Vietnam veterans Stephen Petersen, Mario Pettiti and Hugo Rocha (L-R) all died of cholangiocarcinoma decades after their military service. (Photos provided by veterans’ families)

During the Vietnam War in 1970, Sgt. Mario Pettiti was stationed at a huge American military base near Qui Nhon in Bin Dinh province. After only a year overseas, he returned to his native Ohio and, later in life, found a steady job as a plumber at the local Veterans Administration (VA) hospital in Cleveland.

Decades later, in November 2009, Pettiti started losing weight and feeling nauseous. A gastroenterologist did an endoscopy and found 2 large ulcers and a bacterial infection. The doctor prescribed antibiotics and said the ulcers were causing the discomfort.

Things got worse, however. More blood work ensued, along with a CT scan, which was inconclusive. Even so, Pettiti’s doctor suspected cholangiocarcinoma, also known as bile duct cancer, and arranged a PET scan.

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“That’s when they found it and referred us to an oncologist, who said Mario had 6 months to live, and started him on chemotherapy. But he didn’t respond, and on March 13, 2010, he died at the age of 62,” said his widow, Anne Pettiti.

Like Pettiti, Stephen Petersen also served in Vietnam. He too developed cholangiocarcinoma decades later but never suspected why.

A mechanic who worked on tanks and trucks, Petersen did 3 tours of Vietnam, from late 1969 until early 1972. After complaining of severe stomach pain in 2018, he went to his doctor and quickly learned his fate.

“They diagnosed him with cholangiocarcinoma and told him he’d have 2 months to live if he did not do chemo, and a year if he did,” said his daughter and caregiver, Lisa Sailor, by phone from rural Minnesota. “So Dad did chemo and actually made it 13 months from the date of diagnosis until he died at age 66, on Veterans Day 2018.”

Cancer Appears 40 to 50 Years After Military Exposure

Pettiti and Petersen are among an estimated 470 veterans—the vast majority of them men—who served in the Vietnam War and later contracted cholangiocarcinoma, according to Lourdes Rocha-Nussbaum, a full-time patient advocate at the nonprofit Cholangiocarcinoma Foundation (CCF).

Mario Pettiti in uniform during his 1970 tour of duty in Vietnam. (Photo courtesy of Anne Pettiti)

Rocha, who’s been with the Utah-based foundation for 9 years, said Vietnam veterans are especially susceptible to cholangiocarcinoma—an extremely rare cancer—because of their exposure to liver flukes, which are endemic throughout Southeast Asia.

“The liver fluke basically causes an infection. If that infection is prolonged, it changes the structure of the cells, which is partly why that mutation exists in their cells,” Rocha said. “The veterans who were stationed in Vietnam obviously were exposed through water and food while they were there.”

Veterans who served in Vietnam were also exposed to dioxin, the active ingredient in Agent Orange—a highly toxic herbicide used to defoliate hiding places used by the enemy—which was later linked to dozens of diseases ranging from amyloidosis to rhabdomyosarcoma.

Rocha got involved with the foundation as a volunteer after her father, Hugo Rocha, died in 2012 of bile duct cancer. He had served in Vietnam in 1968, then worked as a rehabilitation counselor at a community college in California for 32 years until his retirement.

In 2010, at age 67, he was diagnosed with stage 4 intrahepatic cholangiocarcinoma, but was never aware of any risk factors that could have led to the diagnosis. And because the disease is not on the presumptive list of illnesses for Vietnam veterans, patients must show proof with research information for the VA to approve a claim and reimburse for care, she said.

Sheila Harrison, the widow of a Vietnam veteran, was the first individual to get a claim approved by the VA for exposure to liver flukes. In Rocha’s case, however, it took 6 years of wrangling with the government until the VA approved her family’s petition.

“My dad started a claim when he was still alive and he was diagnosed,” she said. “Once he passed away, we basically took over that claim and continued filing until they finally did approve his claim saying that [his illness] was the result of his exposure in Vietnam.”

VA: No Definitive Proof Exists

According to an information page maintained by the VA, “veterans who ate raw or undercooked freshwater fish during their service in Southeast Asia, such as Vietnam War veterans, might have been infected. However, the VA is currently not aware of any studies showing that bile duct cancer occurs more often in U.S. Vietnam War veterans than in other groups of people.” The department did not respond to a request for comment.

The CCF counters by saying that “not having studies does not negate the fact that Vietnam veterans were exposed to one definitive risk factor (liver flukes) and another possible risk factor (dioxin). Cases brought to the VA for approval for service connection in regard to both liver fluke and herbicide exposure have been granted and approved. In approving these cases, it demonstrates that the VA recognizes the connection. Therefore, it should be recognized in all cases.”

According to the CCF, the liver flukes Vietnam vets could have been exposed to are Opisthorchis viverrini and Clonorchis sinensis, and both are classified as Group 1 carcinogens and can cause cholangiocarcinoma.

“Infection with the liver flukes does not necessarily mean that a person will develop cholangiocarcinoma, however it puts a person at higher risk to develop it,” CCF states on its website. “This explains why not every Vietnam veteran who served in Vietnam or where the flukes are endemic will be diagnosed with cholangiocarcinoma.”

Stephen Petersen and his daughter, Lisa Sailor, at home in rural Minnesota. (Photo courtesy of Lisa Sailor)

Sailor said that after her father was diagnosed, she began doing online research on Vietnam veterans and cholangiocarcinoma.

“When we went to the VA to talk about getting my dad’s meds, the doctor walked into the exam room and the first thing he said was, ‘I am not here to talk about cholangiocarcinoma and your father’s claim.’ That told me that they don’t want any claims. They’re trying to hide this because they know there are more veterans out there who will get this cancer.”

After the VA denied her claim, Sailor turned to the news media for help. In February 2019, Minneapolis TV station KARE-11 aired a segment about the family’s plight. The VA approved her claim in March 2020, nearly a year and a half after her father’s passing.

Likewise, Pettiti’s claim on behalf of her sick husband was denied twice. The VA finally approved it 3 years after his death. In the meantime, his widow started a Facebook page dedicated to Vietnam vets and cholangiocarcinoma; it now has more than 1750 followers.

“The main concern with getting it approved to show that he died because of his service, and I wanted the recognition for him,” she said.

Added Rocha: “Other individuals have been trying to get their claims approved and they’re not successful. It’s really unfortunate, because Vietnam veterans weren’t properly recognized for their service due to the controversy over the war in Vietnam. I feel like they’re still being left out.”