Colon Cancer

Beating colon cancer through prevention, diagnosis and treatment

20% of identified polyps are polyps that are difficult to detect and have the potential to develop into colon cancer over a relatively short period of time

Prevention and diagnosis using narrow band imaging (NBI) colonoscopy
Testimonial from a colonoscopy patient
Stop colon cancer through genetic cancer screening
Colon cancer surgery with laparoscopic colectomy (minimally invasive surgery)
Treating colon cancer with precision medicine

Prevention and diagnosis using narrow band imaging (NBI) colonoscopy

The American Cancer Society advises that people should undergo colon cancer screening once they reach the age of 45. However, in cases where a person’s risk is higher than normal, for instance those with a family history of colon cancer, it is recommended that they undergo screening before the age of 45.

The recommended age to commence screening is calculated by subtracting 10 from the age of a family member at the time they were diagnosed with colon cancer. The resulting number represents the age at which the first screening should be carried out. For example, if a father was diagnosed with colon cancer aged 50, his offspring should undergo screening from age 40 onwards.

In cases where a polyp measuring less than 1 cm in size is found, it is recommended that the patient undergoes subsequent screening every 3-5 years, and where polyps over 1 cm in size are identified we recommend screening every 1-3 years. If no polyp is found we recommend subsequent screening every 5-10 years (although for those with insulin resistance it may be necessary to increase the frequency of screening, depending on the individual’s body state and other associated colon cancer risk factors).

Colonoscopy is able to provide protection against colon cancer. Since 2015 Samitivej has been cooperating with SANO Hospital—Japan’s leading private hospital specialized in gastrointestinal (GI) endoscopy—to bring this advanced technique to Thailand, enabling Samitivej to double the rate of accurate diagnoses.

Since 2015, doctors from Samitivej’s Liver and Digestive Institute have traveled to Japan to train in colonoscopy and other advanced endoscopies, while doctors from SANO Hospital have come to Thailand to share their knowledge and conduct case studies on Samitivej patients. Read more

A Japanese technique that doubles accuracy rate

1. 60.96% Adenoma Detection Rate (latest colonoscopy statistics as of December 2018)

Polyps identified during colonoscopy fall into two categories: hyperplastic polyps, which do not have the potential to develop into colon cancer; and adenomatous polyps, which do have the potential to develop into colon cancer. Samitivej Hospital’s commitment to developing the quality of its colon cancer screening techniques means that we gather the data from each colonoscopy in order to compare the results with industry standard, as recommended by the American Society for Gastrointestinal Endoscopy (ASGE). This standard outlines that in those aged 50 and above, approximately 25% will be found to have adenomatous polyps present. This is known as the adenoma detection rate. When detection numbers are higher than this average, there is a greater amount of detail offered by the colonoscopy technique being used. Such levels of detail provide a greater chance of identifying polyps that are difficult to detect, such as serrated adenomatous polyps, resulting in an increased level of confidence in the procedure and higher chances of prevention through the removal of adenomatous polyps before they can lead to colon cancer.

While generally accepted rates are considered anything greater than 25%, the 60.96% average adenoma detection rate achieved by GI doctors at Samitivej Sukhumvit is more than twice as accurate as the industry standard defined by the ASGE. The high adenoma detection rates achieved at Samitivej reflect the high quality of our screening process.

The NBI colonoscopy technique we employ, thanks to our longstanding partnership with SANO Hospital, has led us to improve the overall quality of our colonoscopy screening for colon cancer. The technique, which utilizes green/blue light rays to identify the presence of polyps, provides doctors with a clearer view of both protruding and serrated adenomatous polyps. This would not be possible through the use of regular white light rays. Furthermore, the NBI international colorectal endoscopic (NICE) classification simplifies diagnosis and allows for immediate decisions to be made regarding subsequent treatment. For example, in cases where hyperplastic polyps are found they can be removed, or where adenomatous polyps are identified a biopsy sample can be promptly done in order to confirm whether the polyp is indeed cancerous, and to offer indicators as to which stage the cancer has reached, so that an appropriate treatment plan can be formulated.

Additionally, in cases where an adenomatous polyp measuring more than two centimeters in size has been identified, an ESD (endoscopic submucosal dissection) can be carried out to remove the polyp instead of a traditional surgical procedure. The result of an ESD is that patients are able to recover quickly. However, the ESD procedure is highly technical, meaning that the GI specialist must be thoroughly trained and have years of experience. Fortunately, Samitivej has a team of gastrointestinal specialists who have worked alongside medical teams from SANO Hospital to collaborate and share knowledge on numerous case studies.

