Clinical Presentation and Outcomes of Patients with Biliary Malignancies: the Aga Khan University Experience

Background: Gall bladder cancer (GBC) is a common malignancy in our country; very limited data exist onthis malignancy in Pakistan.
Methods: This is a retrospective analysis of all the admitted patients diagnosedwith GBC or cholangiocarcinoma in between 1st January 1995 to 31st December 2007.
Results: A total of 245patients were admitted with diagnosis of GBC or cholangiocarcinoma. Sixty seven percent were females. Righthypochondrial pain (70.6%) and jaundice (49.8%) were the commonest symptoms, followed by nausea andvomiting (11.8%), weight loss (13%), fever (18.8%), anorexia (9.8%) and ascites (3.3%). Gall stones were seenin 132 (53.9%) patients. Pathological diagnosis was confirmed in 155 (63.2%) patients, adenocarcinoma (94.83%)being the predominant type. Metastasis was seen in 204 (83.3%) patients, with liver and abdominal lymph nodesbeing the frequent sites of metastasis. Most of the patients presented to the surgeons (42.9%) andgastroenterologists (35.9%) at their first visit. Only 89 (26.3%) patients were referred to medical oncologistsand 42 (16.7%) of the patients actually received chemotherapy. The patients who received chemotherapy cisplatinand gemcitabine demonstrated partial responses (40%). Common bile duct stricture was seen in 78 patients andstenting was successful in 73 patients. Fourteen (5.7%) patients are alive to date, one is receiving chemotherapy,and another is alive with advanced disease while 10 patients had incidental diagnosis after surgery. Of all 53.9%of patients have died and 38% are lost to follow up.
Conclusion: Most of the patients with biliary cancerspresent late with advanced disease at our referral tertiary care hospital. Minority of the patients receivedchemotherapy and most of responses were observed with cisplatin and gemcitabine combination or capecitbinebased therapy.