bile duct cancer

Vietnam Veterans Who Ate Raw Fish At Risk Of Cholangiocarcinoma, A Rare Liver Cancer

A new study suggests some Vietnam veterans may be dying from a slow-acting parasite linked to a rare liver cancer called cholangiocarcinoma.

This spring, VA missioned a study to evaluate the link between liver flukes and rare bile duct cancer. The liver flukes were likely ingested by eating raw or undercooked fish. Symptoms were believed to not show up for decades. The parasites are known to affect the liver of an estimated 25 million people worldwide.

The small study of 50 blood samples revealed that 20 percent of those samples submitted came back positive or borderline for having fluke antibodies.

The problem was investigated by Senator Charles Schumer (D-NY) who pushed VA to study possible service-connection for bile duct liver cancer linked to liver flukes.

RELATED: VA Loses $2.5 Million Prostate Cancer Malpractice Case

AP Excerpt On Liver Fluke Parasite

According to AP:

The VA study, along with a call by Senate Minority Leader Charles Schumer of New York for broader research into liver flukes and cancer-stricken veterans, began after The Associated Press raised the issue in a story last year. The reporting found that about 700 veterans with cholangiocarcinoma have been seen by the VA in the past 15 years. Less than half of them submitted claims for service-related benefits, mostly because they were not aware of a possible connection to Vietnam. The VA rejected 80 percent of the requests, but decisions often appeared to be haphazard or contradictory, depending on what desks they landed on, the AP found.

The number of claims submitted reached 60 in 2017, up from 41 last year. Nearly three out of four of those cases were also denied, even though the government posted a warning on its website this year saying veterans who ate raw or undercooked freshwater fish while in Vietnam might be at risk. It stopped short of urging them to get ultrasounds or other tests, saying there was currently no evidence the vets had higher infection rates than the general population.

Now, veterans impacted by the bile duct cancer of the liver could have it diagnosed with an ultrasound and blood test.

VA does have a duty to assist, and any Vietnam veteran or veteran who ate fish in Southeast Asia while in the military who ate fish in might be affected and should request exams if VA fails to conduct requisite evaluations to diagnose the infection.

“We are taking this seriously,” said Curt Cashour, a spokesman with the Department of Veterans Affairs. “But until further research, a recommendation cannot be made either way.”

Do We Believe VA?

Are they really “taking this seriously”?

VA is obviously dodging accountability by pushing claims like this into a “presumptive” category, which almost always requires 30 years of research into an issue that is already well-resolved or could be diagnosed using modern medical tools.

For example, VA says it lacks evidence to create a presumptive for burn pit veterans and ignores canine research supporting service connection. The agency also avoids using testing to measure the level of dioxin in a veteran’s body to avoid problems related to the creation of a presumptive condition for service-connection.

VA just will not conduct the blood work or biopsies to evaluate exposure for a particular veteran seeking service-connection.

This leads me to the present issue.

It sounds like many scientists worldwide were already aware the liver fluke caused cancer in an estimated 25 million people who ate raw fish in Southeast Asia.

So guess what.

If a Vietnam veteran believes he ate raw or undercooked fish in Southeast Asia, merely stating this fact during an exam should trigger VA’s duty to assist by conducting required exams to evaluate whether the veteran.

Instead, VA throws out a red herring by tricking us into all seeking presumptive service-connection, which we all know takes decades.

Haven’t Vietnam veterans waited long enough for justice and health care?

This is not just a disability compensation issue.

This is a health care issue, and VA has a duty to evaluate these possibly infected veterans to provide lifesaving treatment to prevent bile duct cancer.

VA’s refusal to provide notices and health care is not surprising but disappointing. How many more studies does VA believe it needs to conduct to trigger its duties?

VA On Flukes And Bile Duct Cancer

VA published a public health announcement on the liver fluke infection that lists more specifics about the cancer:

Bile Duct Cancer (Cholangiocarcinoma) and Liver Fluke Infection

Bile duct cancer (cholangiocarcinoma) is a cancer of the biliary duct system, which includes the gallbladder, bile ducts, and certain cells inside the liver. It is a rare cancer but becomes more common as people grow older.

One risk factor for bile duct cancer is past infection with tiny parasitic worms called liver flukes, which are found in the fresh waters of Southeast Asia. People can become infected by eating fish that have these parasites. Once eaten, the liver flukes grow to adulthood inside the human biliary duct system. The irritation and scarring caused by liver fluke infection can lead to bile duct cancer.

