This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Medicine
The most likely cause of fluctuating jaundice in a middle aged or elderly man is 
Select and explain. 
A. Peri-ampullary carcinoma, B. Liver fluke, C. Choledochal cyst, D. Carcinoma of pancreas
A: Peri-ampullary carcinoma
Answer: A: Peri-ampullary carcinoma 
Explanation: None