Risk Factors For Cholangiocarcinoma And Present Situation Of Studies On The Pathogenesis

Cholangiocarcinoma is a cancer at intrahepatic or extrahepatic bile duct epithelium. Because of its high degree of malignancy, most patients of cholangiocarcinoma are diagnosed too late to take the surgery. The study of etiology and pathogenesis makes a lot of sense on prevention and early diagnosis.This article is divided into two parts. The first part is a Western medical understanding of the etiology and pathogenesis of cholangiocarcinoma. The second part is the Chinese traditional medical understanding of etiology and pathogenesis of cholangiocarcinoma.The first part briefly introduces the definition, epidemiology and the most common classification principle of Cholangiocarcinoma, which emphasizes the present accepted important factors correlating to the cholangiocarcinoma. It mainly includes:primary sclerosing cholangitis, hepatic gallstones, bile duct congenital malformation, musk cat high-testosterone trematode infections, and hepatitis b virus infections. The essay narrates the concept and diagnosis about what listed above, especially describing the study on the relationships with the cholangiocarcinoma and the pathogenesis. There is also a review of the research on some unimportant factors correlating to the cholangiocarcinoma such as helicobacter pylori infection, obesity, chemicals, excessive drinking, diabetes and immunodeficiency virus (HIV), as well as the latest researching hot point.Primary sclerosing cholangitis has a about 4%-50% possibility concurrent rate with cholangiocarcinoma, mainly related to inflammatory stimulation, bile duct structural damage and genetic variations. The possibility that hepatic gallstones induce cholangiocarcinoma is about 0.3%-10%, associated with stones mechanical stimuli, chronic bacterial infections, and long-term cholestasis, etc. There are nearly 15% malignant transformation rate of biliary system abnormalities, in which congenital bile duct cystic expansion occupies 2.5%-30%, Caroli disease 2.5%-7.5%. The carcinogenic pathogenesis are mainly pancreatic juice reverse flow damage theory, carcinogenic substance within biliary theory and bile acid carcinogenic doctrine theory. Human sinensis caused by Clonorchis trematode, Musk cat high-testosterone trematode after and cat high-testosterone trematode after has been proven to be related to cholangiocarcinoma, and Musk cat high-testosterone trematode after is the most important kind of carcinogens, as Clonorchis trematode is the second important one. Their carcinogenic pathogenesis has a relationship with trematode mechanical stimuli, secrete metabolites and chronic inflammation, etc. The incidence of Hepatitis virus infecting cholangiocarcinoma has a number that HBV for 8.5%-25.5%, and HCV for 3.5% -32%,4-14 times higher than normal people. HBV and HCV causes cholangiocarcinoma are proved to do something with X genes (HBx) and their protein products, HCV C genetic encoding C protein. Drinking, diabetes and obesity are already confirmed to increase the risk of intrahepatic cholangiocarcinoma, but no prevention about the extrahepatic cholangiocarcinoma. Immunodeficiency virus (HIV) infecting cholangiocarcinoma incidence is about 5.9 times higher than normal, while other possible factors related with cholangiocarcinoma are smoking and helicobacter pylori infection, but the exact risk and pathogenesis are still to be further investigated.The second part is the cognition of traditional Chinese medicine on the cholangiocarcinoma. The article introduces the Chinese classics and the ancient medical knowledge about the disease. Patients of cholangiocarcinoma often see the doctor by flank pain, jaundice, angular, inappetence. In TCM diagnosis, paining, jaundice and cancer can lead to some reasons related cholangiocarcinoma with congenital deficiency, endowments abnormity; Medical science, viscera losing; Six Yin invading and Qixue condensed; Diet ministry.