Two parasites are commonly involved. One is Opisthorchis verrini, which is found in Southeast Asian countries, including Thailand, Lao People’s Democratic Republic, Vietnam, and Cambodia. The other is Clonorchis sinensis, which is common in rural areas of Korea and China.

Veterans who ate raw or undercooked freshwater fish during their service in Southeast Asia, such as Vietnam War Veterans, might have been infected. However, currently VA is not aware of any studies that show that bile duct cancer occurs more often in U.S. Vietnam War Veterans than in other groups of people.

Other risk factors for bile duct cancer are:

  • Primary sclerosing cholangitis
  • Chronic ulcerative colitis
  • Cysts in the bile ducts
  • Cirrhosis of the liver
  • Hepatitis B or C virus
  • Diabetes
  • Obesity
  • Genetic factors

Symptoms of bile duct cancer

Symptoms of bile duct cancer include jaundice (yellowing of the skin and the whites of the eyes), pain in the abdomen, dark urine, light or ‘clay’ colored stool, fever, itchy skin, nausea and vomiting, and unexplained weight loss. If you are concerned about bile duct cancer, please talk to your health care provider.

Tests for bile duct cancer

Your health care provider uses medical history, physical examination, and may employ a variety of blood tests and medical imaging (Xrays, CT, MRI scans, and/or ultrasound) and consultation with specialists to diagnose bile duct cancer.

Tests for liver fluke infection

Your health care provider arranges for examination of your stool to check for liver fluke infection. If the infection occurred years ago, the test may not show the presence of liver flukes.

Successful Appeal For Cholangiocarcinoma

Here is an example of a favorable Board of Veterans Appeals decision for veterans with this possible affliction who would benefit from reading an example:

The post service private medical evidence includes records from the Mayo Clinic, in Jacksonville, Florida, dated from January 2010 to February 2011, indicating that the Veteran sought a second opinion for cholangiocarcinoma. A liver abnormality was first noted in October 2009 and subsequent tests revealed that he had the disease.

The Veteran underwent VA examination in June 2010. The examiner was unable to attribute the Veteran’s bile duct tumor as being related to events that occurred in military service without resorting to speculation. It was noted that the Veteran had a bile duct tumor almost certainly cholangiocarcinoma. His biopsy was suggestive of, but not diagnostic for, carcinoma. Liver flukes were present in some freshwater fish in Southeast Asia, along with the Far East and Russia. Liver flukes were considered a risk factor for cholangiocarcinoma from the ingestion of raw or poorly cooked fish. However, there was no evidence that the Veteran had liver flukes and his endoscopic retrograde cholangiopancreatography (ERCP) did not mention liver flukes.

In an undated statement received in March 2012, F.P.F., M.D., the Veteran’s treating oncologist, reported that the Veteran was originally seen in October 2010 for presumed cholangiocarcinoma. In further workup at the Mayo Clinic in Jacksonville, Florida, he was definitively diagnosed with metastatic cholangiocarcinoma in November 2010.  

Dr. F.P.F. noted that the Veteran served in Vietnam extensively in the years between 1967 and 1970. The origination of his type of cancer was associated with exposure to a biliary parasite that was commonly found in Vietnam, a trematode of Asia that caused liver cancer. Although the Veteran did not have a history of hepatitis, there was a possibility that his cholangiocarcinoma could be related to this exposure to Opisthornis viverrini.

According to his death certificate, the Veteran died in April 2012 from cholangiocarcinoma.

The record contains medical literature regarding the association between liver flukes and cholangiocarcinoma. An article titled “Cholangiocarcinoma” reports two known causes of the disease: hepatitis C and a parasite, Opisthorchis viverrini-Southeast Asia liver fluke. The parasite was found in raw fish and the water supply of all Southeast Asia.

An Internet article from the US National Library of Medicine at the National Institutes of Health, notes that the risks for cholangiocarcinoma include bile duct cysts, chronic biliary and liver infection, primary sclerosing cholangitis, ulcerative colitis, and a history of infection with the parasitic worm, liver flukes. The article states that cholangiocarcinoma was “rare” and occurred in approximately 2 out of 100,000 people.

A medical review article notes that cholangiocarcinoma is relatively uncommon in western countries, occurring in 0.2-0.7 out of l00,000 people. See “Liver Flukes: the Malady Neglected”, Jae Hoon Lim, M.D., Korean J Radio 12(3), May/Jun 2011, p.273. The incidence of the disease in Asian countries was much higher. Id.  

