Will gallstones develop into gallbladder cancer without resection
2022-05-26
Recently, an old man came to see a doctor because of yellow urine. Because she had a history of gallstones for many years, doctors initially suspected that she had biliary obstruction caused by gallstones. After completing CT examination, it is determined that gallbladder cancer has liver metastasis and lymph node metastasis, resulting in jaundice, but there is no ideal treatment at this stage. The patient's family members said that more than a decade ago, a doctor advised the patient to have an operation to remove the gallbladder, but the old man felt that he had no symptoms and gave up. In life, many people have different degrees of gallbladder problems, and gallstones are the most common. So, should gallstones be removed immediately? If it is not removed, how likely is it to develop into cancer? What factors may promote carcinogenesis? Where does gallstone come from Gallstone is a solid formed by the crystallization of cholesterol, bile pigment and other components in bile after excessive concentration of bile. According to different components, gallstones are usually divided into cholesterol stones, pigment stones and mixed stones, among which cholesterol stones are the most common. From the cause of formation, poor gallbladder contraction and emptying function are the main factors for the formation of gallstones, and abnormal bile components (such as excessive cholesterol or bile pigment components) are also an important factor. So, what is the correlation between poor gallbladder function and abnormal bile composition? Clinically, it is believed that this is closely related to age growth, obesity, gender (female multiple) and pregnancy. In addition, we are familiar with bad eating habits, such as often not eating breakfast, dieting, long-term vegetarian, long-term high cholesterol diet and so on; Abnormal anatomical structure of gallbladder, such as gallbladder separation (referring to the gallbladder cavity in the gallbladder is divided into two or more parts due to various reasons), is also easy to induce gallstones. When gallstones first appear, their volume and space are relatively small, and their impact on gallbladder function is also small. As long as the stones do not block the cystic duct and common bile duct, there will be no obvious symptoms. Doctors call them static stones. With the increase and increase of stones, some patients will have biliary colic or acute cholecystitis, mainly manifested as severe stomach pain after eating or in the middle of the night. Most of them need to go to the hospital to relieve spasm and pain. A few small stones can enter the common bile duct with bile. Once the common bile duct is blocked, it may lead to critical situations such as acute cholangitis and even pancreatitis. There are great differences in the development of patients' condition. In general, many stones may remain stationary or grow slowly all year round. Some patients are asymptomatic for life, but some patients with stationary stones will develop gallbladder cancer after many years. Painless stones are not necessarily safe Many patients with gallstones think that they will be fine without pain, which is obviously too optimistic. In fact, stationary gallstones may also become cancerous. Gallstone induced gallbladder cancer is the result of chronic and long-term stimulation, and does not necessarily experience the process of biliary colic or acute cholecystitis. Stones exist in the gallbladder and are in long-term contact with the gallbladder mucosa. The mechanical damage of stones to the mucosa and the chemical stimulation of bile are easy to induce chronic cholecystitis and eventually lead to canceration. The data from 487 registries nationwide in 2016 released by the National Cancer Center shows that the incidence rate of gallbladder cancer is 4.03/100000, and the incidence rate of gallbladder cancer is higher in areas with high incidence of gallstones. Over the years, the results of epidemiological investigation have confirmed that gallstone is the most important cause of gallbladder cancer. The larger the stone and the longer the history, the higher the risk of gallbladder cancer. Research shows that the risk of gallbladder cancer in patients with gallstones is 13.7 times higher than that in people without gallstones; The incidence rate of gallbladder cancer in patients with a single gallstone diameter greater than 3cm was 10 times that in patients with a gallstone diameter less than 1cm. In addition to gallstones, there are many high-risk factors that may induce gallbladder cancer. 1. Polypoid lesions of gallbladder. Cholesterol polyps are small and grow slowly, and generally will not become cancerous. It is adenomatous polyps that need to be vigilant. Adenomatous polyps grow relatively fast, with a diameter of more than 1 cm, thickened basal capsule wall, and blood supply can be detected by ultrasonic Doppler. Most of them are adenomatous polyps. 2. Patients with gallbladder adenomyosis, especially segmental adenomyosis, are prone to gallbladder stones and have a high risk of canceration. 3. Porcelain gallbladder, stones between gallbladder walls and atrophic gallbladder are all pathogenic factors of gallbladder cancer. 4. Patients with abnormal confluence of biliary and pancreatic ducts, congenital biliary cyst, primary sclerosing cholangitis and inflammatory bowel disease are prone to gallbladder cancer. 5. obese and diabetes patients are high-risk groups of gallbladder cancer. 