[Fat Bear Science] Not eating breakfast can cause gallstones and even gallbladder cancer

As the saying goes, "Eat a good breakfast, a full lunch, and a light dinner." However, many people skip breakfast in order to save time.

Ms. Chang, 35 years old, is in a hurry for work in the morning and has relatively tight time. Breakfast has become a "luxury" for her, so she often skips breakfast. In the past year, she has developed intermittent dull pain in the right upper abdomen. Abdominal CT scan showed cholecystitis and gallstones.

Zeng Jianting

The attending physician of the Hepatobiliary and Pancreatic Tumor Department of the Affiliated Tumor Hospital of Chongqing University graduated from Tongji Medical College of Huazhong University of Science and Technology. He has been engaged in hepatobiliary tumor work for 7 years, is proficient in the diagnosis and treatment of hepatobiliary, pancreatic and spleen surgical diseases, and has been engaged in basic and clinical research on liver cancer for a long time.

From skipping breakfast to gallbladder cancer in just four steps

Skipping breakfast → gallstones → cholecystitis → gallbladder cancer

The main function of the gallbladder is to store and concentrate bile secreted by the liver. The amount of bile secreted by an adult every day is about 800-1200 ml. At night or when we are not eating, the secreted bile is transferred to the gallbladder through the hepatic duct for concentration and storage; when we eat, the food enters the small intestine, stimulating the gallbladder to contract and discharge bile.

If you often skip breakfast, the concentrated bile in the gallbladder cannot be discharged and accumulates in the gallbladder, causing oversaturation of cholesterol in the bile, which in turn causes cholesterol deposition and gradually forms gallstones.

If there are stones in the gallbladder, if they are not treated and controlled in time, once the stones block the gallbladder duct, it will cause more serious symptoms, such as gallbladder enlargement, gallbladder blood vessel compression, etc. It will also greatly increase the risk of bacterial infection. Once infection occurs, it will lead to cholecystitis.

Gallbladder cancer is closely related to gallstones and cholecystitis, and the incidence is increasing. Data show that more than 90% of gallbladder cancer patients have gallstones. Gallbladder cancer is highly malignant, metastasizes early, and progresses rapidly. Due to its close proximity to the liver, it is easy to spread.

Insidious onset, atypical early clinical symptoms

Gallbladder cancer is a malignant tumor originating from the gallbladder. Its incidence is low, accounting for 0.8%-1.2% of all malignant tumors. Gallbladder cancer has no specific clinical manifestations in the early stage, or only has symptoms of chronic cholecystitis. Early diagnosis is very difficult, so most patients are already in the middle and late stages of the disease when they seek medical treatment. The pain in the right upper abdomen is similar to that of calculous cholecystitis. It starts with discomfort in the right upper abdomen, followed by persistent dull pain or dull pain, sometimes accompanied by paroxysmal severe pain and radiating to the right shoulder. Gastrointestinal symptoms include indigestion, aversion to greasy food, belching, and decreased appetite. This is due to the inadequate function of the gallbladder to digest fatty substances. Jaundice Jaundice often appears in the late stage of the disease. It is mostly caused by cancer tissue invading the bile duct and causing malignant obstruction. At the same time, it is accompanied by weight loss, fatigue, and even cachexia, yellowing of the skin and mucous membranes, and itching of the skin. Fever Some patients have fever. Mass in the right upper abdomen In the late stage of the lesion, a mass appears in the right upper abdomen or upper abdomen.

High malignancy, 5-year survival rate is less than 5%

Gallbladder cancer is the most common malignant tumor of the bile duct and one of the most aggressive tumors of the digestive system. It has an insidious onset, rapid progression, and is prone to lymphatic and vascular metastasis in the early stages, resulting in a poor prognosis. There are many risk factors for gallbladder cancer, including gallstones, chronic gallbladder inflammation, gallbladder adenoma, biliary system infection (such as Helicobacter pylori and Salmonella), abnormal pancreaticobiliary duct junction, and obesity. The 5-year survival rate of gallbladder cancer is less than 5%. Adjuvant chemoradiotherapy has limited value in the treatment of gallbladder cancer, and radical surgery is the only way to cure gallbladder cancer.

