Cancer biliary tract

Mortality studies provide suggestive evidence that occupational exposure to PCB s containing 54% chorine are associated with cancer at several sites, particularly liver, biliary tract, intestines, and skin. ... 

A large multicentric cohort study of European vinyl chloride workers revealed a nearly threefold increase in liver cancer based on 24 observed deaths vs. 8.4 expected. The excess was clearly related to time since first exposure, duration of employment, and estimated ranked and quantitative exposures. A cohort study of 10,173 US men who had worked at least 1 year in jobs involving exposure to vinyl chloride confirmed a significant mortality excess in angiosarcoma (15 deaths), cancer of the liver and bilary tract [standardized mortality ratio (SMR) = 641], and cancer of central nervous system (SMR = 180). ° A recent follow-up of this cohort found that excess mortality risk from cancer of the liver and biliary tract, largely due to angiosarcoma, continued risk of mortality from brain cancer had attenuated and excess of deaths from cancer of connective and soft tissue appeared for the first time but was based on few cancers of assorted histology."... 

Malignancies of the biliary tract are uncommon in the United States, with approx 8000 cases reported annually nearly two-thirds of these cases arise in the gallbladder, while the remainder (cholangiocarcinoma) originate from the bile ducts and periampullary region. However, gallbladder cancer occurs in epidemic proportions in many South American and Asian countries, particularly affecting women. 

Gallbladder carcinoma is diagnosed approx 5000 times a year in the United States, making it the most common biliary tract cancer and fifth most common gastrointestinal tract cancer. Also, approx 4500 cases of bile duct cancer occur each year in the United States. Women are more commonly afflicted than men, with a female-to-male ratio of 2.7 1.0. The median age at presentation of gallbladder cancer is 73 yr. In addition, an incidence five to six times that in the general population is seen in southwestern Native Americans, Mexicans, Hispanics, and Alaskans. 

Bond GG, McLaren EA, Sabel FL, et al. 1990. Liver and biliary tract cancer among chemical workers. Am J Ind Med 18 19-24. 

Meperidine differs from morphine in that it has far less antitussive effect and little constipative effect. The drug is particularly useful in cancer patients and in pulmonary patients, in whom the cough reflex must remain intact. However, it does have more seizure-inducing activity than morphine. Although meperidine produces spasms of the biliary tract and colon, such spasms are of shorter duration than those produced by morphine. 

Sato K, Kitajima Y, Miyoshi A et al. Deficient expression of the DPD gene is caused by epigenetic modification in biliary tract cancer cells, and induces high sensitivity to 5-FU treatment. Int J Oncol... 

Seven cohort studies have examined the risk of cancer among populations exposed to dichloromethane. Two studies observed an excess of pancreatic cancer, but the three others which reported on this tumour did not. One study observed an excess of liver and biliary tract cancers among longer-term employees. One study observed an excess of prostate cancer that appeared to increase with level of exposure. One study observed an excess of breast cancer and gynaecological cancers among women with the highest likelihood of exposure and another study observ ed an excess of cervical cancer. With the exception of the prostate cancer excess observed in one study, all the excesses were based on small numbers. No estimates of exposure levels were available for two of the six studies. 

Brown (1992) conducted a cohort mortality study of workers employed at four pesticide manufacturing plants. The 1158 workers employed at Plant 3 of the study, which produced aldrin and dieldrin, were also potentially exposed to l,2-dibromo-3-chloropropane produced at the plant between 1975 and 1976. The cohort included all white males employed for six or more months before 1964 with follow-up through 1987. Although overall cancer mortality at Plant 3 was not elevated (SMR, 0.9 95% Cl, 0.7-1.1 = 72), an excess of liver and biliary tract cancer was observed (SMR, 3.9 95% Cl, 1.3-9.2 5 observed). All of the deaths occurred at least 15 years after first employment (SMR, 4.9), but no association was observed with duration of employment. The SMR for lung cancer was 0.7 (95% Cl, 0.4-1.0). Levels of exposure were not reported. Amoateng-Adjepong et al. (1995) reported the results of an update of the same cohort with three additional years of follow-up. No new association was reported. 

