Pesticides, fresh water fish, liver flukes and nitrosamines: A story of cholangiocarcinoma development in Thailand.

Cholangiocarcinoma is a common hepatobiliary carcinoma in Thailand. It is believed that both chronic exposure to liver fluke infestation and nitrosamine exposure are the two main underlying factors leading to the carcinogenesis. Here, the author further extrapolates and proposes a new hypothesis based on the environmental ecological data that the stimulation of fresh water fish by contaminated pesticide in water reservoirs might be a possible background of the high prevalence of cholangiocarcinoma in Thailand.