Gallbladder cancer incidence in Gwalior district of India: Five-year trend based on the registry of a regional cancer center

Relationship of Diet and Addiction with Gall Bladder Carcinoma-a Case-Control Study at a Tertiary Health Care Centre, India

Some dietary elements, tobacco use, have long been suspected as risk factors for gall bladder carcinoma. The objective of the study was to describe the dietary pattern of the patients with gall bladder carcinoma and to compare the dietary ingredients, and addiction between the cases and controls. Fifty-six gall bladder carcinoma cases and 56 matched controls were compared for diet and addiction patterns. Fried food, junk food, vanaspati, frozen fish, dried fish, red meat, kheer, milled mustard oil, puffed rice containing urea, chili powder, less water consumption, extra salt, tobacco exposure, betel leaf, and alcohol consumption were significantly related with gall bladder carcinoma. Green tea, sunflower oil, butter, ghee, fish intake more than twice weekly, sea fish, packaged milk, some fruits, and vegetables were found protective. Some dietary elements and addiction are related to gall bladder carcinoma, whereas some food items have a protective role.

Rural-urban disparity in cancer burden and care: findings from an Indian cancer registry

BACKGROUND

Cancer incidence and mortality vary across the globe, with nearly two-thirds of cancer-related deaths occurring in low- and middle-income countries. The rural-urban disparity in socio-demographic, behavioural, and lifestyle-related factors, as well as in access to cancer care, is one of the contributing factors. Population-based cancer registries serve as a measure for understanding the burden of cancer. We aimed to evaluate the rural-urban disparity in cancer burden and care of patients registered by an Indian population-based cancer registry.

METHODS

This study collected data from Varanasi, Uttar Pradesh, India, between 2017 and 2019. Sex and site-specific age-standardised rates for incidence and mortality per 100,000 population were calculated. Rural-urban disparities in cancer incidence and mortality were estimated through rate differences and standardised rate ratios (with 95% confidence intervals). Univariable and multivariable regressions were applied to determine any significant differences in socio-demographic and cancer-related variables according to place of residence (rural/urban). Crude and adjusted odds ratios with 95% confidence intervals were calculated.

RESULTS

6721 cancer patients were registered during the study duration. Urban patients were older and had better literacy and socioeconomic levels, while rural patients had higher odds of having unskilled or semi-skilled professions. Diagnostic and clinical confirmation for cancer was significantly higher in urban patients, while verbal autopsy-based confirmation was higher in rural patients. Rural patients were more likely to receive palliative or alternative systems of medicine, and urban patients had higher chances of treatment completion. Significantly higher incidence and mortality were observed for oral cancer among urban men and for cervical cancer among rural women. Despite the higher incidence of breast cancer in urban women, significantly higher mortality was observed in rural women.

CONCLUSIONS

Low- and middle-income countries are facing dual challenges for cancer control and prevention. Their urban populations experience unhealthy lifestyles, while their rural populations lack healthcare accessibility. The distinctness in cancer burden and pattern calls for a re-evaluation of cancer control strategies that are tailor-made with an understanding of urban-rural disparities. Context-specific interventional programmes targeting risk-factor modifications, cancer awareness, early detection, and accessibility to diagnosis and care are essential.

Worldwide distribution, associated factors, and trends of gallbladder cancer: A global country-level analysis

This study aimed to evaluate the global distribution, associated factors, and epidemiologic trends of gallbladder cancer (GBC) by country, sex, and age groups. The Global Cancer Observatory was interrogated for the disease burden of GBC using age-standardized rates (ASR). The prevalence of different potential risk factors for each country was extracted from Global Health Observatory and their associations with GBC incidence and mortality were examined by linear regression analysis using beta coefficients (β). The Cancer Incidence in Five Continents I-XI and the WHO Mortality database were searched and Average Annual Percent Change (AAPC) was generated from joinpoint regression analysis. The incidence (ASR = 2.3) and mortality (ASR = 1.7) of GBC varied globally in 2018 and were higher in more developed countries and among females. Countries with higher incidence had higher human development index (βmale = 0.37; βfemale = 0.27), gross domestic products (βmale = 0.13) and higher prevalence of current smoking (βfemale = 0.05), overweight (βmale = 0.02), obesity (βmale = 0.03), and hypercholesterolaemia (βmale = 0.07). Similar patterns of associations were also observed for mortality with an additional association found for diabetes (βfemale = 0.07). Although there was an overall decreasing trend in mortality, an increasing trend in incidence was observed among some populations, particularly in males (AAPCs, 8.97 to 1.92) and in younger individuals aged <50 years (AAPCs, 12.02 to 5.66). The incidence of GBC varied between countries and was related to differences in the prevalence of potential risk factors. There was an increasing incidence trend among males and younger individuals. More intensive lifestyle modifications and disease surveillance are recommended for these populations.

