GASTROINTESTINAL CANCER PART-2
Welcome to the second part of educational series on GastroIntestinal Cancers. In last issue of GMJ, we started series on GI cancers, and learned that it is very common and since it is in both sexes, overall numbers are very high. Also, there is a wide regional variation in incidence of different GI cancers. We also noted SIGNS AND SYMPTOMS FOR EARLY DIAGNOSIS.
Question: Now Dr. Chiragbhai, we learned about basics of early diagnosis last time. But what leads to GI cancers?
Answer: GI cancers include seven major subsites. And as we saw last time, there is a wide variation in regional incidence, indicating differences in risk factors. Each subsite behaves like a different cancer, with minimum commonalities. Accordingly known risk factors are also different. Many risk factors are unknown or poorly understood.
Que: What are the known risk factors?
Ans: It is very interesting to note that that risk factors range from infection to addiction to diet to genetics. It is truly very diverse. We will see them in more detail as we take up each subsite separately.
Esophagus – tobacco, alcohol, barrett’s esophagus
Stomach – diet, helicobacter pylori infection, tobacco
Colorectal – diet, genetic syndromes
Liver – Hepatitis B/C, alcohol, aflatoxin B1
Pancreas – little is known
Que: That is truly a wide variation. However diet and tobacco/alcohol seem to be commoner.
Ans: Yes, if we can stay away from tobacco and alcohol, that alone would reduce GI cancer burden remarkably. These are very strong risk factors, and are avoidable. But these habits are difficult to leave. Therefore, it is better to focus on our children and youth, so they do not start these habits.
Diet, of the so called Western type, is also an important risk factor. Our traditional diet is proven to be safer for many cancer prevention, as well as cardiovascular risk reduction – which is high in fiber, and low in fat. Fruits are also important.
Que: Is there any test for healthy people for early diagnosis, as in breast cancer?
Ans: Unfortunately there is no good test. We have to depend on early evaluation of symptoms/signs. For colorectal cancers, stool for occult blood and sigmoidoscopy/colonoscopy are regularly recommended tests in West. They are being used in India also, but their utility is not proven here for mass screening, considering significant differences in incidence/regional variation/other factors.
From 3rd episode, we will discuss each of the seven subsite separately.
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. firstname.lastname@example.org