Risk Factor For Gallbladder Cancer Research Articles

7172 Endoscopic ultrasonography for the diagnosis of gallbladder lesions in patients with gallstones.

Purpose: Gallstones are generally considered a risk factor for gallbladder cancer. Since gallbladder cancer has a poor prognosis, accurate qualitative diagnosis of elevated lesions in the gallbladder is needed, even in the presence of gallstones. In this study, the ability of endoscopic ultrasonography (EUS) to detect gallbladder lesions in patients with gallstones was assessed. Patients and Methods: Between April 1992 and September 1999, 62 patients underwent cholecystectomy for an elevated lesion or thickening of the gallbladder wall identified by imaging techniques including EUS. EUS was performed using the Olympus GF-UM20 (7.5MHz) system. The accuracy of EUS was analyzed in relation to the presence or absence of gallstones, the size and number of stones, and presence or absence of acoustic shadowing.The EUS results were compared with histopathologic results. Significance was tested using the chi-square test and the Student's t test. Results: The accuracy of EUS was 70.8% in the gallstone group and 89.5% in the gallstone-free group (NS). The diagnostic accuracy was 75.0% in the patients with stones smaller than 5 mm, 33.3% in the patients with stones between 6 and 10 mm in size, and 77.8% in the patients with stones larger than 11 mm (NS). The accuracy was 66.7% in the patients with 1 to 5 stones, and 83.3% in the patients with 6 or more stones (NS). Acoustic shadowing did not affect the diagnostic accuracy of EUS. Conclusions: Gallstones do not affect the diagnostic accuracy of EUS for gallbladder lesions. However, more diagnostic criteria must be established, and new devices need to be introduced that can provide more information about the lesions.

What Causes Cancer Gallbladder?: A Review

Gallbladder cancer is a common malignancy of the biliary tract. It is the fifth common malignancy of the gastrointestinal tract in United States [1] and third in Northern India [2]. Despite such high prevalence, there is scanty published literature about this disease in indexed journals. Therefore, this article is intended to provide a brief overview of gallbladder cancer risk factors, based mainly on published evidence from analytical epidemiology and recent research findings of biologists and practising oncologists. Furthermore, an attempt has been made to establish an association between different causative factors and the occurrence of the disease.

Epidemiologic aspects of gallbladder cancer: a case-control study of the SEARCH Program of the International Agency for Research on Cancer.

There are few previous epidemiologic studies of gallbladder cancer, a rare but nearly always lethal gastrointestinal cancer with a demonstrated greater frequency in adult women and older subjects of both sexes, and also in the members of populations throughout central and eastern Europe and certain racial groups such as native American Indians. Unfortunately, the prospects for the prevention of this form of cancer are poor. Our purpose in conducting this study was to investigate possible new risk factors for gallbladder cancer and to strengthen our understanding of established causal agents that may be involved in this disease. A large, collaborative, multicenter, case-control study of cancer of the gallbladder was conducted in five centers located in Australia (Adelaide), Canada (Montreal and Toronto), The Netherlands (Utrecht), and Poland (Opole) from January 1983 through July 1988. Case subjects with gallbladder cancer were accrued by the centers from hospital pathology records and from reports to regional cancer registries. Cancer diagnosis was confirmed by either biopsy, cholecystectomy, or at the time of autopsy. Control subjects were randomly assigned at each center from the population. The pooled analysis included 196 case subjects and 1515 control subjects (who did not report previous cholecystectomy). Ninety-eight percent of the subjects were white. Personal interviews of case subjects, control subjects, and surrogates (spouse or next of kin) were conducted by trained personnel. After adjusting for potential confounding factors (age, sex, center, type of interview, years of schooling, alcohol intake, and lifetime cigarette smoking), a history of gallbladder symptoms requiring medical attention (e.g., reduced bile secretion from the gallbladder into the small intestine due to obstructions of the common bile or cystic ducts) was the major risk factor associated with this form of cancer (odds ratio [OR] = 4.4; 95% confidence interval [CI] = 2.6-7.5). This association was present even in subjects who had their first gallbladder examination because of symptoms present more than 20 years earlier (OR = 6.2; 95% CI = 2.8-13.4). Other variables associated with gallbladder cancer risk included an elevated body mass index, high total energy intake, high carbohydrate intake (after adjustment for total energy intake), and chronic diarrhea. All of these risk factors have been previously associated with gallstone disease. These findings are consistent with a major role of gallstones, or risk factors for gallstones, in the cause of gallbladder cancer. Additional information on whether or not screening high-risk subjects for gallstones or gallbladder cancer is needed.

