Update on Vietnam Health Issues: Liver flukes and cancer Jeff Whittle, MD, MPH Staff Physician Clement J. Zablocki VA Medical Center Professor of Medicine, MCW Dept of Med
Objectives Review why we are worried about liver flukes in Vietnam Veterans Discuss testing for: Opisthorchis viverrini Cholangiocarcinoma
Liver fluke
Distribution Most common in Northeast Thailand Also present in Laos Less common in South Vietnam, more common in the North Rare in Cambodia Related flukes in China and Korea
Liver fluke life cycle
Koi Pla
Bile ducts
Test for liver fluke infection When actively infected Look for eggs in stool Not useful for past infection No test for resolved liver fluke infection for clinical use in the United States Worms are all dead after 20-30 years Immune response test could be feasible
Cholangiocarcinoma
Risk factors for this cancer Living in Thailand Particularly in regions with liver flukes Working in fishing industry Inflammation of the biliary tree Cirrhosis of the liver Viral hepatitis – mostly Immune diseases like diabetes
Symptoms of cholangiocarcinoma Jaundice Pain in the abdomen Dark urine and light stool Nausea and vomiting Unexplained weight loss Generally no symptoms until too late
Diagnosing cholangiocarcinoma Pictures of liver CT scan Ultrasound Pictures of biliary tree ERCP – endoscopic injection of dye Transhepatic cholangiogram Magnetic resonance cholangiopancreatogram Biopsy of affected area
Scary study Northpoint VA Medical Center Surveyed 97 Vietnam Veterans 50 had eaten raw or undercooked fish 12 of these had antibodies to a fluke that is found in Korea and China None of these had abnormal bile ducts One of the 50 was known to have cancer – he did not have antibodies
Why we don’t screen We can’t tell who has had liver fluke infestation with available tests Likely could develop a test of past exposure Cholangiocarcinoma is very hard to diagnose before it is incurable There does not seem to be an increased risk of cholangiocarcinoma in Vietnam Veterans
Vietnam Veterans and Research Military service can cause unique problems VVA has experience advocating Increased interest in involving Veterans Identify important and unimportant questions Advise regarding what data to collect, who to enroll, and how to enroll them Help interpret results and get the word out