2. Improving the quality of our colonoscopy exams

Before undergoing a colonoscopy, patients are required to make sure that the colon is as clean as possible. This is carried out by drinking laxative in the morning, in order to flush out any waste products and prepare the colon for the procedure. The endoscopy with the cleanest colon possible then takes place in the afternoon. This is preferable to preparing the colon throughout the night and concluding the endoscopy in the morning as it results in a cleaner colon.

3. NBI colonoscopy technique helps to increase the chances of identifying serrated adenomas

Serrated adenomas are extremely difficult to detect due to their appearance being so similar to the inside of the colon walls. These polyps are also more dangerous because they have the potential to develop into colon cancer over a relatively short period of time—just 2-6 years—when compared to other adenomatous polyps which can take anywhere from 2-10 years to develop into cancer. Furthermore, once colon cancer has already taken hold there is a high chance of it spreading rapidly. The fact that the NBI technique provides a clearer picture of the patient’s colon means that the chances of successful treatment are increased. This is because the quicker a polyp is identified and treated, the greater the possibility of successful treatment, especially when the cancer is found during its initial stages.

Gastroscopy and Colonoscopy Programs

Programs	From (baht)	Promotional Price (baht)
Gastroscopy	26,000	17,200*
Colonoscopy	29,385	25,000**

Available through December 31, 2019

Remarks: Programs include the administration of general anesthetic

*Price includes H.pylori bacteria screening and stomach tissue screening
**Prices exclude polyp removal fees
All programs include doctor fees and outpatient service fees, endoscopy room fees and endoscopy recovery room fees
All programs exclude pre-procedure medical assessment and laxative medication costs
The hospital reserves the right to change the price without prior notice
Promotions are available to Thai nationals and foreigners residing in Thailand only
For more information please visit the Liver and Digestive Institute, Japanese Hospital by Samitivej or email info@samitivej.co.th

Testimonial from a colonoscopy patient

My father, Samuth Nuchnart, came in for a consultation with Dr. Pitulak Aswakul because he was experiencing tightness in the chest and bloating in the stomach. The doctor recommended that he undergo both gastroscopy and colonoscopy, but due to his being 80 years old and never having undergone anything like that he told them he didn’t want to do it since he was afraid of what might happen. She therefore recommended alternative treatment in the form of medication aimed at treating his symptoms for one week which, while it helped a little, did not completely relieve him of his problems. The doctor was then able to convince him to carry out the procedures. At first it all looked so easy but nothing in life is that simple… Read more

Stop colon cancer with genetic cancer screening

In precision medicine the role of the doctor, in addition to treating disease, is to help prevent disease recurrence as well. For instance, many people may be unaware that some cancers can be genetically inherited. We are now able in Thailand to screen for cancer genes.

Next Generation Sequencing Technology has the ability to sequence up to 95% of an entire human genome and conduct genetic mapping of families. Up to 50 of the most common cancer genes can be detected, including those responsible for the three most common cancers in men and women. Read more

Colon cancer surgery with laparoscopic colectomy (minimally invasive surgery)

Until recently, colon cancer surgery was limited to open surgery in order to identify and remove the portion of cancerous colon. Such a procedure often caused anxiety in patients as they worried about not only the cancer treatment itself, but also the rehabilitation and price of surgery, as well as its after effects. Fortunately, the laparoscopic colectomy techniques now available mean that less invasive surgery can be carried out. This involves inserting a high powered microscope camera into the abdomen via a tiny abdominal incision. The tube on which the camera is mounted also carries a tool capable of removing the cancerous section of the colon, including any affected nearby lymph nodes and blood vessels. The side effects of such a procedure are minimal. Rehabilitation times are quick while costs are low when compared with open surgery, which takes longer to carry out and results in lengthy, expensive rehabilitation times.

Read more

Get to know more about a laparoscopic colectomy

Laparoscopic colectomy to a technique involving the insertion of a high powered microscope camera into the abdomen to identify and remove the cancerous areas of the colon, including any affected lymph nodes and blood vessels that are close by.

The colon being a long tubular organ means that surgery must ensure that the surgical margin is about 5-7 cm from the edge of each cancerous area. Nevertheless, the blood vessels responsible for supplying the cancer cells, as well as the lymphatic tubes located along those blood vessels, may also require removal in cases where the cancer has spread to these areas.

