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 rneumann@gannett.com, 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