Surathat Pongnikorn, Nimit Martin Gallbladder and Extrahepatic Bile Duct In Thailand during the period males (377 cases) in a ratio of 1.9:1. 1995-1997, carcinoma of gallblad- Gallbladder cancer and extra- Chapter II der and extrahepatic duct is not in- hepatic bile duct carcinoma are the cluded in the top ten of the most tenth in frequency in Lampang in frequency. The estimated inci- both males (ASR = 3.6) and fe- dence rate is 1.6 per 100 000 among males (ASR = 3.3) which is the males and 2.4 per 100 000 among highest incidence rate among five females. Females (728 cases) are centers. Female are affected more affected by gallbladder and extra- than males in Chiang Mai, Bang- 8 hepatic bile duct cancer more than kok and Songkhla although in Figure 2.8.1 Gallbladder and extrahepatic bile duct cancer in different regions, 1995- GALLBLADDER 1997 AND EXTRAHEPATIC Male *USA, New Maxico 4.3 BILE DUCT American Indian ICD-10 C23-24 Thailand 1.6 Chiang Mai 1.5 Surathat Pongnikorn, M.D. Nimit Martin, M.D. Lampang 3.6 Khon Kaen 1.9 Bangkok 1.2 Songkhla 0.9 0510 ASR (World) Female *India, Delhi 8.8 Thailand 2.4 Chiang Mai 3.2 Lampang 3.3 Khon Kaen 1.6 Bangkok 1.4 Songkhla 1.1 0510 ASR (World) *The highest incidence in CI5 Vol. VIII 38 p. 38-¥” Gallbladder and Extrahepatic Bile Duct Surathat Pongnikorn, Nimit Martin Lampang and Khon Kaen males are Figure 2.8.2 Age-specific incidence rates of gallbladder and extrahepatic bile duct affected more than females. The cancer, 1995-1997 lowest incidence is in Songkhla in Male both males (ASR = 0.9) and females (ASR = 1.1) (Figure 2.8.1). 1 000 # Age-specific incidence rates # # in both males and females are 100 # # higher in Chiang Mai and Lampang # than the other regions. Cancer of 10 # # gallbladder and extrahepatic duct is # hardly seen below 25 years of age. 1 The majority of cases occurs after the age of 55 in men and 45 in Incidence per 100 000 0.1 women with the peak incidence in Age the seventh decade for both sexes 0.01 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75+ (Figure 2.8.2). The percentage of histologi- Chiang Mai# Lampang Khon Kaen cally verified cases varies from Bangkok Songkhla 27.3% in Khon Kaen to 84.6% in Songkhla in men and from 32.4% in Khon Kaen to 76.5% in Song- Female khla in women. The percentage of 1 000 death certificate only cases varies # # from 0.0% in Songkhla to 15.2% 100 # # # in Khon Kaen in men and from # # 0.0% in Songkhla to 14.3% in 10 Bangkok in women (Table 2.8.1). # The most common histological 1 type is adenocarcinoma. From the two volumes of Incidence per 100 000 0.1 Cancer in Thailand during 1988- 1991(Vatanasapt et al.,1993) and 0.01 Age 1992-1994 (Deerasamee et al., 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75+ 1999), gallbladder and extrahepatic # bile duct cancer shows an increase Chiang Mai Lampang Khon Kaen trend in both males and females in Bangkok Songkhla Khon Kaen, Bangkok and Song- Table 2.8.1 Percentage of histologically verified and death certificate only cases, gallbladder and extra hepatic bile duct 1995-1997 1998-2000 % HV % DCO % HV % DCO Male Female Male Female Male Female Male Female Chiang Mai 69.7 60.3 3.0 1.5 75.0 78.8 0.0 0.0 Lampang 53.5 54.8 4.7 9.5 55.6 51.8 8.3 3.6 Khon Kaen 27.3 32.4 15.2 2.9 40.8 47.1 0.0 0.0 Bangkok 72.6 69.5 13.1 14.3 Songkhla 84.6 76.5 0.0 0.0 54.6 90.9 0.0 0.8 %HV = percentage of histologically verified cases, %DCO = percentage of death certificate only cases 39 p. 39-¥” Surathat Pongnikorn, Nimit Martin Gallbladder and Extrahepatic Bile Duct Figure 2.8.3 Trend in incidence of gallbladder and extrahepatic bile duct cancers khla. In Lampang it shows an in- creasing incidence rate especially Male in females. Although in Chiang Mai it shows a declining trend in both 6 sexes (Figure 2.8.3). The highest incidence rate in the world in men is seen in USA, 4 # # New Maxico, American Indian (ASR = 4.3) and in women in In- # # dia, Delhi (ASR = 8.8) (Figure # 2 2.8.1). # # # Incidence per 100 000 0 1989-1991 1992-1994 1995-1997 1998-2000 # Thailand Chiang Mai# Lampang Khon Kaen Bangkok Songkhla Female 6 4 # # # # # # 2 # # Incidence per 100 000 0 1989-1991 1992-1994 1995-1997 1998-2000 # Thailand Chiang Mai# Lampang Khon Kaen Bangkok Songkhla 40 p. 40-¥”.