Materiały źródłowe

• #1 Epidemiology of gallbladder cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6728871/

  According to GLOBOCAN 2018 data, gallbladder cancer (GBC) accounts for 1.2% of all global cancer diagnoses, but 1.7% of all cancer deaths. Only 1 in 5 GBC cases in the United States is diagnosed at an early stage, and median survival for advanced stage cancer is no more than about a year. The incidence of the disease is increasing in the developed world. […] In 2018, about 219,000 people were estimated to have been diagnosed with gallbladder cancer. This constitutes 1.2% of all cancer diagnoses. Gallbladder cancer is the only digestive system cancer that is more common among women than men. In 2018, the estimated incidence was 97,000 for men and 122,000 for women. […] The incidence in the US is lower than that around the world, with a rate of 1.4 per 100,000 among women and 0.8 among men.

• #2 Gallbladder cancer: epidemiology and outcome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3952897/

  Gallbladder cancer, though generally considered rare, is the most common malignancy of the biliary tract, accounting for 80%95% of biliary tract cancers. […] Epidemiological studies have identified striking geographic and ethnic disparities inordinately high occurrence in American Indians, elevated in Southeast Asia, yet quite low elsewhere in the Americas and the world. […] Mortality rates closely follow incidence; those countries with the highest prevalence of gallstones experience the greatest mortality from gallbladder cancer. […] Vague symptoms often delay the diagnosis of gallbladder cancer, contributing to its overall progression and poor outcome. […] Overall mean survival is a mere 6 months, while 5-year survival rate is only 5%. […] The dismal prognosis, in part, relates to the gallbladder lacking a serosal layer adjacent to the liver, enabling hepatic invasion and metastatic progression.

• #3 Gallbladder cancer statistics | World Cancer Research Fund

  https://www.wcrf.org/preventing-cancer/cancer-statistics/gallbladder-cancer-statistics/

  Gallbladder cancer is the 22nd most common cancer worldwide. It is the 23rd most common cancer in men and the 20th most common cancer in women. […] There were 122,491 new cases of gallbladder cancer in 2022. […] The following table gives the top 5 countries by ASR for gallbladder cancer incidence for both sexes combined. […] China, India and Japan had the highest number of gallbladder cancer cases in 2022. […] China, India and Japan had the highest number of deaths from gallbladder cancer in 2022. […] The following 3 tables show the 10 countries with the highest number of gallbladder cancer deaths in 2022 1st for both sexes, then men and women separately.

• #4 Epidemiology of gallbladder cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6728871/

  Gallbladder cancer rates become more common with age, likely because the malignancy takes decades to develop. The average age of diagnosis in the US is 72. Gallbladder cancer is common after the age of 60 years. […] Gallbladder cancer is more common in females than males. Women are two to six times more commonly affected than men. […] A family history of gallbladder cancer can increase a person’s risk of developing gallbladder cancer. […] A history of gallstones carries the highest risk for gallbladder cancer, with the relative risk (RR) being 4.9. About 85% of people who develop gallbladder cancer have cholelithiasis. […] While gallstones are strongly associated with gallbladder cancer etiology, their role as a cause of cancer remains uncertain. […] The overall incidence of gallbladder cancer in patients with gallstones was found to be 0.5% in a Swedish study recently. […] Gallbladder cancer prevention can also take the form of earlier detection via imaging technologies, or surgical removal of polyps and cysts.

• #5 Gallbladder cancer: epidemiology and genetic risk associations – Schmidt – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/28517/html

  Globally, epidemiological trends of gallbladder cancer incidence vary substantially by geographical region. The highest rates of GBC are observed in Chile (27/100,000) followed by regions of northern India (21.5/100,000); see companion articles in this issue of CCO. Other high-risk regions include Poland (14/100,000), south Pakistan (11.3/100,000), Japan (7/100,000) and Israel (5/100,000). Development of gallbladder cancer has been associated with a broad range of risk factors. Further study of the epidemiology of gallbladder cancer may shed light on its multifactorial etiology and lead to better strategies for prevention and management. […] GBC is one of the few cancer types that demonstrate a worldwide gender bias with up to three to six times higher incidence observed in females compared to males. Additionally, the incidence of gallbladder cancer increases consistently with age. More than two thirds of persons diagnosed with gallbladder cancer are over the age of 65 years with the average age of diagnosis being 72 years.

• #6 Epidemiology, risk factors, clinical features, and diagnosis of gallbladder cancer – UpToDate

  https://www.uptodate.com/contents/gallbladder-cancer-epidemiology-risk-factors-clinical-features-and-diagnosis

  Worldwide, there is prominent geographic variability in GBC incidence that correlates with the prevalence of cholelithiasis. High rates of GBC are seen in South American countries, particularly Chile, Bolivia, and Ecuador, as well as some areas of northern India, Pakistan, Japan, Korea, and Poland. In Chile, mortality rates from GBC are the highest in the world. These populations all share a high prevalence of gallstones and/or salmonella infection, both recognized risk factors for GBC. Both genetic factors and socioeconomic issues that delay or prevent access to cholecystectomy for gallstones are thought to be contributory. […] North America is considered a low-incidence area. Estimates from the Surveillance, Epidemiology, and End Results (SEER) database reveal an incidence of 1 to 2 cases per 100,000 population in the United States; incidence is higher in females than in males (1.7 versus 1.0 cases per 100,000 per year). In contrast to the general population, GBC is the most common gastrointestinal malignancy in both Southwestern Native Americans and in Mexican Americans. […] Although the available data support a decreased overall incidence of GBC in the United States over the last 30 years, the incidence may be increasing in younger individuals. Globally, the burden of gallbladder and other biliary tract cancers has risen over the last 30 years.

