Senior Gallbladder Cancer

　　A brief introduction to the causes of elderly gallbladder cancer is as follows:

　　1, Etiology

　　Patients with gallbladder cancer and gallstones account for 60% to 90%, and those with gallstones and gallbladder cancer account for 3% to 14%, so it is generally believed that chronic cholecystitis, cholelithiasis, and gallbladder cancer are closely related to the occurrence of gallbladder cancer. Cholestatic, abnormal cholesterol metabolism, inflammatory bowel disease, genetic factors, sex hormones, X-ray radiation, carcinogens in bile, benign tumor malignancy, and other factors are also assumed to be pathogenic factors for gallbladder cancer, but there is no reliable evidence. Currently, it is generally believed that the occurrence of the disease may be related to multiple factors.

　　2, Pathogenesis

　　Gallbladder cancer can be divided into mass type and infiltrative type. Its pathological tissue type is mainly adenocarcinoma, accounting for about 80% to 90%, undifferentiated cancer accounts for about 10%, and squamous cell cancer and squamous adenocarcinoma account for about 5% to 10%.

　　Gallbladder cancer mainly spreads through lymphatic channels. Those with lymphatic metastasis found during surgery account for 25% to 75%; more than half of the tumors can directly spread to adjacent organs, with the frequency of occurrence in order of liver, bile duct, pancreas, stomach, duodenum, omentum, colon, and abdominal wall; hematogenous spread accounts for less than 1/5.

　　The complications of elderly gallbladder cancer include gallbladder infection, abscess, perforation, as well as liver abscess, subdiaphragmatic abscess, pancreatitis, gastrointestinal bleeding, and so on. It can also form fistulas with nearby gastrointestinal tract, so it is necessary to receive timely treatment.

　　Elderly gallbladder cancer has insidious onset, most of which are asymptomatic in the early stage, with non-specific clinical manifestations, resembling acute or chronic cholecystitis or cholelithiasis, and attention should be paid to differentiation. About half of those who palpate a mass in the upper right abdomen may have liver enlargement, fever, ascites, and anemia in the late stage.

　　A brief introduction to the prevention of elderly gallbladder cancer is as follows:

　　1, Develop good living habits. First, do not smoke. The World Health Organization predicts that if people stop smoking, the world's cancer rate will decrease by one-third after 5 years. Second, do not drink excessively. Cigarettes and alcohol are extremely acidic substances, and people who smoke and drink for a long time are prone to acidic体质.

　　2, Do not eat too much salty and spicy food, do not eat overheated, cold, expired, or deteriorated food; for the elderly, weak, or those with certain genetic diseases, eat some anti-cancer foods and alkaline foods with high alkalinity appropriately to maintain a good mental state.

　　3. Deal with stress with a good attitude. Combine work and rest, and do not overwork. It can be seen that stress is an important cancer trigger. Traditional Chinese medicine believes that stress leads to overwork and physical weakness, thus causing a decrease in immune function, endocrine disorders, leading to metabolic disorders in the body, and the deposition of acidic substances in the body; stress can also lead to mental tension, causing qi stasis and blood stasis, internal invasion of toxic fire, and so on.

　　4. Strengthen physical exercise. Enhance physical fitness, exercise more in the sunshine, and sweat more to excrete acidic substances in the body through sweat, avoiding the formation of an acidic body.

　　5. Live a regular life. People with irregular lifestyles, such as staying up all night to sing karaoke or play Mahjong, will exacerbate acidification of the body, making it easy to develop cancer. Good habits should be developed to maintain an alkaline体质, keeping various types of cancer diseases away from oneself.

　　5. Do not eat contaminated food, such as contaminated water, crops, poultry and eggs, and moldy food. Eat some green organic food and prevent diseases from entering through the mouth.

　　What should elderly patients with gallbladder cancer undergo for examination? The following is a brief description:

　　1. Liver function tests

　　Serum bilirubin levels increase, early on mainly direct bilirubin, and in the late stage, indirect bilirubin also increases. Serum transaminases increase (mainly ALT), which is not proportional to jaundice. When jaundice is obvious, ALT only slightly increases, and alkaline phosphatase (ALP), lactate dehydrogenase (LDH), gamma-glutamyl transferase (GGT), and 5'-nucleotidase (5'-NT) are significantly elevated.

