Hepatitis is the first thing that comes to mind when symptoms such as jaundice (yellowing of the skin, mucous membranes and sclera, etc.), aversion to oil and grease, poor appetite, and vague pain in the upper abdomen occur. If elevated transaminases are also found in the examination and the patient has been infected with hepatitis B, it is even more likely to be treated as an attack of hepatitis. However, there is another disease with similar symptoms to hepatitis, and that is bile duct cancer. Experts remind that when jaundice occurs, it is best to have an abdominal ultrasound or CT examination to see if there is cancer in the intrahepatic bile ducts. Causes: gallstones, liver fluke, hepatitis C virus, alcoholism The age of onset of bile duct cancer is mostly in the age of 50-70, and it is more common in men than women. It is believed that bile duct cancer is related to bile duct stones, liver fluke infection, viral infection (hepatitis B virus, hepatitis C virus, especially hepatitis C virus), autoimmune diseases (primary sclerosing cholangitis, chronic ulcerative colitis), alcoholism and other factors. Bile duct stones, liver fluke and hepatitis C virus infection are all causative factors of bile duct cancer, and these three diseases are very common in the south, so patients with these diseases should be alert to the occurrence of bile duct cancer. 1. Bile duct stones. The incidence of bile duct cancer in patients with gallstone disease is higher than that of normal population. Studies show that 5%-13.7% of bile duct cancer patients have gallstones. Usually, the occurrence of bile duct cancer is closely related to larger bile duct stones (greater than 3 cm). Chronic inflammation of bile duct caused by bile duct stones is a high-risk factor to induce bile duct cancer. 2. Schistosoma hepatica infection. Eating raw fish is easy to be infected with liver fluke, and this parasite causes bile stasis, bile duct fibrosis and bile duct hyperplasia, which is also one of the causes of bile duct cancer. 3. Hepatitis C virus. A case-control study in Korea showed that 12.5% of bile duct cancer patients were positive for hepatitis C virus, which can be said that hepatitis C virus infection is a significant risk factor for bile duct cancer. Reminder: Bile duct cancer is easily misdiagnosed as hepatitis The most common symptom in patients with bile duct cancer is obstructive jaundice, and more than 95% of patients present to the hospital with jaundice. This jaundice usually deepens gradually and is accompanied by symptoms such as itchy skin, tea-colored urine and clay-like stools. Although jaundice is a common symptom of portohepatic cholangiocarcinoma, it is not an early symptom. Patients will have symptoms such as vague pain and discomfort in the upper abdomen, aversion to oil and grease, fatigue, poor appetite and weight loss for a period of time before the appearance of jaundice. As jaundice appears, these symptoms become more pronounced. Clinically, it is also found that a few patients have epigastric pain, fever, chills, jaundice and other manifestations of cholangitis, and as a result, they are misdiagnosed as bile duct stones. Liu Chao said that bile duct cancer lacks typical clinical manifestations in early stage, so early diagnosis is difficult, and patients often consider detailed examination only after the appearance of obstructive jaundice, when the tumor is not early. Therefore, experts emphasize that if patients have symptoms such as jaundice, hidden pain in the upper abdomen, aversion to oil and grease, poor appetite, etc., it is better to do abdominal ultrasound or CT examination to see if there is dilatation of intrahepatic bile ducts to help differential diagnosis, in addition to checking liver function. In addition, elevated tumor marker CA19-9, especially significantly elevated, may also suggest the possibility of hepatoportal bile duct cancer. Treatment: Special location and difficult surgery For this disease, the key is early detection. Once diagnosed, the biliary tract obstruction caused by the tumor should be addressed first, followed by removal of the tumor, because liver failure and biliary tract infection caused by biliary tract obstruction are the main causes of death of patients. About 2/3 of bile duct cancers grow in the porta hepatis. This is a special location where blood vessels are intertwined like wires, and coupled with the fact that the cancer cells tend to invade the vascular nerve tissues when discovered mostly in the middle and late stages, the treatment is difficult and the prognosis is poor. According to statistics, after most bile duct cancer patients are diagnosed, the one-year survival rate of those who take internal and external bile duct drainage is less than 50%; the 5-year survival rate after radical resection is only 13.4%-25.7%. In the Department of Hepatobiliary and Pancreatic Diseases, bile duct cancer is considered to be the “king of cancer” which is more dangerous than pancreatic cancer.