Dr. Tuangsit Suntornpinij stresses that enjoying spicy food is possible but should not involve risk. He reveals symptoms of liver fluke infection, the root cause of bile duct cancer, and advises adjusting eating habits to promote long-lasting liver health, regular exercise, and routine screening for early detection.
On 7 July 2026, amid the growing popularity of Isan regional cuisine known for its bold and distinctive flavors, many overlook a hidden "silent threat" behind favorite spicy dishes like larb, koi, or kung ten. Recently, reports emerged of over 4,000 new students at Mahasarakham University testing positive for liver fluke infection, likely due to contaminated fermented fish (pla ra) or raw fish containing parasites.
In an interview, Dr. Tuangsit Suntornpinij, a liver, pancreas, and bile duct surgical specialist at Wattana Hospital in Udon Thani, who regularly treats bile duct cancer patients, clearly explained why the Isan region is known as the "Capital of Cholangiocarcinoma" or the world's bile duct cancer capital.
Dr. Tuangsit explained that as a surgeon who frequently operates on liver and bile duct cancer, it is always regrettable that most patients seek treatment only at the final stage. This is due to years of accumulated negligence in certain behaviors, particularly regarding liver fluke infection, which is familiar yet often ignored in terms of prevention.
He described "liver fluke infection" as a silent threat that gradually damages liver health without early warning signs. The parasite does not cause immediate symptoms upon entering the body; instead, it embeds and burrows inside the bile ducts, causing repeated chronic inflammation. This long-term inflammation is the starting point for cellular changes that eventually lead to bile duct cancer.
Most infected individuals are unaware of their infection and typically begin showing symptoms between ages 50 and 60, usually when the disease has already advanced significantly.
Warning signs to watch for include abdominal pain caused by bile duct obstruction; jaundice, where the skin and eyes turn yellow due to bilirubin buildup, often accompanied by severe itching; digestive problems such as severe loss of appetite; unexplained rapid weight loss; and fatigue. If these symptoms progress to bloodstream infection, it becomes a critical condition that can lead to death.
Dr. Tuangsit added that beyond liver flukes, the liver and bile ducts face ongoing threats from modern lifestyle factors damaging the liver, including fatty liver disease caused by excess calorie intake—when calories consumed exceed those burned, surplus energy accumulates in the liver causing chronic inflammation that can lead to cirrhosis and liver cancer. Heavy and continuous alcohol consumption, whether social or habitual daily drinking, accelerates liver cell damage. Hepatitis B and C viruses are significant causes of liver tissue destruction, resulting in cirrhosis and liver cancer. Lack of exercise also impairs the body's ability to manage excess fat effectively.
Regarding treatment prospects for liver cancer, Dr. Tuangsit clarified that many mistakenly believe liver or bile duct cancer is untreatable. In reality, the disease stage is crucial. If detected early (stages 1-3), surgical treatment is possible using modern techniques such as open or laparoscopic surgery. Those eligible for surgery have a 60% chance of surviving five years post-operation and can nearly return to normal life.
However, for terminal-stage cancer, treatment focuses on palliative care, including relieving bile duct obstruction and chemotherapy to slow disease progression.
Dr. Tuangsit also recommended ways to prolong liver health by modifying eating habits—consuming 100% fully cooked food, especially freshwater fish and fermented fish dishes. Though flavors may differ, such choices ensure safety. Maintaining energy balance through regular exercise helps burn excess fat, preventing fatty liver. He advised moderate alcohol intake, avoiding heavy and continuous drinking, and regular screening for liver and bile duct cancer, especially for those aged 40 and above or living in high-risk areas. He emphasized not waiting for severe symptoms before seeking medical advice, as prevention and screening are the best strategies to save lives.