRG Category: 203

Mean LOS: 6.3 days

Description: MEDICAL: Malignancy of

DRG Category: 197 Mean LOS: 8.1 days

Description: SURGICAL: Cholecystectomy except

Hepatobiliary System or Pancreas by Laparoscope without C.D.E. with CC

DRG Category: 195

Mean LOS: 9.7 days

Description: SURGICAL: Cholecystectomy with

Gallbladder cancer and biliary duct cancer are relatively rare and account for fewer than 1% of all cancers. In 2005, over 3200 cases will be diagnosed and almost 2000 people will die of this cancer. Gallbladder cancer occurs five times more often in Native Americans than in whites and is more common in white females than in African American females. Most cancers of the gallbladder and biliary tract are inoperable at the time of diagnosis. If the cancer has been found incidentally at the time of a cholecystectomy, longer survival may be possible. More than 75% of gallbladder cancers are nonpapillary adenocarcinomas and approximately 6% are papillary adenocarcinomas; a small number are squamous cell, adenosquamous cell, mucinous, or small cell carcinomas. Papillary cancers have a better prognosis and grow along the connective tissue and blood vessels; they are not as likely to metastasize to the liver and lymph nodes. Adenocar-cinomas occur most frequently at the bifurcation in the common bile duct.

Biliary system cancer is insidious and metastasizes via the lymphatic and blood systems and by direct extension to the liver, pancreas, stomach, and duodenum. Invasion of the gastrointestinal (GI) tract can cause complete obstruction of the extrahepatic bile ducts with intrahepatic biliary dilation and enlargement of the liver. If the tumor is restricted to one hepatic duct, biliary obstruction is incomplete and jaundice may not be present. Inflammatory disorders such as cholangitis (bile duct inflammation) and peritonitis often obscure an underlying malignancy. Infection often accompanies cancer of the gallbladder, and bile duct cancers are associated with ulcerative colitis. In most patients with gallbladder and biliary cancer, the disease progresses rapidly and patients usually survive little more than a year after diagnosis.

The cause of biliary system cancer is unknown, although a possibility is gallstones. When gallstones are present, bile is released more slowly. If the bile contains carcinogens, the gallbladder tissue is exposed to these carcinogens for a longer period of time. Approximately 1% of all cholecystectomy specimens are found to be cancerous. Because of the risk of cancer, even for asymptomatic cholelithiasis, a cholecystectomy is recommended. Primary carcinoma of the gallbladder is rare and is usually associated with cholecystitis. Most biliary cancer is from metastasis, commonly from the head of the pancreas.

Familial clustering is apparent in both of these cancers. It is suggested that genetic factors are important, but are likely to be modified by environment.

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