Four cohort studies and one population-based case-control study have examined the risk of cancer among populations exposed to l,2-dibromo-3-chloropropane, among other chemicals. In two of the cohort studies, an excess of lung cancer was observed based on small numbers of cases. In a third cohort study, an excess of liver and biliary tract cancers was found, while in the fourth an excess of cervical cancer and a non-significant excess of melanoma and leukaemia were observed. How ever, in both of the last two studies, it... 

M. A. Adson, Primary hepatocellular cancers—Western experience, Survey of the Liver and Biliary Tract (L. H. Blumgart, ed.), Churchill Livingstone Publisher, New York, 1988, pp. 1153-1165. 

Surgery is currently the only treatment option for biliary tract cancer. Patients with... 

Morizane,C.,Okada.S..Okusaka.T,Ueno, H., and Saisho, T. (2003) Phase 11 study of cisplatin, epirubicin. and continuous-infusion 5-fluorouracil for advanced biliary tract cancer. Oncology, 64 (4), 475-476. 

Secondary paraproteinemias may be seen in association with hematopoietic cancers (e.g., lymphomas and leukemias), other neoplasms (e.g., colon carcinoma), long-standing chronic urinary or biliary tract infection, rheumatoid factor related to IgM monoclonal protein, and amyloidosis. 

Gastroenterology. The study of the gastrointestinal organs and diseases that relate to them. This includes any part of the digestive tract from mouth to anus, liver, biliary tract, and the pancreas. Studies in this area include constipation, Crohn s disease, diarrhea, gall bladder disease, heartburn, hemorrhoids, irritable bowel syndrome (IBS), ulcers, liver disease, stomach cancer, and others. 

Studies of workers provide evidence that PCBs were associated with certain types of cancer in humans, such as cancer of the liver and biliary tract. Rats that ate commercial PCB mixtures throughout their lives developed liver cancer. Based on the evidence for cancer in animals, the Department of Health and Human Services (DHHS) has stated that PCBs may reasonably be anticipated to be carcinogens. Both EPA and the International Agency for Research on Cancer (lARC) have determined that PCBs are probably carcinogenic to humans. 

Brown 1987b). Additionally, one of the two liver cancers was not a primary carcinoma as it metastasized from another site (unknown). If the metastatic liver cancer is not included in the analysis, the SMR for liver and biliary tract cancer in the whole cohort loses statistical significance (SMR=210, p 0.05) (Nicholson and Landrigan 1994). Other findings included a slight increase in rectal cancer in the first study, but not in the follow-up (see Section 3.2.8.2.3). Limitations of these studies include small number of deaths, relatively short periods of observation, and possible misclassification of the cause of death because it is not clear in every case if death was due to primary cancer of the liver, biliary tract, or gall bladder. 

Deaths from cancers of the digestive system were statistically significantly increased in the Bertazzi et al. (1987) study of capacitor workers summarized in Section 3.2.8.2.1. This category was not specific for the stomach and intestines as it included other parts of the digestive system, including the liver and biliary tract. Of six observed deaths from digestive system cancers, one was due to hepatocellular carcinoma and another from a cancer of the biliary tract. 

Rashid A, Ueki T, Gao YT, et al. K-ras mutation, p53 overexpression, and microsatellite instability in biliary tract cancers a population-based study in China. Clin Cancer Res. 2002 8 3156-3163. 

Rashid A. Cellular and molecular biology of biliary tract cancers. Surg Oncol Clin N Am. 2002 11 995-1009. 

Imai M, Hoshi T, Ogawa K. K-ras codon 12 mutations in biliary tract trrmors detected by polymerase chain reaction denaturing gradient gel electrophoresis. Cancer. 1994 73 2727-2733. 

Lodi G, Szabo E, Holczbauer A, et al. Glaudin-4 differentiates biliary tract cancers from hepatocellular carcinomas. Mod Pathol. 2006 19 460-469. 

Hahn SA, Bartsch D, Schroers A, et al. Mutations of the DPC4/Smad4 gene in biliary tract carcinoma. Cancer Res. 1998 58 1124-1126. 

Henschler has reviewed the toxicity of organochlorine compounds.32 Many are carcinogens (e.g., vinyl chloride, which is associated with liver and biliary tract cancers and angiosarcomas).33 One of the most toxic is 2,3,7,8-tetra-chlorodibenzo p dioxin (3.3). 

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