liver cancer liver fluke

[jerome2]

At least 1/3 of the thais in my area LOEI die of liver or Biliary Vesicle cancer probably induced by liver fluke

nothing is done in hospitals to even distinguish between the 2 ,the 2nd being characteristic of liver fluke

google says Khonkien is the world capital of liver fluke in human

the big question is : vewing the carelessness of their health system ,do thai poeples need a preventive treatment every year and of what brand :parasiquantel is easy ,only 3 takes in one day only

anybody can find out ?

[canman]

Best preventitve treatment is to cook the fish properly before consuming.

[uptheos]

They do love their uncooked fish and meats,.......... mai bpen rai aroy maak is more important!

http://www.liverdoctor.com/liver-problems/liver-fluke/

[francescoassisi]

Where do you get the figure of 30%?

[canman]

They do love their uncooked fish and meats,.......... mai bpen rai aroy maak is more important!

http://www.liverdoctor.com/liver-problems/liver-fluke/

I get that. Somehow I think the main problem is lack of education. If they truely understood the risks I wonder if they would change their eating patterns?

[Briggsy]

http://www.apocpcontrol.org/paper_file/issue_abs/Volume12_No5/1367-1370%20c%204.25%20Narong%20Wongba.pdf

Academic study here. Interesting reading.

[Big Pinkie]

that only leaves 2/3 for moto accidents. nah cant be true.

[iancnx]

So is there a preventative drug to stop the fluke life cycle? Similar to getting rid of worms?

Edited January 15, 2014 by iancnx

[fifthcolumn]

Any of this attributable to swimming? I'm freakedbout about swimming in freshwater in SEA.

[Briggsy]

So is there a preventative drug to stop the fluke life cycle? Similar to getting rid of worms?

Any of this attributable to swimming? I'm freakedbout about swimming in freshwater in SEA.

http://en.wikipedia.org/wiki/Opisthorchiasis

[Sheryl]

Liver cancer is a significant cause of death in Thailand, especially in the north, but does not account for anything near 1/3 of deaths anywhere in the country, not by a very long shot. Even in the parts of the country with the highest rates, only 1-2% of the population get it. It accounts for 1/3 of all cancer deaths and that is probably what the OP read. That is very different from 1/3 of all deaths.

The prevalence of liver fluke in Thailand overall is about 9%, but as high as 35% in some parts of the north and northeast. (Khon Kaen province has the highest rate in the country). Liver fluke is indeed a risk factor for cancer of the liver but not everyone with it will get cancer, in fact most do not.

In addition, liver fluke is not the only cause of liver cancer. High prevalence of Hepatitis B is also a major factor.

Prevention of liver fluke is not to eat raw fish/shellfish -- and fermented fish sauce/paste , a major culprit. The raw crabs put into som tham are also a big culprit.

The Thai MoPH has done/is doing public health education campaigns around this, but habits are hard to change. For some years they also conducted mass treatment campaigns with praziquantel but it did not reduce the prevalence of infection since people kept on eating these foods and thus getting re-infected.

You cannot get the type of fluke in question from swimming, only by ingesting it in food. You can however get something called schistosomasias from swimming in waters that have that parasite. Schisto is a blood fluke, not liver fluke. "Swimmer's Itch" is due to it.

[iancnx]

This is really useful Sheryl, thank you. I heard of an over the counter medicine which can be safely taken annually to provide resistance or kill worms/ flukes. Is this praziquantel? Or is there another well known brand in Thailand without going to clinic / hospital. We have no symptoms, so this is just precautionary medicine. Raw fish is off the menu for the missus from now on.... Smelly crab.... Yuk!!

[Sheryl]

Yes, praziquantel . That is the generic name. It is available without prescription under many brand names, not hard to find.

Be sure she avoids som tham thai and fish paste, too.

[canman]

Yes, praziquantel . That is the generic name. It is available without prescription under many brand names, not hard to find.

Be sure she avoids som tham thai and fish paste, too.

Fish sauce OK? I assume the fermentation process and salt would kill any fluke eggs?

