Cancer Genomics (Oncogenomics): From Risk Modification to Surveillance
Precision Cancer Care Starts in the Genome
At Phuket Cancer Institute, we leverage cuttingedge genomic and epigenetic medicine to guide every stage of cancer care—from lowering hereditary risk before any tumor forms to posttreatment surveillance that keeps recurrence in check. As part of the Bangkok Hospital Network, our ISO 15189:2012aligned laboratory and multidisciplinary precisiononcology team deliver internationalstandard care in Phuket’s renowned wellness hub.
Why Cancer Genomics (Oncogenomics) Matters
| Genomic Insight | Why It’s Important |
|---|---|
| Identify Germline Risk | Highpenetrance mutations (e.g., BRCA1/2, Lynch genes, TP53) guide enhanced screening or prophylactic surgery. |
| Profile Tumor Drivers | Actionable alterations (EGFR, ALK, BRAF, FGFR2, HER2) match patients to targeted drugs. |
| Predict Immunotherapy Response | Microsatellite instability (MSI) and tumor mutational burden (TMB) stratify checkpointblockade candidates. |
| Track Resistance & Minimal Residual Disease | ctDNA/CTC assays detect relapse months before imaging. |
Onesizefitsall oncology is history; precision, patientspecific therapy is our reality.
Our Oncogenomic Service Pathway
| Stage | Key Test / Approach | Primary Outcome |
|---|---|---|
| Risk Modification | Epigenetic age & methylationdrift panel | Lifestyle, nutrition & chemoprevention plan to reduce future cancer risk. |
| Hereditary Screening | 84gene germline NGS panel | Defines inherited risk (BRCA1/2, MLH1, MSH2, APC, TP53, CDH1 …). |
| Diagnostics | NGS ± MSI/TMB/PDL1, HER2 IHC | Defines driver mutations, fusions & amplifications for firstline therapy. |
| Prognosis | Integrated mutation + DNAmethylation score | Predicts recurrence, metastasis, overall survival; tailors followup. |
| Therapeutic Selection | molecular tumor board | Aligns patients to targeted therapy, immunotherapy, ADCs, or trials. |
| Surveillance | ctDNA & CTC monitoring (SpotMAS) | Detects minimal residual disease or molecular relapse early. |
| Pharmacogenomics | DPYD, UGT1A1, CYP2D6, TPMT (+ extended PGx) | Personalized dosing of 5FU, irinotecan, tamoxifen, thiopurines, etc. |
Impact Across Common Solid Tumors
| Tumor Type | Key Gene Changes | Treatment Impact |
|---|---|---|
| Colon | KRAS/NRAS, BRAF V600E, MSI | AntiEGFR only if wildtype KRAS/NRAS; MSIhigh → immunotherapy; BRAF V600E → combotargeted therapy. |
| Stomach | HER2, MSI | HER2 amp → trastuzumab; MSIhigh → PD1 blockade. |
| Pancreas | BRCA1/2, PALB2, KRAS | PARP inhibitors for BRCA/PALB2; KRAS G12C inhibitors (trials). |
| Liver (HCC) | TP53, CTNNB1 | Guides trial enrollment for emerging targeted combos. |
| Bile Duct | FGFR2 fusions, IDH1 | FGFR2 or IDH1 inhibitors now approved. |
| Neuroendocrine | MEN1, DAXX, ATRX | Molecular subtype guides prognosis & trial matching. |
| Breast | HER2, PIK3CA, BRCA1/2, HRD | Trastuzumab/pertuzumab, alpelisib, PARP inhibitors, endocrine biomarkers. |
| Lung (NSCLC) | EGFR, ALK, ROS1, RET, KRAS G12C, MET | TKIs: osimertinib, alectinib, lorlatinib, selpercatinib, sotorasib, capmatinib. |
| Ovarian / Gyn | BRCA1/2, HRD, PIK3CA, MSI | PARP, PI3K, and PD1 inhibitor based on profile. |
| Prostate | BRCA1/2, PALB2, ATM, TP53, PTEN, AR CNVs | PARP inhibitors, PI3K/AKT trials, nextgen ARtargeted therapy. |
5Step PrecisionOncology Workflow
| Step | What Happens |
|---|---|
| 1. Consult | Inperson or telemedicine review with our Genetic Counselor or Clinical Geneticist. |
| 2. Collect | Tissue biopsy or blood/saliva for germline or ctDNA testing. |
| 3. Sequence & Analyze | Highthroughput NGS with AIassisted bioinformatics. |
| 4. Report & Counsel | Actionable plan covering therapy, trials, prophylaxis, lifestyle. |
| 5. Treat & Monitor | Targeted therapy plus continuous molecular surveillance. |
Prognosis: Genetic and Epigenetic Insights
| Factor | Clinical Value |
|---|---|
| Genetic Mutations | TP53, KRAS, BRAF raise recurrence risk; EGFR predicts TKI response; CREBBP, POLD1 may signal longer survival. |
| Epigenetic Signatures | DNAmethylation score refines risk; guides followup cadence and adjuvant therapy decisions. |
RiskModification: Lifestyle and chemoprevention plans based on epigenetic profile.
PostCure Surveillance: Periodic methylation panels flag relapse earlier than imaging.
Standards You Can Trust
We comply with ISO 15189:2012 and follow ACMG, ASCO, NCCN, and ESMO guidelines.
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Phuket Cancer Institute – Care Beyond Cure