• #7 Gallbladder cancer epidemiology, pathogenesis and molecular genetics: Recent update

  https://www.wjgnet.com/1007-9327/full/v23/i22/3978.htm

  Gallbladder cancer is a malignancy of biliary tract which is infrequent in developed countries but common in some specific geographical regions of developing countries. Late diagnosis and deprived prognosis are major problems for treatment of gallbladder carcinoma. The dramatic associations of this orphan cancer with various genetic and environmental factors are responsible for its poorly defined pathogenesis. An understanding to the relationship between epidemiology, molecular genetics and pathogenesis of gallbladder cancer can add new insights to its undetermined pathophysiology. Present review article provides a recent update regarding epidemiology, pathogenesis, and molecular genetics of gallbladder cancer. […] Gallbladder cancer shows an unusual geographic distribution worldwide with substantial geographic variation. Data from Mapuche Indians from Valdivia, Chile, South America shows the rate of gallbladder cancer as: 12.3/100000 for males and 27.3/100000 for females. The native people is these countries exceed for gallbladder cancer mortality rates from cervical (8.0/100000), breast (8.7/100000), pancreatic (7.4/100000), and ovarian cancers (7.3/100000). American Indians in New Mexico, USA, have also very high average annual rate of GBC (8.9/100000).

• #8 Gallbladder cancer epidemiology, pathogenesis and molecular genetics: Recent update

  https://www.wjgnet.com/1007-9327/full/v23/i22/3978.htm

  Although the worldwide occurrence of gallbladder cancer is less than 2/100000 individuals, but this has been recorded with extensive variance. The residents of Indo-Gangetic belt particularly females of northern India (21.5/100000) and south Karachi Pakistan (13.8/100000) have been reported as one of the highest affected regions. Gallbladder cancer is also found in high frequency in Eastern Europe include Poland (14/100000 in Poland), Czech Republic, and Slovakia and Asia whereas south Americans of Indian descent (3.7 to 9.1 per 100000), Israel (5/100000) and Japan (7/100000) have shown intermediate prevalence of gallbladder cancer. […] The majority of the world has decreasing mortality trends in gallbladder cancer but GBC frequency is constantly rising in Shanghai, China which is substantial cause of mortality. Although Gallbladder cancer is more common in females still in some countries like Korea, Iceland and Costa Rica, higher mortality rate has been reported for males as compare to females. The data from National Cancer Institute; SEER Program has revealed only little turn down in incidence over the past few decades.

• #9 Epidemiology, risk factors, clinical features, and diagnosis of gallbladder cancer – UpToDate

  https://www.uptodate.com/contents/epidemiology-risk-factors-clinical-features-and-diagnosis-of-gallbladder-cancer

  Epidemiology, risk factors, clinical features, and diagnosis of gallbladder cancer […] EPIDEMIOLOGY […] Worldwide, there is prominent geographic variability in GBC incidence that correlates with the prevalence of cholelithiasis. High rates of GBC are seen in South American countries, particularly Chile, Bolivia, and Ecuador, as well as some areas of northern India, Pakistan, Japan, Korea, and Poland. In Chile, mortality rates from GBC are the highest in the world. These populations all share a high prevalence of gallstones and/or salmonella infection, both recognized risk factors for GBC. Both genetic factors and socioeconomic issues that delay or prevent access to cholecystectomy for gallstones are thought to be contributory. […] North America is considered a low-incidence area. Estimates from the Surveillance, Epidemiology, and End Results (SEER) database reveal an incidence of 1 to 2 cases per 100,000 population in the United States; incidence is higher in females than in males (1.7 versus 1.0 cases per 100,000 per year). In contrast to the general population, GBC is the most common gastrointestinal malignancy in both Southwestern Native Americans and in Mexican Americans. […] Although the available data support a decreased overall incidence of GBC in the United States over the last 30 years, the incidence may be increasing in younger individuals. Globally, the burden of gallbladder and other biliary tract cancers has risen over the last 30 years.

• #10 Key Statistics for Gallbladder Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/gallbladder-cancer/about/key-statistics.html

  The American Cancer Societys estimates for cancer of the gallbladder and nearby large bile ducts in the United States for 2025 are: […] About 12,610 new cases diagnosed: 6,040 in men and 6,570 in women […] About 4,400 deaths from these cancers: 1,950 in men and 2,450 in women. […] Of these new cases, about 4 in 10 will be gallbladder cancers. […] Gallbladder cancer is not usually found until it has become advanced and causes symptoms. Only about 1 of 5 gallbladder cancers is found in the early stages, when the cancer has not yet spread outside the gallbladder. […] The chances of survival for patients with gallbladder cancer depend to a large extent on how advanced it is when it’s found.

