The main cause of gallbladder cancer may be chronic inflammation of the gallbladder, while other risk factors for gallbladder cancer include obesity, high-carbohydrate diet, smoking and alcohol abuse. Gallbladder stones are usually the main cause of chronic inflammation of the gallbladder, therefore, a significant number of patients first present with fever, chills and other inflammatory manifestations of the biliary system due to acute attacks of cholecystitis. Some relatively specific manifestations such as persistent pain, weight loss and jaundice often suggest that the tumor is unresectable. Usually, elderly patients with a history of biliary colic should be alerted to the possibility of gallbladder cancer when the pain suddenly changes to persistent unrelieved dull pain, especially when it is accompanied by weight loss or right upper abdominal masses. Patients with acute biliary inflammation may experience nausea, vomiting and other gastrointestinal symptoms, which may lead to hepatogenic or post-hepatic jaundice in severe cases. Advanced gallbladder cancer may lead to malnutrition such as weight loss. Physical examination may reveal localized pressure pain below the right margin, palpable enlarged gallbladder, abdominal muscle tension, positive Murphy’s sign and yellow staining of skin and sclera when gallbladder cancer is combined with cholecystitis. Real-time ultrasound is a non-invasive, easy to perform, well-tolerated by patients, and provides timely results. It can assess the extent and degree of the disease (clinical stage of gallbladder cancer) in order to choose a reasonable treatment plan. If gallbladder cancer is suspected, one should choose an intensive CT scan of the abdomen, which can provide more detailed image information than ultrasound and can carefully observe the presence of liver metastases and enlarged lymph nodes in the abdomen, perihepatic, abdominal aorta and inter-abdominal vena cava. MRI and MRI cholangiography are ideal for showing small metastases in the liver in addition to biliary tract invasion; MRI cholangiography is also good for showing portal vein and common hepatic artery invasion, thus helping to rule out inoperable cases. The latter two modalities can be chosen if the stage of gallbladder cancer is suspected to be advanced. Some patients with gallbladder cancer may have elevated serum carcinoembryonic antigen CEA and CA199. Patients with gallbladder cancer often have anemia, elevated alkaline phosphatase and elevated bilirubin, so other tests include routine blood tests, complete liver and kidney functions, and coagulation function. Cranial MRI can rule out intracranial metastases. The staging of gallbladder cancer is the best criterion used to determine the prognosis, which is superior to histological staging, grading and other biological indicators. In the AJCC/UICC TNM system, stage 1 (T1, N0) refers to tumors confined to the mucosal or muscular layer of the gallbladder wall; tumors originating from the Rokitansky-Aschoff sinus are classified as stage 1 even though they are located in the subplasma layer. Stage 2 (T2,N0) is a tumor that invades the peri-muscular layer but does not penetrate the plasma layer or invade the liver, and there are no lymph node metastases. Stage 3 (T3,N0,Tx,N1) means (a) tumor penetrates the plasma membrane layer and liver invasion is less than 2 cm; (b) tumor metastasizes to the primary lymph nodes on the duodenal ligament. Stage 4A (T4, N0.1) refers to tumor invasion of liver greater than 2 cm; Stage 4B (Tx, N2) refers to secondary lymph node invasion or distant metastasis, and lymph node metastasis above hepatoduodenal ligament is classified as distant metastasis. The prognosis of liver invasion alone is better than distant metastasis and hematogenous metastasis, and should be classified as stage 3. The treatment plan of gallbladder cancer depends on the clinical stage of gallbladder cancer and the lymphatic drainage characteristics of gallbladder. lymph nodes and superior mesenteric artery lymph nodes. According to the clinical stage of gallbladder cancer, stage 1 (T1, N0) patients can be cured by simple cholecystectomy; stage T1 tumor has almost no lymph node metastasis, but it must be ensured that the margins of the gallbladder duct must be negative during surgery, and if it is positive, it must be further removed. stage 2 (T2, N0) patients should be treated with extended cholecystectomy (also called radical cholecystectomy), which includes gallbladder removal plus In stage 3 (T3,N0,Tx,N1), the recommended treatment option is also an extended cholecystectomy, and due to the high rate of positive lymph nodes in the confluent area, the common bile duct is usually removed at the same time to completely clear the lymph nodes in this area. stage 4A (T4,N0.1) is also an option to achieve long-term survival; stage 4B (Tx,N2) patients are not suitable for surgery. Stage 4B (Tx, N2) patients are not suitable for surgical treatment, and only reduced-stage treatment is available.