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Year : 2019  |  Volume : 4  |  Issue : 2  |  Page : 74-77

Prevalence of gallbladder cancer in patients with cholecystectomy in Saudi Arabia, cross-sectional study

Department of Surgery, Medical College, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia

Date of Submission15-Mar-2019
Date of Acceptance24-Mar-2019
Date of Web Publication30-Jul-2019

Correspondence Address:
Dr. Mohammad Bukhetan Alharbi
Department of Surgery, Medical College, Imam Mohammad Ibn Saud Islamic University, Zip Code 11543, PO Box 5701, Riyadh,
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijas.ijas_4_19

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Background: Gallbladder cancer, well despite the fact that it is rare, it is the most common malignancy of the biliary tree. However, preoperative abilities to diagnose the disease are still limited. Thus, variability in prevalence globally is obvious.
Materials and Methods: Cross-sectional study was done to assess the prevalence of surgically removed gallbladder from February 2007 to August 2018 which was collected from 1085 patients in a community hospital in Gurayat Hospital, situated along the northern border.
Results: The prevalence of gallbladder cancer was 0.2%. The mean age was 38.4 years. 96 (8.9%) patients were with acute cholecystitis, 107 (9.9%) with acute on chronic cholecystitis, 10 (0.9%) with gangrenous cholecystitis, and 872 (80.3%) patients with chronic cholecystitis.
Conclusion: The prevalence of gallbladder cancer which is discovered at cholecystectomy is rare in Saudi Arabia.

Keywords: Adenocarcinoma, gallbladder adenocarcinoma, gallbladder cancer

How to cite this article:
Alharbi MB. Prevalence of gallbladder cancer in patients with cholecystectomy in Saudi Arabia, cross-sectional study. Imam J Appl Sci 2019;4:74-7

How to cite this URL:
Alharbi MB. Prevalence of gallbladder cancer in patients with cholecystectomy in Saudi Arabia, cross-sectional study. Imam J Appl Sci [serial online] 2019 [cited 2022 Jul 3];4:74-7. Available from:

  Introduction Top

Cholecystectomy procedure is quite common worldwide, with almost 1 million procedures being done annually in the US.[1] Thus, the current condition of a higher rate of cholecystectomy with better ultrasound techniques led to more earlier detection of gallbladder cancer.[2]

Gallbladder cancer is the most common malignancy of the biliary tree; epidemic regions such as Chile, Peru, and India are likely to have environmental factors besides genetic predisposition. Gallbladder cancer risk increases with age and female gender.[3],[4]

The main risk factor for gallbladder cancer is the presence of long-standing gallstone, which has multiple gallbladder mucosal epithelial injuries and repair,[5],[6] patients with gallstone disease have a higher risk of the development of gallbladder cancer up to 57 times, based on multiple cohort studies.[7],[8] Chronic infection was found in almost 15% of cases of malignancy worldwide,[9] and on the other side, all malignancies, in general, are related with chronic inflammation regardless of the infection either absent or present.[10]

 Salmonella More Details typhi is another important factor in endemic areas,[11] other pathological conditions such as primary sclerosing cholangitis and bacterial infections have some relation between chronic gallbladder cancer and gallstone disease, as they share the chronic inflammation component.[3]

Gallstone itself is not the main cause of damage to the epithelial layer of gallbladder, but the action of its nature as a foreign body does this sequence for the development to gallbladder cancer. Hence, this is a classical example of inflammation-associated carcinoma.[12],[13] Furthermore, gallstones larger than 2 cm have a higher chance of developing into gallbladder cancer.[14]

Association between aflatoxin and gallbladder cancer have been reported; it was found that 20% of cases of gallbladder cancer in China have been exposed to aflatoxin, based on serum levels of alpha toxin B1-lysine.[15]

Gallbladder polyps usually found in almost 12% of gallbladders removed surgically, they will be detected in almost 7% of ultrasound done for gallbladder.[16],[17],[18] However, despite that only 0.6% of those polyps are malignant,[19] only polyps ≥10 mm have a higher chance of malignancy approaching 65%.[18] Furthermore, some gallbladder polyps require to follow-up for many years, 7 years is the cutoff where the potentials for malignancy in the follow-up should be clear, which make 10-year follow-up is reasonable for such group of patients.[20],[21]

Gallbladder cancer is not considered to follow adenoma-carcinoma sequence; however, it is believed to follow dysplasia-carcinoma sequence.[14],[22] The fundus of the gallbladder is the most common site for malignancy, and the neck is the least common site. Furthermore, the most common malignancy is adenocarcinoma.[14] The 5-year survival rate is poor, for advanced type (T3, 4) it is 10%.[16],[23]

Other risk factors are obesity,[24] multiparty,[25] smoking,[26] and specific metal exposure with environmental pollution.[27]