Role of Cell Block Technology as an Adjunct to Fine Needle Aspiration in Evaluating as well as Differentiating Liver Lesions

BACKGROUND & OBJECTIVE

Liver lesions are difficult to diagnose and to differentiate primary from metastatic carcinoma, while Biopsy has its limitations. Cell block technology is easily accessible with high diagnostic accuracy. Our aim is 1) To find the role of cell block technology as an alternative to biopsy in identifying liver lesions; 2) To find the efficacy of cell block along with immunohistochemistry (IHC) and ancillary studies in differentiating primary from metastatic lesions; 3) To identify the site of origin of metastatic lesions. This is a descriptive study undertaken in two tertiary care hospitals over a period of three years.

METHODS

Retrospective review of adequate samples from fine needle aspirations from liver lesions under radiological coverage, converted into cell block was done. IHC was applied as needed. Usefulness of cell block preparation was evaluated, and the final diagnosis correlated with the biopsy results.

RESULTS

Analysis of 323 cases found sensitivity of 98.75% and positive predictive value of 99% for all lesions. Sensitivity for metastatic carcinomas was slightly more than hepatocellular carcinoma. However, accuracy of cell block results for individual metastatic lesions and site of origin was less. IHC and morphological pattern worked as an important adjunct in the final diagnosis. On the other hand, contribution of viral markers as a supplement in the final work up was ambiguous.

CONCLUSION

High precision of validity results of cell block technology in comparison with biopsy highlights its pivotal role in conjunction with supportive tests for diagnosing and differentiating liver lesions as well as identifying primary sites in liver metastasis.

Epigenetic downregulation of desmin in gall bladder cancer reveals its potential role in disease progression

Background & objectives:

Gall bladder cancer (GBC) is a fatal neoplasm, with a globally variable incidence rates. To improve the survival rate of patients, a newer set of biomarkers needs to be discovered for its early detection and better prognosis. Our earlier studies on GBC proteomics and whole-genome methylome data revealed expression of desmin to be significantly downregulated with correlated promoter hypermethylation during gall bladder carcinogenesis. Thus, to evaluate desmin as a potential biomarker for GBC, we carried out a detailed follow up study.

Methods:

Methylation-specific polymerase chain reaction (MS-PCR) (n=17, GBC and n=23, non-tumour control), real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR) [n=14, GBC and n=14, adjacent non-tumour (ANT)], immunohistochemistry (n=27, GBC and n=14, non-tumour) and immunoblotting (n=13, GBC and n=13, ANT) were performed in surgically removed gall bladder tissue samples.

Results:

MS-PCR analysis showed methylation of desmin in 88.23 per cent (15/17) gall bladder tumour samples as compared to non-tumour tissues (39.13%, 9/23). Real-time qRT-PCR analysis revealed a significant downregulation of desmin expression in GBC as compared to ANT tissue. This was further confirmed by western blot, showing reduced expression of desmin protein in GBC, as compared to non-tumour tissue. Immunohistochemical analysis also showed a decreased level of desmin i.e., more than 95 per cent (26/27) in tumour cells compared to non-tumours (35.71%, 5/14).

Interpretation & conclusions:

The increased frequency of desmin promoter methylation which could be responsible for its significant downregulation, indicates its potential as a candidate biomarker for GBC. This requires further validation in a large group of patients to evaluate its clinical utility.

Epigenetic regulation of APC in the molecular pathogenesis of gallbladder cancer

Background & objectives:

Loss of function of adenomatous polyposis coli (APC) has been reported in cancer. The two promoters of APC, 1A and 1B also have roles in cancer. But, the epigenetic role of APC promoters is not yet clear in gallbladder cancer (GBC) and gallstone diseases (GSD). We undertook this study to determine the epigenetic role of APC in GBC and GSD.

Methods:

Methylation-specific (MS)-PCR was used to analyze the methylation of APC gene. The expression of APC gene was studied by semi-quantitative PCR, real-time PCR and immunohistochemistry (IHC) in GBC, GSD and adjacent normal tissues.

Results:

Of the two promoters, APC 1A promoter was found methylated in 96 per cent GBC (P=0.0155) and 80 per cent GSD (P=0.015). Exon 1 was downregulated in grade II (P=0.002) and grade III (P=0.0001) of GBC, while exon 2 was normally expressed. Scoring analysis of IHC revealed 0 or negativity in 34.48 per cent (P=0.057) and 1+ in 24.14 per cent (P=0.005) GBC cases suggesting loss of APC expression.

Interpretation & conclusions:

The present findings indicate epigenetic silencing of APC in advanced GBC. The methylation pattern, followed by expression analysis of APC may be suggested for diagnostic, prognostic and therapeutic purposes in GBC in future.

