| [ Summary ] |
Gallbladder cancer (GBC) accounts for about 2 % of all malignancies in Japan. Several GBC risk factors are known, for example, female gender, advanced age, particular race, cholelithiasis, porcelain gallbladder, anomalous pancreatobiliary duct junction, etc. The relationship between cholelithiasis and GBC is considered a major factor for GBC carcinogenesis. Gallstones are found in about 85 % of GBC cases. The size of gallstones seems to be directly linked to GBC risk. In previous studies, the relative risk ratio for GBC was reported to be 2.7 to 20.9 in patients with cholelithiasis. Sequential carcinogenesis is thought to be linked to GBC associated with gallstones. Most of cholelithiasis-related GBCs are thought to progress to dysplasia, carcinoma in situ, and invasive cancer. These changes are likely to be associated with several genetic abnormalities. Even in the early stages of carcinogenesis, TP53 or p16Ink4 / CDKN2 genes are frequently disturbed. In contrast, KRAS or APC mutations became evident in some patients with invasive cancer. Because gallbladder adenoma lacks the molecular changes frequently detected in dysplasia or cancer, most of these lesions seem not to be associated with invasive cancer. To prevent GBC we should resect gallbladders displaying risk factors, including symptomatic cholelithiasis and porcelain gallbladders. |