Gallbladder Tumors

Benign Tumors

Benign gallbladder tumors, including adenomas, cystadenomas, fibroadenomas, adenomyomas, and hamartomas, are found at cholecystectomy in about 1% of patients. Incidence of benign gallbladder tumors is not higher among the elderly.

Malignant Tumors

In the USA, gallbladder cancer is the fourth most common GI cancer. The mean age at diagnosis is 76. Women are primarily affected, and workers in rubber and automotive plants are at particularly high risk. Adenocarcinoma accounts for 80% of all gallbladder cancers; squamous cell carcinoma and adenoacanthoma account for the remaining 20%. Gallstones are present in 85% of cases.

Symptoms, Signs, and Diagnosis

Symptoms include intermittent, vague pain in the right upper quadrant or epigastrium. In the late stages, weight loss and jaundice develop. Often a firm, tender mass is palpable. Abdominal ultrasound and CT provide visualization of the tumor. Endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography is useful for complete evaluation of the biliary tree.

Prognosis and Treatment

Prognosis is related to tumor stage; the majority of patients present with advanced metastatic disease; the 5-year survival rate is only 5%. Death and dying issues must be addressed.

Radical cholecystectomy is the treatment of choice for localized disease. Radiation therapy and chemotherapy are ineffective. Biliary stenting by endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography may provide limited palliation of a mass that causes obstruction or jaundice.