Is gallbladder cancer definitely hereditary?

Gallbladder cancer is one of the common malignant tumors in the biliary system. Among the malignant tumors of the gallbladder, gallbladder cancer ranks first. Others include sarcoma, carcinoid, primary malignant melanoma, giant cell adenocarcinoma, etc. Since the latter are rare, this chapter mainly discusses primary gallbladder cancer. Women are 2 to 4 times more likely to be diagnosed than men. It is more common in people aged 50 to 70 years old.

1. Ultrasound examination: B-ultrasound examination is simple and non-destructive, can be used repeatedly, and has a diagnostic accuracy rate of 0.75, so it should be the preferred examination method. However, B-ultrasound (US) is easily affected by abdominal wall hypertrophy and intestinal gas, and it is not easy to determine the condition of stone-filled and atrophic gallbladder walls. In recent years, people have adopted the method of EUS (endoscopic ultrasound) to better solve the above-mentioned problems of US. EUS uses a high-frequency probe to scan the gallbladder only through the stomach or duodenal wall, which greatly improves the detection rate of gallbladder cancer, and can further determine the degree of tumor infiltration in each layer of the gallbladder wall. Therefore, people use EUS as a further accurate judgment method after US examination. Regardless of US or EUS, the ultrasound images of early gallbladder cancer mainly show raised lesions and localized cystic wall hypertrophy, and there are also mixed types of the two.

2. CT scan: The sensitivity of CT scan for gallbladder cancer is 0.5, especially for the diagnosis of early gallbladder cancer, which is not as good as US and EUS. CT image changes can be divided into three types: ① Wall thickness type: The gallbladder wall is locally or diffusely thickened irregularly. ② Nodular type: Papillary nodules protrude from the gallbladder wall into the cavity, and the gallbladder cavity exists. ③ Solid type: The gallbladder wall is widely infiltrated and thickened by the tumor, and the cavity is filled with cancerous masses to form a substantial mass. If the tumor invades the liver or metastasizes to the liver hilum or pancreatic head lymph nodes, it can often be displayed under CT images.

3. Color Doppler blood flow imaging: Domestic literature reports that abnormal high-speed arterial blood flow signals detected in the gallbladder mass and wall are important features that distinguish primary malignant gallbladder tumors from gallbladder metastatic cancer or benign gallbladder masses.

4. ERCP: Some people report that the diagnosis rate of ERCP for gallbladder cancer that can show the gallbladder can reach 0.7, but more than half of ER-CP examinations cannot show the gallbladder. Its imaging manifestations can be divided into three situations: (1) The gallbladder and bile duct are well visualized: mostly early lesions, typical cases can show gallbladder filling defects or raised lesions connected to the cyst wall with a wide base. Infiltration of the gallbladder wall can show stiffness or deformation of the cyst wall. (2) The gallbladder is not visualized: mostly in the middle and late stages. (3) The gallbladder is not visualized and there is hepatic or extrahepatic bile duct stenosis: filling defects and dilatation of the hepatic bile duct above the obstruction are already late-stage signs.

5. Cytological examination: There are two methods of cytological examination: direct biopsy or bile extraction to find cancer cells. Direct biopsy methods include: gallbladder lesion puncture under B-ultrasound guidance, PTCCS (percutaneous cholecystoscopy), laparoscopy, etc. There are more methods to take bile, such as bile extraction under ERCP, gallbladder puncture under B-ultrasound guidance, PTCD, choledochoscopy, etc. Although the positive rate of cytological examination reported in the literature is not high, it can still be used in combination with imaging examination methods to diagnose more than half of gallbladder cancer patients.