Gastrointestinal Cancer (GC): Symptoms, Diagnosis, Treatment And Risk Factors

Gastrointestinal Cancers arise either in the food pipe, stomach, small intestine, large intestine, liver, or pancreas. There are no signs and symptoms that are specific to cancers. The symptoms are often like other non-cancerous diseases of the gastrointestinal tract. Many risk factors are depending on the location of the cancers. These are most common of increasing age>50years, high-calorie fat diet, smoking, alcohol, sedentary lifestyle, previous radiation to the abdomen, a viral infection like Hepatitis B & C, Gall stones, Familial Genetic Syndromes, etc. Males are slightly more often involved than females, though the difference is not too much. Abdominal pain should never be taken lightly. Gastrointestinal cancer (colon or intestinal cancer) has become the fourth-highest number of cancers in India. Last year, 57,394 cases of Gastrointestinal Cancer were reported. Causes of Gastrointestinal Cancer: It could be genetic. If we overeat salty food, then there could be acidity or acid reflux—chances of Stomach Cancer increase in people who smoke or drink alcohol.

Symptoms of Gastrointestinal Cancer

Persistent symptoms like blood in stools, unexplained weight loss, unexplained anaemia, recurrent vomiting, difficulty swallowing, painless jaundice, pain, and the lump in the abdomen can be due to GI Cancers. These should not be ignored for a long time and should be consulted with specialists at the earliest. The patients with GI cancers often present in advanced stages because these nonspecific symptoms are often ignored and not investigated early. Some times to decrease the symptoms created due to obstruction by cancers, palliative measures like endoscopic stenting is done like putting hollow tubes in the food pipe (oesophagal stenting), intestine Duodenal or colonic stenting), bile duct (biliary stenting). 

Prognosis and diagnosis of Gastrointestinal Cancer

Once the cancer is suspected, the tests are done to confirm the diagnosis and know the cancer stage so that adequate and tailored treatment is provided to the individual. The test done is endoscopy, colonoscopy, Ultrasound, CT scan, Abdomen, MRI abdomen and PET scan. 

• Colonoscopy: It has to be done with the help of necessary medical intervention such as colonoscopy, which helps look at cancer and test its tissues. This allows early detection of gallbladder cancer. But this cannot be detected with routine checkup and everyday medical advice.
• Biopsy: Biopsy refers to sampling a small part of the tumour and examining it with a microscope. A pathologist does this. Gene testing can also be performed on biopsy samples if necessary.
• Endoscopy: Endoscopy confirms colon cancer. The endoscope is a flexible thin tube, which consists of a camera. It transmits the image inside your stomach to a monitor.

Determining the spread of cancer (stages)

The severity or stage of gastrointestinal cancer is estimated by looking at where the tumour is in the stomach, the extent to which it has spread to the stomach tissue and its spread to other internal organs of the body outside of the stomach. Cancer cells originate from cancerous lumps and spread in three ways in the body;

• Through blood
• Via lymphatic
• Straight to the north

The spread of cancer can be localized in the stomach, surrounding tissues, and lymph nodes. Or it may be distal, in the lining (peritoneum) of the liver, lungs, and stomach. When cancer spreads to distant organs, it is called metastasis.

Treatment for Gastrointestinal Cancer

Recently there has been tremendous advancement in all field of cancer-related treatment. The minimally invasive surgery done either by 3D Laparoscopy or Robotic systems has led to decreased discomfort, decreased blood loss, early recovery, less pain and early return to work with no compromise in cancer-related results. Similarly, nanotechnology, improved cancer drugs (chemotherapy), availability of targeted therapy, and immunotherapy have improved patients' longevity and decreased side effects. The recent advancement in the delivery of precise Radiation like IGRT, SBRT and proton therapy have reduced radiation-induced side effects.

Also Read: Cancer Fighting Foods: 4 Best Foods To Add To Your Diet 

Different Therapies for Gastrointestinal Cancer

Depending on the cancer location, a different type of therapy involving Surgery, Chemotherapy and Radiotherapy is given to cure the patient. Depending on the spot, type, or stage of cancer, either one or more of the above therapies in the variable sequence is applied. Sometimes chemotherapy and radiation, either alone or in combination, is given before surgery in locally advanced stages to downgrade the tumour (Neo-adjuvant therapy). Sometimes they are given after the surgery to decrease local recurrence or distant metastasis (Adjuvant Therapy). If cancer is widespread in the body, chemotherapy is the most often treatment given to provide temporary relief or add some extra month or years to life. 

Risk factors for gastrointestinal cancer are:

• A diet consisting of smoked, pickled or salted foods
• Infection with a bacterium called H. pylori
• Family history of gastrointestinal cancer
• Some types of polyps in the stomach
• Low fruit and vegetable food
• Pernicious anaemia
• Persistent gastritis
• Smoking, Old age
• Obesity

Know Why Awareness Is Important In Gastrointestinal Cancer

The most significant need is to create awareness among people and understand the importance of a healthy digestive system. Right now, do you know there is a lack of awareness among people regarding GI cancer? There is a need to create an entire ecosystem of care for patients. Under this ecosystem, early screening of patients, treating patients with modern methods, and better care to reduce their pain should be encouraged. We can reduce our risk by taking the following steps:

• Eat a healthy diet that is particularly rich in fibrous fruits, vegetables and whole grains while avoiding processed food.
• Do regular physical activity and exercise
• Gastrointestinal Cancer and COVID-19
• Keep your weight under control
• Get H. Pylori infection treated
• Avoid smoking and tobacco
• Do not consume alcohol

Gastrointestinal Cancer and COVID-19

This COVID-19/coronavirus pandemic has taken its toll on Cancer treatment also. The scare of COVID has led to delayed cancer-related consultations, and delayed attention to cancer patients due to logistic reasons has led to the advancement of stages. Also, their apprehension of getting Coronavirus infection during immunosuppression in patients on chemotherapy. However, the hospitals and treating specialists take comprehensive care to prevent disease in these patients by screening every cancer patient, sanitizing everything, and segregating COVID patients' movement.

Takeaway Tips

GI cancer grows slowly as a silent killer and affects the body's internal organs such as the large intestine, rectum, food pipe, stomach, kidneys, gallbladder, pancreas or digestive gland, small intestine, appendix and anus. 

• Correct treatment with the timely investigation: As a patient, the symptoms should be taken seriously, and the gastroenterologist should be shown on time. Testing facilities include faecal result blood tests, non-invasive methods such as abdominal ultrasonography, CT scan, and MRI. This makes treatment much more manageable.
• Lifestyle changes necessary: To control the initial symptoms of the disease, doctors recommend lifestyle changes. This includes taking nutritious food, exercising etc. In this, timely examination of patients cannot be ignored at all.
• Innovative methods of investigation: These can vary depending on the status and symptoms of GI cancer disease. To differentiate between them and to detect specific types of cancer, it is essential to examine the patients as soon as possible. With the help of colonoscopy, doctors can look at the gallbladder. This helps them detect certain types of cancer. This makes treatment much more comfortable.

(Inputs By - Dr Pradeep Jain, Director, GI Oncosurgery, Fortis Hospital, Shalimar Bagh)

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