Risk factors of gallbladder cancer: An international collaborative case‐contol study

Risk factors of gallbladder cancer: An international collaborative case‐contol study

Risk factors of gallbladder cancer: An international collaborative case‐contol study

Risk factors of gallbladder cancer: An international collaborative case‐contol study

Risk factors of gallbladder cancer: An international collaborative case-contol study

Risk factors of gallbladder cancer: An international collaborative case-contol study

Risk factors for gallbladder cancer. An international collaborative case-control study.

Gallbladder cancer has an unusual geographic and demographic distribution, suggesting many possible etiologies. A case-control study was undertaken at four hospitals in La Paz, Bolivia, and at one hospital in Mexico City, Mexico. Eighty-four patients with newly diagnosed, histologically confirmed gallbladder cancer were compared with 126 control subjects without stones and with 264 control subjects with cholelithiasis or choledocholithiasis without cancer. All study subjects underwent abdominal surgery. Study subjects were interviewed regarding demographic characteristics, medical history, family history, diet, and exposure to agents presumed to be risk factors for biliary cancer. Virtually all subjects in Mexico were judged to be mestizos (i.e., persons of mixed ancestry) In contrast, race was a very strong risk factor for gallbladder cancer in Bolivia. Relative to mestizos who spoke neither language, the odds ratio (95% confidence interval [CI]) for cases versus control subjects without stones for those who spoke Aymara well was 15.9 (CI, 1.9-179), whereas it was 1.4 (CI, 0.2-8.2) for those who spoke Quechua well. An increased risk was also noted for elevated maximum body mass index (P = 0.03), family history of gallstones (odds ratio [OR] = 3.6 [CI, 1.3-11.4]), and physician-diagnosed typhoid (OR = 12.7 [CI, 1.5-598]). An increased risk was also seen with elevated maximum body mass index; compared with those with a body mass index less than 24 kg/m2, those with an index of 24-25 kg/m2, 26-28 kg/m2, and greater than 28 kg/m2 had odds ratios of 1.6 (CI, 0.4-7.6), 1.3 (CI, 0.3-5.6), and 2.6 (CI, 0.5-18.6), respectively (asymptotic test for trend, P = 0.03). Finally, a number of associations were noted with certain dietary and cooking habits. Patients with gallbladder cancer differed from control subjects in race, body mass, physician-diagnosed typhoid, and certain dietary patterns. These findings may provide useful clues to the pathogenesis of gallbladder cancer, but given the number of analyses performed, additional cases need to be studied.

Risk factors for gallbladder cancer: a Polish case-control study.

A population-based case-control study of gallbladder cancer was conducted in the south-west of Poland, within the frame-work of the SEARCH Programme of the International Agency for Research on Cancer. A total of 73 cases and 186 controls were interviewed using a questionnaire including demographic and socio-economic factors, education, smoking, alcohol, tea and coffee consumption, and past medical history. A validated diet history was used to estimate the daily intake of calories, fats, carbohydrates, proteins, cholesterol, fibres and vitamins C and E. Gallbladder disease was the major determinant of subsequent gallbladder cancer: 41 cases (56%) vs. 15 (8%) controls had a past history of gallbladder disease, corresponding to an odds ratio (OR) of 12.5 (95% confidence interval, 5.8 to 26.6), and the OR was 12.1 for gallbladder problems dating back 20 years or more in the past. There was an inverse relationship with education, the OR being 0.3 (95% CI 0.1 to 1.2) for 13 years of education or more vs. less than 7. Gallbladder cancer risk was positively associated with total calorie intake, with ORs of 1.4, 1.5, 4.1 for the 3 upper quartiles compared with the lowest one (trend, p less than 0.01). Weaker direct associations were observed for proteins, carbohydrates and cholesterol. There was some suggestion of inverse associations with fibre intake, and a more consistent one with vitamins C and E. These results further quantify the role of gallstones, and suggest that total calorie intake and other dietary factors potentially linked with benign gallbladder conditions are involved in the aetiology of gallbladder cancer.

