title: Screening and surveillance for occupational cholangiocarcinoma in workers exposed to organic solvents.
abstract: OBJECTIVE
  This study aimed to establish an efficient strategy for screening and surveillance for occupational cholangiocarcinoma.
  
  
  METHODS
  We evaluated the consecutive changes in laboratory findings during regular health examinations and in abdominal ultrasonography findings before the diagnosis of occupational cholangiocarcinoma in nine patients. The results of laboratory tests and abdominal ultrasonography at the time of diagnosis were also examined.
  
  
  RESULTS
  In all patients, the serum γ-glutamyl transpeptidase (γ-GTP) activity increased several years before the diagnosis of cholangiocarcinoma. The serum alanine aminotransferase (ALT) activity also increased several years before the diagnosis, following an increase in the serum aspartate aminotransferase (AST) activity in most patients. Abdominal ultrasonography before the diagnosis revealed regional dilatation of the bile ducts, which continued to enlarge. At the time of diagnosis, the γ-GTP, AST, and ALT activities were increased in nine, seven, and seven patients, respectively. The regional dilatation of bile ducts without tumor-induced stenosis, dilated bile ducts due to tumor-induced stenosis, space-occupying lesions, and/or lymph node swelling were observed. The serum concentrations of carbohydrate antigen 19-9 (CA 19-9) and/or carcinoembryonic antigen (CEA) were increased in all patients.
  
  
  CONCLUSIONS
  Regular health examinations with a combination of ultrasonography and laboratory tests including the γ-GTP, AST, ALT, CA 19-9, and CEA levels are useful for screening and surveillance for occupational cholangiocarcinoma.
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan. m7696493@msic.med.osaka-cu.ac.jp.
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Takemura
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Nishioka
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kinoshita
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
authors.forename: Genya
authors.initials: G
authors.lastname: Hamano
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
authors.forename: Tokuji
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Surgery, Ishikiriseiki Hospital, Higashiosaka, Japan.
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Gastroenterology, Miyagi Cancer Center, Natori, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Abue
authors.affiliation: Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Aoki
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Nakagawa
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Hijioka
authors.affiliation: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Miyamoto
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Osaki
authors.affiliation: Department of Preventive Medicine and Environmental Health, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Ginji
authors.initials: G
authors.lastname: Endo
authors.affiliation: Department of Occupational and Environmental Management, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kumagai
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001650:Bile Duct Neoplasms / Q000139:chemically induced* / Q000175:diagnosis* / Q000517:prevention & control; D014408:Biomarkers, Tumor / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D018281:Cholangiocarcinoma / Q000139:chemically induced* / Q000175:diagnosis* / Q000517:prevention & control; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced* / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D016273:Occupational Exposure / Q000009:adverse effects*; D012997:Solvents / Q000009:adverse effects*; D014463:Ultrasonography; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D012997:Solvents; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Health examination; Occupational cholangiocarcinoma; Organic solvent; Screening and surveillance