# Preneoplastic lesions in gallbladder cancer

Source: https://onco.cc/key-papers/paper-roa-gallbladder-preneoplastic-lesions-jso-2006/  
OnCo record `paper-roa-gallbladder-preneoplastic-lesions-jso-2006` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Gallbladder cancer mostly grows from flat dysplasia rather than from polyps: dysplasia and carcinoma in situ sit next to four in five cancers, adenomas are rare, and the age gap between dysplasia and invasive cancer suggests about ten years of progression.

## Summary

A review of the epithelial lesions involved in gallbladder carcinogenesis, dysplasia and adenomas, which represent two biologically distinct models. Dysplasia progresses to carcinoma in situ and then invasion; over 80% of invasive gallbladder cancers have areas adjacent to carcinoma in situ and epithelial dysplasia. Adenomas are uncommon (0.14% of cholecystectomies) and adenomatous remnants are found next to fewer than 3% of early carcinomas, suggesting the limited importance of that pathway.

Epithelial dysplasia unassociated with cancer is seen in about 1% of cholecystectomies for symptomatic stones. Metaplasia, dysplasia and carcinoma in situ are present in the mucosa adjacent to cancer in 66%, 81.3% and 69% of cases. The average ages of patients with isolated dysplasia (51.9 years), early carcinoma (56.8) and advanced carcinoma (62.9) form a gradient that suggests progression over roughly 10 years.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Journal: Journal of Surgical Oncology
- Year: 2006
- DOI: 10.1002/jso.20527
- Authors: Roa I, de Aretxabala X, Araya JC, Roa J.
- Findings: Metaplasia, dysplasia and carcinoma in situ adjacent to cancer in 66%, 81.3% and 69% of cases.; Adenomas in 0.14% of cholecystectomies; adenomatous remnants next to fewer than 3% of early carcinomas.; Mean ages 51.9 (dysplasia), 56.8 (early carcinoma), 62.9 (advanced carcinoma): about a 10-year sequence.
- What it means: The morphological argument that gallbladder cancer is a flat-dysplasia disease, which is why it is invisible on imaging until late and why prevention rests on removing the diseased gallbladder rather than on polyp surveillance alone.
- Caveats: Chilean cholecystectomy series; the adenoma fraction may differ elsewhere.; Age gradients estimate, rather than observe, progression time.

## Sources

- Roa et al., J Surg Oncol 2006: preneoplastic lesions in gallbladder cancer: https://doi.org/10.1002/jso.20527
- PubMed: https://pubmed.ncbi.nlm.nih.gov/16724345/

## Connected records

- cancers: [Gallbladder cancer](https://onco.cc/cancers/gallbladder/)
- terms: [Dysplasia (pre-cancerous change)](https://onco.cc/terms/dysplasia/), [Intracholecystic papillary-tubular neoplasm (ICPN)](https://onco.cc/terms/intracholecystic-papillary-tubular-neoplasm/), [Metaplasia, dysplasia, carcinoma in situ: the flat route to gallbladder cancer](https://onco.cc/terms/metaplasia-dysplasia-carcinoma-sequence/)
- journals: [Journal of surgical oncology](https://onco.cc/journals/journal-of-surgical-oncology/)

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