Dysfunction of subtelomeric methylation and telomere length in gallstone disease and gallbladder cancer patients of North Central India

BACKGROUND

Telomeres play an important role in cancer progression. Recently it has been shown that subtelomeric methylation negatively regulates telomere length in various diseases, including cancers. Here, we evaluated the influence of subtelomeric methylation in telomere dysfunction in gallbladder cancer (GBC), and whether this dysfunction is affected by the presence of gallstones.

METHODS

Relative telomere length and subtelomeric methylation levels were assessed using monochrome multiplex quantitative polymerase chain reaction and bisulfite sequencing, respectively, in different gallbladder tissue types including different grades of GBC, gallstones and adjacent non-tumor.

RESULTS

We found telomere length to shorten significantly in overall GBC, but specifically in early grade cancer. We also found D4Z4 and DNF92 subtelomeric sequences to be hypermethylated and hypomethylated, respectively, in GBC; however, their methylation levels differed significantly, only in early grade cancer. We could not find any specific correlation between subtelomeric methylation and telomere length in GBC. Interestingly, telomere length and subtelomeric methylation differed significantly in GBC without gallstones but not in GBC with gallstones.

CONCLUSIONS

This study, thus, suggests that telomere dysfunction and changes in methylation levels may occur earlier in the progression of GBC, while the presence of gallstones may have no influence on telomere length as well as on methylation levels.

Cytopathological diagnosis of gallbladder mass and mural thickening based on imaging findings: A prospective study of 51 cases

Background:

Image-guided fine-needle aspiration cytology (FNAC) serves as first-line diagnostic modalities for the assessment of mural thickening of the gallbladder (GB).

Aim:

The main objective of the present study was to correlate the diagnostic accuracy of preoperative image-guided FNAC of the thickened GB wall based on imaging findings to arrive at a final diagnosis in a tertiary care center.

Materials and Methods:

Fifty-seven image-guided fine-needle aspirations (FNAs) were performed from mural thickening of the GB over a period of 4 years and the smears prepared were stained with Leishman and Papanicolaou (Pap) stain. Out of 57 cases, 51 were included in the study for which follow-up histopathology was performed.

Result:

Out of 51 aspirations, 43 (84.3%) were adequate, 5 (9.8%) were inconclusive, and 3 (5.9%) were inadequate. Among the adequate aspirations, the most common was adenocarcinoma—36 (70.5%). The correlation between confirmatory cytological diagnosis and adequacy was significantly high (P = 0.0001). The overall diagnostic accuracy for adequate aspiration was 95.3%. The common diagnostic pitfalls were necrotic areas, aspiration of reactive hepatocytes adjacent to the GB mass, and mucus islands. No procedural complication was observed in any patient.

Conclusions:

Image-guided FNAC can be used as a safe, rapid, and successful diagnostic procedure with high sensitivity, specifically for supporting and confirming ultrasonography(USG)/computed tomography (CT) diagnosis of GB mass or mural thickening of the wall.

Fine needle aspiration cytology of lesions of liver and gallbladder: An analysis of 400 consecutive aspirations

Background:

Patients presenting with mass lesions of liver and gallbladder are a common occurrence in a cancer hospital in north central part of India. Fine-needle aspiration cytology (FNAC) serves as first line of pathological investigations, but there are pros and cons involved.

Aim:

The main objective of the present study was to establish adequacy of the procedure and to find out diagnostic pitfalls. An attempt was made to analyze inconclusive and inadequate aspirations.

Materials and Methods:

A total of 400 consecutive fine-needle aspirates of liver, belonging to 328 cases over a period of 2 years, were analyzed. Hematoxylin and eosin and May-Grόnwald-Giemsa stains were used. Chi-square test was carried out to compare significant degree of difference in different kind of diagnosis.

Results:

Out of 400 aspirations, 289 (72.2%) were adequate, 75 (18.7%), inconclusive and 36 (9%), inadequate. Among positive aspirations the most common was metastatic adenocarcinoma, 128 (44.2%). The positive diagnosis and adequate aspirations were significantly high (P < 0.0001). Major differential diagnostic problems were: Distinguishing the poorly differentiated hepatocellular carcinoma from the metastatic adenocarcinoma; and leukemia/lymphoma from other malignant round cell tumors. Common diagnostic pitfalls were repeated aspirations from the necrotic area and aspiration of atypical, disorganized and reactive hepatocytes, adjacent to a metastasis. No complications were observed.

Conclusion:

FNAC can be used successfully for the diagnosis of liver and gallbladder lesions, thus avoiding open biopsy. Study indicates the potential of using FNAC in clinical intervention where the incidence of gall-bladder and liver cancer is very high and open biopsy and surgery are not an option.