[Risk factors and etiopathogenesis of cancer of the gallbladder]

Primary cancer of the gallbladder is uncommon but not rare, being in Italy the fourth cause of death for gastrointestinal cancer in females over 65 years old. Two centuries after the first description, this tumor remains characterized by an unfavorable prognosis due to the silent progression of the clinical course and the frequent unresectability at the time of surgery. Early diagnosis, aggressive surgical approach and chemotherapy are the basis for longer post-operative survival rates; in fact, despite the advances in ultrasonography and computer-assisted imaging devices, the prevention of gallbladder cancer remains a problem. In the statistical terms, the risks of an indiscriminate surgical prophylaxis would outweigh the advantages of cancer prevention; in this optic, a recognition of the patients "at major risk" appears to be essential. With this aim we have undertaken a review of current knowledge of the "risk factors" involved in the epidemiology and etiology of gallbladder cancer, deduced from Literature and our surgical experience. It is reasonable to assume that the etiology of this cancer is based on the correlationship between factors with a wide and different penetration in racial-ethnic areas: genetic, systemic and local risk-factors. A genetic influence can be highly suspected in the familiar cases, in the non-carcinoma tumors and in the geographic predominance of the tumor. None of the systemic factors suggested as risk factors (age, sex, obesity, occupational and chemical carcinogens, drugs, etc.) appear to be directly involved; moreover, the main factors, such as female sex and age, are probably mediated through cholelithiasis.(ABSTRACT TRUNCATED AT 250 WORDS)