Gastrointestinal (GI) cancer is a flock term used to describe cancers that affect the digestive system. It includes colorectal cancer (CRC), gastric cancer, liver cancer, esophageal cancer and pancreatic cancer. It has been reported to be a highly prevalent malignancy in Kashmir.

In conversation with Rising Kashmir’s Health Correspondent Mansoor Peer, Senior Consultant at American Oncology Institute (AOI) Acharya Shri Chander College of Medical Sciences (ASCOMS) Jammu, Dr Vikas Roashan, talks about causes, symptoms, screening, treatment and impact of GI tract cancer.

Excerpts!

What is Gastrointestinal cancer?

GI tract cancer is a flock term used to describe cancers that affect the digestive system. It includes colorectal cancer (CRC), gastric cancer, liver cancer, esophageal cancer and pancreatic cancer. Less common GI cancers include those affecting the anus, appendix, bile duct, gallbladder and small intestine, GI neuroendocrine tumours (NETs) and stromal tumours (GISTs), which are set apart by their cell type of origin.

What are its risk factors?

Some factors that increase the risk of stomach cancer include: Gastroesophageal reflux disease (GERD), obesity, increased salt intake and high intake of smoked food, less intake of fruits and vegetables, family history of malignancies, infection with Helicobacter pylori, long-term stomach inflammation, smoking, alcohol and polyps.

What are the ways to prevent it?

Fruits and vegetables should be added to diet each day. Choose a wide variety of colourful fruits and vegetables. Maintain a healthy weight. If you are obese, try to make strategies to reduce weight. Try to plan exercises to reduce weight. The recommended duration of exercise is 150 minutes per week.

Reduce the salt and smoked foods. Protect your stomach by limiting these foods. These foods contain harmful chemicals that lead to the development of cancer.

What is the role of smoking in GI cancer? Is it a contributing factor?

Smoking increases your risk of stomach cancer, as well as many other types of cancer. Quitting smoking is very difficult, so ask your doctor for counseling. Quitting smoking needs counseling and help from doctors.

Should people with a strong family history of stomach cancer consider tests, such as endoscopy, to look for signs?

The stomach has much space, so in the early stages of stomach cancer, many patients experience few or no symptoms. Because of this, stomach cancer is difficult to detect, and physicians often detect the disease at more advanced stages because of this point, it is more challenging to treat.

A team of stomach cancer experts will use various tools and tests designed to diagnose stomach cancer, evaluate the disease, and develop your individualized treatment plan.

In addition, laboratory tests will be done throughout your treatment, and imaging tests will be used to look at your response to treatment and modify your plan when needed.

How much time does it take to develop stomach cancer?

The stomach cancer doubling time is roughly 11 months for early lesions and six months for advanced stages. Within three years, the early stomach cancer progresses to advanced cancer. In the early stages, 50% of patients survive.

What should a patient do if diagnosed with such cancer?

After initial diagnosis, the patient should undergo blood tests, local endoscopy, metastatic evaluation to see whether the disease is localized or metastatic, and finally, depending upon histopathology, treatment is started. The patient should eat well during treatment and maintain healthy weight.

What are tips for the general population to avoid gastric/stomach cancer?

The message to the general masses is to avoid risk factors like smoking, cut the alcohol intake, maintain weight, increase fruit and vegetables in diet and do exercises regularly.

There are many myths in society about cancer patients? What is your message to the people?

There is a common myth that we should cut sugar intake during cancer treatment as cancer uses sugar for growth, but this is not so; carbohydrates should be taken as per body weight and requirement. They are just patients. We need to give them more love and care.

How to reduce the cancer burden?

Thirty to fifty percent of cancers can be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies. The cancer burden can also be reduced through early detection of cancer and appropriate treatment and care of patients who develop cancer. Many cancers have a high chance of cure if diagnosed early and treated appropriately. 

What is the treatment available in J&K for stomach cancer?

There are different types of treatment modalities for patients with stomach cancer. Seven types of treatment are used for stomach cancer management which includes Surgery, Endoscopic mucosal resection (EMR), Chemotherapy, Radiotherapy, Chemo-radiation, Targeted therapies and Immunotherapies.

Newer treatment techniques are being tested in different clinical trials (not available in J&K).