The annual detection of new cases in the US is 8500 patients, with the prevalence of 2/100,000 patient each year.[28],[29],[30]

The overall mean survival rate for patients with advanced gallbladder cancer is 6 months, with a 5-year survival rate of 5%.[31] Well, usually, the diagnosis is late secondary to vague presenting symptoms and lack of serosa.[6],[32],[33] However, most of the gallbladder cancers are adenocarcinoma (80%), originating from fundus (60%), body (30%), and neck (10%). Furthermore, genetic predisposition and presence of cholecystitis are other important features.[4],[34]

  Materials and Methods Top

This a cross-sectional study to assess the prevalence of gallbladder cancer data of surgically removed gallbladder between the years February 2007 and August 2018, which were collected from 1085 patients from the Community Hospital in the Northern Border of Saudi Arabia. Gross examination and microscopic examination were done, and all histopathology reports have been collected and included in the study. Further, cases without or missing report have been excluded from this study, such as cases xanthogranulomatous cholecystitis, polyps, cholesterolosis, and age below 18 years old.

The distribution of gallbladder disease was calculated based on the age; the youngest age was 13 years old and the oldest was 88 years old. Patients with acute cholecystitis were 96 patients, in which 107 patients were with acute on chronic cholecystitis, and 871 patients with chronic cholecystitis. Furthermore, the median age was 35 years, with 865 females and 220 males.

The prevalence of gallbladder cancer was 0.2% (2/1085). The mean age was 38.4 years. 96 (8.9%) patients were with acute cholecystitis, 107 (9.9%) with acute on chronic cholecystitis, 10 (0.9%) with gangrenous cholecystitis, and 872 (80.3%) patients with chronic cholecystitis.

  Discussion Top

The delayed presentation is quite common in gallbladder cancer, due to the nonspecific presentation, further, around 20% of patients will be diagnosed intraoperatively for features of cholecystitis, abdominal pain, nausea and vomiting, anorexia, and weight loss which is the most common complaints.[35] Furthermore, constitutional symptoms, ascites, and a palpable mass are all indicative of advanced disease and poor prognosis.[36]

The most frequent radiological test which is utilized in similar conditions such as ultrasound, which is usually mixed with chronic cholecystitis, especially in early stages of cancer indicated that the sensitivity to detect gallbladder cancer preoperatively approach 44%.[37]

However, risk factors for such disease are still limited but have association with gallstone, high fat and carbohydrate diet, multiple pregnancies, as well as hormonal replacement therapy which will make higher risk of the gallbladder cancer.[38],[39]

Gallstone is the most famous risk factor, also the highest mortality from gallbladder cancer is in Chile, and has the highest prevalence of cholelithiasis.[40],[41] The risk of gallbladder cancer with gallstones is more common up to 5 times than those with a calculous cholecystitis,[42] also women in some studies are not affected by this fact.[43] Further, large size gallstone and long period of symptoms are associated with a higher chance to develop gallbladder cancer.[44] However, from the other side, the presence of stone to develop gallbladder cancer is not a must.[45]

The duration of stone presence is highly important to the development of gallbladder cancer.[46] Chronic inflammation of gallbladder mucosa may develop malignancy trough atypia to dysplasia to carcinoma sequence.[47] Furthermore, P53 mutation may have a role in this sequence of events.[48]

Porcelain gallbladder is considered a risk for gallbladder cancer with 5% chance. Moreover, it seems that focal mucosal calcification (7%) is posing a greater risk over diffuse transmural calcification (porcelain gallbladder).[49]

Current therapies for gallbladder cancer have not shown a dramatic change in the overall survival. However, the current clinical trials focus on symptom control or recurrent disease.[50]

