(P1) A local DELICACY in north-east Thailand, made from raw fish, has been found to be behind a high INCIDENCE of LIVER cancer in the area, and doctors are trying to educate people about the risk.

(P2) The Isaan PLATEAU of north-eastern Thailand is poor, dry, and far from the sea. Home to around one third of the country’s population, most of them ETHNIC Lao in origin, it is RENOWNED for its spicy and inventive cuisine, using whatever ingredients are available.

(P3) Where there are rivers or lakes, they use the smaller fish they catch in a PUNGENT dish called koi plaa. The fish are chopped up finely, and mixed by hand with local herbs, lime juice, and live red ants, and served up raw.

(P4) It is very popular, but also dangerous.

(P5) For decades, certain populations in the north-east have been known to have abnormally high levels of liver cancer.

(P6) In men it comprises more than half of all cancer cases, compared to an average of less than 10% worldwide.

(P7) The high PREVALENCE has long been linked to infection by liver flukes, a kind of PARASITE, found in raw fish.

(P8) But it is only in the last decade that a serious effort has been made to get people to change their eating habits, by cooking koi plaa to kill the flukes before they eat it.

(P9) Dr. Banchob Sripa at the Tropical Disease Research Laboratory in Khon Kaen University is the man largely responsible for this effort.

(P10) “We have been studying this link in our labs for over 30 years”, he said.

(P11) “We found that the liver fluke can make a chemical that causes INFLAMMATION, and after many years, this becomes CHRONIC inflammation, which then becomes cancer.”

(P12) His team found that in some communities up to 80% of people were infected by the fluke, some as young as four years-old, but that the cancer rarely developed before people reached 50. Once it does, though, there is little hope for patients.

(P13) At the university hospital they receive around 2,000 patients a year with a specific form of liver cancer called cholangiocarcinoma.

(P14) Only around 200 of those can be treated, usually by surgery, cutting out the TUMOR from the liver.

Liver Cancer

(P15) The others are given PALLIATIVE CARE until they die.

(P16) The only effective remedy is prevention.

(P17) So Dr. Banchob and his team are running a community-based health education program.

(P18) They also take a PORTABLE ULTRASOUND machine around the villages to screen people for liver fluke infection.

(P19) It is STRIKING how many older people have high levels, indicating that they still eat their koi plaa raw.

(P20) “Sometimes I cook it, but sometimes I forget,” said 61-year-old Jongluck Laonongkwa after his screening. His liver was INFESTED with flukes.

(P21) “I think 60% do understand the causes of the liver cancer,” said Dr. Banchob, “They are aware of the liver fluke.

(P22) “But 10% are still eating raw fish. I believe that 10% probably cannot change. So we should change the environment, make the fish cleaner, to get fewer INFECTIONS.”

(P23) In the villages where the education programs has been running, infection rates are coming down SHARPLY, to below 10% in some.

(P24) It will take more time for liver cancer rates to fall significantly, but the attitude of younger people is ENCOURAGING.

WORDS: 546



If you found the passage difficult to read or had problems understanding specific words or idiomatic expressions, please discuss them with your tutor. The following discussion questions should be answered in your own words and with your own arguments.

  1. Briefly summarize the content of the article in your own words.
  2. Raw fish dishes such as SUSHI and CEVICHE are popular in many countries. Do you eat and enjoy raw fish?
  3. In general, eating fish is considered healthier than eating meat. Do you prefer fish or meat?
  4. Have you ever experienced any type of FOOD POISONING or food-based illness?
  5. Public health education is challenging because it is difficult to get people to change their habits. Why is this difficult?


What do the following expressions mean? Practice using each expression in a sentence; extra points if you can use it in conversation.

  • Palliative care
  • Food poisoning

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