Cohort profile: cholangiocarcinoma screening and care program (CASCAP)

Abstract

BackgroundCholangiocarcinoma (CCA) is an extremely aggressive cancer that is usually fatal. Although globally morbidity and mortality are increasing, knowledge of the disease remains limited. The Mekong region of Southeast Asia, and particularly the northeast of Thailand, has by far the highest incidence of CCA worldwide with 135.4 per 100,000 among males and 43.0 per 100,000 among females being reported in Khon Kaen Province. Most patients are first seen during late stage disease with 5-year survival being less than 10 %. Starting in 1984, control and prevention strategies have been focused on health education. Although early detection can substantially increase 5-year survival, there are currently no strategies to increase early diagnosis.Methods/designThe Cholangiocarcinoma Screening and Care Program (CASCAP) is a prospective cohort study comprising two cohorts- the screening and the patient cohorts. For the screening cohort, ultrasound examination will be carried out regularly at least annually to determine whether there is current bile duct and/or liver pathology so that the optimal screening program for early diagnosis can be established. This cohort is expected to include at least 150,000 individuals coming from high-risk areas for CCA. For the patient cohort, it is estimated that about 25,000 CCA patients will be included during the 5-year recruitment period. All CCA patients will be treated according to routine clinical care and followed so that effective surgical treatment can be formulated. This cohort is indeed a conventional cancer registry. Thus, CASCAP is an ongoing project in which the number of participants changes dynamically.DiscussionsThis is the first project on CCA that involves screening the at risk population at the community level. At the time of preparing this report, a total of 85,927 individuals have been enrolled in the screening cohort, 55.0 % of whom have already undergone ultrasound screening, and 2661 CCA cases have been enrolled in the patient cohort. Among the participants of the screening, whose mean age was 53.8 ± 9.8 years, 55.6 % were female, 77.5 % attained primary school as the highest level of education, 79.9 % were farmers, 29.9 %, reported having relatives with CCA, 89.1 % had eaten uncooked fish, and 42.2 % of those who had been tested for liver fluke were found to be infected.

Epidemiology and Risk Factors of Cholangiocarcinoma

“…The aim of this study is to systematically improve the diagnosis and treatment of CCA patients throughout the northeast of Thailand [70]. For the screening cohort, annual ultrasound examination and - as appropriate - biopsy will be provided in order to establish diagnosis as early as possible.…”

Whole-Genome and Epigenomic Landscapes of Etiologically Distinct Subtypes of Cholangiocarcinoma

“…Current 5-year survival rates for CCA after surgery and chemotherapy remain poor [<20%, (4)], and clinical trials evaluating targeted therapies in unselected CCA populations have shown minimal benefits (5). Existing CCA classification systems are primarily based on either anatomical location (intrahepatic, perihilar, and distal) or pathological features (cirrhosis, viral hepatitis, and primary sclerosing cholangitis), which do not provide insights into mechanisms of CCA tumorigenesis, nor potential targets for therapy.…”

Chronic Opisthorchis viverrini Infection Changes the Liver Microbiome and Promotes Helicobacter Growth

“…Approximately 10% of opisthorchiasis patients are likely to develop CCA [4]. Nowadays, although the incidence of opisthorchiasis is declining due to a multi-faceted control program [2], the incidence of CCA in endemic areas of liver fluke, such as in Khon Kaen Province, remains high [5] and the incidence of CCA elsewhere is increasing [6]. This suggests the etiology of HBD and CCA are associated with multifactorial risk factors [7].…”