Epidemiological Study of Gallbladder Cancer Patients from North Indian Gangetic Planes--a High-Volume Centre's Experience.

Abstract

Gallbladder carcinoma (GBC) is characterized by a dismal prognosis owing to the paucity of early signs and symptoms. North India reports high incidence of GBC possibly due to environmental, dietary and reproductive factors. Understanding the epidemiology of gallbladder cancer has and will continue to provide valuable insights into determining causes and risk factors for gallbladder cancer. Prospective study of gallbladder carcinoma patients, presenting in our department, was undertaken over three year period to evaluate the epidemiological profile of gallbladder carcinoma patients from our region. The peak incidence of GBC was in 31-50 years age group (58 %). Male to female ratio was 1:4.83, with mean age for females (mean 49.1 years) significantly lower than male counterpart (mean 54.9 years) (p value = 0.000423). Majority of patients were non-vegetarians (67%) and 84% of them consumed mustard oil (home made/loose packed) as predominant cooking medium. Majority of the patients of GBC in our study were from low socioeconomic strata (68%) (Kuppuswamy classes IV, V (lower class)). GBC was more commonly seen in females with the age of menarche less than 14 years (83%) and the age of the first child birth less than 20 years (56%). Females with more than two children had higher incidence (57%). Majority of the female patients (71%) were postmenopausal. Gallstones were present in 390 out of 490 patients (80%). Incidental gallbladder carcinoma was detected in 158 out of 490 patients (32%). Pain abdomen was the most common presenting complaint (98%). Significant proportion of the patients with GBC presented with distant metastasis (stage IVB) (52%). The most common histological subtype was adenocarcinoma (78%). Current data suggest that the epidemiology of gallbladder cancer is constantly evolving, with much of this change caused by lifestyle, cultural and dietary factors. Balanced diet, prevention of malnutrition/adulteration, tobacco prevention and early intervention for cholelithiasis may help in decreasing the incidence of this dreaded disease. More structured studies need to be carried out to ascertain risk factors for GBC in our population subgroup.