Some treatments are standard (the currently used), and some are tested in clinical trials. A clinical trial is a study to help improve current treatments schedules or obtain vital information on new treatment techniques for patients with cancer. When clinical trials reveal that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Therefore, patients may want to think about participating in a clinical trial. Some clinical trials recruit only patients who have not received any cancer management.

Different types of treatments which are available for patients

Surgery

Surgery is a common treatment technique for all stages of gastric cancer. The following types of surgery may be used:

• Subtotal gastrectomy when a surgeon removes a stomach part containing cancer, nearby lymph nodes, and parts of other tissues and organs near the tumour.

• Total gastrectomy involves removal of the entire stomach, nearby lymph nodes, and parts of the food pipe, small intestine, and other tissues near the tumour.

If the tumour is blocking the stomach, but cancer cannot be completely removed by standard surgery, the following techniques may be used:

Ø Stent placement: A Technique to insert a stent (a thin, expandable tube) to keep a passage (such as arteries or the esophagus) open. For tumours blocking the passage of the stomach, the operation may be done to place a tube from the food pipe to the stomach or from the stomach to the small intestine to help the patient eat normally and maintain weight.

Ø Endoluminal laser therapy: This is a procedure in which an endoscope (lighted tube) with a laser attached to it is inserted into the body. This laser will act as a knife to remove cancer.

Ø Gastrojejunostomy: A procedure in which part of the stomach along with cancer is removed which is blocking the passage and ends are connected. This allows food and medicine to move from the stomach into the small intestine.

Endoscopic mucosal resection (EMR)

Endoscopic mucosal resection is a technique that uses an endoscope to remove early-stage cancer from the inner lining of the digestive tract. An endoscope is a thin tube with a light source and lens for viewing.

Chemotherapy

Chemotherapy is a cancer treatment technique that uses medicines to stop cancer cell proliferation. It stops cancer growth by killing cancer cells. Chemotherapy is generally given intravenously (through vein via drip set) or through the mouth. The drug reaches the tumour through the bloodstream. The chemotherapy is given depending upon the stage, aggressiveness of disease and type of cancer being treated.

Sometimes regional chemotherapy is used, also called intra-peritoneal chemotherapy. Anticancer drugs are directly placed into the peritoneal space through the tubes in intraperitoneal chemotherapy.

Surgeons are using HIPEC after completing surgery in which warmed chemotherapy is directly delivered into the peritoneal cavity.

Radiotherapy

Radiotherapy is a cancer treatment technique that uses high energy x-ray or other types of radiation in order to treat cancer. It acts by killing tumour cells; there are two techniques of radiation treatment delivery, external beam radiotherapy and brachytherapy. For GI cancers, generally, EBRT is used.

Chemoradiation

Sometimes radiation is combined with chemotherapy to enhance the effect of both modalities. This technique improves the action of radiation.

Chemoradiation can be added before surgery or after surgery for cancer management. It is given after surgery to reduce the risk of local recurrence. When given before surgery, chemotherapy helps shrink the tumour and helps the surgeon remove cancer.

Targeted therapy

In targeted therapy, medicines are used to identify and attack specific cancer cells. Targeted therapies usually do less harm to normal cells than chemotherapy or radiation therapy. The Monoclonal antibodies and multi-kinase inhibitors (MKI) are types of targeted therapy used in the treatment of stomach cancer.

Monoclonal antibodies

Monoclonal antibodies made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these proteins can attach to a particular target on cancer cells that may help cancer cells grow. The antibodies can kill the cancer cells, block their growth, or stop them from spreading. Monoclonal antibodies are given by intravenous route. Targeted therapy can be used alone and sometimes, in combination with other carry drugs, chemotherapy or radioactive material.

There are different types of monoclonal antibodies

· Trastuzumab (Herceptin) blocks the effect of the growth factor protein HER2, which sends regulatory growth signals to gastric cancer cells.

· Ramucirumab blocks the effect of particular proteins, including vascular endothelial growth factors. This may help keep cancer cells under check and may kill cells also. It also prevents the growth of new blood vessels that cancer needs to grow.

Trastuzumab and ramucirumab are given to treat stage IV gastric cancer and gastric cancer that cannot be removed by surgery or has recurred.