Gall bladder carcinoma is the most common biliary tract cancer. Delayed presentation and early spread of tumor make it one of the lethal tumors with poor prognosis. Considering that simple cholecystectomy for T1 disease could offer a potential cure, it is increasingly needed to identify it at early stages. Identification of high-risk cases and offering prophylactic cholecystectomy can decrease the incidence of gallbladder carcinoma. With advances in diagnostic tools like contrast-enhanced endoscopic ultrasound, elastography, multidetctor CT, MRI, and PET scan, we can potentially diagnose gallbladder carcinoma at early stages. This paper reviews the various diagnostic modalities available and an algorithmic approach to early diagnosis of gallbladder carcinoma. 1. Introduction Gallbladder carcinoma (GBC) is the most common biliary tract cancer, accounting for 3% of all tumors [1]. GBC is hard to detect and diagnose in its early stages because it usually has very slight symptoms or is asymptomatic. But once the diagnosis is confirmed, most of these patients often have metastasis and invasion. Furthermore, GBC is not sensitive to radiotherapy and chemotherapy. All of these characteristics make GBC a highly lethal tumor with a 5-year survival rate of less than 5% [2]. Considering that survival after simple cholecystectomy for T1 disease is reported to be near 100% [3]. It becomes increasingly necessary for early diagnosis and identifing patients at high-risk of carcinoma and offer them prophylactic cholecystectomy. The prevalence of gallbladder cancer (GBC) shows great geographical variation. It is rare in the Western world, including the USA, UK, Canada, Australia, and New Zealand, where the incidence rates range between 0.4 and 0.8 in men and between 0.6 and 1.4 in women per 100？000 population. However, high incidence rates, up to 2–4 in men and up to 4–6 in women, have been reported from various countries in central and south America, central and eastern Europe, and Japan. Though the overall age-adjusted incidence rates of GBC in India are low (1.0 for men and 2.3 for women per 100 000 population), the incidence in women in Delhi in north India and Bhopal in central India is as high as 6.6 and 5.2, respectively, much higher than 0.6 in Chennai, and 0.8 in Bangalore in south India. In Delhi, GBC (incidence rate 6.6) was the fourth most common cancer (following cervix, breast, and ovary; incidence rates being 30.1, 28.3, and 8.7, resp.) and the most common gastrointestinal cancer in women (commoner than oesophagus 4.6, stomach 2.4, and colon 2.0) [4]. Risk
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