According to information from the Cancer Treatment Centers of America, cancer of the liver was rare malignancy in the United States, and one of the most common malignancies in parts of Asia and Africa. Certain liver parasites were recognized risk factors for this type of liver cancer, especially in parts of Southeast Asia.   An Internet article from the University of California at San Fransisco, dated in August 2007, similarly indicates that chronic or persistent inflammation of the bile duct increases a person’s chances of developing bile duct cancer. A number of inflammatory diseases increase the chances of bile duct cancer including ulcerative colitis, primary sclerosing cholangitis, congenital bile duct cysts, and biliary parasites. Although rarely seen in the United States, these food-or water-borne parasites were very common in Asia.

An Internet article entitled “Opisthorchis viverrini-Liver Fluke” notes that the association between the parasite and liver cancer is so strong that the parasite was accepted as a known carcinogen even though the mechanism was not fully understood. Most of the world need not worry about developing O. viverrini. In order to develop the disease one would have to live or travel in Southeast Asia, including Thailand, Laos Vietnam or, and eat raw or undercooked freshwater fish such as carp. See “Opisthorchis viverrini-Liver Fluke A Trematode of Asia That Causes Liver Cancer (Cholangiocarcinoma)”, Drisdelle, R., Oct 23 2009;  

Here, review of the article about cholangiocarcinoma, the Internet article from the Cancer Treatment Centers of America, and an article from Memorial Sloan-Kettering Cancer Center, entitled “Gallbladder & Bile Duct Cancers,” all suggest a link between parasites in Asia from raw fish and cholangiocarcinoma.

There is no dispute that the Veteran had a current disability, cholangiocarcinoma. His testimony and Dr. F.T.P’s opinion, the Veteran’s statements and the internet articles establish an in-service injury, namely exposure to river flukes and other parasites. Dr. F.T.P’s opinion as to the nexus between in service exposure and the current disease was somewhat equivocal; but when viewed in light of the internet articles, supports a nexus to service.

A June 2010 VA examiner was unable to attribute the Veteran’s bile duct tumor to events that occurred in military service without resorting to speculation. The examiner did not provide a negative opinion and the examiner’s statement weighs neither for nor against the claim. Fagan v. Shinseki, 573 F.3d 1282 (Fed. Cir. 2009). In view of the totality of the evidence, Board finds that the probative evidence of record is at least in equipoise as to the question of service connection and that cholangiocarcinoma is as likely as not due to the Veteran’s active military service. Under such circumstances, with the resolution of all reasonable doubt in the appellant’s favor, and without ascribing error to the action by the RO, the Board concludes that service connection for cholangiocarcinoma is warranted. See 38 U.S.C.A. § 5107(b).


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  1. some of the things we had in the Nam were invaded by other life forms and not cooked right. So who knows what happened to my liver

  2. Rep. Doug Lamborn (R-Colo.) has introduced a bill to let veterans choose between a Department of Veterans Affairs or a private-sector doctor without getting pre-authorization from the VA. The bill would essentially create a veterans health insurance program to let veterans use their VA benefits either in or outside of the department’s system. In the meantime, the Senate Veterans Affairs Committee is voting this week on new legislation that would redesign the current VA Choice Program.

    Press Releases
    Rep. Lamborn Introduces Veterans Empowerment Act
    Washington, November 21, 2017


    1. Dental patients often prescribed inappropriate antibiotic prophylaxis
      Suda KJ, et al. Open Forum Infect Dis. 2017;doi:10.1093/ofid/ofx250.
      November 27, 2017

      Researchers investigating antibiotic prescribing trends at a Department of Veterans Affairs dental clinic found that most patients who should have received only one dose of antibiotic prophylaxis before undergoing a procedure were instead prescribed a prolonged duration of prophylaxis after the procedure.


      1. If all goes as planned, repeat that is if all goes as planned, the new VA super mall money pit may be opening sometime next year.

        “VA hospital should open summer of 2018”

        But hey, this is the VA so we know that is not going to happen!

    2. They are redesigning the Choice Programs’ Cookie Jar to now have a much wider circumference and they are placing bacon grease on the interior walls for easier entry and exit, et al.

  3. Im Ashly Buchanan 59 years of age, i was diagnosed of COPD and Hepatitis b in 2013, my doctor told me that there was no possible way i can get a cure to COPD and Hepatitis b, so i started taking antiviral medications lamivudine (EPIVIR), there was a day i decided to do some research online i saw some comment on how Standard Herbs Home have helped people with herbal remedy to cure a lot of deadly disease, i contacted Standard Herbs Home and they sent me herbal medicine which i used for 4 weeks then i went for check-up and i was COPD and Hepatitis b free totally .thank you Standard Herbs Home God bless you.

