GASTROINTESTINAL CANCER PART-1
Welcome to the first part of educational series on GastroIntestinal Cancers. In last issue of GMJ, concluding 14th part of Breast Cancer series was published.
Question: Thank you Dr. Chiragbhai Shah. Our readers learned a lot from your series on breast cancer. It helped to clarify concepts for many and provided significant awareness on this issue. I am glad that you have decided to continue writing. May I ask why you have chosen this topic, and not your current interest i.e. stem cell transplant?
Answer: Thank you. I am also happy to continue writing for this highly educated group of readers. Many of whom inspire me with their excellent work in respective fields. This is my small effort to create awareness and provide information to assist busy doctors in making right decisions for their patients.
My goal therefore is to first choose topics of wider interest, with more incidence, more impact on mortality and morbidity. As you have mentioned, stem cell transplant is my recent interest but I take care of many more patients with solid tumors like breast, GI, head/neck and other cancers and they are equally challenging and important.
Que: How important is this topic?
Ans: GI cancers include esophagus, stomach, intestine, colon, rectum, anal canal, hepatobiliary, pancreas.
Nationally, Stomach is second most common cancer. In Gujarat, esophagus is 5th most common cancer in both men and women. Thus, if all GI cancers are taken together, they account for a large number. Interestingly, there is significant regional variation, e.g. esophagus is first in men in Nagpur registry, gall bladder cancer is significantly more common in North India, Stomach more common in South India.
Also, most are diagnosed late and are difficult to treat.
Que: Why are they diagnosed late?
Ans: Many of these present with nonspecific GI symptoms and hence ignored for long. Imaging studies/endoscopy for diagnosis are often done late or are not widely available or are not interpreted properly.
Important symptoms/signs/clues like GI bleed, melena, persistent (over 3-4 weeks) abdominal pain, dysphagia, altered bowel habits – new persistent constipation or diarrhea, jaundice, iron deficiency anemia in an adult especially men, positive stool for occult blood, weight loss should be evaluated thoroughly. These do not always mean a GI cancer, but frequently lead to an early diagnosis, which is so important for saving a life.
Que: What tests are recommended for early diagnosis?
Ans: Most important is not to ignore above noted signals. Thereafter, tests depend upon specific subsite. However I would like to mention that a good sonography, and/or endoscopy can diagnose most cases early. Barium studies can be used as initial tool (although not enough) only if endoscopy is not available. When feasible, CT scan is a better test. Newer imaging modalities provide additional benefit. Importantly, tumor markers should not be used for initial diagnosis, except in case of primary liver cancer. Just remember SONOGRAPHY/CT and ENDOSCOPY.
Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA), 98243 12144, 98988 31496
Diplomate American Board of Oncology and Hematology. Ahmedabad.
Shyam Hem-Onc Clinic. 402 Galaxy, Near Nehrunagar Circle, Ahmedabad.
98243 12144; 98255 78080 (Dr. Munjal Pandya). firstname.lastname@example.org