• #11 Incidence, Mortality, and Survival Trends in Cancer of the Gallbladder and Extrahepatic Bile Ducts in Lithuania

  https://www.mdpi.com/1648-9144/59/4/660

  Incidence and mortality from gallbladder and extrahepatic bile duct cancer decreased in both sexes in Lithuania. […] Incidence and mortality rates were higher in females than in males. […] Relative 1-year and 5-year survival rates showed a steady increase during the study period among males and females. […] Age-standardized rates for gallbladder cancer and extrahepatic bile duct cancer among females decreased from 3.91 to 1.93 cases per 100,000 individuals between 1998 and 2017, and from 2.32 to 1.59 cases per 100,000 individuals between 1998 and 2017 among males. […] The relative 1-year survival rate of male patients diagnosed with gallbladder and extrahepatic bile duct cancer in the period of 1998–2017 was 41.78% (95% CI 37.80–45.73), and showed a steady increase from 28.25% in the period 1998–2002 to 45.73% in the period 2013–2017.

• #12 Is gallbladder cancer decreasing in view of increasing laparoscopic cholecystectomy? | Annals of Hepatology

  https://www.elsevier.es/es-revista-annals-hepatology-16-articulo-is-gallbladder-cancer-decreasing-in-S166526811931542X

  Recent studies in Europe have described declining rates of incidence and mortality in gallbladder cancer, whereas Chile and Japan have seen increases. Some studies have hypothesized that increased utilization of LC may play a role in the declining mortality and incidence rates. However, the use of elective cholecystectomy as a secondary prevention of gallbladder cancer is controversial. The trends in GBC and LC have not recently been characterized in the U.S. This study will describe trends in GBC incidence and mortality rates and LC rates. Additionally, we will examine the relationship between GBC and LC rates. […] Since the early 1970s, GBC incidence and mortality rate have declined. Women and older age groups continue to have the highest risk for GBC, despite having greater declines. Incidence significantly decreased among whites, but did not among blacks. The number of inpatient LC procedures increased by 15% between 1994 and 2008; however, inpatient and outpatient LC rates remained stable. LC rate was not significantly correlated with either GBC incidence or mortality.

• #13 Epidemiology of gallbladder cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6728871/

  Gallbladder cancer is among the minority of cancers that present with a greater proportion of cancer mortality than incidence. While the incidence accounts for 1.2% of all cancer diagnoses, gallbladder cancer mortality accounts for 1.7% of all cancer deaths. Estimated age-standardized mortality rates (per 100,000) of other gastrointestinal cancers are colorectum (8.9), liver (8.5), stomach (8.2), esophagus (5.5) and pancreas (4.4). […] About 2000 people die annually in the US from gallbladder cancer. This constitutes a rate of 0.7/100,000 among women and 0.5/100,000 among men, which is 2-3 times lower than the global average (and more disparate when it comes to gender). […] In the US gallbladder cancer incidence has decreased over the past decades among all racial and ethnic groups except non-Hispanic blacks.

• #14 Gallbladder cancer incidence and mortality, United States 1999-2011

  https://www.cancer.fr/professionnels-de-sante/veille/nota-bene-cancer/bulletin-n-276/gallbladder-cancer-incidence-and-mortality-united-states-1999-2011

  Gallbladder cancer is a rare cancer with unusual distribution, and few population-based estimates for the United States have been published. […] During 2007-2011, approximately 3,700 persons were diagnosed with primary gallbladder cancer (rate = 1.13 cases per 100,000) and 2,000 died from the disease (rate = 0.62 deaths per 100,000) each year in the United States. […] Two-thirds of gallbladder cancer cases and deaths occurred among women. […] Gallbladder cancer incidence and death rates were three times higher among American Indian and Alaska Native persons than non-Hispanic white persons. […] During 1999-2011 gallbladder cancer incidence rates decreased among women but remained level among men; death rates declined among women but stabilized among men after declining from 1999-2006.

• #15 Gallbladder cancer incidence statistics | Cancer Research UK

  https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/gallbladder-cancer/incidence

  Gallbladder cancer European age-standardised (AS) incidence rates for females and males combined increased by 66% in the UK between 1993-1995 and 2017-2019.[1-4] The increase was of a similar size in females and males. […] For females, gallbladder cancer AS incidence rates in the UK increased by 74% between 1993-1995 and 2017-2019. For males, gallbladder cancer AS incidence rates in the UK increased by 57% between 1993-1995 and 2017-2019. […] Gallbladder cancer incidence rates have increased overall in some broad age groups in females and males combined in the UK since the early 1990s, but have remained stable in others.[1-4] […] For gallbladder cancer, incidence trends largely reflect changing prevalence of risk factors and improvements in diagnosis and data recording. Recent incidence trends are influenced by risk factor prevalence in years past, and trends by age group reflect risk factor exposure in birth cohorts.