  4. Do we believe the VA? Of course. I believe that the VA has probably known about it for a decade and did all they could to bury it.

    In God We Trust – VA – not so much

  5. I read elsewhere on this and it included that drinking the water from the rivers over there would also cause these liver flukes. If that is so then I know I’m at risk too, because they hardly ever re-supplied us with potable drinking water and we had to fill up our canteens from a stream we’d come across. They gave us these malazone tablets to put in the canteen to purify the water but the tablets made the water taste so damn bad you couldn’t drink it unless you poured a bunch of Kool Aid powder into it. Even that wouldn’t get rid of that bad taste those tablets gave. I stopped using the tablets and just drank the water without them.

    1. Those purification tablets were pure chlorine and if improperly dispense per ratio, caused cholestrol plaques in major arteries.
      It also harmed the enamel of your teeth as well.
      Amoebic Dysentery , along with Cholera and Giardia Lamblia
      It is disgraceful that they have add something to the presumptive list, wait 30 years for the study. Then you have the Secretary saying we cant determine if it is age related.
      Moron needs help if something needs to be adjudicated 30 years later.
      Equitable relief is applying the same standard as workers compensation that civilians receive.

  6. Interesting that the board stated clearly that it was service connected rather than just remanding it.

    As for the rest, Cashour and the VA are talking out their ass. No. The VA is not taking it seriously. If they were, they would not be bullshitting vets with the call for more research. It seems most competent cancer specialists are already aware of the likelihood of cancer from liver flukes.

    It seems simple. Do the blood test or biopsy. If the fluke may be present, service connection should be automatic. No need to provide jobs for VA researchers to study it to death. No need to continue the charade of it not existing when the VA refuses to even look.

    As for the lie about it not being higher than the general population, which population are they comparing it to? The US population? Or those in SE Asia?

    Not only does the VA ignore their duty to assist, but they ignore the “more likely as not” standard.

    ….and the vet ends up dead.

  7. Any time the VA denies your claim, you MUST call for an immediate hearing ON THE RECORD with evidence to support your claim, and evidence of how the VA handled your claim. The VA has no interest in processing your claim and using evidence to support your claim, and using basic logic. Get an attorney referral from Ben and go in with your guns loaded. When you are forced to appeal your claim via the Board of Veterans Appeals and then the Court of Veterans Appeals you are setting yourself up against a team of government lawyers and you will not see any benefits in your lifetime. Semper Fi, brothers!

  8. Ask the lobbyist why they are delaying the connection. Simple, budget $$$ shifted from blood and sweat to hardware and paper tiger contracts.

  9. I know we are suppose to stay on topic,……..but!!!

    Remember, never trust the VA. Recently the VA diagnosed me with Carpal Tunnel Syndrome, and of course I would need surgery on both wrists.

    My private Ortho surgeon, asked for a copy of the VA report, I asked that he not trust anything VA related, and that he should conduct his own testing. That testing was completed today, this morning. There is NO CARPAL TUNNEL SYNDROME IN EITHER WIRST!!!!!


    Buyer beware anytime the VA is involved, and don’t forget….

    ……..(‘(…´…´…. ¯~/’…’)
    ……….”…\………. _.·´

    1. Trust that the VA will act against you.
      I had a director of a regional office admit this to me; (Off the record, of course.
      You must treat the VA as an adversary, the enemy in every encounter and DO NOT TRUST ANYTHING THEY SAY.

      1. Spot on as always, windguy, and, Oldmarine, the VA, would love to hack off all of our trigger fingers. Opps, did I use hack and VA in the same sentence?

        Maybe, it is possible, there is an outside chance, I may have, unintentionally, misunderstood, what the Eastern Block transplant, hack said. Is it possible, he may have said “You have to pull your car through the tunnel, use both hands” ?

        Thinking back…………………………..fuck no, I used the valet service…

  10. Here’s two articles which interconnect with each other!
    1.) From: “ news”
    “Veterans Are Key as Surge of States OK Medical Pot for PTSD!”
    27 Nov 2017
    Associated Press
    From the article, quote; “Twenty-eight states plus the District of Columbia now include PTSD in their medical marijuana programs,…”

    The “interconnected article” is from;
    “Sessions Says He Is Sticking With His Predecessors’ Tolerance of State-Legal Marijuana”
    By: Jacob Sullum | Nov. 14, 2017 4:33 p.m.

