Do not ignore the diagnosis of gallbladder stones and gallbladder polyps, and always be alert to gallbladder cancer!

Author: Yang Zhiying, Chief Physician of China-Japan Friendship Hospital

Reviewer: Shi Wenzai, attending physician at Peking University International Hospital

Gallbladder cancer is more common in people aged 60-80 years and is relatively more common in women.

Today we will talk about gallbladder cancer from the perspective of its cause. Friends who are interested can learn about it together.

1. What are the causes of gallbladder cancer?

The main reason is that some chronic diseases of the gallbladder, such as chronic cholecystitis, gallstones, gallbladder polyps, adenomyosis, cholangitis, etc., exist for a long time and may induce gallbladder cancer.

Figure 1 Original copyright image, no permission to reprint

These include some congenital anatomical abnormalities, such as congenital bile duct cysts caused by abnormal pancreaticobiliary confluence, pancreatic juice reflux in the bile duct, etc., which are high-risk factors for gallbladder cancer.

Patients with these high-risk factors must pay special attention. Gallstones and gallbladder polyps are the most common findings during physical examinations. When they are first discovered, they may be taken seriously and checked frequently. When they are observed for one or two years or two or three years, if there is no change or symptoms, they are easily ignored. If you do not pay attention to it or ignore it at this time, gallbladder cancer may occur in the future.

In addition, heredity also has a certain impact on gallbladder cancer. There was once a family of four brothers and sisters, and three of them got gallbladder cancer one after another. This is a very typical example.

Of course, there is no good research data on how much role genetic factors play in the occurrence of gallbladder cancer, but judging from the patients' conditions, many patients are still affected by genetic factors.

Another reason is that the whole family lives in a common environment, so environmental factors may also be one of the reasons for the familial clustering of gallbladder cancer.

2. Why are gallstones likely to cause gallbladder cancer?

Gallstones are the most important and common factor leading to gallbladder cancer.

So do all patients with gallbladder cancer have gallstones?

No, but most people, about 70%-80%, have gallstones. There are two factors:

The first is mechanical stimulation. Gallstones in the gallbladder cause long-term mechanical stimulation to the gallbladder mucosa.

The second is gallbladder inflammation. Gallbladder inflammation is prone to occur if there are stones. Long-term chronic inflammation can also cause some lesions in the gallbladder mucosa and cause cancer.

So does it mean that cancer will definitely develop if you have gallbladder stones?

Not really. Nowadays, there are many patients with gallstones, but not many with gallbladder cancer. This is because gallstones usually cause some symptoms. When there is inflammation and pain, many gallbladders are removed, and gallbladder cancer will not occur in the future.

Of course, there are some asymptomatic gallstones, which are easy to be ignored because they have no symptoms. For example, carrying stones for twenty or thirty years may cause long-term irritation and induce gallbladder cancer.

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Therefore, patients with gallstones should be especially careful even if they have no symptoms. They should have a physical examination every year to closely observe changes in the stones and gallbladder wall, so as to achieve early detection and early treatment.

3. What kind of gallbladder polyps should alert you to gallbladder cancer?

If a physical examination is conducted, the detection rate of gallbladder polyps is very high. We believe that some polyps are called physical examination diseases, which means that if you don’t have a physical examination, you will never know. Only a physical examination can discover them.

Gallbladder polyps smaller than 1 cm have a very low rate of canceration. Most of them are cholesterol polyps, which are related to diet, such as overnutrition, metabolic abnormalities, etc., which lead to excessive concentration of cholesterol in bile and precipitation. The cholesterol crystals formed hang on the gallbladder wall and become gallbladder polyps. This type of polyp is inorganic and rarely grows to more than 1 cm, and generally will not become cancer. However, gallbladder polyps with the following characteristics should be paid close attention to:

First, fast-growing gallbladder polyps. For gallbladder polyps smaller than 1 cm, you can just observe closely and don't worry. Of course, during the observation process, if you find that it grows rapidly, such as three or four millimeters in half a year, even if it is a relatively fast-growing polyp, you should be careful about this kind of polyp and need an expert to identify whether there is a problem.

Second, gallbladder polyps with a broad base. Ordinary cholesterol polyps are like a fruit hanging on the gallbladder wall, with a very thin root. If the root is very thick, it means the base is very broad, which is a characteristic manifestation of gallbladder cancer, and you should be extra careful.

Third, gallbladder polyps with blood flow signals. Now color Doppler ultrasound can see whether there are blood flow signals in the polyps. Polyps with blood flow signals may be adenomatous polyps or cancer.

Figure 3 Original copyright image, no permission to reprint

Therefore, we can make a preliminary judgment on the nature of the polyp based on the growth rate, base width, and the presence or absence of blood flow, and then give the correct treatment under the guidance of a doctor.