[Briggsy]

Yes, praziquantel . That is the generic name. It is available without prescription under many brand names, not hard to find.

Be sure she avoids som tham thai and fish paste, too.

You expertise is always very helpful.

Could you say why you advise to avoid som tam thai, which has no fermented fish generally. Som tam pla raa does. Was it a slip of the finger and you were referring to som tam pla raa or is there something about som tam thai that you are advising is dangerous.

I ask because I eat som tam thai on occasion.

[Sheryl]

I think bottle fish sauce is Ok but avoid homemade as they may not have boiled it first. fermentation does not eradicate the flukes, in fact fermented fish paste is a major culprit.

Som tham: What you need to avoid is not only fermented fish but the little raw crab they like to put in.

[infinity11]

'The raw crabs put into som tham are also a big culprit.'

So fluke can come from (raw) seafood too?

How about bla som, issan prepared possibly fermented fish, how safe is that?

[Sheryl]

The little crabs in som tham are not from the sea, they from river/rice paddies.

Any fermented fish that is not cooked thoroughly before preparation is a risk.

[jerome2]

like i said the hospitals dont bother to investigate what cancer it is they simply say liver cancer ,go home

Liver cancer is a significant cause of death in Thailand, especially in the north, but does not account for anything near 1/3 of deaths anywhere in the country, not by a very long shot. Even in the parts of the country with the highest rates, only 1-2% of the population get it. It accounts for 1/3 of all cancer deaths and that is probably what the OP read. That is very different from 1/3 of all deaths.

The prevalence of liver fluke in Thailand overall is about 9%, but as high as 35% in some parts of the north and northeast. (Khon Kaen province has the highest rate in the country). Liver fluke is indeed a risk factor for cancer of the liver but not everyone with it will get cancer, in fact most do not.

In addition, liver fluke is not the only cause of liver cancer. High prevalence of Hepatitis B is also a major factor.

Prevention of liver fluke is not to eat raw fish/shellfish -- and fermented fish sauce/paste , a major culprit. The raw crabs put into som tham are also a big culprit.

The Thai MoPH has done/is doing public health education campaigns around this, but habits are hard to change. For some years they also conducted mass treatment campaigns with praziquantel but it did not reduce the prevalence of infection since people kept on eating these foods and thus getting re-infected.

You cannot get the type of fluke in question from swimming, only by ingesting it in food. You can however get something called schistosomasias from swimming in waters that have that parasite. Schisto is a blood fluke, not liver fluke. "Swimmer's Itch" is due to it.

[francescoassisi]

Sheryl, although the basis of your advice is sound, you seem a little confused about fish sauce and "nam prick" and fermented fish paste as well as the many forms of Som Tam.

Transmission is from raw fish, but I understand that some kinds of fluke are transmitted also from consumption water plants which form a common accompaniment to many Thai dishes.

Self diagnois and over the counter treatment is NOT recommended as the treatment takes a long time and often different drugs; Egaten (Triclabendazole) and Praziquantel are allegedly the most effective.

[96tehtarp]

I think bottle fish sauce is Ok but avoid homemade as they may not have boiled it first. fermentation does not eradicate the flukes, in fact fermented fish paste is a major culprit.

Som tham: What you need to avoid is not only fermented fish but the little raw crab they like to put in.

Please don't laugh. Now I am worried.

I eat som-tam with home-made Palaa (raw fermented fish past) and Poo Na Khem (raw salted fermented small black rice paddy crabs) probably 3-4 times per week.

I also eat raw buffalo meat, cooked in lime juice.

On special occasions I eat Roooo, that's fresh raw uncooked pig's blood in a stew of boiled pig's head (no pig's brain it's been removed). They add the blood at the last minute just before eating it.

I've never had a problem, other than mild diarrhoea maybe once every 12-18 months over the past 15+ years.

Should I be screening for liver flukes, or worse? I take Mebendazole once every three months just in case, for other worms.

I don't want to end up with liver cancer. I did some google-ing and found that some of these parasites can end up in your brain eg. neurocysticercosis!

