| disease | Gallbladder Cancer |
| alias | Carcinoma of the Gall-blader |
Among malignant tumors of the gallbladder, gallbladder carcinoma (carcinoma of the gallbladder) ranks first, while others include fleshy tumors, carcinoids, primary malignant melanoma, and giant cell adenocarcinoma. Since the latter are all rare, this chapter primarily focuses on primary gallbladder carcinoma. It is 2 to 4 times more common in women than in men and is predominantly seen in individuals aged 50 to 70.
bubble_chart Etiology
Gallbladder cancer patients with gallbladder stones account for 60-90%, while 3-14% of gallbladder stone patients develop gallbladder cancer. Therefore, chronic cholecystitis and gallbladder stones are generally considered to be closely related to the occurrence of gallbladder cancer. Factors such as bile stasis, cholesterol metabolism disorders, inflammatory bowel disease, genetic factors, sex hormones, X-ray exposure, carcinogens in bile, and malignant transformation of benign tumors have also been hypothesized as causes of gallbladder cancer, but none have reliable evidence. Currently, it is generally believed that the occurrence of this disease may be related to multiple factors.
bubble_chart Pathological Changes
Gallbladder cancer patients with gallbladder stones account for 60-90%, while 3-14% of gallbladder stone patients develop gallbladder cancer. Therefore, chronic cholecystitis and gallbladder stones are generally considered to be closely related to the occurrence of gallbladder cancer. Bile stasis, cholesterol metabolism disorders, inflammatory bowel disease, genetic factors, sex hormones, X-ray radiation, carcinogenic factors in bile, and malignant transformation of benign tumors have also been hypothesized as potential causes of gallbladder cancer, but none have reliable evidence. Currently, it is generally believed that the disease may be associated with multiple factors.
bubble_chart Clinical ManifestationsGallbladder cancer has an insidious onset, and most cases are asymptomatic in the early stages. The main clinical manifestations include pain in the upper middle or upper right abdomen, which may be intermittent or continuous, dull or colicky, and progressively worsens. Abdominal pain can radiate to the right shoulder, back, chest, and other areas, sometimes making it difficult to distinguish from gallbladder stone. Weight loss and jaundice are also relatively common, along with symptoms such as loss of appetite, weakness, nausea, and vomiting. In some cases, it may present as acute or chronic cholecystitis. A palpable mass in the upper right abdomen is found in about half of the cases. In the advanced stage, hepatomegaly, fever, and ascites may occur.
Complications include gallbladder infection, empyema, perforation, as well as liver abscess, subphrenic abscess, pancreatitis, portal vein thrombosis, intestinal obstruction, gastrointestinal and intra-abdominal bleeding, and the formation of fistulas with nearby gastrointestinal tracts.
Early-stage gallbladder cancer lacks distinctive clinical manifestations and often coexists with cholelithiasis, leading to misdiagnosis as cholecystitis or cholelithiasis in over half of cases. Previously, the preoperative diagnosis rate was only 8.6%. With the application of ultrasound and CT, this rate has improved to 19–38% or even 75–88%. Notably, by the time symptoms become apparent, most cases are already at an advanced stage.
Ultrasound, a non-invasive method, is currently the only test capable of detecting gallbladder cancer early. Its key features include irregular thickening of the gallbladder wall and fixed intracavitary echogenic masses without acoustic shadowing, making it the preferred diagnostic tool. Percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) may reveal irregular filling defects in the gallbladder fundus, non-visualization of the gallbladder, or narrowing and displacement of the common bile duct or right hepatic duct due to external compression. CT has a diagnostic accuracy of about 60%. During ERCP or PTC, bile can be collected for cytological examination. Percutaneous transhepatic direct cholecystography under X-ray or ultrasound guidance has success rates of 85% and over 95%, respectively. Additionally, gallbladder wall biopsies can be obtained for cytological analysis, with a diagnostic accuracy of around 85%. Laparoscopy can detect tumor nodules and allow for cytological or histological diagnosis via biopsy. Laparoscopic pulse contrast imaging has a diagnostic accuracy of approximately 70–80% and may detect early-stage cancer. It typically shows widened gallbladder pulse, uneven thickness, or interruption.
bubble_chart Treatment Measures
The preferred treatment is surgical removal of the gallbladder and local lymph nodes. If one lobe of the liver is involved, partial hepatectomy is also required. If both lobes of the liver are affected with distant metastasis, only palliative surgery can be performed. For extensive bile duct invasion causing obstruction, biliary drainage is performed to relieve jaundice. Radiation therapy and/or chemotherapy can be administered after tumor resection or in cases where resection is not possible to prolong survival.
Early diagnosis of this disease is difficult, resulting in a poor prognosis. The 5-year survival rate after surgery is 0–7%, with occasional reports exceeding 10%. 80% of patients die within one year of diagnosis.
