How Common Are Gastrointestinal Cancers?
Stomach, esophagus and Colorectal cancers put together account for 19% of all cancers worldwide and account for 22% of all cancer related deaths.
Why Do We Get Them?
Inspite of research and scientific advancements, it is not completely clear as to why some people develop and some people do not develop these cancers. However, we know risk factors, which predispose to cancer. These include lifestyle and dietary habits including alcohol, smoking, low fibre intake, replacement of our traditional whole grain by refined carbohydrates and overweight individuals or obesity. There is also a small group of population with genetic conditions predisposing to cancer in almost every generation.
Are They Curable?
Fortunately, battle against cancer can be won if detected early and prompt intervention is sought. Curative treatment usually revolves around surgery as the backbone with significant role of other supporting modalities like medical oncology (for chemotherapy), radiation oncology (for radiotherapy), medical gastroenterology (for endoscopy) and radiology (for scan) besides others. If symptoms are disregarded and not investigated early, they can spread and become advanced disease, which cannot be cured. However, even in advanced disease, meaningful remedies to improve quality of life with endoscopic measures with or without chemotherapy or radiotherapy and other palliative strategies including pain specialist can be employed.
At Institute of Gastrosciences, Gleneagles Global Health City, Chennai, our department has operated on 102 patients from 2013 to 2017 for colorectal cancer, of which over 70% were accomplished by keyhole (laparoscopy) surgery. Along with laparoscopy, we follow Enhanced Recovery After Surgery (ERAS) protocol, which helps patients to be discharged as early as the third postoperative day and move on to resuming normal life early.
How To Detect Early?
Elderly individuals are at higher risk than younger individuals are, though there has been an upsurge in cancer in younger people as well. Often, pain is treated incorrectly as acidity, gas, or gastritis by over the counter medications. If symptoms persist or recur, it is good to seek advice from a gastroenterologist if there is a need for a simple diagnostic procedure like endoscopy. Any recent change in bowel habits (constipation and/or loose stools) especially lasting for beyond a month needs prompt attention as this could be early gut cancer rumbling and trying to warn you. Unintentional weight loss and appetite loss, onset of anemia (low haemoglobin) with weakness, easy fatiguability and a sense of unwellness can be pointers to cancer and need prompt medical attention and investigation. Any blood in the stool or vomit or passage of black stool could mean bleeding from cancer of gut, often mistook as piles bleeding or gastritis. On your visit to gastroenterologist, you may be advised stool occult blood, endoscopy (of food pipe/stomach or large intestine) with biopsy, ultrasound and/or CT scan along with some blood tests called tumour markers.
How To Prevent Them?
There are two ways to prevent cancer.
One is to lead a healthy life style and incorporate a balanced diet with whole grain cereals, fruits and leafy vegetables to increase the dietary fibre intake, refrain from excess of red meat and processed meat, refined carbohydrates (white bread, maida, bakery items, sugar), grilled and charred food. Limit use of preserved and tinned food items. In meat, prefer lean meat. Antioxidants to detoxify our system are abundant in food items like garlic, turmeric, beetroot, spinach, berries, fresh vegetables, beans and dark chocolate. Smoking and use of nicotine use in any form should be avoided. Alcohol intake has to be limited. Needless to say, staying stress free and exercising goes a long way in staying fit.
Second is to detect them early when they are still pre-cancerous and tackle them before they transform into ugly full fledged cancer. Polyps are mushroom like outgrowths from intestinal lining which over 5 to 10 years if left unattended can progress to cancer. These can be easily detected and plucked out by endoscopy and kept on surveillance. Endoscopy for screening in stomach cancer has been an effective strategy in Japanese with a 30 to 40% reduction in stomach cancer related death. Detection of Helicobacter pylori in stomach and eradication can significantly reduce risk of development of stomach cancer.
Colonoscopy for screening in colorectal cancer is a standard of care in America for individuals above the age of 50. Indian guidelines currently recommend screening for colorectal cancer in high risk individuals (family history of cancer, colonic polyps/ syndromes and inflammatory bowel disease like Ulcerative colitis or Crohn’s colitis). However, with increasing incidence and availability of curative modalities of treatment in early disease, it is prudent to be aware of the red flag signs and seek early expert assessment.
Dr. Saravanan M.N, Senior Consultant GI Surgery, Minimally Invasive & Bariatric Surgery, Gleneagles Global Health City, Chennai.