Don't laugh, I know I probably shouldn't be eating the above, but they all taste really good, once one acquires a taste for it.

All the meds listed are very cheap in Thailand. Should I be concerned enough to talk to a Thai doctor?

[macleans]

96tehtarp, you definitely should stop eating those foods. Eating raw fresh water fish including Pla-ra and Phoo-Khem may give you flukes. Eating "Loo" may give you pig tapeworms, which are far more dangerous than the ones acquired from eating raw beef. To make it worse, there is a good chance you may end up contacting streptococcus suis, a very dangerous baterium, caused by consumption of raw pig meat (including blood). The infections are prevalent in the north and Isaan due to their culture of eating raw meat. You could end up having meningitis, often presented in the form of permanent hearing loss, if you contact the disease.

I'm Thai but have always avoided the foods you listed. In fact, I'll never eat raw pig meat even if it means I'll have to starve.

[Sheryl]

+1

As to whether or not you may have liver fluke, you may, but risk is also connected to how endemic it is in the area where you live. Where in Thailand are you?

[Sheryl]

Sheryl, although the basis of your advice is sound, you seem a little confused about fish sauce and "nam prick" and fermented fish paste as well as the many forms of Som Tam.

Transmission is from raw fish, but I understand that some kinds of fluke are transmitted also from consumption water plants which form a common accompaniment to many Thai dishes.

Self diagnois and over the counter treatment is NOT recommended as the treatment takes a long time and often different drugs; Egaten (Triclabendazole) and Praziquantel are allegedly the most effective.

I am well aware of the difference between fish sauce and fish paste.

Both can transmit liver fluke. Though in the case of fish sauce, only if homemade. Nowadays most people use bottled.

As to types of Som Tam, I find that definitions vary in different parts of the country. In many places, including where I live, "som tham thai" includes raw crab. Raw crab is as much a risk as raw fish.

[jerome2]

the only symptom is the doctor after the analyse saying you got 1 year and it means you got 3 months

This is really useful Sheryl, thank you. I heard of an over the counter medicine which can be safely taken annually to provide resistance or kill worms/ flukes. Is this praziquantel? Or is there another well known brand in Thailand without going to clinic / hospital. We have no symptoms, so this is just precautionary medicine. Raw fish is off the menu for the missus from now on.... Smelly crab.... Yuk!!

[96tehtarp]

96tehtarp, you definitely should stop eating those foods. Eating raw fresh water fish including Pla-ra and Phoo-Khem may give you flukes. Eating "Loo" may give you pig tapeworms, which are far more dangerous than the ones acquired from eating raw beef. To make it worse, there is a good chance you may end up contacting streptococcus suis, a very dangerous baterium, caused by consumption of raw pig meat (including blood). The infections are prevalent in the north and Isaan due to their culture of eating raw meat. You could end up having meningitis, often presented in the form of permanent hearing loss, if you contact the disease.

I'm Thai but have always avoided the foods you listed. In fact, I'll never eat raw pig meat even if it means I'll have to starve.

Everybody around here eats the foods I listed, and I've never heard of anyone here getting sick from them. Although our pork all comes from commercial pig farms where I expect the pigs are vaccinated. That's still no excuse for my eating these dishes though. The OP included the alarming rate of liver cancer in his area. I'll have to reconsider my eating habits.

I understand the risks you describe might be a reason why the local Thai people rush to the Dr. and pay for a shot at the first sign of a headache, fever, diarrhoea etc. They don't wait and do cultures. They get a shot.

Thanks for mentioning streptococcus suis. I googled it.

I'm still not sure if I should be concerned about liver flukes enough to speak to a Thai Dr. about it and possibly get some de-fluking medicine. I already take de-worming medicine every few months just in case. I may already have liver flukes.

[jerome2]

it takes at least 15 years to make a cancer so if you are farang and more than 60 no need to check your shit

heavily infected if more than 10.000 eggs /gram of shit

I think bottle fish sauce is Ok but avoid homemade as they may not have boiled it first. fermentation does not eradicate the flukes, in fact fermented fish paste is a major culprit.