  Conclusion Top

Gallbladder cancer prevalence in Saudi Arabia is rare; thus, pathological assessment of the sample with proper staging plays an important role in further definitive surgery.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Ingraham AM, Cohen ME, Ko CY, Hall BL. A current profile and assessment of North American cholecystectomy: Results from the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2010;211:176-86.  Back to cited text no. 1
Butte JM, Matsuo K, Gönen M, D'Angelica MI, Waugh E, Allen PJ, et al. Gallbladder cancer: Differences in presentation, surgical treatment, and survival in patients treated at centers in three countries. J Am Coll Surg 2011;212:50-61.  Back to cited text no. 2
Hundal R, Shaffer EA. Gallbladder cancer: Epidemiology and outcome. Clin Epidemiol 2014;6:99-109.  Back to cited text no. 3
Lazcano-Ponce EC, Miquel JF, Muñoz N, Herrero R, Ferrecio C, Wistuba II, et al. Epidemiology and molecular pathology of gallbladder cancer. CA Cancer J Clin 2001;51:349-64.  Back to cited text no. 4
Roa I, Ibacache G, Roa J, Araya J, de Aretxabala X, Muñoz S. Gallstones and gallbladder cancer-volume and weight of gallstones are associated with gallbladder cancer: A case-control study. J Surg Oncol 2006;93:624-8.  Back to cited text no. 5
Wistuba II, Gazdar AF. Gallbladder cancer: Lessons from a rare tumour. Nat Rev Cancer 2004;4:695-706.  Back to cited text no. 6
Pilgrim CH, Groeschl RT, Christians KK, Gamblin TC. Modern perspectives on factors predisposing to the development of gallbladder cancer. HPB (Oxford) 2013;15:839-44.  Back to cited text no. 7
Hsing AW, Bai Y, Andreotti G, Rashid A, Deng J, Chen J, et al. Family history of gallstones and the risk of biliary tract cancer and gallstones: A population-based study in Shanghai, China. Int J Cancer 2007;121:832-8.  Back to cited text no. 8
Kuper H, Adami HO, Trichopoulos D. Infections as a major preventable cause of human cancer. J Intern Med 2000;248:171-83.  Back to cited text no. 9
Chiba T, Marusawa H, Ushijima T. Inflammation-associated cancer development in digestive organs: Mechanisms and roles for genetic and epigenetic modulation. Gastroenterology 2012;143:550-63.  Back to cited text no. 10
Nagaraja V, Eslick GD. Systematic review with meta-analysis: The relationship between chronic salmonella typhi carrier status and gall-bladder cancer. Aliment Pharmacol Ther 2014;39:745-50.  Back to cited text no. 11
Leitch A. A British medical association lecture on gall stones and cancer of the gall bladder: An experimental study. Br Med J 1924;2:451-4.  Back to cited text no. 12
Adsay NV. Neoplastic precursors of the gallbladder and extrahepatic biliary system. Gastroenterol Clin North Am 2007;36:889-900, vii.  Back to cited text no. 13
Reid KM, Ramos-De la Medina A, Donohue JH. Diagnosis and surgical management of gallbladder cancer: A review. J Gastrointest Surg 2007;11:671-81.  Back to cited text no. 14
Koshiol J, Gao YT, Dean M, Egner P, Nepal C, Jones K, et al. Association of aflatoxin and gallbladder cancer. Gastroenterology 2017;153:488-940.  Back to cited text no. 15
Corwin MT, Siewert B, Sheiman RG, Kane RA. Incidentally detected gallbladder polyps: Is follow-up necessary? – Long-term clinical and US analysis of 346 patients. Radiology 2011;258:277-82.  Back to cited text no. 16
Andrén-Sandberg A. Diagnosis and management of gallbladder polyps. N Am J Med Sci 2012;4:203-11.  Back to cited text no. 17
Bhatt NR, Gillis A, Smoothey CO, Awan FN, Ridgway PF. Evidence based management of polyps of the gall bladder: A systematic review of the risk factors of malignancy. Surgeon 2016;14:278-86.  Back to cited text no. 18
Elmasry M, Lindop D, Dunne DF, Malik H, Poston GJ, Fenwick SW. The risk of malignancy in ultrasound detected gallbladder polyps: A systematic review. Int J Surg 2016;33 Pt A: 28-35.  Back to cited text no. 19
Park JY, Hong SP, Kim YJ, Kim HJ, Kim HM, Cho JH, et al. Long-term follow up of gallbladder polyps. J Gastroenterol Hepatol 2009;24:219-22.  Back to cited text no. 20
Gallahan WC, Conway JD. Diagnosis and management of gallbladder polyps. Gastroenterol Clin North Am 2010;39:359-67, x.  Back to cited text no. 21
Trivedi V, Gumaste VV, Liu S, Baum J. Gallbladder cancer: Adenoma-carcinoma or dysplasia-carcinoma sequence? Gastroenterol Hepatol (N Y) 2008;4:735-7.  Back to cited text no. 22
Donald G, Sunjaya D, Donahue T, Hines OJ. Polyp on ultrasound: Now what? The association between gallbladder polyps and cancer. Am Surg 2013;79:1005-8.  Back to cited text no. 23
