Epidemiology and risk factors

Gallbladder cancer (GBCA) is the fifth most common gastrointestinal cancer and the most common biliary tract malignancy in the United States, with an incidence of 1.2 per 100,000 persons per year. Because of its tendency to present at an advanced stage, it has historically been considered an incurable disease with a dismal prognosis. In appropriately selected cases, radical surgery is possible and offers some patients a chance at long-term survival. Despite this, in the majority of cases, the outcomes of patients with advanced GBCA remain poor.

There are many known risk factors for GBCA, including cholelithiasis, obesity, multiparity, and typhoid fever. In addition, there are geographic variations in the prevalence of the disease, with rates highest in Chile, India, Israel, Poland, and Japan. In the United States, the disease prevails in Native American women from New Mexico. Gallstones are present in the majority of patients; however, the relationship between causation and association is unclear. In some cases of GBCA, a focus of cancer may be found in a gallbladder adenomatous polyp; however, in the majority of cases, small polyps of the gallbladder do not harbor malignancy and are non-neoplastic and may be simply observed. Polyps greater than 1 cm, those arising in the setting of primary sclerosing cholangitis, or those discovered in patients older than 50 years of age are more likely to harbor cancers and, therefore, should be treated with cholecystectomy if a patient is an appropriate candidate for surgery.