My uncle is 55 years old and is suffering from carcinoma in gallbladder with asymmetric cell development leading to the mouth of the pancreas. The CECT scan report says that G.B. is slightly distended. Gross asymmetrical wall thickening is seen mainly in the fundus of the gallbladder extending up to the neck forming a soft tissue mass. This mass shows poor heterogeneous enhancement and appears to invade the adjacent liver parenchyma. Radioopaque calculus is seen in the GB lumen. This ill-defined mass is seen extending from the neck of gallbladder along the cystic duct into the CBD. Hereby, compressing the CBD, the mass has extended beyond the porta hepatitis to encircle the main portal vein and the common hepatic artery and it is possibly invading adjacent head of the pancreas. The proximal CBD is dilated and mid-CBD is constricted due to the extension of the GB mass. The main portal vein and the common hepatic artery is encircled by the gallbladder mass. The liver is mildly enlarged. Ill-defined poorly enhancing hypodense lesions are seen in the liver adjacent to the GB fossa. Under this circumstance, kindly advice the way out and give your valuable feedback as early as possible so that we can take necessary steps from this end.
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I have gone through reports (attachment removed to protect patient identity) and history above. Based on which looks like he has metastatic carcinoma gallbladder (stage IV). In general, overall survival in such cases is about six months without chemotherapy and with chemotherapy, it can be extended up to one year. As the disease has spread to the liver and it is encasing, portal vein surgery is not an option.
Further plan will depend on how good is his general condition. As the disease is also blocking cystic duct, his bilirubin is increasing and chemotherapy is not possible with rising bilirubin. First step is to decrease bilirubin to normal for which he will require ERCP (endoscopic retrograde cholangiopancreatography) with stenting or PTBD (percutaneous transhepatic biliary drainage. I would prefer ERCP with stenting if possible as it is better tolerated by the patient. After that an FNAC (fine needle aspiration cytology) from gall bladder mass to confirm cancer is advisable. Then he can be started on chemotherapy to keep the disease under check. Meanwhile, he should continue with pain medication and supportive care.
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