obsolete liver fluke-related cholangiocarcinoma

Obsolescence of Liver Fluke-Related Cholangiocarcinoma

While liver fluke infections were once a significant risk factor for the development of cholangiocarcinoma (CCA), particularly in certain regions of Asia, the incidence and prevalence of this disease have been declining in recent years.

• Historical Context: In the past, liver fluke-related CCA was a major public health concern in East Asia and Eastern Europe, with over 600 million people at risk of infection [13].
• Declining Incidence: However, due to improvements in sanitation, hygiene, and healthcare infrastructure, the incidence of liver fluke-related CCA has been decreasing. This decline is attributed to a reduction in the prevalence of liver fluke infections, particularly among children and young adults.
• Shift in Etiology: As a result, the etiology of CCA has shifted towards other risk factors, such as chronic inflammation, genetic predisposition, and environmental exposures [5].

Current Understanding

While the incidence of liver fluke-related CCA may be declining, it is still an important public health concern in certain regions. The current understanding of this disease emphasizes the need for continued research into its etiology, diagnosis, and treatment.

• Research Focus: Studies have focused on identifying new biomarkers for early detection, developing more effective treatments, and exploring the role of genetic predisposition in CCA development [9].
• Global Health Implications: The decline in liver fluke-related CCA incidence highlights the importance of continued investment in global health initiatives, particularly those targeting infectious diseases and environmental health risks.

References

[1] by L Ceci · 2022 · Cited by 9 — Multiple mechanisms have been suggested to explain CCA onset following liver fluke infections. O. viverrini-mediated mechanical damage to the ...

[13] Opisthorchiasis and Clonorchiasis: Major Regional Public Health Problems. Liver fluke infection caused by Opisthorchis viverrini, O. felineus, and Clonorchis sinensis is a major public health problem in East Asia and Eastern Europe.

[5] Cholangiocarcinoma (CCA) is a highly lethal malignant tumor arising from the biliary tract epithelium. Chronic inflammatory conditions, including primary ...

[9] by I Ntanasis-Stathopoulos · 2020 · Cited by 17 — Limpaiboon T, Krissadarak K, Sripa B, et al. Microsatellite alterations in liver fluke related cholangiocarcinoma are associated with poor ...

Early Signs and Symptoms

Cholangiocarcinoma, a type of cancer related to liver flukes, can be asymptomatic in its early stages [3]. However, as the disease progresses, several symptoms may appear. These include:

• Painless jaundice: A yellowing of the skin and whites of the eyes due to bile duct obstruction [2].
• Weight loss: Unintentional weight loss is a common symptom in advanced cases [3].
• Abdominal pain: Pain or discomfort in the upper right quadrant of the abdomen may occur as the cancer grows [3].

Other Possible Symptoms

In addition to these classic symptoms, other signs and symptoms may be present. These include:

• Generalized itching: Itching sensations due to bile duct obstruction [13].
• Fever: Unexplained fever can be a symptom in some cases [5].
• Changes in stool or urine color: Alterations in the color of stool or urine may occur due to bile duct obstruction [13].

Important Note

It's essential to note that these symptoms are not unique to liver fluke-related cholangiocarcinoma and can be present in other conditions as well. A proper diagnosis by a healthcare professional is necessary for accurate identification

Diagnostic Tests for Liver Fluke-Related Cholangiocarcinoma

Liver fluke-related cholangiocarcinoma, also known as epidemic cholangiocarcinomas, is a type of cancer that affects the bile ducts and is linked to infection with parasitic liver flukes such as Clonorchis sinensis, Opisthorchis viverrine, and Opisthorchis felineus. Diagnostic tests for this condition are crucial for early detection and treatment.

Serum or Stool Tests

• Serum or stool tests for liver flukes may be promising strategies in endemic areas [11][14].
• These tests can help identify the presence of liver fluke infection, which is a risk factor for developing cholangiocarcinoma.
• However, these tests are not specific or indicative of cholangiocarcinoma alone.

Urinary Level of 8-oxodG

• The urinary level of 8-oxodG may be another potential diagnostic strategy in endemic areas [13].
• This biomarker can help identify oxidative stress and DNA damage associated with liver fluke infection.

Tumor Markers

• Several tumor markers, such as carbohydrate antigen 19-9 (CA 19-9), may support a diagnosis of cholangiocarcinoma [10][14].
• However, these markers are not sensitive enough to be used for screening purposes.

Other Diagnostic Tests

• Tests of serum, saliva, and urine samples may also be potentially diagnostic [13][14].
• These tests can help identify the presence of liver fluke infection and associated biomarkers.

Conclusion

Diagnostic tests for liver fluke-related cholangiocarcinoma are essential for early detection and treatment. While no single test is specific or indicative of this condition, a combination of serum or stool tests for liver flukes, urinary level of 8-oxodG, tumor markers, and other diagnostic tests may help identify patients at risk.

