Disease Overview
gallbladdercarcinomaisrise源ingallbladder mucosaofmalignant tumor，isbiliary tractsystemthe most commonmalignant tumor。incidence居digestivesystemmalignant tumorNo.6position，commonly occurs ininelderlyfemales，male-to-female ratioapproximately1:3。early-stagesymptomsinsidious，at diagnosismoreasadvanced-stage，relatively poor prognosis，5yearsurvival rateonly5%-10%。Gallstonesismost importantofrisk factor，approximately70%-80%gallbladdercarcinomapatientscombineandGallstones。surgical resectionis唯onecancanRadical treatmentoftreatmentmethod，butonlyhave20%-30%patientscanacceptedradical surgery。
Major Causes
Gallstones：most importantofrisk factor，stonesmorelarge、disease coursemorelong，riskmorehigh，stonesdiameter>3cmthoserisksignificantincreasing。
Gallbladder polypoid lesions：diameter>1cm、widebasal、rapidlyincreaselargeofMalignant transformation of polypschangeriskrelativelyhigh。
Chronic cholecystitis：long-termchronic inflammatory stimulationcanInducingcarcinomachange。
Porcelain gallbladder：gallbladder wallExtensivecalcification，malignant transformation risk极high(10%-25%)。
Congenital anomalous pancreaticobiliary junction：bileStasis,pancreasfluidReflux,increasingmalignant transformation risk。
ObesityandHigh-fat diet：increasingbilegallbladder固alcohol饱anddegree，promotestonesformbecome。
Genetic factors：havegallbladdercarcinomafamily historythoseincreased risk。
Other factors：Smoking、Diabetes, Parasiticlife虫infection、environmentaltoxinelementetc.。
Common Symptoms
early-stagesymptoms：typicallynosymptomsoronlymanifestationasrightupper腹discomfort、digestiveadverse，easyandgallbladderConfused with inflammation.
upperabdominalpain：persistentorparoxysmalrightupper腹pain，towardrightShoulder and backregionradiation。
jaundice：Tumor invadesbile ductcausingbiliary tractobstruction，appearingskin, Scleral icterus,small便deepJaundice, clay-colored stools.
rightupper腹mass：advanced-stagecaninrightupperAbdominal palpationand坚hardofmass。
food欲decreaseretreat、emaciation：tumorConsumptivecausingprogressivebody weightunderdecrease。
fever：tumornecrosis, Secondaryinfectioncancausingfever。
advanced-stagesymptoms：ascites、hepaticfunctionFailure,cachexiaetc.。
Pathological Classification
glandularcarcinoma(80%-90%)：mostcommon，includingpapillary adenocarcinoma、tubular adenocarcinoma、mucinous adenocarcinoma
squamous cell carcinoma(3%-10%)：andlong-term炎conditionstimulation、stonesrelated
adenosquamous carcinoma：relatively poor prognosis
undifferentiated carcinoma：extremely high degree of malignancy
othertype：neuroendocrine tumors, Muscletumoretc.
TNM Staging(AJCC8th edition)
Primary Tumor (T)
Tis：Carcinoma in situ
T1a：Tumor invadesmucosal lamina propriaormuscular layer
T1b：Tumor invadesmuscular layer
T2：Tumor invadesserosa, Not yetbreakthroughserosa
T3：tumorbreakthroughserosa，ordirectlyinvasionhepaticViscera,and(or)invasiononeAdjacentorgan
T4：Tumor invadesportal vein主dryorhepatic artery，orinvasion两orand abovehepaticexternalorgan
Regional Lymph Nodes (N)
N0：No regional lymph node metastasis
N1：hepatic hilumlymph nodes(includingcystic duct、common bile duct、hepatic artery、portal veinsurrounding)metastasis
N2：otherregionallymph nodes(retroperitoneal、periduodenal、peripancreatic、superior mesenteric artery旁)metastasis
Distant Metastasis (M)
M0：No distant metastasis
M1：Distant metastasis present
Clinical Stage Grouping
0stage：Tis N0 M0
Ⅰstage：T1 N0 M0
Ⅱstage：T2 N0 M0
ⅢAstage：T3 N0 M0
ⅢBstage：T1-3 N1 M0
ⅣAstage：T4 N0-1 M0
ⅣBstage：anyT N2 M0，anyTanyN M1
Diagnosis
Tumor markers：CA19-9(mostnormalusing)、CEA、CA125、CA153canelevated。
Imaging studies：
ultrasound：preferredexamination，showgallbladder wallincreasethick、mass
CT：assessmenttumorsize、invasionextent、lymph nodesmetastasis
MRI/MRCP：moreclear晰showbiliary tractobstruction
PET-CT：usingindistantmetastasisscreening
endoscopic ultrasound(EUS)：assessmentdepth of invasion，guidancepuncture biopsy
pathological biopsy：ultrasoundorCT-guidedunderpuncture，orsurgeryinbiopsy
Prevention and Follow-up
Gallstonestreatment：diameter>2-3cmofstonesrecommendedpreventiontyperesectiongallbladder
gallbladderPolypsmonitor：diameter>1cmorfast速increaselargethoserecommendedresection
healthy diet：lowfat、lowgallbladder固alcohol饮food，controlbody weight
regularbodyExamination:high-riskpopulationregularlyperformedgallbladderultrasound examination
quit smoking and limit alcohol：reduceincidence risk
follow-up：postoperativelyfirst 2 yearsevery 3-6 monthsfollow-up examination，years 3-5every 6 monthsonce，after 5 yearsannuallyonce