Malignant tumours of gallbladder and extrahepatic bile ducts

Biliary tract neoplasms are divided into cancers of the gallbladder (GB) and intrahepatic and extrahepatic bile ducts (EBD). GB and EBD tumours are closely related, although they show marked differences in epidemiology, aetiology and clinical presentation. GB neoplasms are uncommon in North America but endemic in South America and Asia, whereas EBD tumours show no geographic predilection. Both gallbladder cancer (GBC) and extrahepatic bile duct cancer (EBDC) present at an advanced stage, and are associated with an aggressive course and poor prognosis. These tumours occur primarily in older patients and are strongly associated with chronic inflammation of the biliary epithelium. GBC is more common in women while EBDC is slightly more common in men. Over 90% are carcinomas, usually of the pancreaticobiliary type. Histologic grade, histologic type and stage of disease are useful prognostic indicators. Compared with other histologic variants, papillary carcinomas at both sites have a more favourable prognosis. Despite the common embryologic and histologic features of the bile duct and gallbladder, the natural history and management of cancer arising from these structures have both similarities and major differences.