• #16 Gallbladder cancer incidence statistics | Cancer Research UK

  https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/gallbladder-cancer/incidence

  The number of new gallbladder cancer cases on average each year in the UK is projected to rise from around 1,700 cases in 2023-2025 to around 3,100 cases in 2038-2040.[1] […] Gallbladder cancer incidence rates are projected to rise by 47% in the UK between 2023-2025 and 2038-2040, to 4 cases per 100,000 people on average each year by 2038-2040.[1] […] Gallbladder cancer incidence rates (European age-standardised (AS) rates) in England in females are 90% higher in the most deprived quintile compared with the least, and in males are 38% higher in the most deprived quintile compared with the least (2013-2017).[1]

• #17 Epidemiological trends of gallbladder cancer in Australia between 1982 to 2018: A population-based study utilizing the Australian Cancer Database

  https://www.ahbps.org/journal/view.html?doi=10.14701/ahbps.21-169

  The incidence of GBC in Australia reached its nadir in 2006. The decline between 1998 and 2006 might be partially explained by an increase in the uptake of cholecystectomy in Australia, particularly after the introduction of laparoscopic cholecystectomy in circa 1990. […] Our study showed that the incidence of GBC had notable shifts over the time period analyzed; initially steady between 1982 to 1997, a decline from 1998 to 2005, followed by a significant increase from 2006 to 2017. […] Mortality also showed a significant decline of 71% in Australia over the last 35 years. This is substantially better than other worldwide estimates. […] In conclusion, over the last 35 years, the incidence, mortality, sex, and age demographics of GBC in Australia have exhibited shifts. A steady rise in GBC incidence since 2006 is of concern and warrants further investigation and should be a focus of future research.

• #18 Frontiers | Global, regional, and national burden and trends analysis of gallbladder and biliary tract cancer from 1990 to 2019 and predictions to 2030: a systematic analysis for the Global Burden of Disease Study 2019

  https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1384314/full

  Globally, the number of incident cases increased by 84.8% from 107,787 (95% UI: 96,900-119,860) in 1990 to 199,211 (95% UI: 166,769-219,615) in 2019. However, the overall age-standardized incidence rate showed a decrease of 0.48% (95% confidence interval [CI]: 0.40 to 0.55%) per year from 1990 to 2019. In 2019, there were 256,340 (95% UI: 215,699 to 282,004) prevalent cases globally, with an age-standardized prevalence rate of 3.2 (95% UI: 2.7 to 3.5) per 10^5 population. The age-standardized prevalence rate decreased by an average of 0.27% (95% CI: 0.19 to 0.35%) per year from 1990 to 2019 worldwide. Gallbladder and biliary tract cancers caused 172,441 deaths (95% UI: 144,899 to 188,615) and 3,621,473 (95% UI: 3,102,423 to 3,969,071) DALYs worldwide in 2019. In 2019, the global age-standardized mortality and DALYs rates were 2.2 (95% UI: 1.8 to 2.4) and 44.0 (95% UI: 37.6 to 48.2) per 10^5 population, decreased by an average of 0.58 and 0.67% per year globally between 1990 and 2019.

• #19 Gallbladder Cancer: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/278641-overview

  Survival is correlated with staging based on the American Joint Committee on Cancer (AJCC) tumor, node, metastases (TNM) staging system. Most patients have regional disease or distant metastases at presentation. Therefore, the prognosis in gallbladder disease is poor, with 5-year survival rates of 15-20%. […] The highest rates of gallbladder cancer in the US are found in the US Native American and Hispanic, especially Mexican, populations. A substantial female predominance exists in the US and worldwide, with female-to-male ratios of approximately 2.5:1 to 3:1. Gallbladder cancer is most typically diagnosed in the seventh decade of life, with a median age of 62-66 years.

• #20

  https://www.ijmedicine.com/index.php/ijam/article/view/1480

  Incidence of gallbladder carcinoma (GBC) is high among the north Indian population. […] Evaluation of GBC epidemiology will provide important insights into determining causes and risk factors for gallbladder cancer. […] The aims and objectives were to study the epidemiology, clinical presentation and etiological factors of GBC. […] Incidence of GBC at this centre was 1.49%. […] GBC was more prevalent among old women (mean age 52.6212.14 years) belonging to low socio-economic status (SES) (52.94%). […] Gallstones remain the chief risk factor for this malignancy. […] Histopathological examination of all cholecystectomy specimens for early pre cursor lesion could serve as an important means of early detection of this carcinoma.

• #21 Gallbladder cancer epidemiology, pathogenesis and molecular genetics: Recent update

  https://www.wjgnet.com/1007-9327/full/v23/i22/3978.htm

  The development of gallbladder cancer has been linked to various genetic and environmental factors. Chronic infection of gallbladder or/and environmental exposure to specific chemicals, heavy metals, and even many dietary factors, have been found to be associated with GBC formation. […] Present data suggest that gallstones are a major risk factor for GBC but their role as a cause for gallbladder cancer is still not certain. […] The significant risk in 3rd degree relatives and the disease manifestation in several high risk pedigrees as reported in previous studies gives a strong indication for genetic susceptibility to GBC. […] The present existing information regarding genetic and molecular alterations in GBC is still very much limited. Like other neoplasms, GBC is a multifactorial disorder involving multiple genetic alterations.

