Barriers Leading to Delayed Presentation of Patients with Gallbladder Cancer
Keywords:
Delayed presentation, benign gall bladder disease, gallbladder cancer (GBC).Abstract
Introduction: Gallbladder cancer carries a poor prognosis because early disease is often asymptomatic and many patients are identified only after the tumour has progressed to an advanced, frequently unresectable stage. This study explored factors contributing to delayed recognition of gallbladder cancer, with attention to radiological findings and histopathological features observed in resected gallbladder specimens. The objective of this study is to examine patient-related and diagnostic contributors to delayed detection of gallbladder cancer, particularly socioeconomic barriers and limitations of commonly used investigations.
Methods: A prospective observational study was performed between January 2021 and December 2022 among 42 patients with gallbladder cancer identified on imaging. For patients who underwent surgery, histopathological examination of resected specimens was used to verify malignancy. Information was gathered using a structured questionnaire and analyzed accordingly.
Results: Among the 42 patients, 30 (71.43%) were women. A large proportion lived in rural settings (33, 78.57%), had education below the SSC level (29, 69.05%), and came from low-income households (28, 66.67%). The leading presenting features were abdominal pain (30, 71.43%), jaundice (13, 30.95%), weight loss (9, 21.43%), and abdominal mass (5, 11.90%). On CECT of the abdomen, the most frequent findings included a gallbladder mass (20, 47.62%), hepatic invasion (9, 21.43%), gallstones (6, 14.29%), choledochal cyst (3, 7.14%), enlarged porta hepatis lymph nodes (3, 7.14%), and ascites (1, 2.38%). CA 19-9 was elevated in 24 patients (57.14%). Histopathology demonstrated associations between gallbladder malignancy and gallstones in 6 patients (14.29%), choledochal cyst in 3 (7.14%), and gallbladder polyp in 11 (26.19%).
Conclusion: Delayed identification of gallbladder cancer is likely shaped by a combination of patient and diagnostic factors. Low socioeconomic status, residence in rural areas, and limited educational attainment were prominent barriers, while poor awareness of early symptoms and the limited diagnostic yield of commonly used imaging and tumour markers further contributed to delay. Interventions targeting these modifiable factors may facilitate earlier diagnosis and more timely treatment.
Journal of Surgical Sciences 2024;28(1): 36-41
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