Love yourself and be a giver”
Ms. Poonpan Chaiyakul and her Sarcoma treatment journey.

“Sarcoma is unlike other cancers;
it is not detectable by a blood test.
So, a blood test is pointless. It can pop up
in any part of the body. By the time we are in the know,
it already has become a tumor.”

Sarcoma: a surreptitious cancer

Ms. Poonpan Chaiyakul told us about the dreadful characteristics of “sarcoma,” one of the lesser-known cancers rarely encountered in Thailand, resulting in limited research, case reports, medications, and specialists for its treatment. That’s the impetus she founded the Siriraj Foundation Fund for advanced sarcoma research hoping for new treatment discoveries.

With gentle eyes and an energetic look, Ms. Poonpan surprised us she was trying to beat the sarcoma that had been with her for four years. 

“I didn’t get enough rest back then. I was busy doing a lot of things. But I usually have regular health checkups and thought I was always healthy. In July 2019, I had a health checkup as usual; the blood tests didn’t indicate anything suspicious. However, I incidentally found a lump on my abdomen.”

The suspicious lump did not cause pain or elicit fear of malignancy, only a shade of disquietness. Ms. Poonpan decided to have a CT scan, and the result was a tumor 7-8 cm. in diameter arising from the smooth muscle within the colonic wall. After laparoscopic surgery and tissue biopsy of the mass came unexpected results. The tumor was malignant leiomyosarcoma, a rare cancer that transforms a healthy person into a patient overnight. 

Due to the low prevalence of sarcoma in Thailand and a doctor’s recommendation not to have chemotherapy but only follow-up care, Ms. Poonpan sends her biopsy tissue and result to the University of Miami (Sylvester Comprehensive Cancer Center). This sarcoma research and treatment center treats hundreds of cancer patients every year. The treatment guidelines there may be different from the ones in Thailand. After the evaluation of her lab results, the suggestion was for her to receive six cycles of chemotherapy at the center, which took around 4-5 months. Ms. Poonpan decided to travel to the US to receive the recommended treatment.

Second cancer

In early 2020, Ms. Poonpan returned to Thailand. A year and a half afterward (mid-2021), the second cancer arose near the same area. She had to undergo surgery again, but the result was concerning. 

“The tumor was in the smooth muscles of the abdominal wall adjacent to the intestine. If only the tumor were removed, without a margin of normal surrounding tissue, residual cancer could continue to grow. So, the doctor also removed part of the abdominal wall and intestine.”

Ms. Poonpan decided to consult with the team of specialists at MedPark Hospital. One of them was Dr. Sudpreeda Chainitikun, an internist specializing in medical oncology and a graduate of MD Anderson Cancer Center in Texas. After reviewing her medical history and thorough physical examinations, the team concluded that her condition was very concerning. They suggested she receive four cycles of chemotherapy to shrink the tumor and recuperate for surgery, followed by two more cycles of chemotherapy, resulting in 6 cycles overall.

“Chemotherapy was very tough because each cycle equaled two doses for me. The first cycle was not that severe; I only felt rundown. However, the second cycle came with 7-8 days of dizziness and harsher fatigue. Nausea and vomiting didn’t occur because Dr. Sudpreeda preemptively prescribed medications for me. And I also had a loss of taste.”

Change oneself for happiness.

The surgery went well. The doctors continue to provide follow-up care, now approaching almost four years since she first encounter with sarcoma. Ms. Poonpan fully understands that chemotherapy invariably damages healthy cells. She made lifestyle changes to take charge of her health in earnest, beginning with changing her diet, focusing mainly on vegetables, fruits, and plant-based proteins, with occasional fish and organic vitamin supplements. She was also interested in alternative treatments such as naturopathy, Anapanasati meditation, and breathing exercises for relaxation.

She also changed to a new way of thinking, “love yourself more,” and being “a giver” back to society because happiness for each person is different. Hers is to love herself, love others, and give best wishes to sarcoma patients by establishing the Siriraj Foundation Fund for advanced sarcoma research to support research on sarcoma, which is rare in Thailand, resulting in the lack of knowledge about the treatment and pathogenesis of sarcoma, which is necessary for a personalized treatment approach.

“It’s mind over body… I always tell myself I’m fine. What happened was one of the experiences in my life. I have learned enough about it. I just want to be with my family for a long time. So, I will be the new me who love myself more, be grateful for everything around me, like the sun, the universe, or my family that keep me breathing, happy, and healthy, and spread love and good feeling to each other.”

Causes of sarcoma

Sarcoma, also known as soft tissue sarcoma, is not widely discussed due to its rarity, resulting in slow progress in drug development research.

The causes of sarcoma may be unclear, but it involves the mutation of cancer cells in tissues, and the mutated genes are not specific. There is no specific targeted drug therapy for sarcoma in clinical use. There are not many proven drugs. Most respond poorly to medications. The primary site of sarcoma is non-specific; it can develop anywhere in the body. Sarcoma in different locations requires different investigations and treatments.

“Each type of sarcoma responds to drugs differently concerning sensitivity to treatment. The sarcoma in Ms. Poonpan was leiomyosarcoma. It arose from the smooth muscles in the colonic wall and spread to the abdominal wall, a rare and challenging case. Normally, if cancer occurs in confined spaces, such as the anus or bile ducts, one-centimeter cancer would cause strong pain. And if cancer occurs in vital organs such as bone, bone pain would occur. If it develops in your airways, you will have throat irritation with a cough. There would be obvious symptoms. But in Ms. Poonpan’s case, it was in the abdomen with room to expand. And its small size did not evoke pain strong enough to draw attention.” Dr. Sudpreeda Chainitikun, one of the doctors on the care team, provided more details about her sarcoma.

Treatment for sarcoma

The primary treatment for sarcoma is surgery combined with chemotherapy and/or radiotherapy, which must be individualized. If a patient’s condition is fit for surgery, a doctor would recommend it. However, surgery is not appropriate, chiefly because when first detected, cancer has spread to other sites, forcing doctors to prescribe medications.

“The medication for Ms. Poonpan was the same formula that the University of Miami (Sylvester Comprehensive Cancer Center) used. A response rate of 20-30% counts as a major success. Luckily, she had a great response to the medication. Her cancer is under control requiring only regular follow-up monitoring. If her cancer does not recur in the next five years, there is a high likelihood that her cancer is vanquished.” Dr. Sudpreeda said.

Siriraj Hospital has initiated a cancer gene sequencing project for Thai patients since 2019 and developed OMICs technologies for cancer diagnosis. The setup of the Siriraj Foundation Fund for advanced sarcoma research is a crucial beginning that will lead to the generation of new knowledge and establish research components, such as in vitro models of in vitro cancer for targeted sarcoma treatment according to the precision medicine approach.

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Tel. 02-090-3124 from 8:00 am.- 8:00 pm.