The famous Hong Kong entertainer Shen Tianxia, who was nicknamed “Fatty” by the audience, once brought endless laughter to people, died recently in Hong Kong’s Queen Mary Hospital after a long illness. There are various speculations about her condition, including pancreatic cancer, liver cancer, bile duct cancer, and severe cholangitis. …… According to the doctors who attended the consultation of “Fatty”, “Fatty “The real condition is: bile duct cancer secondary to liver metastasis, surgery to remove the tumor after the liver metastasis cancer recurrence, and finally died of liver failure. Bile duct cancer, a term that sounded slightly unfamiliar 20 years ago, is now refreshing the attention of doctors and patients with its high mortality rate and low survival period. While liver cancer is the “king of cancer”, bile duct cancer, which is invisible in the liver, is the “king of cancer”. Cholangiocarcinoma is a malignant tumor of the extrahepatic bile duct originating from the confluence of the left and right hepatic ducts to the lower end of the common bile duct. Primary bile duct cancer is rare, accounting for 0.01%~0.46% of general autopsy, 2% of tumor patient autopsy and 0.3%~1.8% of biliary tract surgery. In Europe and the United States, gallbladder cancer is 1.5 to 5 times more common than bile duct cancer, and in Japan, there are more bile duct cancers than gallbladder cancers. The ratio of male to female is about 1.5~3.0. The age of onset is mostly 50~70 years old, but it can also be seen in young people. In China, the latest survey report shows that the incidence of this disease has increased about 3 times in the past 20 years in several major cities such as Guangzhou, which is a more economically developed city in China. The occurrence of bile duct cancer is closely related to lifestyle. A large number of epidemiological surveys show that women over 40 years old who are obese and like high-fat and high-calorie diet are more likely to suffer from bile duct cancer and other biliary cancers than their peers, so they should pay more attention to it. 1.How bile duct cancer occurs Although the exact cause of bile duct cancer is still unknown, the latest research finds that mutation of oncogenes and oncogenes in the body is the internal cause of bile duct cancer, while poor lifestyle is the main external cause of the disease. According to clinical survey, more than 70% of bile duct cancer patients have poor lifestyles such as alcoholism, meat preference, lack of exercise and overwork. In recent years, the significant increase of people’s poor lifestyles has led to a yearly increase in the incidence of biliary cancers such as cholangiocarcinoma. With the intensification of social competition, people are under more pressure in work and life, and they are under long-term mental stress and physical strain, and their bodies and minds are in a subhealthy state for a long time, which leads to neural regulation and metabolic disorders. The significant improvement of material living conditions, so that people’s diet structure gradually from the original coarse grains, vegetables to large fish and meat, high fat, high-calorie diet change, a lot of alcohol, too much strong coffee and drinks containing preservatives have also become part of the diet structure of many people. In addition, people use cars to walk more, physical activity is significantly reduced, and many people are in the state of sitting and moving less. These can cause poor bile excretion and a lot of stagnation in the gallbladder and bile duct, if the body is accompanied by obesity, it will further increase the cholesterol content in the blood, aggravating the impact on the function of the bile duct. This, over time, may lead to gallstones, chronic inflammation of the biliary system, and even cancer. According to clinical statistics, middle-aged people over 40 years old have the most pressure and are more prone to biliary inflammation and biliary cancers, while middle-aged women before and after menopause have a significantly higher risk of biliary diseases than men of the same age due to changes in endocrine and estrogen levels affecting bile secretion and regulation. “Fatty” has undergone surgery for gallstones, bile ducts and liver tumors in recent years, and her illness can be said to be closely related to her obesity and excessive work pressure, frequent late nights and excessive physical and mental fatigue, as well as her “greedy mouth” which likes to eat high-fat and high-calorie foods. Her illness can be said to be inseparable from a series of bad lifestyles, such as obesity and excessive work pressure, frequent late nights and excessive physical and mental fatigue, as well as “gluttony” of high-fat and high-calorie food. 2.What are the main symptoms of cholangiocarcinoma? The clinical manifestations of cholangiocarcinoma are summarized into four major symptoms: jaundice, abdominal pain, itchy skin and other related symptoms: (1) Jaundice. Patients with cholangiocarcinoma lack typical symptoms in the early stage, and most of them are diagnosed with jaundice. Jaundice is characterized by progressive aggravation and deepening, and is mostly painless, while a few patients have fluctuating jaundice. Progressive obstructive jaundice is the main symptom of extrahepatic cholangiocarcinoma. (2) Abdominal pain About half of the patients have right upper abdominal pain and swelling or fever, weight loss, loss of appetite and other symptoms. The degree of pain and fever are mild, but a few patients may show the manifestation of acute cholangitis. Once the abdominal pain starts, there are similar to cholelithiasis and cholecystitis. According to clinical observation, abdominal pain and jaundice can appear after only 3 months of bile duct cancer onset. (3) Skin pruritus It may appear before or after the appearance of jaundice, or it may be accompanied by other symptoms such as tachycardia, bleeding tendency, mental atrophy, weakness and fatty diarrhea, abdominal distension, etc. Skin pruritus is caused by the increase of bilirubin content in the blood, which stimulates the peripheral nerves of the skin. (4) Other symptoms such as jaundice, abdominal pain, and other symptoms such as nausea, vomiting, emaciation, deep yellow urine like soy sauce or strong tea, light yellow stool or even clay color, etc. In advanced stage, when the tumor ruptures, biliary bleeding may occur, black stool, positive fecal occult blood test, or even anemia may occur; in case of liver metastasis, liver enlargement, cirrhosis, splenomegaly and ascites may occur. 