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6 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Adenocarcinoma is the usual form of gallbladder cancer, about nine in ten cases, starting in the mucus-making gland cells of the lining. Everything on the main gallbladder cancer page (causes, staging, surgery, chemotherapy with immunotherapy) is written about this type unless it says otherwise.
Adenocarcinoma of the gallbladder arises from the glandular epithelium of the mucosa, usually on a background of chronic cholecystitis and gallstones, and in the WHO classification (5th edition, 2019) is subdivided by pattern: the common biliary (pancreatobiliary) type, intestinal type, gastric foveolar, mucinous, signet-ring, clear cell, hepatoid and other rare patterns (Nagtegaal 2020; Roa 2022). Cancer Research UK uses a simpler split into non-papillary, papillary and mucinous adenocarcinoma. In the largest pathology series conventional pancreatobiliary-type adenocarcinomas had a female to male ratio of 3.9 and a mean size of 2.9 cm (Dursun 2012, in which they were the comparator for mucinous carcinoma). Grade (1 well, 2 moderate, 3 poorly differentiated), depth of invasion (T category), the T2a or T2b side, lymphovascular and perineural invasion, node number and the cystic duct margin are the pathological findings that drive treatment (CRUK stages and grades; Shindoh 2015; Aloia 2015).
Because adenocarcinoma is the type every guideline and trial assumes, its management is the main page's: simple cholecystectomy suffices for Tis and T1a, radical cholecystectomy from T1b, adjuvant capecitabine after resection (BILCAP), and gemcitabine and cisplatin with durvalumab or pembrolizumab for advanced disease (TOPAZ-1, KEYNOTE-966), with HER2-directed therapy for the HER2-positive subset. The mucinous, papillary, adenosquamous and neuroendocrine pages describe how the rarer types differ.
| Setting | Approach | Guideline |
|---|---|---|
| Resectable disease | Simple cholecystectomy for Tis and T1a; radical cholecystectomy with liver bed and portal lymphadenectomy from T1b; adjuvant capecitabine (BILCAP). | not mapped |
| Advanced disease | Gemcitabine and cisplatin with durvalumab or pembrolizumab; zanidatamab for HER2-positive disease after chemotherapy. | not mapped |