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Gastrointestinal (GI) Cancers

By Dr. Sandeep Batra in Cancer Care / Oncology

Oct 25 , 2021 | 2 min read

Gastrointestinal Cancer is a collective term used to describe cancers that affect the digestive system. Worldwide, the most commonly diagnosed GI cancers include: colorectal cancer (CRC), gastric cancer, liver cancer, esophageal cancer and pancreatic cancer.

LLess common GI cancers include those affecting the anus, appendix, bile duct, gallbladder and small intestine as well as GI neuroendocrine tumors (NETs) and stromal tumors (GISTs)

Disease Burden:

GI cancers are responsible for more cancer-related deaths than any other type of cancer. In 2020, they accounted for an estimated 3.5 million deaths worldwide, with a further 5.0 million new cases diagnosed in the same year.

CRC is the most common type of GI cancer, with 1.9 million new cases diagnosed worldwide in 2020, making it the third most common of all organ cancers, after lung and breast.

CRC:

CRC occurs when a growth in the lining of the large intestine (colon), or at its end (rectum), becomes cancerous. It is one of the leading causes of cancer-related deaths in men and women, worldwide.

Approximately 25% of patients with CRC present with metastases at the time of initial diagnosis, and almost a half go on to develop metastases at some point, contributing to its high mortality rate.

Common symptoms include: changes in bowel habits, general or localized abdominal pain, weight loss without other specific causes, weakness, iron deficiency and anemia.

Risk factors include age, inflammatory bowel disease, family history, elevated body mass index, reduced physical activity, alcohol consumption and cigarette smoking, as well as a number of dietary factors. High consumption of processed and red meat is thought to contribute to increased risk, while high fruit and vegetable intake is thought to confer protection.

Management:

Early stage:

Colon cancer: surgery is the standard of care, followed by adjuvant chemotherapy

Rectal cancer: a curative treatment approach is possible based on surgery, often with a mix of chemotherapy & radiation

Stage 4 disease: Numerous genes and pathways are implicated in disease initiation and the treatment decision is based on the molecular profile of the tumor, prior therapy, treatment tolerability and treatment goals. Targeted therapy and immunotherapy have improved the dismal survival outcomes associated with advanced stage 4 disease

Gastric cancer:

The prevalence of gastric or stomach cancer varies significantly in different regions of India. Common symptoms include: weight loss, dysphagia, dyspepsia, vomiting, early satiety and/or iron deficiency anemia. Obesity is some times associated with cancers of the cardia or proximal stomach. Reflux is associated with cancers occurring at the gastroesophageal junction

Management:

For very early tumors: endoscopic resection is appropriate For locally advanced disease perioperative therapy is recommended

For metastatic disease: Doublet or triplet agent chemotherapy is recommended, in case tumor is positive for markers which favor targeted therapy, the same is given along with chemotherapy

Liver cancer:

Liver cancer is the third most common form of GI cancer. There are two major subtypes: HCC and the Bile duct cancer. HCC is the more common of the two, with rates increasing globally for the last 20 years (and predicted to continue to increase until 2030)

Common symptoms include: pain, fatigue, weight loss and jaundice

Risk factors include: alcohol abuse, chronic liver disease, liver cirrhosis and hepatitis infection

Management:

Patients with advanced disease: Oral tablets (Tyrosine Kinase Inhibitor-TKI), immunotherapy and anti VEGF therapy have been able to improve the survival and quality of life of advanced stage patients. For patients with end-stage disease, best supportive care (BSC) is recommended to improve and sustain the quality of life