gallbladder and bile duct tumours

Introduction

gallbladder cancers are rare and often diagnosed late with poor prognoses
bile duct cancers (cholangiocarcinomas) are often small, difficult to reach and surrounded by inflammation or scar tissue, standard biopsy and cytology methods often fail to give clear diagnosis hence new biomarkers such as BiliSeq have been developed to improve diagnosis sensitivity from below 50% to over 80%

in Victoria in 2023, gallbladder cancer was diagnosed at a rate of 3.8 per 100,000 males and 3.1 per 100,000 females with median age at diagnosis of gallbladder cancer is 72 years in males and 74 in females, accounting for 0.7% of all cancers diagnosed and 1.8% of all cancer-related deaths - only 3 of these were Dx at age under 40yrs ¹⁾

said to be female HOWEVER, in 2023, 294 Victorians were diagnosed with gallbladder cancer, of these, there were 152 males and 142 females
age > 65 (average age at Dx is 72 yrs)
cholelithiasis (gallstones)
gallbladder polyps
chronic cholecystitis
chronic Salmonella typhi (typhoid enteric fever) infection
porcelain gallbladder
primary sclerosing cholangitis / primary biliary cirrhosis
choledochal cysts
obesity
possibly smoking and industrial chemical exposures
there is no strong evidence that pregnancy independently makes gallbladder cancer biologically more aggressive in a predictable way, or that it consistently speeds tumor growth, but pregenancy does increase the risk of gallstones and generally will delay surgical management of these until post-partum and this could delay Dx.

age > 50yrs
smoking
primary sclerosing cholangitis / primary biliary cirrhosis
chronic biliary inflammation / bile‑duct stasis - cholelithiasis (gallstones), chronic cholecystitis
chronic bacterial cholangitis
Fasciola (liver flukes) infection: Opisthorchis viverrini and Clonorchis sinensis infestations in Southeast Asia
congenital biliary cysts - choledochal cysts, Caroli disease, and polycystic liver disease cause structurally abnormal, dilated ducts prone to stone formation and chronic inflammation
chronic hepatitis C virus/hepatitis B virus, cirrhosis
steatohepatitis (fatty liver) / obesity
alcoholic cirrhosis
familial syndromes (e.g., Lynch syndrome, cystic fibrosis), inflammatory bowel disease (IBD)
HIV / AIDS
industrial solvents like dichloromethane

diagnosis is often late (only 20% are diagnosed early) as it mimics gallbladder disease and may only be diagnosed after cholecystectomy for biliary diease
raised CEA and CA 19-9 levels may suggest this diagnosis but is not specific
ultrasound + CT or MRI may detect a mass
MRCP
laparoscopy

5-year survival rate for localized gallbladder cancer which can be resected surgically is 66%
5-year survival rate for metastatic disease is 2%

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