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CASCAP
CASCAP is the acronym for the Cholangiocarcinoma Screening and Care Program based at the Faculty of Medicine, Khon Kaen University in Thailand.

Cholangiocarcinoma
Cholangiocarcinoma (CCA), is an extremely aggressive, usually fatal, bile duct cancer with liver involvement in its later stages.

Cholangiocarcinoma and the Mekong region of Southeast Asia
The Mekong region of Southeast Asia, and particularly the northeast of Thailand, has long been known as the area having by far the highest incidence of CCA worldwide. It is estimated that there are up to about 20,000  cases annually in this region alone. Most patients are first seen during the late stage of the disease with five-year survival being less than 10%. For more than three decades, control and prevention strategies have focused mainly on primary prevention, emphasizing health education based on reducing the rate of eating raw, fermented or partially cooked freshwater fish   , the source of liver fluke Opisthorchis viverrini infection, Opisthorchiasis    which is a primary cause of CCA, and use of the anthelminthic drug praziquantel. Although early detection can substantially increase 5-year survival, there have been until recently no strategies in place to increase the success of early diagnosis.

Cholangiocarcinoma screening
The Cholangiocarcinoma Screening and Care Program (CASCAP) aims at screening 1,000,000 at risk individuals using ultrasonography in the northeast of Thailand in order to provide a high quality database on CCA in the region, determine the optimal screening program for early diagnosis, and maximize the success of surgical treatment thus increasing both the patient’s quality of life and chances of long-term survival. Over 200,000 have already undergone examination.

In order to reach as many of the at risk population as possible, a CASCAP training course based at Khon Kaen University Hospital has been established in order to increase the number of the doctors and general practitioners who can perform ultrasound examinations in rural northeast Thailand. Online consultation by CASCAP experts will aid assist less experienced medical workers with interpreting the ultrasonographic findings. The online expert and rural health workers can then communicate with each other for the proper management of each patient.

CASCAP Tools
Online consultation is part of the larger scheme called CASCAP Tools. This is a web application aimed at archiving data from both healthy and patient individuals. For the former it acts as a CCA “surveillance” system to determine which individuals develop bile duct and/liver pathology. The surveillance system stores both information regarding risk factors of CCA and ultrasonography imaging data. For the patient group, CASCAP Tools follows the treatment and success of the medical intervention. Both types of information are regularly updated over 6- and 12-month intervals for individuals whose ultrasonographic findings were positive and negative, respectively.

CASCAP Tools is accessible free of charge to public and private hospitals as well as to other health facilities for their own use. Upon logging into the system with user identification and password, the health care personnel can enroll risk groups to receive ultrasonography for CCA screening using a unique identification. At the appointment date for ultrasonography, the physician only needs to enter the patient identification into the ultrasonography device before performing the examination. The physician can then store each image required followed by entering information regarding the diagnosis. All of this information will be transferred to the CASCAP server operated by the Cholangiocarcinoma Foundation of Thailand.

By the beginning of 2016, more than 739,826 individuals have been enrolled into the risk group for further screening, more than 216,727 have received an ultrasonography examination and there are more than 2800 health care facilities that have activated CASCAP Tools. To date, 8100 cases of CCA have been diagnosed, many at an early stage for which surgery can be curative.

CASCAP funding
The program is funded by:

Khon Kaen University.

National Research Council of Thailand.

Crown Property Bureau, Kingdom of Thailand.

Cholangiocarcinoma Foundation of Thailand.

Grenzone (Thailand) Co. Ltd through Professor Teh Bin Tean.