Stop colon cancer in its tracks with genetic cancer screening


Samitivej utilizes next-generation sequencing to identify the presence of genetic irregularities which can indicate colon cancer DNA, including cases where there is no known family history of the disease. The technique offers accuracy rates of up to 90% and can reduce the fatality risk by 50% when cancer is identified early enough.
Samitivej’s team of doctors specialized in the field of genetics and inherited diseases is ready to offer consultations and advice on various issues, such as health checkups involving genetic screening to identify risk levels for colon and other forms of cancer, as well as long-term prevention planning advice. Genetic cancer screening can now be carried out by using samples from the patient’s blood, saliva or cells located on the inside of a person’s cheek. None of these techniques require the patient to fast, and the results can be ready within 30 days. Moreover, if any risk is found, patients can consult with our gastroenterologists about preventive measures. Our gastroenterologists specialize in colonoscopy and other endoscopic procedures, they have received training in the use of NBI technique developed in Japan.



Prevention and diagnosis for colon cancer with NBI technique


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 calculations for determining the recommended age to commence screening are carried out 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, when a father was diagnosed with colon cancer aged 50, his offspring should undergo screening from the age of 40 onwards. Endoscopic procedures are capable of providing protection against colon cancer. Samitivej has since 2015 been coordinating with SANO Hospital in Japan - an institution with world-leading expertise in all related GI endoscopies - to bring the Japanese technique to Thailand, enabling Samitivej to double the rate of accurate diagnoses. Since 2015, Samitivej sends doctors from our Liver and GI Institute to Japan to train in endoscopies, while SANO Hospital has sent doctors to share their knowledge and conduct case studies on Samitivej patients.

A Japanese technique that helps to double accuracy rates
1. A 60.95% Adenoma Detection Rate (the latest colonoscopy statistics as of December 2018).
Polyps identified during colonoscopy fall into two categories, namely 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 the industry standards as recommended by American Society for Gastrointestinal Endoscopy (ASGE) which outlines that in those aged 50 and above, approximately 25% will be found to have an adenomatous polyp present (otherwise known as the adenoma detection rate). Hence, when these 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 spot, 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. The 60.96% average adenoma detection rate achieved by doctors at Samitivej therefor is more than two times more accurate than the industry standard as laid out by the ASGE.

The NBI (narrow-band imaging) technique we employ due to our longstanding partnership with Japanese specialists has led to us improve the quality of our colon cancer screening programs. The technique, which utilizes green/blue light rays to identify the presence of polyps, gives doctors a clearer view of any adenomatous polyps, whether the polyps are protruding or serrated. This would not be possible through the use of regular white light rays. Furthermore, the NBI international colorectal endoscopic (NICE) classification makes diagnosis easier 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 will provide confirmation of whether the polyp is indeed cancerous and 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 2 centimeters in size has been identified, instead of a traditional surgical procedure an ESD (endoscopic submucosal dissection) can be carried out to remove said polyp. The result of an ESD is that patients are able to make a fast recovery. However, the ESD procedure is highly technical, meaning that the GI specialist responsible must be thoroughly trained with years of experience. Fortunately, Samitivej has a team of gastrointestinal specialists who have worked alongside medical teams from SANO Hospital to share knowledge and collaboration on numerous case studies.

2. Improving the quality of our colonoscopy
Before undergoing a colonoscopy, patients are first 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, which is preferable to preparing the colon throughout the night and concluding the endoscopy in the morning.

3. NBI technique helps to increase the chances of identifying serrated adenomas
Serrated adenomas are extremely difficult to spot 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 – in just 2-6 years – when compared to other adenomatous polyps which can take anywhere from 2-10 years to develop into cancer. Furthermore, when colon cancer has already taken hold, there is a high chance of it spreading rapidly. Hence, the fact that NBI technique provides a clear 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.



Treating colon cancer with targeted therapy


Samitivej is delivering precision medicine to help in the fight against cancer by utilizing medication that specifically targets harmful cancer cells, meaning that other cells are left undamaged. The response rates of such forms of treatment are as high as 80%, compared to regular chemotherapy treatments which typically offer 30% response rates.
Conventional treatments

There are currently a number of cancer treatments available which can be used alongside one another to offer the best chance of success. The three main forms currently used are surgery, radiation therapy and medication or chemotherapy. Their uses depend entirely on the stage which the cancer has reached.