Benefits of laparoscopic colectomy

Research has found that colon cancer can be removed through either laparoscopic colectomy or open surgery. Both techniques are effective in extracting the affected section of colon. However, laparoscopic surgery offers the following benefits:

A series of five tiny scars measuring approximately 0.5-1.0 centimeters in length, with one larger scar measuring 4-6 centimeters in length for the incision through which the colon is removed. This differs from an open surgery which would leave one scar that would measure up to 15-20 centimeters in length.
Less post-surgical pain when compared to an open surgery due to the smaller incisions necessary.
A reduction in risk associated with wound dehiscence (the wound reopening along the suture line) and infections. Subsequent scar treatment is simplified due to its smaller size, making it a much safer option.
Rapid patient rehabilitation times. Laparoscopic colectomy patients are able to stand and walk around within 1-2 days of the procedure. Those who undergo an open surgery require at least one week of bed rest before they may attempt similar movements.
The expenses associated with rehabilitation are not that high because patients usually recover quickly, meaning that they do not require lengthy stays in the hospital.
Laparoscopic colectomy procedures allow surgeons a much clearer view of the cancer situation than open surgery, which is especially crucial in difficult cases such as rectal cancer.

Treatment in the form of a laparoscopic colectomy is suitable for patients of any age, even those who are too weak for other forms of treatment. This means that it also offers an effective treatment option for the elderly who may otherwise experience difficulties in terms of rehabilitation and side effects related to open surgery. Laparoscopic colectomies are also advisable for patients with difficult-to-treat forms of cancer, such as in those for whom the cancer has spread to multiple locations—tending to occur as a result of a person’s genetics—because a laparoscopic colectomy enables surgeons to remove various sections of the colon. Alternatively, in cases where the cancer has been found in the same vicinity, laparoscopic colectomy surgery allows for a whole section of the colon to be removed so that the remaining healthy sections can be stitched back together.

Treating colon cancer with precision medicine

Recent innovations in the field of medicine mean that the lives of cancer sufferers can be significantly extended. It is even possible to completely eradicate colon cancer through the use of specially designed drugs. Read more

Drugs used to treat colon cancer

There are a number of effective drugs currently available for the treatment of colon cancer, particularly stage 4 colon cancer when the cancer cells are spreading to nearby organs or other organs in the body. Such drugs can be categorized into the following three groups:

Chemotherapy drugs: Medication that targets cancer cells directly. When used on numerous occasions, chemotherapy drugs have also been found to destroy healthy cells, leading to significant side effects for the patient including hair loss, nausea, vomiting and diarrhea.
Targeted therapy:A form of treatment that is often used alongside chemotherapy, targeted therapy specifically targets the cancer cells, even though each form of cancer differs greatly from one another. Targeted therapy results in less damage to other cells in the body, making this form of treatment more effective than chemotherapy alone. For instance in cases of stage 4 colon cancer treated exclusively with chemotherapy, the average survival rate is approximately one year, whereas the average survival rate for patients who have undergone targeted therapy alongside chemotherapy is approximately three years. This is the reason why combined treatment is now considered more effective than chemotherapy alone.Targeted therapy is being used much more frequently to treat cancer due to its high level of efficacy. While chemotherapy is effective in around 30-50% of cases, targeted therapy used in conjunction with chemotherapy offers up to 60-80% success rates. The benefits of targeted therapy are that it specifically targets cancer while causing minimal side effects.
Immunotherapy: This form of cancer treatment, which affects white blood cells, requires a detailed analysis of the cancerous tissue in order for treatment to be most effective. Doctors in charge of the analysis are the ones solely responsible for deciding whether or not a patient is suited to undergoing a course of immunotherapy treatment. Cancer cell growth is usually hidden from the body’s white blood cells, meaning they are unable to seek out and destroy these harmful foreign bodies. Immunotherapy drugs injected into the veins help white blood cells detect and locate cancer cells with greater success, enabling the white blood cells to eventually destroy the previously hidden cancer cells.

Results of drug-based colon cancer treatment

Colon cancer is the most common frequently occurring form of cancer found in Thailand today. When detected in its early stages, there is a chance that colon cancer can be successfully eradicated. Even those suffering from stage 4 colon cancer who receive appropriate treatment can still lead a better quality and longer life than those who do not receive chemotherapy.

Chemotherapy, targeted therapy or immunotherapy treatments will be carefully considered by medical staff in order to ensure that patients get the most out of any treatment they receive.

If you are diagnosed with colon cancer, there is no need to feel overly afraid. Consulting with a doctor who will ensure you receive the correct form of treatment can significantly increase your chances of beating the disease. Alternatively, if stage 4 colon cancer has been detected, receiving the proper course of treatment could enable you to survive for longer than you may imagine, with some patients having lived a peaceful and fulfilling life for more than five years after diagnosis.

Early identification and treatment of colon cancer means a greater chance of success. Be sure to attend your annual health checkups. If you are over the age of 45 you are advised to undergo regular colonoscopies to screen for colon cancer. Additionally, those with a family history of colon cancer should not wait until they reach 45 years of age to undergo screening for the disease.