Gallbladder cancer has a hidden onset, lacks specific clinical manifestations in the early stages, and is mostly in the late stage when seeking treatment, making it difficult to implement effective treatment. It progresses rapidly clinically, has a poor prognosis, and has a low 3-year survival rate. Early diagnosis and implementation of radical resection surgery can improve patient prognosis and enhance quality of life. Understanding the risk factors related to the occurrence and development of gallbladder cancer and taking effective preventive measures as early as possible for high-risk populations is of great clinical significance for early diagnosis, early treatment, and prolonging survival.
1、 Gallbladder Disease
1. Gallstones
Gallstones are a common benign disease in clinical practice, with a global adult prevalence rate of 10.0% to 20.0%. Most patients have no obvious symptoms in the early stages, but as the condition progresses, they may experience nausea, loss of appetite, abdominal pain, diarrhea, etc. At present, many studies at home and abroad have confirmed that gallstones are closely related to the occurrence and development of gallbladder cancer. Research has found that the risk of developing gallbladder cancer is related to the size and number of gallstones. As the size and number of gallstones increase, their risk also increases. Therefore, the timely implementation of gallbladder preserving lithotomy or cholecystectomy for patients with gallstones is conducive to reducing the incidence rate of gallbladder cancer.
2. Gallbladder polyp
Gallbladder polyp is a common gallbladder disease, the overall incidence rate is 0.3%~12.3%, and the incidence rate in China is 7.3%. Pathologically, it can be divided into two categories: tumor polyps (adenomas, leiomyomas, lipomas, etc.) and non tumor polyps (cholesterol polyps, inflammatory polyps, etc.), with an overall cancer conversion rate of about 3.0%. Gallbladder polyps with a diameter<10.0mm have a lower risk of malignant transformation, while polyps with a diameter ≥ 10.0mm or a number ≥ 3 are closely related to the incidence of gallbladder cancer. Microfluidic imaging and contrast-enhanced ultrasound are helpful in distinguishing between benign and malignant gallbladder polyps.
2、 Cholangiopathy
1. Primary sclerosing cholangitis
Primary sclerosing cholangitis is a chronic cholestatic disease characterized by inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts. Studies have shown that patients with this condition have a significantly increased risk of developing gallbladder cancer. It is recommended that such patients be monitored annually through B-ultrasound examination, and those with high-risk factors such as gallbladder polyps should be evaluated as early as possible whether cholecystectomy is necessary.
2. Anomaly of pancreaticobiliary junction
Anomaly of pancreaticobiliary junction is a congenital anatomical anomaly in which the connection between the common bile duct and pancreatic duct is located outside the duodenal wall, forming a long common duct above the Oddi sphincter. Due to the loss of regulatory function of the Oddi sphincter, pancreatic juice can reflux into the biliary system, and bile can also reflux into the pancreatic duct, leading to cholangitis, gallstones, pancreatitis, and other conditions. Research has shown that this type of patient is a high-risk population for gallbladder cancer and bile duct cancer, and their cancerous mechanism is related to persistent inflammation caused by pancreatic juice reflux into the bile duct. Given the high correlation between abnormal pancreaticobiliary junction and gallbladder cancer, it is recommended to consider prophylactic cholecystectomy for such patients.
3、 Obesity is a common chronic endocrine metabolic disease caused by abnormal accumulation of fat in the body, leading to excessive increase in body mass. Excessive obesity is associated with an increased risk of various cancers, including gallbladder cancer. At present, the mechanism of action between obesity and gallbladder cancer is not yet clear. Some studies suggest that obesity is beneficial for the formation of gallstones, increases blood sugar levels, and thus increases the risk of developing gallbladder cancer. Therefore, appropriate control of body mass is of great significance for early prevention of gallbladder cancer.
4、 Dietary habits
Dietary habits are closely related to the occurrence of cancer. In regions and countries such as Europe, Asia, and the United States, high calorie and low fiber dietary habits can promote the occurrence of cholesterol stones. Gallstones are one of the most important susceptibility factors for gallbladder cancer, which can induce chronic inflammation of gallbladder tissue and promote carcinogenesis. Consuming high fiber fruits and vegetables such as carrots and sweet potatoes can accelerate intestinal transport, reduce bile acid accumulation and cholesterol stone formation, and lower the risk of gallbladder cancer. Healthy eating habits and balanced nutrition are beneficial for preventing gallbladder cancer.