 So today on Let's Talk Surgery, we're going to discuss gallbladder, carcinoma or cancer of the gallbladder. Now for many places that would be the most common cancer of the biliary tree and indeed so it is with my unit. Now we do see this in the older population and we have a female predominance as far as these tumors are concerned. Unfortunately, the vast majority of the patients that do come to us have very advanced disease because what happens to gallbladder cancer, it invades locally, it spreads via the venous system, it spreads via lymphatics. So when we do see these patients, they already have obstructive jaundice as there's local infiltration of the biliary tree and many of these tumors are undeceptable and all we can really do for the patient is palliative care where we will drain the biliary system either via drainage via percutaneously or via the biliary duct from the ampullus side. Why do these patients develop gallbladder cancer? There are a few risk factors that you must be aware of. The vast majority of them will have gallstones, although gallstones are very prevalent in the vast majority of people, gallstones will not develop gallbladder cancer. So, you know, we have to say though that the vast majority of them do have gallstones. Porcelain gallbladder, that's calcification of the wall, you know, there are various reports from a very low incidence of porcelain gallbladder to about 60% incidence of porcelain gallbladder. I think the majority of cases these days only put it about two or three percent. So, not really. We do see polyps as well as pre-malignant lesion. You get benign and malignant pre-malignant polyps, at least the adenomatous polyps, but we also seek just normal cholesterol or inflammatory polyps as well. So, you've got to think of patients with polyps, patients with sclerosis and colonitis. That would also be a risk factor. And then certain parts of the world, like South America, where we see salmonella infections, they have a higher incidence, at least, of gallbladder cancer than we would have down here locally. So, you've got to think of those infections. There are some reports of helicobacter pylori in the biliary tree as well. So, that might also be one of the risk factors. So, many of these patients will have previous symptoms of biliary colic, some form of biliary tree symptoms, at least similar to, perhaps, biliary colic from just normal cololithiasis. We do see patients with that. The majority of them will come in. They would have already have lost weight, as I said. They are joined from local infiltration and obstruction of the biliary tree. And we do see, I must say, also the very fortunate patient where we will do an ultrasound. We will see gallstones, diagnosed acute colisostatis, and we'll book a colisostectomy. And then on histology, it might come back that there's an insight to a very early gallbladder carcinoma. And in those cases where there's a clear margin, it's well within the wall of the gallbladder, we're not going to go back and do any further surgery. In a tertiary unit where we deal with gallbladder carcinomas, patients will be fully worked up. As I said, many of these cases advance. And it's all about a surgery possible. So the patient will go through a full range of investigations, imaging investigations, which might just mean CT scan and MRI, but also then specifically of the biliary tree. And we might just do ERCPs as well, or PTCs, et cetera. Those, of course, are also used just for the palliation in case the resection is not possible. You have to have a wide margin, or at least a clear margin of resection. So parts of the liver will also have to be removed. And in many cases, that would mean the biliary tree as well. So there'll need to be a hookup between the intrapatiol ducts and the enteric system. So these patients tend to have a very poor prognosis. And we see, as you know, on average for us, nothing more than a six-month survival and very poor five-year survival rates. And the only ones that we do see are those incidental incitococcinomas that we do a normal colostectomy for acute colostitus. So fortunately, a rare disease that we don't see often, very poor prognosis, and something that you just have to watch out for, and please refer them to a tertiary unit where these patients can be managed properly.