Gallbladder Carcinoma: Epidemiology, Risk Factors and Modes of Presentation in Eastern Part of India
Introduction: Gallbladder cancer is the most common malignant tumour of the biliary tract worldwide and also the most aggressive cancer of the biliary tract with the shortest median survival from the time of diagnosis. Materials and Methods: A descriptive observational study was carried out at R.G. Kar Medical College, Kolkata over a period of one and half years (January 2012 to June 2013) Fifty one diagnosed cases of carcinoma gall bladder (proven either on preoperative/peroperative biopsy or computed tomography or ultrasound guided fine needle aspiration cytology) were included as study subjects. Interview of the study subjects for eliciting socio demographic, reproductive and other risk factors was done. Information on clinical and histological staging was ascertained by review of relevant records/reports as well as clinical examination as and when applicable. Results: Our study revealed that gallbladder cancer has a prominent peak in the 5th decade of life with the mean age of presentation being 58.2 years. Male:female ratio of gallbladder cancer is 1:2.93. Only four patients had a suggestive family history. Most of the patients are from rural Bengal and of poor socioeconomic status. The most prevalent addiction in the affected patients was addiction to tobacco and pan (beetle leaf) Most of the patients were having body mass index below 24, which is in sharp contrast to the available literatures. Significant association between gallstone disease and chronic typhoid infection was found. In female significant association is found with reproductive characteristics. Increased exposure to reproductive hormones by means of increased level of estrogen and progesterone in body as in OCP intake, early age at menarche, late age of first pregnancy, late menopause etc, postmenopausal status are found in majority of female patients. Pain is the most common symptom followed by constitutional symptoms, and most common clinical finding was jaundice followed by lump abdomen. Majority of patients presented at later stage of the disease i.e. in stage IV and stage III with initial raised CA19 9 level. Conclusion: Gall bladder cancer is a very deadly disease with very poor prognosis with most of the cases presenting in advanced stages.