Appointment sheet
Carcinoma in situ and dysplasia of the gallbladder
Prepared with OnCo (onco.cc/prep/gallbladder-carcinoma-in-situ-and-dysplasia/). Orientation, not medical advice; your team knows your case.
My details
Name
Date of appointment
Hospital and clinician
Who is coming with me
What I know, what is unclear, changes to discuss
Saved in this browserWhat I know so far
What is unclear to me
Changes since last time
My questions
9 on the sheetNewly diagnosed
- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example Grade of dysplasia, Absence of invasion through the basement membraneversus lamina propria invasion, Cystic duct margin status, Rokitansky-Aschoff sinus involvement, Pyloric and intestinal metaplasia in the background mucosa), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
Tis or dysplasia with a clear cystic duct margin
- 5.For my situation (tis or dysplasia with a clear cystic duct margin), which of the standard options do you recommend and why?
Positive cystic duct margin or Rokitansky-Aschoff sinus involvement
- 6.For my situation (positive cystic duct margin or rokitansky-aschoff sinus involvement), which of the standard options do you recommend and why?
Gallbladder polyp in primary sclerosing cholangitis
- 7.For my situation (gallbladder polyp in primary sclerosing cholangitis), which of the standard options do you recommend and why?
Any stage
- 8.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 9.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
The words I may hear
- Gallbladder polyp (polypoid lesion): A small growth on the inside wall of the gallbladder, usually spotted by chance on an ultrasound scan.
- Rokitansky-Aschoff sinus: Tiny pouches where the gallbladder lining pushes down into the muscle wall, common in gallbladders damaged by stones and inflammation.
- Dysplasia (pre-cancerous change): Abnormal-looking cells in a surface lining that are not yet cancer but are on the way.
- Cystic duct margin: The cut end of the short duct that joined the gallbladder to the main bile duct, examined by the pathologist after a gallbladder is removed.
- Simple cholecystectomy: The standard operation to remove the gallbladder, almost always by keyhole surgery for gallstones.
- Radical (extended) cholecystectomy: The cancer operation for gallbladder cancer: the gallbladder (if still present) is removed together with a rim of the liver it sits against and the lymph nodes along the bile duct and liver blood vessels.
- Carcinoma in situ (CIS): Cancer cells that fill the lining layer where they started but have not broken through the basement membrane into the tissue beneath.
Tests and results to bring
Biomarker results to ask for: Grade of dysplasia (low or high), Absence of invasion through the basement membrane (Tis) versus lamina propria invasion (T1a), Cystic duct margin status, Rokitansky-Aschoff sinus involvement, Pyloric and intestinal metaplasia in the background mucosa.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Tis or dysplasia with a clear cystic duct margin: No further surgery; follow-up because occasional late recurrences reflect a field effect. (Simple cholecystectomy, Cystic duct margin)
- Positive cystic duct margin or Rokitansky-Aschoff sinus involvement: Consider bile duct margin re-excision or further surgery at a hepatobiliary centre. (Cystic duct margin, Rokitansky-Aschoff sinus, Radical (extended) cholecystectomy)
- Gallbladder polyp in primary sclerosing cholangitis: Cholecystectomy advised for polyps of any size by international guidelines; a 2020 cohort supports short-interval imaging first when no high-risk feature is present. (Gallbladder polyp (polypoid lesion), Simple cholecystectomy)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.
Answers and next steps
Saved in this browserWhat I was told
Agreed next steps, dates and who to call