Current Perspectives on Opisthorchiasis Control and Cholangiocarcinoma Detection in Southeast Asia

Abstract

Similar to bile duct cancer or cholangiocarcinoma (CCA) in the western world, opisthorchiasis-associated CCA in Southeast Asia is an aggressive cancer with high mortality rates. It is known to cause a significant health burden in the opisthorchiasis region in Thailand and possibly throughout mainland Southeast. To reduce this health burden, a comprehensive prevention and control program for opisthorchiasis, as well as CCA, is required. In this review, our aim is to provide a brief update of the current situation regarding the natural history of opisthorchiasis and health burden of CCA in Southeast Asia. A comprehensive approach to tackling these issues being implemented in Thailand under the “Cholangiocarcinoma Screening and Care Program” is described. This comprehensive program consists of a three stage prevention and patient care program. The primary prevention component involves opisthorchiasis screening using a new and sensitive urine assay. The secondary prevention component involves screening for CCA and periductal fibrosis, with suspected CCA patients following the protocol for confirmation and appropriate treatment. Due to the eco-epidemiology of opisthorchiasis-induced CCA, the anticipated impacts and outcomes of the program include short-, medium-, and the long-term goals for the reduction of CCA incidence. To achieve long-term sustainable impacts, concerted efforts to raise social awareness and participating action by general public, non-government organizations, and government agencies are necessary. The strategic plans developed for this program can be expanded for use in other endemic areas as well as being a model for use in other chronic diseases.

Systematic Analysis of the Application and Inappropriate Use/Misuse of Statistics in Cholangiocarcinoma Research in Southeast Asia

“…It is also noted that all research articles (100%) in medicine and pathophysiology were published by researchers from Thailand. This supports the statistics showing that Thailand is the country with the highest incidence of CCA in the world (Khuntikeo et al, 2018).…”

Vaccination of hamsters with Opisthorchis viverrini extracellular vesicles and vesicle-derived recombinant tetraspanins induces antibodies that block vesicle uptake by cholangiocytes and reduce parasite burden after challenge infection

“…The human liver fluke Opisthorchis viverrini is endemic in different countries of Southeast Asia including Thailand, Lao PDR, Cambodia, southern part of Vietnam and Myanmar [1, 2]. Furthermore, liver fluke infection is associated with a high incidence of liver pathology including cholangiocarcinoma (CCA) [3, 4]. Current control efforts rely on drug treatment and health education; however, they are not sustainable [5, 6].…”

Attenuation of CD47-SIRPα Signal in Cholangiocarcinoma Potentiates Tumor-Associated Macrophage-Mediated Phagocytosis and Suppresses Intrahepatic Metastasis

“…It is a rare cancer worldwide, but increasing incidences have been observed [9] , [10] . CCA is a major health problem in Thailand, where the highest incidences and mortalities are documented [11] . The close association between CCA and chronic infection or chronic inflammation, regardless of the cancer causes, was reported [12] .…”