Diagnostic and management issues in gallbladder carcinoma

Carcinoma of the gallbladder is a rare malignancy, with an incidence rate in the United States of 2.2 to 4.4 per 100,000 persons. Its clinical presentation is nonspecific, and the majority of patients have advanced disease at presentation. The diagnosis is rarely made preoperatively. About 90% of gallbladder cancers are adenocarcinomas. Surgical treatment is curative for lesions localized to the mucosa and submucosa, but these represent only about 16% of all gallbladder carcinomas. The role of radical surgery with node dissection and liver resection is controversial. Chemotherapy and radiation therapy do not have a major role in the treatment of gallbladder carcinoma. The prognosis is very poor, with a 5-year survival rate of less than 5%.