Thursday, September 18, 2014

Testing the Waters, Finding a Cause

Mom at Kure Beach, NC, 1953
I'm not sure who took this photograph of mom when she was at Kure Beach, NC, in 1953, but this photo marks a transition time in her life. She had already met dad and they would marry the day after Christmas that same year. This is one time they were apart during that year between his discharge from the Air Force and their wedding.

Mom already had several surgeries by 1953, including a broken wrist which was set wrong. The surgeons had to re-break her wrist and re-set it. She also had one ovary removed for some reason (precancerous?). Other than these issues, mom was rarely ill.

After mom died, I finally had the breathing room to learn more about cholangiocarcinoma and the causes behind this cancer. What I learned was vague at first. This type of cancer is more prevalent in Asian countries, where it is mainly caused by a common parasitic infection of the bile duct. These parasites, or liver flukes, infect people who eat food that contains this parasite. But, this risk factor is small outside Asian countries.

Other factors that can contribute to the 2,000-3,000 cases per year in the U.S. today include bile duct stones, choledochal cysts, or an ulcerative colitis that affects that entire large bowel creating what is known as primary sclerosing cholangitis (PSC, or type of inflammation of the bile duct). All of these conditions are rare, which can account for the rareness of the disease in this country. But, the numbers of people who are diagnosed with cholangiocarcinoma are rising. Why?

The main culprit, in my opinion, is Thorotrast. Thorotrast is a highly radioactive contrasting dye that was used in x-rays in the 1930s, 1940s, and -- in the U.S. -- through the 1950s. Most other countries stopped using this highly radioactive agent by 1950. Patients in the U.S., however, were possibly exposed to this contrasting agent every time they had x-rays through at least the mid-1950s.

The harmful part about Thorotrast is its half-life. This radioactive chemical stays in the body for about 22 years or more. As it decays, it emits harmful alpha radiation. Interestingly enough, this chemical gravitates to the patient's liver and bile duct. Patients who ingested Thorotrast are 100% more likely than the general population to develop bile duct cancer.

There's no way to track how many patients ingested Thorotrast during its time on the market, but one source states that between two to ten million people worldwide were treated with this radioactive compound. What researchers have discovered recently is that a disproportionate number of people who have developed bile duct cancer were once treated with Thorotrast. These cancers occur, usually, decades after the initial treatment.

This delay in cancer development could easily explain the age factor in developing cholangiocarcinoma. More than two out of three patients who develop bile duct cancer are older than age 65.

Mom was 78-years-old when she was diagnosed with cholangiocarcinoma. She had x-rays, at least two to three of them, before this photo was taken at Kure Beach in 1953. These thoughts are disconcerting for me for a number of reasons, but mainly because she looks like she deserved better. We all deserve better.