Som tham: What you need to avoid is not only fermented fish but the little raw crab they like to put in.

Please don't laugh. Now I am worried.

I eat som-tam with home-made Palaa (raw fermented fish past) and Poo Na Khem (raw salted fermented small black rice paddy crabs) probably 3-4 times per week.

I also eat raw buffalo meat, cooked in lime juice.

On special occasions I eat Roooo, that's fresh raw uncooked pig's blood in a stew of boiled pig's head (no pig's brain it's been removed). They add the blood at the last minute just before eating it.

I've never had a problem, other than mild diarrhoea maybe once every 12-18 months over the past 15+ years.

Should I be screening for liver flukes, or worse? I take Mebendazole once every three months just in case, for other worms.

I don't want to end up with liver cancer. I did some google-ing and found that some of these parasites can end up in your brain eg. neurocysticercosis!

Don't laugh, I know I probably shouldn't be eating the above, but they all taste really good, once one acquires a taste for it.

All the meds listed are very cheap in Thailand. Should I be concerned enough to talk to a Thai doctor?

[jerome2]

http://en.wikipedia.org/wiki/Opisthorchiasis

In regions where Opisthorchis viverrini is highly endemic, the incidence of cholangiocarcinoma is unprecedented.^[5] For instance, cholangiocarcinomas [bile duct cancer] represent 15% of primary liver cancer worldwide, but in Thailand's Khon Kaen region, this figure escalates to 90%, the highest recorded incidence of this cancer in the world.^[5] Of all cancers worldwide from 2002, 0.02% were cholangiocarcinoma caused by Opisthorchis viverrini.^[4]

lao kao is the major cause of liver cancer ?

i think the fluke is responsible ,and that there is a will to hide this fact ,

the preventive treatment being not recommended, the hospitals would be left with only one possibility left.

Like they did about 20 years ago, analyse the shit of all the population of issarn ,which they must remember as beeing the nightmare of their life (high class peoples doing this job for 10 millions of low class peoples) .That would explain it ,but I cannot be sure,

you would have to send the sample abroad to see whether it is a liver or bile duct cancer ,the 2nd being characteristic of liver fluke

here like I said 1/3 of the peoples die from that and i think the statistics are flawed

as soon as they see it's a liver cancer they send the guy or woman back home,leaving the local hospital the pain control problem until death
this fluke is Group 1 carcinogen

http://en.wikipedia.org/wiki/Carcinogens#Classification_of_carcinogens

[faraday]

If you are concerned, go to see your Doctor.

[jerome2]

Figure 3 shows that the incidence of CCA in the four major regions of Thailand varies by at least 12-fold and has a strong positive correlation with the prevalence of O. viverrini infection (Sripa et al., 2007). For example, in adult males, there is an 8.5 fold increase in CCA incidence in the upper Northeast province of Nakhon Phanom (85.5 %) over the Southern province of Prachuap Khiri Khan (10.0 %) (Sripa et al., 2007). This difference is an example of the marked regional variation of liver cancer deaths, with the highest mortality rate (per 100,000) in Northeast provinces, which harbors 9 out of the top 10 provinces with highest number of liver cancer deaths in Thailand (Sripa and Pairojkul, 2008). Few data on CCA incidence in Lao PDR have been reported (Shin et al., 2010). However, suspected CCA diagnosed by ultrasonography has been observed in ~5% of people in villages endemic for opisthorchiasis in the Lao PDR (Phompida S, personal communication). A disproportionate number of deaths occur in male heads of households, who often are the family’s primary wage earner. Therefore, opisthorchiasis and CCA also exert a heavy economic toll that in Thailand costs at least $120 million annually in both medical care and lost wages (Andrews et al., 2008). Typically O viverrini infection begins in childhood, residents harbor chronic infections and, after three to four decades, liver cancer is diagnosed in a subset of individuals, with males affected more than females. CCA has a poor prognosis; death is swift, usually occurring within 3–6 months of diagnosis