Ruhi Dixit

Gall bladder carcinoma: Aggressive malignancy with protean loco-regional and distant spread

The most common malignancy of biliary tract is gallbladder cancer (GBC) which is the third most common cancer in gastrointestinal tract. It is a lethal disease for most patients in spite of growing awareness and improved diagnostic techniques. GBC has a very poor prognosis and the 5 year survival rate is < 10%. Although etiology of the carcinoma of the gallbladder is still obscure, various factors have been implicated, cholelithiasis being the most frequent. The incidence of GBC worldwide is based on the gender, geography and ethnicity which suggest that both genetic and environmental factors can cause GBC. The major route of spread of gallbladder cancer (GC) is loco-regional rather than distant. It spreads by lymphatic, vascular, neural, intraperitoneal, and intraductal routes. Sonography is usually the most common imaging test to evaluate symptoms of biliary tract disease including suspected GC. With recent advances in imaging modalities like multi-detector computed tomography (CT) scanners, magnetic resonance imaging-positron emission tomography/CT diagnosis of gallbladder cancer has improved. Studies have also targeted molecular and genetic pathways. Treatment options have included extended and radical surgeries and adjuvant chemotherapy. This review article deals in detail with important aspects of carcinoma gallbladder and its manifestations and challenges. Role of various imaging modalities in characterization and accurate staging has been discussed. The loco-regional spread of this aggressive malignancy is dealt explicitly.

Association of Methylenetetrahydrafolate Reductase Gene Polymorphism (MTHFR) in Patients with Gallbladder Cancer

Purpose5,10-Methylenetetrahydrofolate reductase (MTHFR) is a key enzyme in folate metabolism and plays a major role in DNA methylation. There are two popular MTHFR polymorphisms known as C677T and A1298C which are found to be involved in folate metabolism and lowering the enzyme activity, thus may be linked with cancer development. This study aims to look at the association of these polymorphisms in gallbladder cancer.MethodsThirty patients each with gallbladder cancer, cholelithiasis, and normal gallbladder were genotyped for the above-given polymorphisms by PCR-restriction fragment length polymorphism (RFLP) method.ResultsC677T MTHFR polymorphism was not associated (χ2 = 2.44, p = 0.85) with an increased likelihood of having gallbladder cancer. A1298C was significantly associated (χ2 = 28.87, p < 0.001) with risk of developing gallbladder cancer. A1298C was significantly correlated with grade (r = 0.337, p < 0.001) and histopathology (r = 0.446, p < 0.001).ConclusionThis study proposed that MTHFR A1298C polymorphism may be associated with risk of developing gallbladder cancer, and there is no association between C677T polymorphism and gallbladder cancer.

Why Is Gallbladder Cancer Common in the Gangetic Belt

Carcinoma of the gallbladder (CaGB) is the commonest malignancy of the biliary tract. There is wide variation in the incidence of carcinoma of the gallbladder in India ranging from 1.2 per 100,000 for males and 0.9 per 100,000 for females in southern India to 4.5 per 100,000 males and 10.6 per 100,000 females in northern India. The incidence is highest in eastern Uttar Pradesh and western Bihar regions of India. This wide geographical variation in the incidence of carcinoma of the gallbladder suggests that environmental factors might be playing an important role in its causation. Both these regions lie downstream of the river Ganges which is the main source of water for all uses such as drinking water and for irrigation. The river Ganges receives an extremely high load of pollutants in the form of untreated domestic sewage, industrial and agricultural effluents containing aromatic hydrocarbons, nitrosamines and chemicals such as nitrates and nitrites which are by-products from domestic sewage. Pesticides which are frequently used in agricultural industry can also play a role in CaGB. Typhoid infection is prevalent in this region which may also be associated with the gallbladder carcinogenesis. Lifestyle and smoking have also been correlated with the CaGB. Adulteration in our cooking oil (mustard) by sanguinarine and diethylnitrosamine has also been found to be linked with CaGB. It is possible that carcinoma of the gallbladder is the disease of multifactorial etiology.