USA: The incidence and mortality of cholangiocarcinoma in North America has increased dramatically in the past decades.2-4 In the United States, there are approximately 5,000 new cases diagnosed each year.1 Age-adjusted rates for cholangiocarcinoma are highest among Hispanics and Asians (2.8–3.3/100,000) and lowest among non-Hispanic whites and blacks (2.1/100,000). Men appear to have a slightly greater mortality from the disease than women (1.9 and 1.5 per 100,000, respectively).5
UK: Whilst the numbers of new cases per year and the annual death rates from cholangiocarcinoma in the UK have been seen to be rising over the past few decades, accurate published data has been difficult to find.
During 2014, four ICD-101 codes relating to cholangiocarcinoma were agreed upon – C22.1, C24.0, C24.8 and C24.9 – and these were used together for the first time to produce data in the ‘Rare and Less Common Cancers’ report jointly produced by the National Cancer Intelligence Network (NCIN)2 and Cancer523.
This initial report4 covering England only, shows cholangiocarcinoma data for four years, 2010 – 2013, with incidence figures, 2010:1,832; 2011:1,864; 2012:1,945; 2013:1,965 and mortality figures, 2010:1,720; 2011:1,844; 2012:2,018; 2013:2,161 prompting the following comment in the Executive Summary of the report: “A number of cancer sites stand out as having comparatively high mortality rates considering their incidence rates… biliary tract cancers (cholangiocarcinoma/bile duct cancer (intra-or extrahepatic)) … 3.64 vs. 3.58 per 100,000 population respectively…”
We are currently awaiting the figures for the other countries of the UK, Scotland, Wales and Northern Ireland.
Thailand: Cholangiocarcinoma is a malignant neoplasm arising from the bile duct epithelia. It is one of the most common cancers in Thailand, especially in the north eastern part, where the prevalence of liver fluke infection is high. Age standardized incidence rate shows the highest incidence in Khon Kaen, Thailand – approx 84 per 100,000 in males and 36 per 100,000 in females.
Thailand has the world’s highest incidence of cholangiocarcinoma – Dr Narong Khuntikeo explains why he has specialised in hepatobiliary surgery:
“I was first trained as a general surgeon but I had a keen interest in hepatobiliary and pancreatic surgery. My interest has been initiated from seeing a huge number of CCA patients coming into the ward and this is the highest incidence in the world. I would like to be able to provide them with the most curative therapy possible. That is why I chose to become a liver surgeon for CCA patients.”
In summary, cholangiocarcinoma is a devastating cancer. Its incidence seems to be increasing around the world; it presents late in its course, is difficult to diagnose accurately and early, and most cases cannot be cured.