• #22 The Diagnosis and Management of Gallbladder Cancer Upper Gastrointestinal Cancer – GMKA – Global Medical Knowledge Alliance

  https://gmka.org/the-diagnosis-and-management-of-gallbladder-cancer/

  Gallbladder cancer is a rare disease with a poor prognosis. The overall 5-year survival rate is 19%, ranging from 65% for localized cancers to 28% for regional and less than 2% for distant or metastatic disease. Worldwide in 2020, an estimated 115,949 people were diagnosed with and 84,695 died from gallbladder cancer. Particularly high incidence and mortality is seen in the countries of Chile, Japan, Northern India and among indigenous populations in South, Central and North America. The incidence of gallbladder cancer continues to rise, primarily due to increasing risk factors and incidental cancers discovered after cholecystectomy. It is hypothesized that inflammation of the gallbladder wall mucosa may lead to dysplasia, and this dysplasia ultimately leads to carcinoma. As such, risk factors are often those associated with chronic inflammation. These include gallstones, gallbladder polyps, primary sclerosing cholangitis, infections such as Salmonella Typhi, anomalous junction of the pancreaticobiliary ductal system and porcelain gallbladder. Genetic links continue to be studied, with support for genetic predispositions, familial components and sex-linked genetic variants. Environmental risks associated with specific occupations and chemical exposures may also be associated with gallbladder cancer, such as petroleum, and those found in chemical processing, textiles and paper mills. Additional risk factors, such as cigarette smoking and autoimmune diseases may present potential for mucosal inflammation and dysplasia.

• #23 The Diagnosis and Management of Gallbladder Cancer Upper Gastrointestinal Cancer – GMKA – Global Medical Knowledge Alliance

  https://gmka.org/the-diagnosis-and-management-of-gallbladder-cancer/

  The presentation and diagnosis of gallbladder cancer can be challenging, generally due to non-specific symptoms, low clinical suspicion and lack of reliable screening. As a result, many patients are found to have gallbladder cancer during the work-up or treatment of cholelithiasis, cholecystitis or choledocholithatisis, with as many as 20% being diagnosed at time of cholecystectomy. Common presenting symptoms include abdominal pain, nausea and vomiting, jaundice, fatigue, anorexia and weight loss. Ultrasound is often the initial diagnostic study, particularly if the patient is being worked up for gallstone related pathologies. Findings that are suggestive of gallbladder cancer include mural thickening or calcification (particularly if asymmetric), a mass protruding into the lumen, a fixed mass in the gallbladder, loss of the interface between the gallbladder and liver, or infiltration of the liver. In addition, as many as 23% of polyps over 1 cm in diameter contain an invasive cancer. For patients with suspicious lesions or incidentally diagnosed gallbladder cancer, cross-sectional imaging is recommended, including CT or MRI/MRCP. These modalities allow for more accurate evaluation of involvement and extent of gallbladder cancer.

• #24 Gallbladder Cancer Follow-up: Further Outpatient Care, Deterrence/Prevention, Prognosis

  https://emedicine.medscape.com/article/278641-followup

  Because survival is usually very short in patients with advanced disease, close follow-up is essential to preserve the best quality of life. For patients with earlier stage disease who are treated with surgery and postoperative radiation therapy and chemotherapy, intermittent posttreatment imaging studies can be considered (particularly in the first few years). […] Because a calcified (porcelain) gallbladder has up to a 25% incidence of associated gallbladder cancer, this is an indication to consider a cholecystectomy even in an asymptomatic patient. […] A small percentage (10%) of patients with gallbladder polyps are found to have underlying gallbladder cancer. The risk increases with age and the size of the polyp. A cholecystectomy should be considered if a gallbladder polyp greater than 1 cm in size is found in a patient older than 50 years.

• #25 Why do people with primary sclerosing cholangitis require so much cancer screening? | AASLD

  https://www.aasld.org/liver-fellow-network/core-series/why-series/why-do-people-primary-sclerosing-cholangitis-require-so

  Malignancy remains a significant contributing factor to mortality in patients with PSC. […] In particular, patients with PSC are at increased risk for hepatobiliary (cholangiocarcinoma, gallbladder cancer, hepatocellular carcinoma) and colorectal cancers. […] Similar to CCA, patients with PSC are at a markedly increased risk for gallbladder cancer. Though the literature is varied, it is estimated that the prevalence of GBC in people with PSC is between 2.5% and 3.5%, with some studies reporting up to 21%. This increased risk is thought to be a consequence of chronic gallbladder inflammation that accelerates the metaplasia-dysplasia-carcinoma sequence. […] The AASLD currently recommends surveillance of gallbladder polyps 8 mm with US every 6 months and referral for cholecystectomy for polyps 9 mm or greater.

