Author/Editor		Trotovšek, Blaž; Sojar, Valentin; Stanisavljevič, Dragan; Tomažič, Aleš
Title		Rak žolčnika
Translated title		Gallbladder carcinoma
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 72, št. Suppl 1
Publication year		2003
Volume		str. I-37-9
Language		slo
Abstract		Background. Carcinoma of the gallbladder is a tumour with a dismal prognosis and 5 years overall survival rate less than 5%. Among the tumours of the gastrointestinal tract it is fifth in the row and its incidence is approximately 1.2/105. Tumour occurs more often (2-6 times) in women and in people over 50 years old (90%). According to the Slovenian Registry of Cancer fory ear 1998 the incidence of gallbladder carcinoma was 2.7/105 and it occurred 4 times more often among women. The most important risk factors for development of gallbladder carcinoma are: bile stones, chronic inflammation and polyps of the gallbladder. Carcinoma of the gallbladder develops in only 2-3% of the patients with bile stones. When discovered, carcinoma has already invaded the liver in 60%, regional lymph nodes in 45% and the other surrounding organs in 40%. Carcinoma is at time of diagnosis already disseminated in distant organs in 20%. Only in 10% of the patients it is confined to the gallbladder wall. Before the routine use of the ultrasound, computed tomography and tumour markers the disease was discovered preoperatively in 10% versus 90% today. Diagnostic percutaneous biopsy is not recommended. TNM classification and staging of the disease is important for the decision of the modality of treatment. Conclusions. For TNM stage I gallbladder carcinoma, simple cholecystectomy is sufficient When stage II-Na is discovered, "en block" resection of gallbladder, liver segments 4b and 5, common bile duct and thorough lymphadenectomy is recommended. Regional radiotherapy and intraarterial chemotherapy with Mitomycin-C are showing promising results. Longterm outcome in patients with gallbladder carcinoma is improving but it is still disappointing.
Summary		Izhodišča. Rak žolčnika je tumor s slabo prognozo. Opisano 5-letno prežive je je večinoma pod 5%. Je peti najpogostejši tumor prebavne cevi (1.2/105). Tumor je pogostejši pri ženskah (2-6:1) in starejših od 50 let (90%). Po podatkih Registra raka R Slovenije za leto 1998 je bila incidenca v Sloveniji 2,7/105 in razmerje med ženskami in moškmi 4:1 Med pogostejše dejavnike tveganja prištevamo žolčne kamne, kronično vnetje žolčnika in polipe žolčnika. Karcinom se pojavi le pri 2-3% bolnikov z žolčnimi kamni. Ob odkritju bolezni je rak že razširjen v jetra (60%), področne bezgavke (45%), druge organe v bližini (40%). Zasevke v drugih organih odkrijemo pri 20% bolnikov, le pri desetini bolnikov je bolezen omejena na steno žolčnika. Pred rutinsko uporabo ultrazvoka, CT in tumorskih markerjev je bila bolezen pred operacijo odkrita le v 20%. Danes jo odkrijemo v 90%. Z ozirom na velikost tumorja, prizadetost bezgavk in odda jene zasevke bolnike razvrstimo v stadije bolezni po klasifikaciji TNM. Zaključki. Za uspešno zdravljenje raka žolčnika stadija I zadošča odstranitev žolčnika, za stadij II-IVa je nujna resekcija 4b in 5. segmenta jeter, resekcija skupnega žolčevoda ter odstranitev bezgavk. Regionalna radioterapija in intraarterijska kemoterapija z mitomycinom sta pokazali obetavne rezultate. Rezultati zdravljenja napredovalega karcinoma žolčnika so slabi.
Descriptors		GALLBLADDER NEOPLASMS NEOPLASM STAGING TREATMENT OUTCOME