[Fat Bear Science] Did you find polyps in your gallbladder during a physical examination? Pay attention, these types of polyps are prone to cancer

With the improvement of living standards and the popularization of health examinations, more and more people are found to have gallbladder polyp-like lesions. Seeing the word "lesion", everyone starts to worry. Isn't polyp a very common benign disease? What does lesion mean? Is it early cancer?

Expert Profile

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Luo Xianzhang

Deputy Chief Physician of the Hepatobiliary and Pancreatic Tumor Center of the Affiliated Cancer Hospital of Chongqing University, Doctor of Medicine.

He is proficient in the diagnosis and treatment of hepatobiliary, pancreatic and spleen surgical diseases, and is good at basic and clinical research on liver cancer, diagnosis and treatment of hepatobiliary, pancreatic and spleen tumors. He can independently perform various open surgeries, laparoscopic surgeries, various punctures, biliary stent implantation, ERCP and other routine hepatobiliary and pancreatic surgeries. He has rich experience in the treatment of perioperative liver inflammatory response syndrome.

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Huang Zejun

Deputy Chief Physician of Ultrasound Medicine Department, Affiliated Cancer Hospital of Chongqing University.

He is good at diagnosing abdominal, gynecological, superficial organ tumors and common cardiovascular diseases through ultrasound.

Which gallbladder polyps have a tendency to become cancerous?

Gallbladder polypoid lesions refer to lesions that protrude or bulge from the gallbladder wall into the gallbladder cavity. It is a morphological and imaging concept, and the ultrasound detection rate in adults is 4.2% to 6.9%. Because gallbladder polypoid lesions are difficult to diagnose before surgery, they are called "gallbladder polypoid lesions" or "gallbladder bulge lesions."

There are two common types of polyps, including neoplastic polyps and non-neoplastic polyps.

Neoplastic polyps (also known as true polyps)

Refers to gallbladder polyps caused by the hyperplasia of the glands and muscle layers of the gallbladder itself. This is a true gallbladder polyp, including adenoma and adenocarcinoma. The former has a certain chance of malignant transformation and is a precancerous lesion. The latter is mostly early gallbladder cancer; other rare ones include hemangioma, lipoma, leiomyoma, neurofibroma, etc.; true gallbladder polyps can be benign or malignant.

Non-neoplastic polyps (also known as pseudopolyps)

It is the most common, such as cholesterol polyps (cholesterol crystals), inflammatory polyps (formed by chronic cholecystitis or gallstones), gallbladder adenomyosis, etc. Cholesterol polyps account for the vast majority, with a proportion of up to 80%. Other rare ones include adenomatous hyperplasia, xanthogranuloma, ectopic gastric mucosa or pancreatic tissue, etc. In the past, medical concepts believed that pseudopolyps themselves did not have the potential for malignant transformation.

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Gallbladder polypoid lesions are associated with these factors

Gallbladder polypoid lesions generally have mild symptoms or even no symptoms, and are mostly discovered during physical examination ultrasound. The cause is still unclear, and it is generally believed to be related to chronic inflammation. It has been reported that long-term drinking, high-fat diet, obesity, thickening of the gallbladder wall, diabetes, staying up late and irregular lifestyle are also important causes. Among them, inflammatory polyps and adenomyosis are both inflammatory reactive lesions, and cholesterol polyps are the result of systemic lipid metabolism disorders and local inflammatory reactions in the gallbladder.

Gallbladder cancer is a relatively rare malignant tumor. At present, domestic and foreign literature reports that some gallbladder cancers develop from primary gallbladder adenomas, so it is very likely that a similar adenoma-adenocarcinoma progression sequence exists in some cases.

If the tumor penetrates the serosa or invades the local lymph nodes, the prognosis of advanced gallbladder cancer is poor, with a 5-year survival rate of less than 25%. If the tumor is confined to the muscularis mucosa or the connective tissue around the muscle, the 5-year survival rate is better, reaching 100% or 57% to 72% respectively. Therefore, if gallbladder cancer is found, the most important thing is to detect it early and treat it early.

The treatment process for gallbladder polyps is shown in the figure below.

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Abdominal ultrasound is the test of choice

Abdominal ultrasound is a relatively low-cost, low-risk, and widely used clinical technology that plays an important role in the diagnosis and follow-up of gallbladder polyps. For patients with multiple polyps, the management decision is based on the largest polyp. For gallbladder polyps that may have malignant signs, we can further examine and identify their nature through ultrasound angiography.

Ultrasound angiography has become a fast, convenient, accurate and reliable imaging method because it can display blood flow signals within the lesion in real time.

Ultrasound contrast-enhanced features of gallbladder cancer

Heterogeneous hypoechoic nodules are found in the gallbladder wall or cavity. The lesions show rapid hyperenhancement in the arterial phase, are unevenly distributed, and multiple irregular vascular structures can be seen. The gallbladder wall structure has poor continuity at the attachment site of the lesion, and the normal structure disappears.

Ultrasound contrast imaging of gallbladder polyps

During the arterial and delayed phases, the enhancement is always synchronous with or slightly higher than that of the gallbladder wall.

Ultrasound contrast imaging findings of gallbladder adenomyosis

The gallbladder wall is focally thickened, and in the arterial phase it is seen to be synchronously enhanced with the gallbladder wall in a ring shape. The gallbladder wall structure is continuous and complete at this location.

Ultrasound contrast imaging has a high accuracy rate in diagnosing benign and malignant gallbladder space-occupying lesions. It can provide more reliable diagnostic information for clinicians. When ultrasound contrast imaging indicates malignant lesions, cholecystectomy is recommended.

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How to prevent gallbladder polyps or lesions

Eat breakfast every day

Eat breakfast on time every morning to allow the gallbladder to contract and discharge some of the bile. This way, the concentration of bile stored in the gallbladder will not be very high, and the probability of causing cholesterol crystallization gallbladder polyps will be greatly reduced. If you skip breakfast, the bile secreted at night cannot be used and will remain in the gallbladder. If the bile stays in the gallbladder for too long, it can stimulate the gallbladder to form gallbladder polyps or make the original polyps larger and more numerous.

Three meals a day is important

Not only breakfast, but also regular diet and regular meals are also important. The liver in the human body is responsible for secreting bile, which is stored in the gallbladder. The main function of bile is to digest oily foods. Excessive cholesterol intake can increase the metabolism and cleaning burden of the liver and gallbladder, and cause excess cholesterol to crystallize, accumulate and precipitate on the gallbladder wall, thus forming polyps. Therefore, patients with gallbladder polyps should reduce their cholesterol intake, especially at night, and should avoid eating high-cholesterol foods such as eggs (especially egg yolks), fatty meat, seafood, scaleless fish, animal offal and other foods.

Develop a healthy lifestyle

Overcome unhealthy living habits such as smoking, drinking, staying up late, etc. Insist on outdoor sports and maintain a good mental state.

Text/Fat Bear Photos/Partially from the Internet (Please contact us to delete if there is any infringement) Review/Hepatobiliary and Pancreatic Tumors Department Ultrasound Medicine Department

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