• #26 Epidemiology of gallbladder cancer in the Unites States: a population-based study – Alkhayyat – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/62842/html

  Gallbladder cancer (GBC) is the most common neoplasm of the biliary tract with the lowest rates of survival. There are limited data in the literature regarding the epidemiology of GBC. Using a large database, we aim to describe the epidemiology using a US population database. Of the 56,197,690 individuals in the database, 4,790 individuals with GBC were identified with a prevalence rate of 8.5 per 100,000. Asian race has the highest prevalence of GBC (13.6/100,000). Patients with GBC were also more likely to be smokers, have a history of alcohol abuse, obesity, diabetes, cholelithiasis, chronic cholecystitis, primary sclerosing cholangitis (PSC), and chronic viral hepatitis. This is one of the largest US population studies to date evaluating the epidemiology of GBC. The 20-year period prevalence rate of GBC was 8.5 per 100,000. Patients with GBC were more likely to be elderly, females, obese, diabetic, and have chronic hepatobiliary disorders. Current literature shows that unlike other gastroenterological malignancies, GBC is more common in women compared to men. It is also more common in older individuals with 72 years old being the average age of diagnosis in the US. It is more prevalent in certain ethnicities and regions of the world compared to others which is attributed to different environmental exposures and genetic predisposition. Interestingly, the global distribution of GBC and gallbladder stones—the most commonly cited risk factor—is found to be related. Other risk factors reported in the literature include a family history of GBC, gallbladder polyps, primary sclerosis cholangitis, chronic infections with Salmonella and H. pylori, congenital biliary cysts, abnormal pancreaticobiliary junction, hormonal therapy in postmenopausal women, cigarette smoking, heavy alcohol drinking, and obesity. Our population-based study of 56 million patients showed that the 20-year period prevalence rate of GBC is 8.5 per 100,000 among the US population. In our cohort, patients with GBC were more likely to be elderly (age 65) and females. GBC is considered one of the few cancers where the incidence is higher in women than men, this is thought to be due to a higher prevalence of gallstones in women. After adjusting for several factors in the multivariate analysis, we found that female gender is an independent risk factor for GBC. In our cohort, gallstone was the single most important risk for GBC, which is consistent with prior studies. Moreover, it is believed that the geographic pattern of GBC correlates with the prevalence of gallstones. Chronic inflammation can also lead to the deposition of calcium in the gallbladder wall, a condition called porcelain gallbladder. However, today, the association between GBC and porcelain gallbladder is controversial. The data on obesity as a risk factor for GBC is conflicting. Our study however, is in agreement with the previous studies that showed an increased risk of GBC in obese patients. In a systematic review of eight studies, obesity and body mass index (BMI) were significantly associated with GBC. Cigarette smoking and heavy alcohol use were also associated with GBC. Emerging data suggest that chronic HBV and HCV infections may also play a role in extrahepatic bile duct cancers. In our study, we found a higher risk of developing GBC in HBV or HCV infection. Moreover, PSC was significantly associated with higher risk of GBC with a seven-fold increased risk compared to the general population. GBC remains a highly fatal cancer, with only 10% of cases presenting at a surgically resectable stage with an overall 5-year survival of 60% for localized tumors, 30% for regional spread, and 2% for distant spread. Our study is in agreement with the previous literature in regards to the association of GBC with female sex, older age, gallstone disease, cholecystitis, obesity, diabetes, smoking, alcohol abuse, chronic HBV and HCV infections, family history of GBC, and PSC. This is the largest US study to-date demonstrating incidence rate higher than previously reported. GBC is a rare disease with a poor prognosis. GBC epidemiology is an evolving and is constantly reshaped by several factors including lifestyle, geographic, and diet. The clinician must keep a high index of suspicion of GBC in patients with the risk factors emphasized in this study for timely detection, diagnosis, and better outcomes.

• #27

  https://journals.lww.com/sujh/fulltext/2024/01000/epidemiology_of_gallbladder_cancer_in_india.15.aspx

  India is a high-incidence area for gallbladder cancer (GBC), contributing approximately 10% of the global GBC burden. […] The incidence has been steadily rising in both genders. […] Gallstones are present in 80% of Indian GBC patients, increasing the vulnerability of the gallbladder to mucosal injury. […] However, the incidence of GBC is disproportionate to the prevalence of gallstones in the country. […] Additional cofactors such as older age, lower socioeconomic status, chronic Salmonella typhi infection, Helicobacter pylori infection, exposure to pollutants, heavy metals, chemicals, adulterated mustard oil, and smoking in patients with gallstones have been identified as promoters of carcinogenesis. […] Environmental risk factors, including soil and water contamination by industrial wastes, agricultural effluents, and human sewage, have also been identified as putative risk factors.

• #28 Gallbladder carcinoma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/gallbladder-carcinoma-1?lang=us

  Gallbladder adenocarcinoma is the most common primary biliary carcinoma and the 5th most common malignancy of the gastrointestinal tract 1. […] Predominantly affects older persons with long-standing cholecystolithiasis, and as such is most common in elderly women (60 years of age, F:M ratio = 4:1) 1,3. […] Risk factors include 1: chronic cholecystitis, gallstones are seen in 70-90% of cases 3,4, familial adenomatous polyposis syndrome (FAP), inflammatory bowel disease (IBD), porcelain gallbladder, gallbladder polyps 1 cm that are sessile and solitary, primary sclerosing cholangitis 13, anomalous junction of pancreaticobiliary ducts 16, certain ethnicities and geographical groups (e.g. Native Americans and Chileans) 16, chronic infections including the typhoid carrier state 16, exposure to carcinogens (e.g. lead, cadmium, chromium) 16, obesity, diabetes mellitus, and dietary factors 17, family history of gallbladder carcinoma 18.

