STUDY OF GALLBLADDER CANCER & IDENTIFICATION OF ITS RISK FACTORS AMONG THE PATIENTS WITH CHOLELITHIASIS-A MULTICENTRE STUDY IN NORTH BENGAL

Dr. Md. Zahangir Alam*, Dr. Most. Fatema Khatun, Dr. Md. Bani Amin, Dr. Milan Kumar Saha, Dr. Shamima Hamid and Dr. Md. Samsuzzaman Khan

ABSTRACT

Background: The etiology of cholesterol gallstones is multifactorial, with interactions of genes and the environment. Risk factors for gallbladder cancer (GBC) except gallstones are not well known. Gallbladder cancer is usually associated with gallstone disease, late diagnosis, unsatisfactory treatment, and poor prognosis Objective: The study is aimed at finding out the prevalence of gallbladder cancer & identification of its risk factors among patients with cholelithiasis admitted in tertiary level hospitals of North Bengal. Methods: This was descriptive type of cross-sectional study. This study was carried out in the department of surgery of Rajshahi Medical College Hospital, Rajshahi from January 2013 to June 2013. The patients with inclusion criteria admitted in tertiary level hospitals of North Bengal. Data was collected from the patients with inclusion criteria of different tertiary Level Hospitals in North Bengal. Different doctors were selected as a data collector for the different hospitals. At first principal investigator was explained the procedure of data collection to data collectors. Then the data collectors were arranged all the information of the patients to fulfill the objectives of the study through a structured questionnaire by face to face formal interview and from patient’s record sheets. The principle investigator was monitored the procedure of data collection of the study. Result: The mean age was found 45.3±15.0 years with range from 9 to 85 years. Majority (74.0%) patients were female and 286(95.3%) were married. Abdominal pain, nausia, vomiting and abdominal discomfort were more common (58.0%) complaints of the patients. More than one fourth 80(26.7%) patients had over weight and 70(23.3%) were obese. Majority (93.3%) patients were found in normal temperature, 9(3.0%) jaundice and 6(2.0%) patients had lymphadenopathy. During abdominal examination 174(58.0%) had tenderness, 4(1.3%) abdominal lump/ palpable mass, 78(26.0%) Murphy's sign, 3(1.0%) ascites and 8(2.7%) underwent digital rectal examination. Almost all (99.7%) patients were operated and more common indication was chronic calculus cholecystitis 215(71.7%) and 299(99.7%) biopsy send for histopathological examination. Malignancy found in 8(2.7%) of the study patients, among them half (50.0%) of the patients belonged to age >60 years followed by 5(62.5%) patients were female. Almost two third 5(62.5%) patients had obesity, 2(25.0%) patients had salmonella infection of GB, 5(62.5%) chronic inflammation of GB, 1(12.5%) polyp within GB and 2(25.0%) immunized. All patients had adenocarcinoma in histopatholgy. In malignant cases, 5(62.5%) patients were found in tumour stage 1, 2(25.0%) stage 2 and 1(12.5%) stage 0. One third 6(75.0%) patients were found in tumour grade 1 and 2(25%) in grade 2. Regarding the association between risk factor with malignant and without malignant group Obesity, infection of GB, inflammation of GB, suspicious pathology within GB, immunization status, fertility, under hormonal contraceptives and ≥ 5 number of pregnancy were significantly (p<0.05) higher in malignant group. Conclusion: There is a statistical or indirect association between the risk factors and development of GBC among the patients with cholelithiasis.

Keywords: Gallbladder Cancer, cholelithiasis, surveillance.