　　2. Tumor markers

　　The levels of carcinoembryonic antigen (CEA) in serum or bile, and CA19-9 and CA50 in serum can be elevated in gallbladder cancer, which also helps in diagnosis.

　　3. Detection of oncogenes and oncogene products

　　4. Apoptosis

　　The rate of apoptosis in gallbladder cancer reaches 40%, and the rate of apoptosis in poorly differentiated gallbladder cancer is higher than that in well-differentiated gallbladder cancer, indicating that apoptosis plays an important role in the onset of gallbladder cancer and can be used as a prognostic indicator for gallbladder cancer.

　　5. B-ultrasound

　　6. CT

　　The diagnostic rate for gallbladder cancer is 65% to 90%, which can be localized and quantified, showing irregular nodular thickening or uniform thickening of the gallbladder wall; soft tissue mass shadow inside the cystic cavity; single or multiple small nodular changes inside the cavity; often accompanied by gallstones or calcification of the gallbladder wall. According to the above manifestations, CT divides gallbladder cancer into three types: thickened gallbladder wall type (also known as inflammatory type, accounting for 25%), mass type (accounting for 50%), and nodular type (accounting for 25%). All of these types can appear with bile duct obstruction and liver metastasis.

　　7. MRI

　　The diagnostic rate is similar to that of ultrasound and CT. MRI of gallbladder cancer often uses spin echo, and gallbladder cancer is divided into mass type and infiltrative type.

　　8. Retrograde Cholangiopancreatography (ERCP) and Percutaneous Transhepatic Cholangiography (PTC)

　　The diagnostic rate for gallbladder cancer is about 50% to 70%, which can show gallbladder bile duct lesions, gallbladder filling defects or non-imaging, or displacement or stenosis of the hilum or common bile duct.

　　9. Laparoscopy or Ultrasound Laparoscopy (IVS)

　　Under laparoscopy, gallbladder enlargement and deformation, thick and turbid gallbladder wall or a grayish white mass, or nodular and uneven gallbladder surface, with abnormal blood vessels can be observed. If gallbladder contrast, biopsy, or bile cytology examination can be performed directly under laparoscopic vision, it can be diagnosed.

　　Laparoscopic ultrasound (IUS) has high resolution and can also check in all directions of the gallbladder, observe the layers of the gallbladder more clearly, and can also make a diagnosis of small elevated lesions that cannot be detected by surface ultrasound.

　　10. Abdominal Artery Angiography

　　The diagnostic rate is 70% to 80%, and it can be seen that the gallbladder artery is widened, uneven in thickness, interrupted, twisted, or with new tumor vessels.

　　11. X-ray Examination

　　Oral cholecystography and intravenous cholangiography can show the shape and size of the gallbladder and bile ducts, to infer whether there is obstructive gallbladder or bile duct dilation, and at the same time understand whether there are defects in the filling of the gallbladder and bile ducts and compression, but more than 85% are not visible, and the diagnostic value is small.

　　Firstly, choose easily digestible foods. In the short term after surgery, try to reduce the intake of fat and cholesterol, and increase foods rich in protein, such as lean meat, seafood, and dairy products. Eat more foods rich in dietary fiber and vitamins, such as fresh fruits and vegetables. Aim for small and frequent meals. Avoid foods such as brain, liver, kidney, fish, and fried foods. It is even more important to avoid fatty meat and alcohol to prevent affecting liver function or causing bile duct stones.

　　Summary of the treatment methods for elderly gallbladder cancer:

　　1. Treatment

　　The preferred treatment is surgical resection of the gallbladder and local lymph nodes. If one lobe of the liver is invaded, partial resection of the liver lobe should also be performed. If both lobes of the liver are involved and there is distant metastasis, only palliative surgery can be performed. If there is extensive invasion of the bile duct causing obstruction, internal and external bile duct drainage or placement of a stent can be performed to relieve jaundice. Radiotherapy and (or) chemotherapy can be performed after tumor resection and for those who cannot be resected.

　　2. Prognosis

　　Early diagnosis and treatment directly affect the prognosis. The 5-year survival rate after early surgery is 60% to 80%, and the 10-year survival rate is 44%. While the 3-year survival rate for advanced cancer is 5% to 7%.