Malignant Diseases of the Gallbladder and Bile Ducts

Malignant diseases of the gallbladder and biliary tree are challenging cancers in the elderly, often presenting late with poor prognosis. As surgery affords the only cure for gallbladder and biliary cancer, the appropriate selection of patients who may benefit and application of current and disease-specific surgical procedures are paramount. Gallbladder cancer tends to be either an incidental finding after laparoscopic cholecystectomy or an advanced and metastatic cancer with dismal outlook. Gallbladder polyps and porcelain gallbladder are two particular conditions that warrant attention because of malignant risk. Cholangiocarcinomas include intrahepatic tumors, treated akin to primary hepatic malignancy; Klatskin tumors at or near the bifurcation which require special consideration; and distal bile duct tumors which act as periampullary cancer. Management of each will be elucidated with detailed attention to diagnostic work up and discriminatory testing to guide treatment decisions for the clinician.