In cases of early stage cancer, surgery offers the best opportunity to remove the cancer successfully because the cancer cells will not yet have spread to other organs. Surgery in such cases is the recommended way to halt the cancer in its tracks and ensure that the patient has the best chance of making a full recovery.

With regard to late stage cancer (stage 4), which has typically spread to organs close by or other organs in the body, a course of chemotherapy is generally administered. Such treatment involves destroying all cells in a certain area with the aim of eradicating the disease, as it is hard to tell where the cancer may be hiding. However, such destruction means that it is not only the cancerous cells which are affected, but all cells, whether good or bad. The side effects of this type of treatment include hair loss, mouth ulcers and exhaustion, resulting in cancer patients’ anxiety when they hear chemotherapy mentioned as a potential method of treatment.

Targeted therapy

This is an extremely useful asset in the fight against cancer due to its effectiveness when compared to chemotherapy which offers a 30% response rate, while targeted therapy has a response rate of up to 80%.

The benefits of targeted therapy are that the treatment is highly specific, while side effects are relatively low, meaning that also elderly cancer patients who may not be strong enough to undergo a course of chemotherapy can be treated with greater efficacy than was previously possible.

Targeted therapy as a form of treatment for colon cancer comes in the form of intravenous medication and orally administered drugs. The oral medication available includes Regorafenib, which is suitable for cancer patients who have not responded well to other types of cancer drugs. Intravenously administered targeted medication comes in various forms, such as Bevacizumab, Cetuximab and Aflibercept, which are used alongside chemotherapy drugs to provide a 50% greater possibility of a successful response to treatment than was previously possible. In cases where the cancer has spread to the liver, the use of chemotherapy drugs in conjunction with targeted medication can increase the chances of successful treatment by up to 50%, resulting in 5-year longer life expectancy for colon cancer sufferers.

Treating cancer successfully with targeted therapy medication first relies upon accurate and highly detailed screening, carried out by specialist oncologists. This is due to each individual patient’s symptoms differing greatly from one another, meaning that their treatment must also be flexible enough to suit their individual needs. Precision medicine is therefore utilized because of its ability to treat cancer cells specifically, meaning there is greater efficacy in terms of treatment, with better results thereafter.


Endoscopy procedure testimonials



Approximately one year ago, Ms. Williams started to notice changes in her energy and digestion. Upon visiting doctor and having full medicals she was told that there was no health issues present. Knowing that something must have been overlooked, she decided to visit Dr. Morakod. What Dr. Morakod discovered during a screening were multiple, potentially dangerous polyps.

Ms. Jean W.

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Our doctors



Pathipat Durongpongkasem

Faculty of Medicine Siriraj Hospital, Mahidol University , 2009|The Second Class Honors M.D., Faculty of Medicine. Faculty of Medicine Siriraj Hospital, Mahidol University , 2009|Bachelor of Business Administration (General Management). Ramkhamhaeng University. , 2009|Diploma of Thai Board of Internal Medicine. Faculty of Medicine Siriraj Hospital, Mahidol University , 2015|Diploma of Thai Subspecialty Board of Gastroenterology. Faculty of Medicine Prince of Songkla University , 2017|Certificate of Advanced Endoscopy. NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital. , 2018

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Vinita Oranrap

M.D., Faculty of Medicine Mahidol University. Faculty of Medicine Siriraj Hospital, Mahidol University , 2011|Diploma Thai Board of Internal Medicine. Faculty of Medicine Prince of Songkla University , 2015|Diploma of Thai Sub Board of Gastroenterology. Faculty of Medicine Chulalongkorn University , 2018

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Rewat Boonanuwat

The First Class Honors M.D., Faculty of Medicine. Faculty of Medicine Siriraj Hospital, Mahidol University , 2008|Diploma of Thai Board of Internal Medicine. , 2014|Diploma of Thai Sub Board of Gastroenterology. , 2016|Certificate of Advanced Endoscopic, NKC Institute of Gastroenterology and Hepatology. Songklanagarind Hospital. , 2017

