Gall bladder cancer: a review

Introduction: Gall bladder cancer is the most aggressive cancer and the commonest malignant tumor of the biliary tract worldwide.The incidence increases with age and women are more commonly affected. Surgical resection is the only chance for complete cure,however only 10% of patients are candidates for curative surgery at initial presentation.Objective: To review the current concepts and key issues in the diagnosis and management of gallbladder cancer.Methodology: A systematic review of published literature was done using search Google Search Engine, Highwire press and Springer Link selected papers were taken and books from author's collection used for further reference.Results: The risk factors of gallbladder cancer include race (like India), cholelithiasis,polyps, pancreatico-biliary maljunction anomalies, chronic inflammation, exposures to heavy metals and chemicals and infections (e.g. liver flukes). It may present as mass lesion, localized wall thickening or polypoid growth. Adenocarcinoma is the commonest histological type.The clinical presentation is divided into 5 syndromes namely acute cholecystitis, chronic cholecystitis, biliary tract disease, non specific symptomatology and symptoms related to metastatic disease.Complete surgical treatment is the only curative treatment for gallbladder cancer but only a few cases are seen at this curative stage.Conclusion: Gallbladder cancer is relatively uncommon with high mortality rate. Risk factors include advance age, female gender, cholelithiasis, porcelain gallbladder, gallbladder polyps, congenital biliary cysts, chronic infection and smoking.Most are discovered incidentally at routine cholecystectomy or present at advance stage of the disease. Surgery is the only curative therapy for gallbladder cancer and the extent is dependent on the TNM stage. However, at diagnosis, only 10% of patients are candidates for curative surgery.Keywords: Gallbladder, Cance

The practice of hepatocellular cancer surveillance in Nigeria

Background: Hepatocellular cancer is a disease of global and public health importance due to the widespread distribution of risk factors and associated high case fatality. Hepatocellular Cancer (HCC) in Sub-Saharan Africa is commonly seen among the younger age groups (<45 years) who present mostly in the terminal stage, when the disease is not amenable to any curative therapy. Hepatocellular Carcinoma surveillance employs the use of simple, cheap and readily available investigations, to detect early curable cancer in individuals with risk factors for HCC.Objectives:The aim of this study is to assess the practice of hepatocellular cancer screening among physicians.Methodolgy:This is a nationwide online survey carried out among physicians who care for patients with HCC. A questionnaire was sent out via a web link to all consenting doctors in Nigeria. The responses were collated in a cloud-based application and data was analysed using Epi-info version 20.Results:Atotal of 218 respondents, 142 were males (65.1 %) with a mean age of 37.6 ± 5.7 years. The modal age group was 31-40 years 153 (69.5%). The main factors considered as a hindrance to surveillance were; the cost of the tests (57.7%), failure of return of patients (50.5%) and not being aware of a surveillance program (45.2 %). The majority of the respondents were Gastroenterologists and Family Physicians. 54% of the gastroenterologists and 64% of the family physicians have never offered HCC surveillance to their patients.Conclusion:This survey highlights a knowledge gap in HCC surveillance among physicians. There is a need to make HCCsurveillance a daily routine among patients at risk by all physicians. Keywords: Surveillance, Hepatocellular Carcinoma, HBV, HCV, Cancer screening