Wang F, Wang B, Qiao L. Association between obesity and gallbladder cancer. Front Biosci (Landmark Ed) 2012;17:2550-8.  Back to cited text no. 24
Andreotti G, Hou L, Gao YT, Brinton LA, Rashid A, Chen J, et al. Reproductive factors and risks of biliary tract cancers and stones: A population-based study in Shanghai, China. Br J Cancer 2010;102:1185-9.  Back to cited text no. 25
Wenbin D, Zhuo C, Zhibing M, Chen Z, Ruifan Y, Jie J, et al. The effect of smoking on the risk of gallbladder cancer: A meta-analysis of observational studies. Eur J Gastroenterol Hepatol 2013;25:373-9.  Back to cited text no. 26
Chhabra D, Oda K, Jagannath P, Utsunomiya H, Takekoshi S, Nimura Y. Chronic heavy metal exposure and gallbladder cancer risk in India, a comparative study with Japan. Asian Pac J Cancer Prev 2012;13:187-90.  Back to cited text no. 27
Kiviluoto T, Sirén J, Luukkonen P, Kivilaakso E. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 1998;351:321-5.  Back to cited text no. 28
Steinert R, Nestler G, Sagynaliev E, Müller J, Lippert H, Reymond MA. Laparoscopic cholecystectomy and gallbladder cancer. J Surg Oncol 2006;93:682-9.  Back to cited text no. 29
Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin 2006;56:106-30.  Back to cited text no. 30
Levy AD, Murakata LA, Rohrmann CA Jr. Gallbladder carcinoma: Radiologic-pathologic correlation. Radiographics 2001;21:295-314.  Back to cited text no. 31
Henson DE, Albores-Saavedra J, Corle D. Carcinoma of the gallbladder. Histologic types, stage of disease, grade, and survival rates. Cancer 1992;70:1493-7.  Back to cited text no. 32
Lai CH, Lau WY. Gallbladder cancer – A comprehensive review. Surgeon 2008;6:101-10.  Back to cited text no. 33
Pandey M. Risk factors for gallbladder cancer: A reappraisal. Eur J Cancer Prev 2003;12:15-24.  Back to cited text no. 34
Taner CB, Nagorney DM, Donohue JH. Surgical treatment of gallbladder cancer. J Gastrointest Surg 2004;8:83-9.  Back to cited text no. 35
Donohue JH. Present status of the diagnosis and treatment of gallbladder carcinoma. J Hepatobiliary Pancreat Surg 2001;8:530-4.  Back to cited text no. 36
Hederström E, Forsberg L. Ultrasonography in carcinoma of the gallbladder. Diagnostic difficulties and pitfalls. Acta Radiol 1987;28:715-8.  Back to cited text no. 37
Pandey M, Shukla VK. Lifestyle, parity, menstrual and reproductive factors and risk of gallbladder cancer. Eur J Cancer Prev 2003;12:269-72.  Back to cited text no. 38
Strom BL, Soloway RD, Rios-Dalenz JL, Rodriguez-Martinez HA, West SL, Kinman JL, et al. Risk factors for gallbladder cancer. An international collaborative case-control study. Cancer 1995;76:1747-56.  Back to cited text no. 39
Szot J. Epidemiological analysis of mortality caused by solid tumors in the Metropolitan Region, Chile, 1999. Rev Med Chil 2003;131:641-9.  Back to cited text no. 40
Csendes A, Becerra M, Smok G, Medina E, Maluenda F, Morales E. Prevalence of gallbladder neoplasms in cholecystectomies. Rev Med Chil 1991;119:887-90.  Back to cited text no. 41
Lowenfels AB, Maisonneuve P, Boyle P, Zatonski WA. Epidemiology of gallbladder cancer. Hepatogastroenterology 1999;46:1529-32.  Back to cited text no. 42
Gullo L. Risk of pancreatic and periampullary cancer following cholecystectomy. Ann Oncol 1999;10 Suppl 4:127-8.  Back to cited text no. 43
Diehl AK. Gallstone size and the risk of gallbladder cancer. JAMA 1983;250:2323-6.  Back to cited text no. 44
Misra S, Chaturvedi A, Misra NC, Sharma ID. Carcinoma of the gallbladder. Lancet Oncol 2003;4:167-76.  Back to cited text no. 45
Csendes A, Becerra M, Rojas J, Medina E. Number and size of stones in patients with asymptomatic and symptomatic gallstones and gallbladder carcinoma: A prospective study of 592 cases. J Gastrointest Surg 2000;4:481-5.  Back to cited text no. 46
Albores-Saavedra J, Alcántra-Vazquez A, Cruz-Ortiz H, Herrera-Goepfert R. The precursor lesions of invasive gallbladder carcinoma. Hyperplasia, atypical hyperplasia and carcinoma in situ. Cancer 1980;45:919-27.  Back to cited text no. 47
Wee A, Teh M, Raju GC. Clinical importance of p53 protein in gall bladder carcinoma and its precursor lesions. J Clin Pathol 1994;47:453-6.  Back to cited text no. 48
Stephen AE, Berger DL. Carcinoma in the porcelain gallbladder: A relationship revisited. Surgery 2001;129:699-703.  Back to cited text no. 49
Sachs TE, Akintorin O, Tseng J. How should gallbladder cancer be managed? Adv Surg 2018;52:89-100.  Back to cited text no. 50


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