Effects of ethyl 4-chloro-2-methylphenoxyacetate on bile composition in golden hamsters.

The effects of ethyl 4-chloro-2-methylphenoxyacetate (MCPA) on the cholesterol levels in the liver, serum and gallbladder bile, the composition of both biliary lipids and bile acids, and the hepatic enzyme activities relating to the bile acid formation were investigated in male golden hamsters. MCPA was administered orally to the animals at the doses of 200, 500 and 1,000 mg/kg/day for 2 weeks. Clofibrate (500 mg/kg/day) was also tested for comparison, because of its similarity to MCPA in chemical structure and pharmacological actions. Body weight gain was slightly decreased, but liver to body weight ratio was increased in the MCPA groups of 500 and 1,000 mg/kg and also in the clofibrate group. In these groups, the cholesterol level in the liver was decreased but that in bile was increased. The composition of biliary bile acids was also changed in both the MCPA groups (500 and 1,000 mg/kg) and the clofibrate group, but in a different manner; the levels and proportions of secondary bile acids were increased in the MCPA groups, while those of cholic acid and deoxycholic acid were decreased in the clofibrate group. These results indicate that MCPA and clofibrate may affect cholesterol catabolism differently, although these two compounds contain the same chlorinated phenoxy acid moiety. The increased level of cholesterol in bile might lead to the formation of cholesterol gallstone, which is frequently found in patients with gallbladder cancer. It is inferred that exposure to MCPA could be a risk factor for gallbladder cancer, which was initiated with some chemical carcinogens, because it increased the levels and proportions of both cholesterol and secondary bile acids in bile.

A Case‐Control Study of Biliary Tract Cancer in Niigata Prefecture, Japan

A case‐control study of biliary tract cancer was conducted in Niigata prefecture where the mortality of the cancer is the highest in Japan. The cases were 109 patients with gallbladder cancer and 84 with bile duct cancer, and the controls were 386 sex‐ and age‐matched neighborhood controls. For gallbladder cancer, a past history of biliary tract disease, a positive family history of cholelithiasis and a taste for oily foods were high risk factors. Intakes of animal proteins and fats such as fish, eggs, meat, etc., ingestion of vegetables and fruits, and taking snacks were low risk factors for gallbladder cancer. For bile duct cancer, a past history of biliary tract disease, a family history of cerebral vascular accident, a thin constitution and taking a small amount of foods were high risk factors, and a family history of heart disease, obesity, intakes of alcohol, animal proteins and fats, or frequent intakes of vegetables and fruits were low risk factors.

Gallstone Size and the Risk of Gallbladder Cancer

Gallstones are a major risk factor for gallbladder cancer, but few persons with stones experience development of tumors. To examine this relationship, a case-control study was performed. Each of 81 cancer cases was matched for age, sex, hospital, and admission date with two controls, one with benign gallbladder disease and one with a nongallbladder diagnosis. Persons with large gallstones were found to be at increased risk for cancer. For those with stone diameters of 2.0 to 2.9 cm, the odds ratio (v stone size less than 1 cm) was 2.4; for stones 3 cm or larger, the ratio was 10.1. This association of large gallstones with cancer was not hypothesized before data analysis and should be replicated in other settings before being accepted. If confirmed, however, this finding might have implications for the management of silent gallstones.