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Anupong Tangaroonsanti

Faculty of Medicine Siriraj Hospital, Mahidol University , 2004|Diploma Thai Sub-Board of Gastroenterology. Faculty of Medicine Ramathibodi Hospital, Mahidol University , 2012|Diploma Thai Board of Internal Medicine. Faculty of Medicine Siriraj Hospital, Mahidol University , 2010|The First Class Honors M.D., Faculty of Medicine, Mahidol University. Faculty of Medicine Siriraj Hospital, Mahidol University , 2004|Visiting scientist, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida , 2016

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Charlie Laohapand

M.D., Faculty of Medicine Mahidol University , 2008|The First Class Honors M.D., Faculty of Medicine, Mahidol University. Faculty of Medicine Siriraj Hospital, Mahidol University , 2008|Diploma of Thai Board of Internal Medicine. Faculty of Medicine Siriraj Hospital, Mahidol University , 2014|Diploma of Thai Sub Board of Gastroenterology. Faculty of Medicine Siriraj Hospital, Mahidol University , 2016|Certificate of Attendance for the 26th United European Gastroenterology Week October 22-24,2018. Vienna , 2018|Certificate of Attendance for the Global Perspective in Gastroenterology. WGOGAT International Conference. , 2018

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Pongjarat Nun-anan

M.D.,Faculty of Medicine, Thammasat University. Faculty of Medicine Thammasat University , 2006|Diploma of Thai Board of Internal Medicine. Faculty of Medicine Prince of Songkla University , 2012|Diploma of Thai Sub Board of Gastroenterology Faculty of Medicine Thammasat University , 2015

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Morakod Deesomsak

The First Class Honors M.D., Faculty of Medicine, Khon Kaen University, 2006.|Diploma of Thai Board of Internal Medicine, The Medical Council of Thailand, 2010.|Diploma of Thai Sub-Board of Gastroenterology, 2012.

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Nathavut Sirimontaporn

M.D., Faculty of Medicine, Chulalongkorn University. Faculty of Medicine Chulalongkorn University , 1999|Diploma of Thai Board of Internal Medicine, The Medical Council of Thailand. , 2005|Diploma of Thai Sub Board of Gastroenterology and Hepatology. , 2009|Master Degree of Science, Chulalongkorn University. Faculty of Medicine Chulalongkorn University , 2009|, 2009

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Pitulak Aswakul

Certificate in Advanced Endoscopy Siriraj Hospital . Faculty of Medicine Siriraj Hospital, Mahidol University , 2011|Thai Board of Gastroenterology, The Royal College of Physicians of Thailand. , 2005|Thai Board of Internal Medicine, The Medical Council of Thailand. , 2001|Grad Diploma in Clinical Science, Khonkaen University, Khonkaen, Thailand . Khon Kaen University , 1998|MD (Second Class Honors), Khonkaen University, Khonkaen, Thailand. Khon Kaen University , 1996

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Thawat Mongkolporn

M.D., Faculty of Medicine, Chiang Mai University, 1996.|Diploma in Clinical Sceience (Medicine) Chiang Mai University, 1997.|Diploma of Thai Board of Internal Medicine, The Medical Council of Thailand, 2000.|Diploma of Thai Board of Gastroenterology, 2006.

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Surasak Aekpongpaisit

The Second Class Honors M.D., Faculty of Medicine, Chulalongkorn University. Faculty of Medicine Chulalongkorn University , 1994|Diploma of Thai Board of Internal Medicine, The Medical Council of Thailand. , 2001|Diploma of Thai Board of Gastroenterology. , 2003

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Teerha Piratvisuth

The First Class Honors M.D.,Faculty of Medicine, Prince of Songkla University, 1985.|Diploma of Thai Board of Internal Medicine, 1989.|Certificate Clinical Fellow in Hepatology, King's College School of Medicine and Dentistry, Lond|Certificate Clinical Fellow in Hepatology and Endoscopy, The University of Texas-Houston Medical Sch|Diploma of Thai Sub-Board of Gastroenterology, The Medical Council of Thailand, 2004.|Director of NKC Institute of Gastroenterology and Hepatology.|President Thai Association for the Study of the Liver (2011-2012).|Vice President for APDW, 2012.|Vice Chairman for Ethic and Executive Council member of APASL.|Associate Professor of Medicine, Prince of Songkla University, Hat Yai, Thailand.

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