6. Genetic factors are involved in the occurrence of some gallbladder cancers. Is it feasible to "protect gallbladder and take stone" As an auxiliary digestive organ, gallbladder has specific physiological functions. A healthy gallbladder plays a positive role in the health of digestive system and even the whole body. Therefore, whether the gallbladder should be removed in the treatment of gallbladder diseases needs to be decided after weighing the advantages and disadvantages. We can neither blindly pursue gallbladder protection nor perform surgery casually. There has always been a dispute about whether to cut the gallbladder or not. At present, there are mainly four opinions on this problem: the vast majority of patients do not want to remove the gallbladder; Traditional Chinese medicine suggests taking medicine instead of surgery; Surgeons in a few hospitals carry out bile preservation and lithotomy; The vast majority of doctors in class III hospitals recommend cholecystectomy when indicated. Which way to choose depends on the individual situation. I suggest that patients who have no symptoms and have gallbladder function can be rechecked regularly, and there is no need for surgical treatment. During the observation period, if patients are willing to take medicine for conditioning, whether traditional Chinese medicine or western medicine, they can try under the guidance of doctors in regular hospitals. Clinically, there are a few patients who take medicine to dissolve and excrete stones. However, if the medicine has no effect after taking it for a period of time, it is necessary to stop the medicine in time and adjust the treatment method, so as to avoid toxic and side effects of long-term medication. As for many people's tendency to protect the gallbladder and take stones, it may indeed benefit some patients, but because the causes of gallstone formation have not been removed, the vast majority of patients will still relapse. This is why many doctors do not recommend bile preservation and stone removal for treatment. Therefore, for patients with gallstone who meet the surgical indications, it is recommended to remove the gallbladder as soon as possible to prevent canceration. For example, gallstones exceed 2 cm; The thickness of gallbladder wall in patients with stones is more than 4 mm; Stones fill the gallbladder; Patients with a medical history of more than 10 years. Gallbladder polyps more than 1 cm in diameter; Thickening of gallbladder wall at the base of polyp; The obvious blood supply of polyps was observed by conventional color Doppler ultrasound. Segmental adenomyosis of gallbladder; Diffuse adenomyosis of gallbladder; Focal adenomyosis of gallbladder increased rapidly. In addition, patients with gallbladder atrophy, porcelain gallbladder and gallstone between gallbladder walls should also receive preventive cholecystectomy as soon as possible. B-ultrasound of liver and gallbladder should be done at least once a year In view of the clear etiology of gallbladder cancer, we can strengthen the screening of high-risk patients and implement preventive cholecystectomy for those with high cancer risk. The risk of gallbladder cancer in the general population is very low, and normal physical examination can be used at ordinary times; Patients with the above-mentioned high-risk factors need to strengthen screening for early detection and treatment. It is suggested that serum CEA and CA199 should be tested every 6 months, and B-ultrasound examination of liver and gallbladder should be carried out at the same time; The general population is recommended to test serum CEA and CA199 once a year and do hepatobiliary B-ultrasound once a year. Personal prevention is suggested to start from improving the lifestyle. Obese patients can gradually change their physical state from high-risk groups to ordinary people through scientific diet control and gradual exercise; Diabetes patients should pay attention to diet control, cooperate with active exercise, follow the doctor's advice to use hypoglycemic drugs or insulin, and maintain good physical condition; The general population should try to live a regular life, eat a balanced diet, eat more vegetables and fruits, properly eat more eggs, milk and fish rich in high-quality protein, eat less processed meat products, and actively engage in sports. Extended reading What is the relationship between cholecystitis and gallstone Cholecystitis is closely related to cholecystolithiasis. The vast majority of cholecystitis occurs and develops on the basis of cholecystolithiasis, which is called calculous cholecystitis; Very few patients with cholecystitis are not complicated with stones, that is, non calculous cholecystitis. According to the different causes, clinical manifestations and treatment methods of cholecystitis, cholecystitis is divided into acute cholecystitis and chronic cholecystitis. Acute cholecystitis is mostly caused by stones blocking the cystic duct or stones embedded in the neck of the gallbladder or ampulla of the gallbladder. Its initial performance is aseptic inflammation dominated by gallbladder wall edema. With the extension of the course of disease, bacteria gradually invade and develop into suppurative inflammation. If the infection cannot be controlled in time, it may lead to gallbladder wall gangrene or even gallbladder perforation. At the onset of the disease, the patient will feel severe pain mainly in the right upper abdomen, accompanied by a significant increase in body temperature. The test shows that the white blood cells rise. Ultrasound can see the swollen gallbladder with edema and thickening of the gallbladder wall. Through fasting and anti infection treatment, most acute cholecystitis can be effectively controlled. In the initial stage of inflammation, it can also be completely cured by surgical cholecystectomy. When the conservative treatment of a few severe patients can not be controlled, ultrasound-guided gallbladder puncture and drainage can be implemented, and the gallbladder can be removed at a selected time about 6 weeks after the inflammation subsides. Most of chronic cholecystitis have no obvious symptoms, and a few have nonspecific symptoms such as fullness and dull pain after meals. Ultrasound can show diffuse and uniform thickening of gallbladder wall and intraluminal stones. Surgical treatment is also recommended for patients with chronic cholecystitis with the above indications. (outlook new era)
Edit：Yuanqi Tang Responsible editor：Xiao Yu
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