Gallstones considered the leading risk factor for gallbladder cancer

Gallstones and chronic cholecystitis are closely related to the occurrence of gallbladder cancer. Gallstones are considered the primary risk factor for gallbladder cancer. Studies have shown that about 90% of gallbladder cancer patients have gallstones, and the risk of gallbladder cancer in patients with gallstones is 13.7 times that of people without gallstones.

Gallbladder adenomatous polyps are also known risk factors. Other possible risk factors include gallbladder adenomyosis, smoking, metabolic syndrome (diabetes, obesity, hyperlipidemia, etc.).

Attention! The following are high-risk groups for gallbladder cancer

■ Elderly patients: The rate of cholecystitis cancer in patients over 50 years old increases dramatically;

■ Female patients: The male to female ratio of chronic cholecystitis patients is about 1:3;

■Chronic cholecystitis with long course and recurrent attacks;

■ Those with stones, especially multiple or full-filled stones;

■ Large stones: As the size of gallstones increases, the incidence of gallbladder cancer increases accordingly. The incidence of gallbladder cancer in stones with a diameter greater than 3 cm is 10 times higher than that in stones less than 1 cm.

■Patients with gallbladder polyps whose size is larger than 1 cm, especially those larger than 1.5 cm, have a significantly increased risk of canceration.

■Patients with abnormal bile-pancreatic duct junction.

Gallbladder stones, should I remove it or not?

Clinically, patients with gallstones and cholecystitis are often confused about whether they should have their gallbladder removed. The Expert Consensus on Standardized Diagnosis and Treatment of Gallbladder Cancer (2016) clearly states that cholecystectomy is recommended for symptomatic gallstones, whether single or multiple. Cholecystectomy is also recommended for asymptomatic gallstones if one of the following conditions is present:

01

Single stone, with a diameter of more than 3 cm;

02

Single stone, less than 3 cm in diameter, if there is a family history of gallstones or the patient is over 50 years old;

03

Multiple stones, with the risk of developing biliary pancreatitis;

04

Patients with porcelain gallbladder or diabetes mellitus and thickening of gallbladder wall greater than 3 mm should be considered as chronic cholecystitis.

05

Imaging examinations suspected gallbladder cancer, but based on the principles of tumor surgery and the limitations of puncture biopsy, surgical resection and rapid intraoperative pathological examination were required to exclude gallbladder cancer;

06

Imaging examinations showed concurrent xanthogranulomatous cholecystitis. Although asymptomatic, immediate surgical pathological examination was recommended to exclude gallbladder cancer.

Actively adjust your lifestyle to prevent gallstones

■Control your weight and eat a healthy diet

Obesity makes us more susceptible to gallstones, so we should avoid high-fat, high-calorie diets and maintain a good weight. Eating more fiber-rich foods can improve cholesterol metabolism and help prevent the formation of stones.

■Eat breakfast to lose weight

A regular diet (three meals a day) can make the gallbladder contract and empty regularly, reduce the time bile stays in the gallbladder, and prevent the formation of stones.

■ Vegetarians should take appropriate lecithin supplements

Normally, cholesterol, bile salts and lecithin are mixed in a certain ratio and suspended in bile in the form of micro-particles. When this ratio is disrupted, gallstones are easily formed. Some vegetarians do not take enough lecithin, and the excessive fiber in vegetarian food hinders the reabsorption of bile acid, which reduces the bile salt concentration in bile. They should supplement lecithin appropriately.

■Regular annual physical examination

For gallstones, ultrasound is the most effective and convenient method. A physical examination once a year can promptly detect gallstones and whether the gallbladder has cancer.

Text/Fat Bear Photos/Internet (Please contact us to delete) Review/Zeng Jianting

Member of China Medical We-Media Alliance

Science Popularization China Co-construction Base

Chongqing Science Popularization Base/Chongqing Health Promotion Hospital

Chongqing Municipal Science and Technology Commission Science and Technology Communication and Popularization Project

National Health Commission National Basic Public Health Service Health Literacy Project