Screen the unseen: Time to fight GI cancer with early diagnosis & treatment

New Delhi: Although most people seem to be aware of common lifestyle diseases such as diabetes, hypertension and heart failure, most of the population has never even heard about gastrointestinal (GI) cancer. The unawareness coupled with lack of screening programs has pushed the disease to be among the most prevalent kinds of cancer in India.

Last year, 57,394 new cases of GI cancer were documented in India. Affecting more men than women, GI progresses slowly as a silent killer, affecting internal organs such as colon, rectum, esophagus, stomach, liver, gallbladder, pancreas, small intestine, appendix, and anus, etc. From difficulty in swallowing, discomfort in the abdomen to persistent indigestion and dark stools with or without blood, most patients do not consider opting for immediate screening of these symptoms. Why? Since most of these symptoms are related to lifestyle factors such as smoking, drinking, fast-foods and a lack of physical activity, patients usually indulge in self-diagnosis. What it leads to is, advance the progression of GI disease from benign to the malignant stage making it difficult to treat.

The time, therefore, is right to address the rising patient numbers by focusing on key areas such as regular screenings and raising awareness about the importance of a healthy digestive tract. Thanks to the efforts of the World Gastroenterology Organisation (WGO), we celebrate World Digestive Health Day (WDHD) on the 29^th of every May to initiate a yearlong public health campaign focusing upon a specific medical condition, its symptoms, modes of prevention, diagnosis, and treatment. The theme this year is “Early Diagnosis and Treatment of GI Cancer”. Considering that there is a lack on the insights of GI cancer among the population, there is a need to build a holistic ecosystem of medical care that encourages early diagnosis and supports the treatment with advanced palliative care.

Speaking about the disease, Dr Sharat Putta, Consultant Gastroenterologist & Transplant Hepatologists, Krishna Institute of Medical Sciences, Secunderabad said, “Early detection of cancer is the cornerstone of strategizing ways to manage and control the symptoms.  Technological advancement is a key that enables us to detect the presence of cancer in the initial stages. Take, for example, the case of gastric cancer. Although the prognosis of gastric cancer is limited but curing the disease in the benign stage is possible. With the help of advanced procedures such as endoscopy and techniques such as chromoendoscopy, a doctor can detect, manage, and treat gastric cancer”.

While screening is one of the elements in the effective management of GI cancers, certain patients with associated complications such as obstructive jaundice require more sophisticated screening. For instance, a CT scan, an MRI or an ERCP cannot confirm the presence of bile duct cancer. Hence, the doctors require smarter clinical procedures to have a direct visualization of the duct to extract tissue for biopsy and recommend correct treatment plan. Enter cholangioscopy.

Marking a shift from existing technologies, a leap in the screening of gastrointestinal diseases, cholangioscopy has emerged as one of the most trusted ways to detect initial signs of GI cancers. “As a minimally invasive procedure, the procedure entails a doctor using a thin, flexible tube with a tiny 1mm-wide video camera at the end to carefully observe the inner lining of the bile duct. In case of finding a suspicious area, the doctor will extract a small piece of tissue from the site through biopsy for laboratory examination. Cholangioscopy is an extremely safe procedure allowing a caregiver to even differentiate between the kinds of cancers,” says Dr Mahesh Goenka, Director, Institute of Gastrosciences, Apollo Gleneagles Hospitals, Kolkata and President, Society of Gastrointestinal Endoscopy of India.

While GI cancer can be managed with regular screenings and smarter medical interventions such as cholangioscopy, a major gap remains i.e. unawareness. For instance, doctors around the world still feel that a lot more needs to be done to make the diagnostic solutions a common knowledge to the masses.

According to Dr Rajesh Puri, Director, Gastroenterology, Institute of Digestive and Hepatobiliary Sciences Medanta – The Medicity “People in developed countries opt for screening programs at regular intervals which aids in early detection of GI cancer. However, India still lacks easy accessibility to screen GI cancer in the initial stages compared to its western counterparts. The lack of initial screening programs in India leaves no scope for accurate data collection. This, in turn, leads to 90% of the patients being diagnosed with GI cancer at an advanced stage.