Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Gastroenterol Hepatol. 2012 Apr;27(4):642-53. doi: 10.1111/j.1440-1746.2011.07048.x.
Gallbladder cancer (GBC) is the leading cause of cancer related mortality in certain geographic areas. Most of the patients with GBC have advanced disease at presentation, precluding curative resection resulting in a dismal prognosis. However, recent advances in the understanding of its epidemiology and pathogenesis coupled with development of newer diagnostic tools and therapeutic options, has resulted in enhanced optimism towards the management of the disease. The leading risk factors are gallstones, advancing age, female gender, anomalous pancreaticobiliary ductal junction, certain ethnic groups and geographic populations. Advances in radiological imaging and the advent of endoscopic ultrasound have facilitated early detection and accurate staging of the tumor. A high index of suspicion in high risk groups is necessary to pick up incidental and early GBC, as surgical resection is curative. In patients with suspected GBC, an open surgical resection that is appropriate for that stage is advocated. Adjuvant combination chemotherapy and molecular targeted therapy are emerging as effective therapeutic options in those with advanced GBC. Endoscopic palliation of biliary and gastric outlet obstruction with metallic stents has improved their quality of life. Prevention remains the hitherto less explored option to reduce GBC related mortality. Prophylactic cholecystectomy in high risk groups is a cost-effective option. A multi-disciplinary systematic global approach to initiate collaborative ventures to understand epidemiology, standardize management strategies, conduct multi-centric trials with newer therapeutic agents and initiate preventive measures, would pave way for the future conquest of the disease.
胆囊癌（GBC）是某些地理区域癌症相关死亡的主要原因。大多数 GBC 患者在就诊时已处于晚期疾病，无法进行根治性切除，导致预后极差。然而，近年来对其流行病学和发病机制的认识不断深入，加上新的诊断工具和治疗选择的发展，为疾病的治疗带来了更大的希望。主要的危险因素包括胆结石、年龄增长、女性、异常胰胆管连接、某些种族和地理人群。放射影像学的进步和内镜超声的出现促进了肿瘤的早期发现和准确分期。在高危人群中保持高度怀疑是必要的，以便发现偶发性和早期 GBC，因为手术切除是治愈的。对于疑似 GBC 的患者，提倡根据该阶段进行开放式手术切除。辅助联合化疗和分子靶向治疗已成为晚期 GBC 的有效治疗选择。金属支架用于胆道和胃出口梗阻的内镜姑息治疗改善了患者的生活质量。预防仍然是减少 GBC 相关死亡率的探索较少的选择。在高危人群中预防性胆囊切除术是一种具有成本效益的选择。多学科系统的全球方法可以发起合作，以了解流行病学，标准化管理策略，开展使用新型治疗药物的多中心试验，并启动预防措施，为未来征服这种疾病铺平道路。
