Epidemiology and Molecular Pathology of Gallbladder Cancer

Abstract

Gallbladder cancer is usually associated with gallstone disease, late diagnosis, unsatisfactory treatment, and poor prognosis. We report here the worldwide geographical distribution of gallbladder cancer, review the main etiologic hypotheses, and provide some comments on perspectives for prevention. The highest incidence rate of gallbladder cancer is found among populations of the Andean area, North American Indians, and Mexican Americans. Gallbladder cancer is up to three times higher among women than men in all populations. The highest incidence rates in Europe are found in Poland, the Czech Republic, and Slovakia. Incidence rates in other regions of the world are relatively low. The highest mortality rates are also reported from South America, 3.5–15.5 per 100,000 among Chilean Mapuche Indians, Bolivians, and Chilean Hispanics. Intermediate rates, 3.7 to 9.1 per 100,000, are reported from Peru, Ecuador, Colombia, and Brazil. Mortality rates are low in North America, with the exception of high rates among American Indians in New Mexico (11.3 per 100,000) and among Mexican Americans. The main associated risk factors identified so far include cholelithiasis (especially untreated chronic symptomatic gallstones), obesity, reproductive factors, chronic infections of the gallbladder, and environmental exposure to specific chemicals. These suspected factors likely represent promoters of carcinogenesis. The main limitations of epidemiologic studies on gallbladder cancer are the small sample sizes and specific problems in quantifying exposure to putative risk factors. The natural history of gallbladder disease should be characterized to support the allocation of more resources for early treatment of symptomatic gallbladder disease in high–risk populations. Secondary prevention of gallbladder cancer could be effective if supported by cost–effective studies of prophylactic cholecystectomy among asymptomatic gallstone patients in high–risk areas.

Cytologic diagnosis of gallbladder lesions — A study of 150 cases

“…Gallbladder (GB) carcinoma is among the five most common forms of gastrointestinal cancers worldwide [1] and it shows marked geographic and ethnic variation [2][3][4]. In European countries and the United States of America the incidence of GB carcinoma is rare [5].…”

Telomere length variation in biliary tract metaplasia, dysplasia, and carcinoma

“…[1][2][3] Dysplastic changes of this epithelium, including flat in situ carcinoma, are recognized as precursor lesions for invasive biliary tract carcinoma. Additionally, metaplastic changes have been implicated as an even earlier potential precursor in gallbladder carcinoma.…”

Routine Histopathologic Examination of Two Common Surgical Specimens—Appendix and Gallbladder: Is It a Waste of Expertise and Hospital Resources?

“…However, it is not unusual to observe it in some parts of India, Chile, Bolivia, and Mexico [10][11][12], and is the most common biliary cancer worldwide.…”

“…They occur more frequently in the seventh decade of life and are more common in women. Majority of cholecystectomies are done for cholecystitis or cholelithiasis; hence, most gallbladder carcinomas are found incidentally [11,[14][15][16]. An important risk factor for gallbladder carcinoma is cholelithiasis, which is present in 95 % of cases.…”