Gall Bladder Cancer: What Needs to Be Done in India?

Abstract

Gall bladder cancer (GBC), uncommon in the West, is common in north India. The Indian Council of Medical Research (ICMR) Cancer Registry needs to be expanded to include more cities in north India. Whether any specific types of gallstones carry higher risk of GBC needs to be investigated. Natural history of asymptomatic gall stones in a high GBC incidence area needs to be studied. The role of PET scan in staging has to be established. Results of major resections in terms of mortality and survival in Indian settings are awaited. Pathologists need to use a standardized proforma to report GBC. Web based multi-institutional databases need to be generated and a national GBC biobank has to be created. There is an urgent need to establish an Indian GBC Consortium.

Appendices

Appendix 1: GBC Checklist

1.1 Radiologist/Sonologist

Evaluate and report the GB wall for its thickness in every patient with GS; if the GB wall is >3 mm, report it as thick-walled GB (TWGB).

1.2 Clinician

TWGB on US should be further evaluated with contrast-enhanced CT scan.

1.3 Surgeon

Open and examine all GBs removed for GS, subject any suspicious area (mass, nodule, ulcer or thickening) to frozen section, and ask for early histopathology if frozen section is not available.

Send all (even normal looking) GBs for histopathology.

Review all histopathology reports so as not to miss an incidental GBC.

1.4 Pathologist

Inform the surgeon about every incidental GBC (incidental GBC should be treated as a notifiable disease).

1.5 Surgeon

Advise patients with incidental GBC to consult a GI/ HPB/Oncology surgeon as early as possible for possible reoperation for completion extended cholecystectomy (incidental GBC should be treated as a semi-emergency).

Appendix 2: Biobank

GBC offers a unique variety of controls, viz., patients with GBC but without GS, patients with GS (and associated chronic cholecystitis CC and xanthogranulomatous cholecystitis XGC) and patients with normal GB (removed during operations on liver, CBD and pancreas).

All hospitals which agree to be a part of the GBC Consortium should establish and maintain a biobank which should be available for use by the members of the Consortium for any ongoing or future studies.

Blood, plasma, serum, tissue (tumour, adjacent normal part of GB in patients with GBC, normal liver, metastatic lymph nodes, liver metastases, omental or peritoneal metastases), bile, stones, saliva and urine (from patients with GBC); blood, saliva and urine from normal persons (e.g. relatives of patients with GBC).

All samples to be stored in preservative media at −80 °C.

Extraction and storage of DNA from tissue and blood.

All paraffin blocks and FNAC slides of GBC (and adequate number of controls, viz., CC, XGC and normal GB also) to be preserved.

Universal informed consent form for ongoing and any possible future research on the banked biomaterial.