• #29 Arsenic causing gallbladder cancer disease in Bihar | Scientific Reports

  https://www.nature.com/articles/s41598-023-30898-0

  The etiology of gallbladder cancer apart from the few reasons has been a mystery, however the interplay of gallstones, genetic susceptibility, changes in the lifestyle factors and infections lead to progression of the cancer disease. […] The present study throws new light on the association between gallbladder carcinogenesis and arsenic poisoning in the Gangetic plains of Bihar through the novel pathway. […] The raised arsenic concentration in the gallbladder cancer patients biological samples-gallbladder tissue, gallbladder stone, bile, blood, and hair samples was significantly very high in the arsenic exposed area. […] The study also confirms that the studied control subjects had non-significant arsenic concentration in their blood and hair samples. A significantly high arsenic concentration (p0.05) was detected in the blood samples with maximum concentration 389 g/L in GBC cases in comparison to control. Similarly, in the gallbladder cancer patients, there was significantly high arsenic concentration observed in gallbladder tissue with highest concentration of 2166 g/kg, in gallbladder stones 635 g/kg, in bile samples 483 g/L and in hair samples 6980 g/kg respectively.

• #30 Epidemiology of gallbladder cancer

  https://www.termedia.pl/Epidemiology-of-gallbladder-cancer,80,36699,0,1.html

  PlumX metrics: According to GLOBOCAN 2018 data, gallbladder cancer (GBC) accounts for 1.2% of all global cancer diagnoses, but 1.7% of all cancer deaths. Only 1 in 5 GBC cases in the United States is diagnosed at an early stage, and median survival for advanced stage cancer is no more than about a year. The incidence of the disease is increasing in the developed world. […] Gallstones, biliary cysts, carcinogen exposure, typhoid, and Helicobacter pylori infection, and abnormal pancreaticobiliary duct junctions are all risk factors, many of which account for its geographical, ethnic and sex distribution. Genetics also plays a strong role, as about a quarter of GBC cases are considered familial, and certain ethnicities, such as Native Americans, are at far higher risk for the neoplasm. Prevention includes weight loss, vaccination against and treatment of bacterial infections, early detection and elimination of polyps and cysts, and avoidance of oral estrogen replacement therapy.

• #31 Gallbladder cancer epidemiology, pathogenesis and molecular genetics: Recent update

  https://www.wjgnet.com/1007-9327/full/v23/i22/3978.htm

  The existing literature has reported mutations of the TP53 gene in between approximately 27% to 70% of gallbladder carcinomas. […] Various lines of evidence suggest role for various environmental risk factors in Gallbladder carcinoma. Despite of many articles regarding genetic predisposition of gallbladder cancer there is no established genetic marker. Also, very limited Genome wide association studies (GWAS) have been conducted in gallbladder cancer till now.

• #32 Epidemiology of gallbladder cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6728871/

  Gallbladder cancer has historically had a poor prognosis due to its late diagnosis. In the US, 43% of gallbladder cancers were found after cancer had spread to regional organs or lymph nodes, while 42% were found after spreading to distant organs or lymph nodes. The median survival in the US is 12-14 months for patients undergoing resection, and six months for patients treated with palliative stenting. […] The average 5-year survival rate in the US for gallbladder cancer is 18%. For those with stage I cancer, where the cancer is confined to the gallbladder, the 5-year survival rate is 60%. […] While the proportion of distant/regional metastasized diagnoses had been decreasing for decades, it has recently increased, in line with the recent spikes in incidence and mortality in the developed world.

• #33 Gallbladder Carcinoma : A Comprehensive Review and Recent Updates | IntechOpen

  https://www.intechopen.com/online-first/1219270

  Patients undergoing radical cholecystectomy for gallbladder cancer should be monitored with imaging studies every 3 to 6 months for the first 2 years, followed by every 6 to 12 months for up to 5 years. Additionally, CEA and CA 199 levels should be assessed as clinically indicated to aid in detecting recurrence. […] Screening for gallbladder cancer (GBC) is not conducted on a population-wide basis due to its low overall incidence and the lack of cost-effective screening tools. However, targeted screening is recommended for high-risk individuals, including those with large gallstones (3 cm), porcelain gallbladder, gallbladder polyps 1 cm, primary sclerosing cholangitis (PSC), anomalous pancreaticobiliary duct junction (APBDJ), chronic bacterial infections (Salmonella or Helicobacter), and a family history of GBC. In high-risk groups, ultrasound (USG) serves as the first-line screening tool, performed annually to detect gallbladder abnormalities.