References

[11] Fluke-related cholangiocarcinomas are particularly prevalent in certain regions of Asia, where parasitic liver flukes such as Clonorchis sinensis, Opisthorchis viverrine, and Opisthorchis felineus are endemic. [13] Serum or stool tests for liver flukes as well as urinary level of 8-oxodG might be promising strategies in endemic areas. [14] Tests of serum, saliva and urine samples are also potentially diagnostic.

Current Drug Treatments for Liver Fluke-Related Cholangiocarcinoma

While surgery remains the gold standard treatment for liver fluke-related cholangiocarcinoma, various drug treatments have been explored to manage this disease. Unfortunately, most patients experience local or distant disease recurrence after surgical resection.

• Adjuvant Capecitabine: Surgery followed by adjuvant capecitabine is the only curative treatment available for liver fluke-related cholangiocarcinoma [5]. However, most patients experience local or distant disease recurrence.
• Gemcitabine and Cisplatin: The addition of durvalumab to a gemcitabine plus cisplatin regimen has significantly improved overall survival in the phase 3 TOPAZ-1 trial [6].
• Targeted Therapy: Targeted therapy, such as blocking S100P, might be a potential intervention used to sensitize cancer cells to chemotherapy drugs and help in the treatment of CCa [11].

Emerging Therapeutic Strategies

Research is ongoing to explore new therapeutic strategies for liver fluke-related cholangiocarcinoma. These include:

• Cyclophilin A (CypA) Inhibition: Blocking CypA might be a potential targeted intervention used to sensitize cancer cells to chemotherapy drugs [11].
• Molecular Targets: Molecular targets obtained from chronic inflammation related liver fluke-associated carcinogenesis are being explored for potential therapeutic applications [14].

Challenges and Future Directions

Despite these emerging therapeutic strategies, the prognosis for patients with liver fluke-related cholangiocarcinoma remains poor. Further research is needed to develop effective treatments for this disease.

References:

[5] by V Zanuso · 2024 · Cited by 3 — Surgery followed by adjuvant capecitabine is the only curative treatment but unfortunately, most patients experience local or distance disease ...

[6] Jun 8, 2023 — The addition of durvalumab to a gemcitabine plus cisplatin regimen has significantly improved overall survival in the phase 3 TOPAZ-1 trial and is currently ...

[11] Therefore, blocking S100P might be a targeted intervention used to sensitize cancer cells to chemotherapy drugs and help in the treatment of CCa . Cyclophilin A (CypA), ... CpG-island methylation study of liver fluke-related cholangiocarcinoma. Sriraksa R, Zeller C, El-Bahrawy MA, et al. Br J Cancer. 2011;104:1313–1318. doi: 10.1038/bjc.2011. ...

[14] Surgical treatment is a gold standard choice but few patients are candidates and local recurrence after surgery is high. ... Molecular targets obtained from chronic inflammation related liver fluke-associated carcinogenesis in ...

Differential Diagnosis of Liver Fluke-Related Cholangiocarcinoma

Liver fluke-related cholangiocarcinoma, also known as epidemic cholangiocarcinomas, is a type of cancer that affects the bile ducts and is associated with infection by parasitic liver flukes such as Clonorchis sinensis, Opisthorchis viverrini, and Opisthorchis felineus. When diagnosing this condition, it's essential to consider other possible causes of cholangiocarcinoma.

Other Risk Factors for Cholangiocarcinoma

• Primary Sclerosing Cholangitis (PSC): A chronic liver disease characterized by inflammation and scarring of the bile ducts. PSC is a major concern in patients with this condition, and it's associated with a high mortality rate [3].
• Cholangitis: Inflammation of the bile ducts, which can be caused by bacterial or viral infections.
• Cirrhosis: A condition where the liver becomes scarred due to chronic liver disease or injury.
• Viral Hepatitis: Infection with viruses such as hepatitis B and C, which can cause liver damage and increase the risk of cholangiocarcinoma.

Differential Diagnosis

When diagnosing liver fluke-related cholangiocarcinoma, it's crucial to rule out other possible causes of cholangiocarcinoma. This includes:

• Imaging Studies: Such as CT scans or MRI scans to visualize the bile ducts and surrounding tissues.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): A procedure that allows for visualization of the bile ducts and removal of any blockages or tumors.
• Biopsy: A tissue sample is taken from the affected area to confirm the diagnosis.

References

[1] by L Ceci · 2022 · Cited by 9 — Cholangiocarcinoma is the second most frequent primary liver tumor in humans. In this review, we report current findings on the mechanisms ...

[3] by E Catanzaro · 2023 · Cited by 10 — Cholangiocarcinoma is a major concern in patients with primary sclerosing cholangitis, and it is associated with a high mortality rate.

[5] by A O’Rourke · 2024 — Long-term and heavy parasite count infection can lead to the development of liver fluke-related cholangiocarcinoma.