http://www.stargazette.com/article/20100114/NEWS01/1140338
Veteran's Widow Battles Killer Parasite From
Vietnam |
Horseheads woman raises alert about cancer-causing disease
January 14, 2010, 5:45 pm
Elusive as they were, Pete thought he knew his enemies over there. The
Viet Cong. The North Vietnamese. Their sympathizers.
Nobody ever warned him about parasites in the water he drank, but they
were there. Nobody ever mentioned the parasites could cause cancer,
but they could. Nobody ever told him that cholangiocarcinoma might kill
him some day, but it did.
Now his widow, Sheila Harrison of Horseheads, is fighting her own war
-- against the disease that took her husband's life.
She does it by alerting other Vietnam veterans, and the health care
workers who treat them, to check for this deadly disease. Early and
often.
Cholangiocarcinoma is a rare cancer of the bile ducts, which drain
bile from the liver to the gallbladder and into the small intestine.
Symptoms don't usually develop in the early stages, so the cancer often
is well advanced by the time it's discovered.
"It's a miserable, miserable disease," Sheila said.
Edward "Pete" Harrison was 58 when he died four years ago
next Wednesday -- on Jan. 20, 2006.
The following year, the Department of Veterans Affairs ruled that his
death was service-connected. Sheila was awarded widows' benefits --
small consolation.
She said it was the VA's first such ruling related to that disease
and service in Vietnam. The department has now issued a total of six,
she said, "with many more in the works."
Pete survived wounds from multiple shell fragments in Vietnam, where
he served from 1969 to 1970 with the 1st Infantry Division.
But after he was diagnosed with cholangiocarcinoma in 2005, he was
dead within six months.
Now, Sheila urges other vets not to wait until it's too late.
If you Google cholangiocarcinoma and Sheila Harrison, you'll find her
write-up about her husband and the disease under the heading "Vietnam
Veterans" and, below that in larger type, "Parasite Warning."
The warning is this: "Have your bile ducts checked before any
symptoms occur."
People everywhere have read the page. Many have contacted Sheila, some
with stories similar to hers.
She offers words of comfort and advice, sometimes helping people maneuver
through the VA claims process.
"A lot of people don't know anything about it until somebody's
diagnosed with it," she said of the disease. She and Pete were
like that, once.
She said doctors "are not looking for it in our guys, especially
30 or 40 years after they got out of Vietnam."
When he got out, Pete, who was a sergeant in the Big Red One, counseled
veterans at the Labor Department's office in Corning. He would have
been proud of his widow and the work she's doing today.
"My husband spent his whole working life working for veterans.
He said, 'This isn't right; we've got to let veterans know about this,'"
Sheila said.
"He thought it was really important to get the word out, which
is why I'm doing what I'm doing."
Roger Neumann is a staff writer for the Star-Gazette. His column runs
Fridays. Also read his blog for veterans, "Roger That," on
the homepage of the Web site www.stargazette.com. He can be reached
by phone at (607) 271-8256, by e-mail at [email protected], or by
fax at (607) 733-4408.
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Cholangiocarcinoma
* What: Cholangiocarcinoma is a rare malignant growth in the bile ducts
and is most prevalent in people ages 50 to 70. About 200 cases of bile
duct cancer are diagnosed in the United States each year. Often, it
is diagnosed in advanced stages.
* Symptoms: Jaundice, clay-colored stools, itching, loss of appetite,
weight loss, fever, chills, and abdominal and back pain. Symptoms seldom
develop during the early stages.
* Treatment: Surgery, liver transplantation, chemotherapy, radiation
therapy, photodynamic therapy and biliary drainage.
http://cmr.asm.org/cgi/content/full/17/3/540
Clonorchiasis and Cholangiocarcinoma: Etiologic Relationship and Imaging
Diagnosis
INTRODUCTION
Several trematode parasites in humans are known to be epidemiologically
linked with malignancy; notable examples are the associations between
the blood-fluke Schistosoma haematobium and tumors of the bladder urothelium
(79) and between the liver-flukes Clonorchis sinensis and Opisthorchis
viverrini and cholangiocarcinoma. The areas where human clonorchiasis,
a disease caused by chronic C. sinensis infection, is endemic are confined
largely to the Far East. In these regions, clonorchiasis is considered
an important cause of recurrent pyogenic cholangitis and cholangiocarcinoma.
Several well-documented epidemiological, histopathological, and experimental
studies of C. sinensis have provided convincing evidence of a relationship
between this trematode infection and the tendency for malignant transformation
of the biliary epithelium in humans and experimentally infected animals
(11, 42, 46).
In this paper, evidence indicating that C. sinensis is an etiological
factor in the pathogenesis of human cholangiocarcinoma and morphological
features of clonorchiasis and cholangiocarcinoma, with particular reference
to imaging diagnosis, are reviewed.
Epidemiology
Clonorchiasis is endemic in the Far East, especially in southern and
northeastern China, eastern Russia, Vietnam, and Korea (90). The custom
of eating raw freshwater fish contributes to the high incidence of infection
in these areas (14).