• #34 Surveillance for hepatobiliary cancers in patients with primary sclerosing cholangitis – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/surveillance-for-hepatobiliary-cancers-in-patients-with-primary-sclerosing-cholangitis/

  Key principles in the surveillance of hepatobiliary cancers including cholangiocarcinoma, gallbladder adenocarcinoma, and hepatocellular carcinoma (HCC) in patients with primary sclerosing cholangitis (PSC). […] 1. Surveillance for cholangiocarcinoma and gallbladder cancer should be considered in all adult patients with primary sclerosing cholangitis (PSC) regardless of disease stage, especially in the first year after diagnosis and in patients with ulcerative colitis and those diagnosed at an older age. 2. Surveillance for cholangiocarcinoma and gallbladder cancer should include imaging by ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI), with or without serum carbohydrate antigen 19-9, every 6 to 12 months. 3. Endoscopic retrograde cholangiopancreatography (ERCP) with brush cytology should not be used routinely for surveillance of cholangiocarcinomas in PSC. 4. Cholangiocarcinomas should be investigated by ERCP with brush cytology with or without fluorescence in situ hybridization analysis and/or cholangioscopy in PSC patients with worsening clinical symptoms, worsening cholestasis or a dominant stricture. 5. Fine-needle aspiration of perihilar biliary strictures should be used with caution in PSC patients considered to be liver transplant candidates because of concerns for tumor seeding if the lesion is a cholangiocarcinoma. 6. Surveillance for cholangiocarcinoma should not be performed in PSC patients with small-duct PSCs or those younger than age 20. 7. The decision to perform a cholecystectomy in PSC patients with a gallbladder polyp should be based on the size and growth of the polyp, as well as the clinical status of the patient, with the knowledge of the increased risk of gallbladder cancer in polyps greater than 8 mm. 8. Surveillance for hepatocellular carcinoma in PSC patients with cirrhosis should include ultrasound, CT or MRI, with or without α-fetoprotein every 6 months.

• #35 Gallbladder Cancer Follow-up: Further Outpatient Care, Deterrence/Prevention, Prognosis

  https://emedicine.medscape.com/article/278641-followup

  Survival at 5 years is correlated with stage of disease at presentation. Only 10-20% of patients present with localized disease. The remainder present with regional or distant spread. From 1989 to 1996, 5-year survival in patients with primary gallbladder cancer was 50% for stage I disease and 2% for stage IV disease.

• #36 Gallbladder cancer: epidemiology and outcome | CLEP

  https://www.dovepress.com/gallbladder-cancer-epidemiology-and-outcome-peer-reviewed-fulltext-article-CLEP

  Improved imaging modalities are helping to diagnose patients at an earlier stage. […] The last decade has witnessed improved outcomes as aggressive surgical management and preoperative adjuvant therapy has helped prolong survival in patients with gallbladder cancer. […] Those with PSC therefore should undergo annual gallbladder cancer surveillance, via abdominal ultrasound screening, for masses. […] The prognosis worsens when the tumor invades the deeper layers of the gallbladder. […] The metastatic rates also increase with deeper invasion of the gallbladder tumor. […] The potential for long-term survival exists in some with node-positive disease. […] Thus, early diagnosis is imperative as surgery can be curative. […] Improved imaging modalities as well as accurate diagnostic markers will potentially help outcomes. […] Secondary prevention should follow the clarification of the value of prophylactic cholecystectomy in endemic areas and in patients at risk.

• #37 Gallbladder cancer: epidemiology and outcome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3952897/

  Improved imaging modalities are helping to diagnose patients at an earlier stage. […] The last decade has witnessed improved outcomes as aggressive surgical management and preoperative adjuvant therapy has helped prolong survival in patients with gallbladder cancer. […] In the future, the development of potential diagnostic markers for disease will yield screening opportunities for those at risk either with ethnic susceptibility or known anatomic anomalies of the biliary tract. […] Meanwhile, clarification of the value of prophylactic cholecystectomy should provide an opportunity for secondary prevention. […] Primary prevention will arrive once the predictive biomarkers and environmental risk factors are more clearly identified.

• #38 The Diagnosis and Management of Gallbladder Cancer Upper Gastrointestinal Cancer – GMKA – Global Medical Knowledge Alliance

  https://gmka.org/the-diagnosis-and-management-of-gallbladder-cancer/

  There are multiple staging systems for gallbladder cancer, including the modified Nevin-Moran, the American Joint Committee on Cancer (AJCC) TNM system and the Japanese Biliary Surgical Society. There is controversy regarding the superiority of each system in predicting survival, but the TNM system is most commonly used. The current 8th edition AJCC TNM staging, updated to improve prognostic precision, is noteworthy for division of T2 category into two sub-groups based on the anatomical location of the tumor: T2a (peritoneal side) and T2b (hepatic side). The value of staging laparoscopy is evident as 50% of patients present with unresectable disease at the time of staging. […] Few studies have published on the optimal timing of surveillance and recurrence after gallbladder cancer resection, but up to 50% of patients recur within 2 years of surgery. Therefore, NCCN guidelines recommend imaging every 3-6 months for 2 years then 6-12 months for up to 5 years or as clinically indicated.

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