A35-year-old female physician from a global non-profit organisation sought care at Bumrungrad International Hospital after months of worsening abdominal discomfort. A CT scan in her home country had revealed a partial colonic obstruction and a right ovarian mass, but the suboptimal quality of the images left the diagnosis unclear.

Swift action taken

Upon her arrival, our multidisciplinary team immediately set to work. A repeat CT scan using advanced multi-phase protocols and thin-cut technology (3mm) revealed circumferential wall thickening in the left upper colon, with severe luminal narrowing and suspicious lymph node involvement, raising concern for colon cancer. Additionally, a 7.7 cm complex right ovarian mass suggested either ovarian metastasis or a synchronous malignant tumour.

Within 24 hours, these findings were evaluated in detail by our radiologist, trained at the University of California San Francisco, guiding subsequent care. Clinical Associate Professor Tossapol Kerdsirichairat, MD FACG FASGE, an advanced endoscopist trained at the University of Michigan and Johns Hopkins University, performed a colonoscopy the following day. Navigating a 6 mm lumen with a slim endoscope, he confirmed an obstructing mass in the left upper colon and completed a thorough examination to exclude additional lesions.

During the colonoscopy, Dr Kerdsirichairat concurrently performed an upper endoscopy to evaluate for potential gastric lesions, which are sometimes associated with hereditary cancer syndromes. This dual approach underscores the importance of comprehensive diagnostic evaluations in patients with a suspected genetic predisposition to cancer, facilitating early detection and management of multifocal gastrointestinal lesions. This reveals gastric intestinal metaplasia associated with Helicobacter pylori, a known carcinogen.

A PET-CT scan conducted by our radiologist, trained at Wake Forest Baptist Medical Center, highlighted potential peritoneal tumour implants and minimal ascites, suggesting malignant spread. Weekly tumour board discussions culminated in a comprehensive plan: laparoscopic colectomy, oophorectomy, and hyperthermic intraperitoneal chemotherapy (HIPEC).

The surgery, led by a colorectal surgeon with Cleveland Clinic Foundation training, utilised minimally invasive techniques to resect the left colon and remove both ovaries. HIPEC with mitomycin C was administered, improving survival prospects for patients with peritoneal metastases. Frozen sections by our pathologist, trained at the University of Washington, confirmed metastatic adenocarcinoma in the ovaries, enabling precise intraoperative decisions.

Over just 18 days, a comprehensive diagnosis was established: T4N0M1 colorectal cancer with a gene mutation in adenomatous polyposis coli (APC), linked to familial adenomatous polyposis. Molecular findings informed treatment, and systemic adjuvant chemotherapy was initiated based on the National Comprehensive Cancer Network (NCCN) guidelines, a standard used for cancer care at large academic institutions in the US. Genetic counselling, provided by a Harvard-trained expert, ensured appropriate family screening for hereditary risks.

Putting patients first

This case exemplifies Bumrungrad’s integrated, patient-centred care model, combining world-class expertise, cutting-edge technology, and seamless teamwork to achieve optimal outcomes. Beyond treating disease, our mission prioritises restoring patients’ quality of life, embodying the highest standards of global medical care.