People living in Southeast Asia are at increased risk for cholangiocarcinoma if they live in a region with certain liver flukes.
Liver flukes implicated:
(1) Clonorchis sinensis
(2) Opisthorchis viverrini
When to suspect:
(1) the patient has lived in a region endemic for a pathogenic liver fluke
(2) clinical evidence of liver fluke infection (positive stool for ova and parasites), with risk increasing with heavier fluke burden (eggs per gram stool)
The risk increases if the patient has additional risk factors for cholangiocarcinoma such primary sclerosing cholangitis, inflammatory bowel disease, viral hepatitis, toxins, hepatolithiasis, biliary duct cysts, asbestos and chemicals.
Differential diagnosis:
(1) obstructive cholangiopathy associated with Fasciola hepatica
A patient with Schistosomiasis may develop cholangiocarcinoma, but so far this appears to be coincidental.
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