Epidemiological and biochemical aspects of an important sequel to cholelithiasis: gallbladder cancer

  • B. L. Strom


The clinical presentation of patients with gallbladder cancer is similar to that of those suffering from the more common pancreatic cancer. The prognosis is similarly poor. Cancer of the gallbladder is known to vary widely in incidence1. It is more common in certain Latin American countries than in North American countries; more common in the southwest, north central, and Appalachian regions than other regions of the USA; more common in women than in men; and more common in Indians than whites, but lower in blacks than either of the other groups2. A recent paper3 reported the incidence of gallbladder cancer as five times more frequent in La Paz, Bolivia, than in the USA. This higher incidence could not be explained by differences in the age or sex distribution of the two populations, and was only partially explained by differences in racial composition. Inasmuch as gallbladder cancer rarely occurs in the absence of cholelithiasis, some authors have suggested that routine cholecystectomy might be considered when gallstones are discovered, simply as prophylaxis against gallbladder cancer1,4. Other papers in this symposium describe, in detail, the epidemiology of cholelithiasis. In this paper the epidemiology of this very serious sequel of cholelithiasis will be discussed, especially as to the degree that it provides clues to the disease’s aetiology. The literature on gallbladder carcinoma comprises case reports, case series, descriptive epidemiological studies, analyses of secular trends, and experimental animal studies, all of which are useful in generating hypotheses about disease aetiology. Analytical epidemiological studies are notably lacking. The available data will be reviewed. In addition, some intriguing biochemical clues to its aetiology will be reviewed, as well as the approach currently under way to explore these clues in more detail.


Bile Acid Biliary Tract Gallbladder Cancer Extrahepatic Bile Duct Biliary Tract Cancer 
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