The incidence of gallbladder cancer is gradually increasing, with more women than men, and the incidence increases with age. About 82% of gallbladder cancer patients are over 50 years old. More than 70% of gallbladder cancer patients have gallbladder stones in conjunction with gallbladder cancer. I. Etiology and pathology The etiology is not very clear. Gallbladder cancer is closely related to gallbladder stones, and the larger the gallbladder stones are, the higher the risk of gallbladder cancer. The malignancy rate is higher in chronic cholecystitis combined with calcification of the gallbladder wall. Adenomatous polyps of the gallbladder with a diameter greater than 1 cm and a short, thick tip are prone to malignant transformation. The former is a polyp-like lesion of variable size protruding into the gallbladder cavity, while the latter has a thickened gallbladder wall that can infiltrate into the liver and adhere closely to it. Histologically, it is mainly adenocarcinoma, and rarely, squamous cell carcinoma and mixed carcinoma. Metastases are mainly direct infiltration of liver parenchyma and surrounding organs, including duodenum and pancreas; lymphatic metastases, from gallbladder lymph nodes and lymph nodes within hepatoduodenal ligament to lymph nodes behind the head of pancreas, hepatic artery and abdominal cavity artery; hematogenous metastases are less common. Clinical manifestations and diagnosis Lack of specific clinical symptoms, and those with combined gallbladder stones mostly show symptoms of gallbladder stones and cholecystitis in the early stage. As early symptoms are not obvious, patients often consult the doctor late and the early diagnosis rate is low. The common clinical staging of gallbladder cancer is Nevin staging, which divides gallbladder cancer into 5 stages according to the extent of lesion invasion: Stage I: in situ cancer within the mucosa of gallbladder; Stage II: invasion of mucosa and muscular layer; Stage III: invasion of whole gallbladder wall; Stage IV: invasion of whole gallbladder wall and surrounding lymph node metastasis; Stage V: invasion of liver and/or metastasis to other organs. Early detection, early diagnosis and timely radical resection is the only treatment principle for gallbladder cancer. 1. Simple cholecystectomy: if the cancer is limited to the mucosal layer or submucosal layer, simple cholecystectomy can achieve the purpose of radical treatment. This is common when gallbladder cancer is found after cholecystectomy for gallbladder stones or gallbladder polyp-like lesions. 2. Cholecystectomy plus regional lymph node dissection: tumor invades the muscular layer or the whole layer of gallbladder and gallbladder lymph node metastasis. The gallbladder is removed and the lymph nodes within the hepatoduodenal ligament, the lymph nodes behind the head of the pancreas and group 8 lymph nodes (i.e. the lymph nodes adjacent to the common hepatic artery) are removed. 3.Union partial hepatectomy: for carcinoma of the base of gallbladder with liver infiltration, union partial hepatectomy and removal of lymph nodes. If there is infiltration of adjacent organs (such as transverse colon and duodenum), the scope of resection should be expanded. 4. Combined extrahepatic bile duct partial resection: for cancer of gallbladder neck or bile duct with extrahepatic bile duct involvement and obstructive jaundice, gallbladder resection should be performed, and the involved bile duct should be removed at the same time, lymph nodes should be removed, and Roux-en-y anastomosis of hilar bile duct jejunum should be performed. 5.Postoperative radiotherapy, chemotherapy and herbal treatment are not effective. Prognosis Most of the gallbladder cancers seen clinically are in advanced stage, with low radical resection rate, 1-year survival rate less than 80% and 5-year survival rate less than 5% after surgery. The prognosis of papillary carcinoma with better differentiation is better. Early removal of gallbladder with stones or polyps, or selective biliary stone or polyp removal is expected to prevent the occurrence of gallbladder cancer.