    It looks as though the AG, Jeff Sessions, is backtracking on his mission to prosecute as many pot users as possible – Maybe!
    Of course there’s other groups out there, as in the Psychiatry Field, who still only want to give “pharmaceutical drugs” to patients! Basically, kow-towing” to “BIG Pharma’s lobbyists” for what? The answers are simple: “For money!”
    Then, there’s the VSO’s who are NOT going along with veterans, many being their own members, over this issue! In their “reasoning”, it’s not conducive to “bucking the VA!” WHY? Because, in their minds, they would “lose favor” within the VA!
    Or, could it be, the VSO’s would no longer receive taxpayers monies from VA’s upper management?
    We ALL know many of the VSO’s are “In bed” with VA management! Are they worried about losing those “cozy little offices” in the VHA’s around our nation?

  11. Let’s see IF I got this straight.
    A Vietnam veteran must die first – then, during an autopsy, it might show where the vet picked up this little “worm”!

    Kinda like when Agent Orange was first discovered. Then, veterans were subjected to “testing” NOT related to the dioxins. Basically, a veteran had blood drawn, and IF no “dioxins” were found – BAM! The veteran was misdiagnosed and the “presumption of NOT having been afflicted by it, was greater than IF the veteran WAS afflicted!” Thereby releasing VA from any medical treatment and/or compensations for the ailments Agent Orange caused!
    IF a veteran was further tested on other possible ailments. The VA could then take those ailments and give “service connection” only IF the veteran WAS diagnosed while serving on active duty! Once the veteran left active duty, and was diagnosed, the VA could state the malady occurred after, or before, the veteran entered into the military! Thereby, absolving the VA, military and government agencies of all liabilities!
    Get the picture!

    1. The problem VA will have is that if these soldiers were sent to Vietnam without Quinine, Chloroquine and Primaquine phosphate (Anti malararials) there is a problem.
      The two phases of malaria prophylaxis is pre deployment and post deployment.
      When a mosquito infected with malaria enters your system , it heads straight to the liver which therefore avoids the immune system ,subsequently attacking red cells forming new ones called merosomes full of malaria.
      Same as chromosonous bullshitticus the stuff VA employees are made from

      TunaBeastus FatEmployeecus

      1. CorpsmanUp,
        I caught malaria while serving in Vietnam in 1968.
        Since then, I’ve received NO help from VHA!
        The only thing they’ve said was, “[I] shouldn’t go out and donate blood!”

        How’s that for medical care and advice!

      2. Hopefully your medic documented on a field card ir stateside post your deployment.
        The malaria prophylaxis was required in those endemic areas including Thailand, Burma and Laos in which many veterans have been denied because of thr “conflict” status.
        Congress is at fault , and that is because of the labeling of either an expeditionary/campaign medal.
        War is war and training for war is still war.
        These medals can truly obfuscate many claims that are military service related.
        Our court system is one of them.
        The quaker oatmeal, silk robe wearing judges are the root cause of the declination of America’s strength.
        Many of them probably never have been in the military.

      3. It doesn’t matter whether you served in Thailand or Viet Nam, you qualify for the same benefits and treatment

      4. Find a sick VA bureaucrat and donate blood to him/her. Do it in California because it is not a felony there.

  12. Do you all realize the pattern the VA remains steadfast at? This pattern is coming-up with potential causes of Veteran deaths *as it’s happening* while ignoring ALL evidence prior and during…oh, another dead Vet…let’s get some $$$$ to study this…AGAIN…and *just maybe* those poor flukes inside the unfortunate fish were affected by Agent Orange and we can blame the flukes and not AO…I smell rotten flukes in the woodpile.

  13. The VA is so stupid, now that many veterans participated in thr DNA genomics testing, it would be very wise for VA to come correct.
    A DNA test can confirm titers, and antibodies of flukes and parasites.
    The VA is a RICO FLUKE itself, sucking dry the taxpayers money.
    It would be funny if all all of those South East Asia countries and other countries made claims to be compensated for all the children GI unbeknownst left behind.
    That genetic health testing program wiuld disappear so fast.
    I wo uld use that genomic testing program to shut the VA up fast. Just go to your local University and do some research in their agricultural and genetics program. Learn about phermones in insects and cytomeglia processes. It is very detailed, but VA needs a spanking by some scholar in that area.
    Hope someone interviews on , so that it could be posted here.

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