3.How to detect bile duct cancer in early stage Because of the lack of specific clinical manifestations in early stage of bile duct cancer, early detection is difficult and the diagnosis is often delayed. In recent years, due to the development of diagnostic imaging and the accumulation of clinical experience, with the application of “B” type ultrasound examination and percutaneous hepatic percutaneous cholangiography (PTC), the diagnosis of bile duct cancer can be obtained in some cases before surgery. (1) Ultrasound examination can show the dilated bile duct and the site of obstruction due to cold obstruction, and occasionally can detect the tumor, but cannot clearly show the nature of the lesion. (2) Percutaneous hepatic percutaneous cholangiography (PTC) is the main method to diagnose cholangiocarcinoma, and the confirmation rate can reach 94-100%. It can show the condition of intrahepatic bile duct and obstruction site, so as to clarify the location and invasion range of the tumor. It can also be used to take biopsies from the obstruction site for pathological examination to obtain a definite diagnosis. (3) Retrograde cholangiopancreatography (ERCP) can show the distal bile duct of obstruction, and when combined with PTC, it can show the extent of bile duct cancer obstruction. (4) CT and magnetic resonance imaging (MRI) It can show the extent of tumor invasion and whether there is metastasis in the abdominal lymph nodes. (5) Angiography It includes selective hepatic arteriography, splenic portal vein angiography and percutaneous hepatic puncture portal vein angiography, etc. It can better determine whether cholangiocarcinoma can be resected. However, it cannot know the lymphatic metastasis and whether the caudal lobe of liver is invaded. (6) Other examinations such as laparoscopy, serum immunological examination and general laboratory tests can be used for the auxiliary diagnosis of cholangiocarcinoma. 4.How to treat bile duct cancer Bile duct cancer can be divided into high bile duct cancer, middle bile duct cancer and lower bile duct cancer according to the location of cancer, and high bile duct cancer accounts for about 60% to 70% of all bile duct cancers and is the most common. “Fatty” is suffering from high-grade cholangiocarcinoma. Cholangiocarcinoma is not sensitive to radiotherapy and chemotherapy, and surgery is the most important treatment for it. However, the disease starts insidiously and patients hardly feel any discomfort in the early stage, but once jaundice, abdominal pain and other symptoms appear, they are often in the middle or late stage when they seek treatment. Clinical statistics show that about 50% of bile duct cancer patients have liver or blood metastasis once the cancer is detected, and only 30% of them have the chance of surgical resection, and the longest survival period for inoperable patients is less than two years. Of those who can be treated surgically, only 30% can achieve 5-year survival. The ultimate cause of death for almost all patients with cholangiocarcinoma is not the cholangiocarcinoma itself, but the metastatic cancer to the liver. Cholangiocarcinoma is one of the least treatable and most difficult malignancies to cure, with an overall 5-year survival rate of only about 5%. “Fatty” underwent bile duct surgery in August 2006, followed a year later by surgery to remove metastatic liver cancer, which was the cause of her death. During her illness, “Fatty” still did not pay attention to diet control and reasonable rest, which undoubtedly aggravated the disease and accelerated the deterioration of her health condition. 5.How to prevent cholangiocarcinoma (1) Active prevention and treatment of precancerous lesions Since cholangiocarcinoma is closely related to gallstones, congenital common bile duct cysts and bile duct papilloma, it is important to prevent and treat these diseases in time. In addition to early detection of biliary diseases, gallstones and chronic inflammation of the biliary system should be taken seriously and treated early and reasonably. Gallstones should be treated by surgical extraction, and common bile duct cysts should be removed at an early stage, and internal drainage of cysts should be avoided as much as possible, and bile duct papillomas should be surgically removed in time to avoid malignant transformation, regardless of whether they are symptomatic or not. (2) Pay attention to diet It is advisable to eat more foods with anti-biliary tract and bile duct cancer effects, such as shark fin, chicken gizzard, buckwheat, barley, tofu dregs, monkey head mushroom, etc.; eat more foods with anti-infection and anti-cancer effects, such as buckwheat, mung beans, rape, toon, taro, white onion, bitter gourd, lily, marjoram, ground ear, carp, water snake, shrimp, loach, jellyfish, yellow catfish, needlefish, etc.; eat more foods with bile-loving and laxative effects, such as Eat more foods that are good for the bowels, such as lamb’s trotter, burdock root, figs, walnuts, sesame seeds, goldenseal, sea cucumber, etc. Eat less fatty meat, roast meat, animal liver, fried food, sweets and other high-fat, high-calorie foods, avoid overeating, do not drink alcohol or drink less alcohol, drink less preservatives and highly pigmented drinks, etc. (3) less snacks after meals Many people like to sit leisurely on the sofa after dinner and watch TV while eating snacks. In fact, people in this curled position, the abdominal cavity pressure increases, gastrointestinal peristalsis is restricted, not conducive to food digestion and absorption and bile excretion. If you keep snacking, it will increase the burden on the digestive tract and affect the absorption of bile acids, which can easily lead to biliary diseases. (4) Change the bad habit of not eating breakfast Long-term skipping breakfast will increase the concentration of bile, which is conducive to bacterial reproduction and can easily lead to gallstones and other biliary diseases. Adhering to breakfast can promote the flow of bile, reduce the viscosity of bile and reduce the risk of disease. (5) Maintain a healthy and happy mood Long-term mental tension and emotional depression will also interfere with the normal work of the liver and gallbladder, which is not good for health. You should learn to release work and life stress and find a channel to enjoy your mood. (6) Don’t overexert yourself. Overexertion can affect the function of the biliary tract, so even if you are busy at work, you should arrange time, ensure sleep and combine work and rest. (7) Adhere to appropriate exercise to avoid overweight If you are engaged in light or moderate physical activity, you should take a brisk walk or similar exercise for about 1 hour a day, and arrange at least 1 hour of more vigorous sweating exercise every week; obese people should control their weight.