FAQs on GI Cancer

What is a cancer?

Cancer, also known as a malignant tumor in medical terms, is a disease in which cells of any part of body divide without control and form tumors. These cancers can spread in many ways, directly to nearby areas, via lymphatic's to lymph nodes and via blood to distant (far off) organs.

What causes formation of a cancer ?

Cancers are primarily an environmental disease with 90-95% of cases attributed to environmental factors and 5-10% due to genetics. It is nearly impossible to prove what is the specific cause of a cancer in any individual, because most cancers have multiple possible reasons. Common environmental factors that contribute to cancer death include tobacco (25-30%), radiation (both ionizing and non-ionizing), (10%), stress, lack of physical activity, and environmental pollutants.

What are GI Cancer ?

Gastrointestinal (GI) cancers which arise in organs of gastrointestinal tract like cancers of Esophagus (food pipe), stomach, small intestine, large intestine (colon and rectum), and related organs like liver, pancreas and biliary tract (gall bladder and bile ducts)

Are they common in India ?

These cancers are not uncommon and the incidences of these cancers are growing except stomach cancers.

What are the symptoms ?

Though there are no specific sign or symptoms which conclusively point towards cancers, there are strong indicators like lump in abdomen, difficulty in swallowing, severe loss of appetite and weight, prolonged bleeding from the GI tract (Bleeding per rectum in elderly age group), alteration in bowel habits, painless deep jaundice with white colored stools and itching, Intestinal obstruction in elderly, sudden detection of Diabetes with weight loss etc.

What are the investigations ?

There are no authentic tests to detect cancer in normal patients. However, when symptoms are there or in high risk patients various tests are employed as prescribed by doctor. In GI cancers investigative modalities for diagnosis or staging are Ultrasound, Upper or Lower GI Endoscopies, CT Scans , MRI test, Endoscopic ultrasound, PET scan, Tumor markers (though not very specific , but different markers are secreted by different tumors), Biopsy etc . Not all tests are required in all cancers. Sequencing of tests is decided by treating doctor.

What are tumor markers ?

Tumor markers are the substances present in the blood, urine or body tissues that are elevated in particular cancers. Different tumor markers are raised n different cancers. There are many different tumor markers, each indicative of a particular disease process, and they are used to help detect the presence of cancer. An elevated level of a tumor marker can indicate cancer; however, there can also be other causes of the elevation. Also note that absence of the tumor markers, the specific cancer cannot be ruled out. Hence they are of limited significance with a few exceptions. The most common use of tumor markers is in the follow up period after a specific therapy.

Can we detect a cancer at an early stage ?

As all the organs related to the gastrointestinal (GI) tract are inside the body and are not visible on the outside except the anus, these cancers are difficult to detect in earlier stages. For this reason these tumors are usually detected in advanced stages (GI cancer produce symptoms only when they have grown to a significant size causing blockage or bleeding) or when spreads all around. They are sometimes detected in early stages either by chance on investigations for other purposes or when screening is done in high-risk patients or population.

Does it spread from one person to another ?

No, not at all! Cancers do not spread from one person to other like any infectious diseases.

Are GI cancers curable ?

If a cancer is diagnosed at an earlier stage almost all cancers are curable, whereas the chances of a cure decrease if diagnosed at an advance stage. In advanced stages, your doctor can employ multiple modalities like surgery, chemotherapy or radiotherapy either alone or in different combination to maximize the chances of cure. If the patient cannot be cured of the cancer, the aim of the treatment is to improve the quality of life until the patient survives and to aim for maximum longevity of life. "Cure" for cancer is measured in 5 year disease free survival i.e. if a patient survives for more than 5 years free of disease, he or she is considered to be "cured". Any patient treated for cancer should remain in lifelong follow up with his doctor to pick up any rare recurrences early, thereby planning further treatment.

What are the treatments available for cancer ?

Three kinds of treatment are used to treat cancer :
  • Surgery - Taking out the cancer in an operation.
  • Chemotherapy - Using anti-drugs to kill cancer cells.
  • Radiation therapy - Aiming high-energy rays at the cancer to destroy it.
These modalities can be used either alone or in different combination to achieve the best possible outcome for a specific patient. Even if the disease cannot be cured, these can be used to prolong life and give good quality of life as much as possible. Other therapies used for the palliative purposes (relief of symptoms) are radiofrequency ablation (killing tumor with the use of radiofrequency waves), cryotherapy (by freezing tumor), ethanol injections in to the tumor, chemoembolization (blocking the blood supply to the tumor), Palliative stenting (putting stents) in esophagus, duodendum, bile duct, colon to relieve obstruction.

Does the cancer spread faster once operated ?

No, this is a myth! It does not spread any faster than it would have done otherwise, if appropriately trained experts perform the surgery.

What is Chemotherapy ?

Chemotherapy drugs are designed to kill rapidly dividing cells (cancer cell divide rapidly without any control). These are given before or after the surgery to decrease the chances of spread and/or recurrence. They are also used alone in disseminated tumors for palliative purposes. They have certain side effects that can be minimized by taking preventive measures. The newer drugs are relatively well tolerated. Most of these are temporary and fade away with time.

What is Radiotherapy ?

Radiotherapy is use of high energy waves to kill cancer cells. This is also used either before or after surgery to decrease chances of local recurrence. Radiotherapy along with chemotherapy can also be used for some GI cancers in patients who refuse surgery (though most of the times it's are not curative).

Does cancer run in families ?

Yes some cancers like colorectal cancers (cancer of large intestine), stomach and pancreas can run in families.

Which doctor is best for my cancer surgery ?

An adequately trained gastrointestinal surgeon is best suitable for treating gastrointestinal cancers.

What can I do to increase my chances for cure?

As soon as the cancer is diagnosed it should be treated by relevant doctors, treatment should be completed in regular fashion without interruption. Regular follow up is must to detect recurrences early so that intervention can be done at the earliest to increase the chances of cure further.

Is Laparoscopy is a Good option for treatment of my G I Cancer ?

Laparoscopy has come in a big way in abdominal surgeries. Laparoscopic cancer surgery is very much feasible and safe with good oncological outcome. In fact laparoscopic colorectal surgery can be considered better than open surgery. But one should be cautious to get laparoscopic surgery by trained laparoscopic GI Cancer surgeons.

When will I know that my cancer is cured ?

After completing the advised therapy, patient is kept in close follow up atleast for 5 years. Patient can be considered cured of cancer if there is no recurrence during this period as recurrence after this period is extremely rare.