Primary gallbladder cancer is a common malignant tumor of the biliary system, and its incidence has been increasing significantly in recent years. It accounts for about 5% of cancer tissue specimens at autopsy, and 91% of them have an age of onset above 50 years. The incidence rate of female patients is about three times that of male patients. Gallbladder cancer has no specific clinical symptoms and signs in the early stage, and most patients are already in the middle and late stage when they are diagnosed, so the surgical resection rate is low and the 5-year survival rate after surgery is less than 5%, thus its early diagnosis and treatment have attracted more attention from scholars. I. Incidence and related diseases The incidence of primary gallbladder cancer is related to geography and ethnicity. The incidence rate is higher in South American countries, Mediterranean region and Japan. The incidence of gallbladder cancer is closely related to gallbladder stones. Statistics in China show that 49.7% of gallbladder cancers are associated with gallbladder stones. Overseas data are even higher, with about 70% of gallbladder cancer patients having gallbladder stones. All of them are much higher than the general population of similar age. Symptoms and signs Gallbladder cancer lacks typical symptoms and signs. About 66% of patients with gallbladder cancer have abdominal pain, 59% have weight loss, 51% have xanthoma, 40% have loss of appetite, and nearly 40% have epigastric masses. The clinical manifestations are different in different periods of disease onset. The symptoms and signs of patients with gallbladder cancer depend on the location, degree of development and scope of the cancer. Generally speaking, patients with biliary tract symptoms of gallbladder cancer have more obvious clinical manifestations, which are easy to attract attention. The right upper abdominal mass, smooth and soft in texture, is mostly an enlarged gallbladder. Once xanthogranuloma appears, it indicates that the tumor has invaded the right hepatic duct, common hepatic duct or common bile duct, but it should also be considered that it may be due to the surrounding enlarged lymph nodes compressing the bile duct. Tumor invasion of the liver can also cause xanthogranuloma. In a small number of patients with gallbladder cancer, gangrene may be caused by stones in the biliary system. Most patients with abdominal pain and gangrene can be differentiated from periampullary cancer. Tumor markers and gene research So far, no specific tumor markers for gallbladder cancer have been found, and related research work is still in progress. The positive rate of carcinoembryonic antigen (CEA) in the serum of gallbladder cancer patients is 70%, and the positive rate of glycocalyx antigen (CA19-9) is 81%. In addition, the detection of CA12-5, CA15-3 and CA50 in serum has also been reported in the diagnosis of gallbladder cancer, but they all lack specificity and can only be used as auxiliary tests for gallbladder cancer. In recent years, it has been proposed that the combined test of CEA and CA199 is helpful for diagnosis, but it also has the problem of low specificity, and can be used as an auxiliary diagnosis and observation index for follow-up after surgical resection. IV. Imaging examination X-ray examination is of little diagnostic value for this disease. Using oral method cholecystography, most patients show non-functional gallbladder. Barium meal of the upper gastrointestinal tract can show compression of the duodenal region of the gastric sinus, but this sign can also appear in the acute inflammatory phase of the gallbladder. The following imaging tests can be helpful in the diagnosis of this disease. (a) Ultrasound examination From the current literature, among various imaging methods, ultrasound examination still has the highest diagnostic rate for gallbladder cancer, with a confirmation rate of 62%~83%. (II) CT examination In previous years, the sensitivity of CT scan for gallbladder cancer diagnosis was low due to the influence of tumor size and contrast of surrounding organs. Recently, CT has been updated and its detection rate of gallbladder cancer has been significantly improved. CT can observe the size and shape of gallbladder, especially the wall of gallbladder, and enhanced scan can show the thickness of gallbladder wall. (MRI is a new examination method applied in clinical practice in recent years, and its clarity of biliary system examination is significantly better than that of CT; it can better show various modes of spread of primary gallbladder cancer, especially the invasion of hepatoduodenal ligament and para-abdominal aorta by the tumor than CT and ultrasound. However, due to respiratory artifacts, partial volume effects and the thin fat layer between the tumor and the duodenum, the accuracy of MRI in showing duodenal invasion is low and prone to misjudgment. With the development of MRI water imaging technology, magnetic resonance cholangiopancreatography (MRCP) has been successfully applied in clinical practice, which can obtain three-dimensional images of the bile and pancreatic ducts and clearly display the biliary system inside and outside the liver. V. Treatment Since it is difficult to determine the clinical stage before surgery, it is also difficult to determine the surgical approach before surgery. Therefore, the decision of which procedure to use can only be made after the nature, extent and stage of the lesion are clearly identified by surgical exploration. Currently, most surgeons choose the surgical approach according to the clinical stage of Nevin. For patients with Nevin stage I (carcinoma in situ with tumor invasion limited to the mucosal layer) or adenomatous malignancy, simple cholecystectomy is performed; for stage II (tumor invasion to the submucosal and muscular layers), cholecystectomy and regional lymph node dissection is performed; for stage III (tumor invasion to the whole wall of the gallbladder, but not yet accompanied by lymph node metastasis), in For patients with stage III (tumor invading to the whole gallbladder wall but not yet accompanied by lymph node metastasis), liver wedge resection should be done along 1.5-4 cm of gallbladder margin at the same time; for patients with stage IV (involvement of the whole gallbladder wall combined with lymph node metastasis around the bile duct), middle lobe resection (right anterior lobe of liver, left inner lobe and surrounding lymph nodes) should be done; for patients with stage V (tumor invading to the liver or other organs with lymph nodes around the common bile duct or distant metastasis), palliative resection of gallbladder and mass or dissection only should be done. The patients with stage V (tumor invasion of the liver or other organs with peribiliary lymph nodes or distant metastases) can undergo palliative resection of the gallbladder and mass, or dissection only.