In 1947, Stoll (106) estimated that 19 million Asians harbored this
liver fluke. Despite a gradual decrease in its prevalence over the decades,
the International Agency for Research on Cancer Working Group estimated
in 1994 that about seven million people were infected in areas of endemic
infection (46). The national survey in Korea in 1997 revealed that the
prevalence of clonorchiasis was still 1.4% (77a). The difficulty of
eliminating clonorchiasis in areas of endemic infection has been attributed
mainly to the difficulty in detecting infected cases, although other
contributory factors, including reinfection after treatment, have been
discussed (37, 64). C. sinensis is currently the most prevalent human
parasitic helminth detected by fecal examination in Korea (52, 76).
The rate of clonorchiasis in areas of endemic infection is greater
in aged people and in men than in the younger age groups and in women
(93, 99, 102). The rate of positive results in fecal examination generally
reaches a maximum in the age group from 50 to 59 years. In addition,
the same age-related pattern has been observed for worm burden. The
higher infection rates and heavier worm burden in older people suggests
that humans have little protective immunity and are superinfected throughout
life. The infection rate decreases in the seventh decade, which might
reflect an elevated death rate among the infected population. The higher
percentage of clonorchiasis in men and in old people is probably related
to dietary habits. In areas of endemic infection, people traditionally
prefer to eat raw freshwater fish, soaked simply in vinegar or red-pepper
mash, as an appetizer when drinking liquor at social gatherings. In
some areas, fermented raw fish is a favorite side dish. Because women
infrequently participate in such rituals, they are less frequently exposed
to the infection.
Liver flukes have a life span of 20 to 25 years; this creates a problem
for Asian immigrants to other areas, who may develop clinical symptoms
several years after leaving an area of endemic infection (90, 109).
Clonorchiasis in North America has been reported in recent decades,
reflecting the immigration of people from areas of endemic infection
(49, 83, 89, 97, 98, 117). The prevalence of clonorchiasis among these
immigrants varies between studies, ranging from 15.5 to 26% (9, 97,
98); however, most of these reports were published more than 10 years
ago. Although clonorchiasis does not have a great impact on public health
in North America, recognition of this parasite and its associated complications
continues to be important for the correct diagnosis of disease in immigrants
or travelers from areas of endemic infection (91). Unfortunately, the
common clinical features of clonorchiasis, along with the increased
risk of developing long-term sequelae such as cholangiocarcinoma, remain
largely unknown to many physicians providing care for this population.
More info on topic is provided in link above...
Also there is additional info at this other link: http://emedicine.medscape.com/article/277393-overview
Causes
The etiology of most bile duct cancers remains undetermined. Currently,
gallstones are not believed to increase the risk of cholangiocarcinoma.
Chronic viral hepatitis and cirrhosis also do not appear to be risk
factors.
Infections
In Southeast Asia, chronic infections with liver flukes, Clonorchis
sinensis, and Opisthorchis viverrini have been causally related to cholangiocarcinoma.
Other parasites, such as Ascaris lumbricoides, have been implicated
in the pathogenesis of cholangiocarcinoma.
Observations have raised the possibility that bacterial infections with
Helicobacter species may play an etiologic role in biliary cancer.8
Inflammatory bowel disease
A strong relationship exists between cholangiocarcinoma and primary
sclerosing cholangitis. Cholangiocarcinoma generally develops in patients
with long-standing ulcerative colitis and primary sclerosing cholangitis.9
The lifetime risk of developing this cancer in the setting of primary
sclerosing cholangitis is 10-20%. At increased risk are patients with
ulcerative colitis without symptomatic primary sclerosing cholangitis
and a small subset of patients with Crohn disease.
Chemical exposures
Certain chemical exposures have been implicated in the development of
bile duct cancers, primarily in workers in the aircraft, rubber, and
wood-finishing industries.
Cholangiocarcinoma occasionally has developed years after administration
of the radiopaque medium thorium dioxide (ie, thorotrast).
Congenital diseases of the biliary tree, including choledochal cysts
and Caroli disease, have been associated with cholangiocarcinoma.
Other conditions rarely associated with cholangiocarcinoma include bile
duct adenomas, biliary papillomatosis, and alpha 1 -antitrypsin deficiency.
www.bioportfolio.com/indepth/Cholangiocarcinoma.pdf
Some cautions on this topic from a Veteran's Advocate to be aware of:
passing out news articles can sometimes prove to be a dangerous business.
From a professional standpoint I see a lot of holes in this article.
1. The disease/condition mentioned is not one of the "presumptive"
illnesses related to service in Vietnam by the VA
2. Just because his death was rated as service-connected does not mean
it was due to that particular condition (though the implication is there
in the article) (Hepatitis B is a risk factor as well and many veterans
were exposed to that disease in Vietnam) I cannot see that all the relevant
facts are contained in the article below.
3. No where does this article itself link parasites with this veterans
service connection for death or his disease/condition.
4. If the story is true and there are only 6 cases rated as service
connected thus far, I suspect it may be a number of years before the
VA does connect this as a Vietnam "presumptive" illness. I
would also suspect it would be an extremely difficult claim to prove.
5. From what I can see there has been no medically "confirmed"
link to this though a parasite is known as one of the "possible"
risk factors
