From the Guidelines
Cholangiocarcinoma risk factors include primary sclerosing cholangitis (PSC), liver fluke infections, chronic liver diseases, biliary tract abnormalities, and other factors that promote chronic inflammation and DNA damage, as reported in the most recent study 1.
Key Risk Factors
- Primary sclerosing cholangitis (PSC): strongest risk factor in Western countries, increasing risk by 400-1000 times 1
- Liver fluke infections (Opisthorchis viverrini and Clonorchis sinensis): major risk factors in Southeast Asia 1
- Chronic liver diseases: cirrhosis, viral hepatitis B and C, and non-alcoholic fatty liver disease increase risk 1
- Biliary tract abnormalities: choledochal cysts, Caroli's disease, and cholelithiasis (gallstones) contribute to risk through chronic inflammation 1
Other Risk Factors
- Older age (typically over 50) 1
- Obesity, diabetes, and use of hormonal contraceptives: associated with an increased risk of intrahepatic cholangiocarcinoma (iCCA) 1
- Smoking and exposure to certain chemicals like Thorotrast (a previously used contrast agent) 1
- Genetic conditions: Lynch syndrome and genetic polymorphisms in DNA repair genes may play a role 1
- Inflammatory bowel disease: particularly ulcerative colitis, increases risk independent of PSC 1
Geographic Variations
- Incidence of cholangiocarcinoma varies by region, with higher rates in Southeast Asia and increasing incidence of iCCA in Western countries 1
- Risk factors also vary by region, with liver fluke infections being more common in Southeast Asia and PSC being more common in Western countries 1
From the Research
Risk Factors for Cholangiocarcinoma
- Primary sclerosing cholangitis (PSC) is a major risk factor for cholangiocarcinoma, with 30-50% of cases occurring within the first year after PSC diagnosis 2
- Liver fluke infestation, hepatolithiasis, and hepatitis viruses (HCV, HBV) are also identified as risk factors for cholangiocarcinoma 3, 4
- Other potential risk factors include:
- Parasitic infections
- Biliary-duct cysts
- Toxins
- Inflammatory bowel disease
- Cirrhosis
- Diabetes
- Obesity
- Alcohol drinking
- Tobacco smoking
- Host genetic polymorphisms 4
- Chronic biliary tract inflammation is a common underlying factor for cholangiocarcinoma 3, 5
Patient Characteristics and Risk
- Older males with large-duct PSC and concurrent ulcerative colitis are at increased risk of developing cholangiocarcinoma 2
- Patients with small-duct PSC, concurrent Crohn's disease, or pediatric/female PSC patients are at lower risk of developing cholangiocarcinoma 2
- New biomarkers, such as antibodies to glycoprotein 2, have been found to be associated with an increased risk of developing cholangiocarcinoma in PSC patients 2