Primary carcinoma of the gallbladder
This adenocarcinoma represents <1% of all cancers. It occurs chiefly in those over 70 years of age and is commoner in females. Gallstones are usually present but a definite relationship is uncertain. The presenting features are of jaundice and occasionally right hypochondrial pain. A mass may be palpable in the right hypochondrium. The diagnosis is often made at operation and cholecystectomy is performed if possible. Few patients survive 1 year.
This sometimes affects the extrahepatic biliary tree, giving rise to jaundice. Surgery, if possible, is the only effective treatment. Alternatively, a stent or tube can be passed through the obstruction during PTC or ERCP. The progosis is poor.
Malignant tumours of the ampulla
These present with a cholestatic jaundice which may occasionally be intermittent. They may ulcerate and produce gastrointestinal haemorrhage. The diagnosis is usually made at ERCP. Carcinoma of the ampulla can sometimes be resected with a 40% 5-year survival rate (compare with pancreatic carcinoma.