Cholangiocarcinoma

Cholangiocarcinoma is a type of cancer that forms in the slender tubes (bile ducts) that carry the digestive fluid bile. Bile ducts connect your liver to your gallbladder and to your small intestine. Cholangiocarcinoma, also known as bile duct cancer, occurs mostly in people older than age 50, though it can occur at any age.

There are several risk factors associated with cholangiocarcinoma. These include chronic inflammation of the bile ducts, such as from conditions like primary sclerosing cholangitis or chronic biliary stones. Other risk factors include liver fluke infection, exposure to certain chemicals, smoking, and certain inherited genetic conditions.

In higher risk Southeast Asian countries, parasitic infections by liver fluke infestation are key risk factors. Liver flukes are parasitic trematodes that, when ingested via raw, pickled, or undercooked fish, can live in the host biliary system for decades.

While it may not be possible to prevent cholangiocarcinoma entirely, certain measures can help lower the risk. These include maintaining a healthy lifestyle, avoiding exposure to known carcinogens (e.g. smoking, excessive alcohol consumption), undergoing regular health check-ups and managing underlying liver or biliary conditions.
Liver fluke infection is a major risk factor for cholangiocarcinoma in Southeast Asia. Food safety practices can help to reduce the risk of parasitic infestation. Here are some guidelines to follow:

• Cooking: Thoroughly cook all freshwater fish and seafood, as cooking kills the parasites. Ensure that fish is cooked to an internal temperature of at least 145°F (63°C).
• Freezing: If consuming raw or undercooked fish, freezing it at -4°F (-20°C) for a minimum of 24 hours can help kill the parasites.
• Avoid raw or undercooked fish: Avoid consuming raw or undercooked fish, especially from freshwater sources, as they may be contaminated with liver fluke larvae.
• Proper sanitation: Maintain good hygiene practices, such as washing hands thoroughly with soap and clean water before handling food, especially after using the toilet and before meals.
• Safe drinking water: Ensure that the water you drink is filtered, boiled, or comes from a safe source to prevent contamination.
• Proper waste disposal: Avoid using rivers or bodies of water as waste disposal sites, as it can contribute to the spread of liver fluke larvae.
• Awareness of high-risk areas: If you live in or visit areas known for liver fluke infections, like certain rural regions, be mindful of the local food practices and potential risks associated with consuming raw or undercooked fish.

The symptoms of cholangiocarcinoma can vary depending on the location and stage of the cancer. Common symptoms include abdominal pain, weight loss, jaundice (yellowing of the skin and eyes), itching, fatigue, loss of appetite, and dark urine. However, it is important to note that these symptoms can also be caused by other conditions, so proper medical evaluation is necessary for an accurate diagnosis.
 

To investigate and diagnose cholangiocarcinoma, various medical tests and procedures are employed. These may include blood tests to assess liver function and tumor markers, imaging studies such as ultrasound, CT scans, or MRIs, bile duct brushings for cytology, endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiopancreatography (MRCP), and ultimately, a tissue biopsy for definitive diagnosis.
 

Treatment options for cholangiocarcinoma depend on the stage and extent of the cancer, as well as the patient’s medical conditions. They can include surgery to remove the tumor, liver transplantation in select cases, chemotherapy, radiation therapy, and targeted therapy. The treatment plan is tailored to each individual scenario and may involve a multidisciplinary approach with input from surgeons, oncologists, and other specialists.
 

Treatment for cholangiocarcinoma may lead to potential complications. Surgery may carry risks related to anesthesia, bleeding, infection, or bile leakage. Chemotherapy may bring about side effects such as nausea, vomiting, hair loss, and fatigue. Your healthcare team will monitor and manage any potential complications to ensure the best possible outcome.
 

Taking care of a cholangiocarcinoma patient involves regular medical consultations and check-ups to monitor the condition, manage symptoms, and adjust treatment as needed. Providing emotional support, maintaining a healthy diet, encouraging physical activity within the patient's abilities, and following the healthcare team's recommendations are important aspects of self-care. It is essential to communicate openly with healthcare professionals and seek their guidance throughout the patient's journey.
Moreover, cancer patients in general, have weaker immunity and particular attention should be paid to food safety. It is advised that they avoid to eat:
•      raw or undercooked meat, poultry and eggs
•      raw or undercooked seafood, e.g. sushi, oysters, clams and mussels
•      raw or unpasteurized dairy products, e.g. milk and cheeses
•      ready-to-eat raw vegetables, e.g. prepackaged salad vegetables, seed sprouts