Cholelithiasis and Incidence of Carcinoma Gall Bladder

Abstract

An association between Cholelithiasis and Carcinoma of the Gall Bladder has long been recognized but the reported Incidence varies. A common opinion appears to be that the Cancer is the result of prolonged irritation be calculi and the primary object of this paper is to review such an opinion in the light of the work done by the author as an alarmingly high Incidence of Carcinoma Gall Bladder has been found in the female population of Punjab. Gall Bladder disease is a common problem amongst women attending the Surgical Out-patient Department of General Hospitals of Lahore. They come mostly when the disease has been present for a number of years and has reached a chronic stage or they present as Surgical Emergencies, where Emergency surgery has to be performed and requires meticulous pre and post operative care. Why they do not come at an early stage? The answer probably lies in the socio economic problems, Socio taboos and an unfounded fear of going in for Hospitalization. Quite a large number get admitted and then at the merest mention of an operation leave against medical advice. So the number getting treatment is really limited. But the one thing which has been obvious over the years is a very high incidence of Malignancy of Gall Bladder and that is the basis of this study. Gall Bladder disease patients can present as Acute or Chronic Cholecystitis, s complications of Cholelithiasis or just Cholelithiasis discover incidentally or as Malignancy which is generally far advanced and where nothing ca be done even for palliative purposes. Either Liver secondaries or wide local involvement is present. One thing seen constantly by us in our study and seen by other research workers abroad is that Cholelithiasis and Malignancy of Gall Bladder are invariably associated. It is observed in our study that all Carcinoma cases were females and all had stones in the Gall Bladder. Cholecystitis and cholelithiasis occurs in women mostly and affects males less often. This study was conducted between January 1981 to December 1983.