Vigilance required in early detection of stomach, oesophageal cancers

Optimal management of digestive health especially in detecting stomach and oesophageal cancers in the early stages calls for proactive care, say experts.

“Early detection is crucial, but because stomach and oesophageal cancers often present with non-specific symptoms which are often overlooked, they are frequently diagnosed in advanced stages,” said Dr Hafizah Zaharah Ahmad, consultant clinical oncologist. According to the Ministry of Health, late-stage cancer diagnoses—stage 3 and 4—have increased to 65.1 percent as documented in the National Cancer Registry Report 2017-2021. [https://www.moh.gov.my/index.php/database_stores/attach_download/657/2548] Hafizah noted that cancers diagnosed in the late stages drastically reduce the survival rate of patients (Table 1). Therefore, early symptom recognition is crucial in detecting cancers of the digestive tract.

Table 1: The 5-year survival rate for stomach and oesophageal cancers.

While stomach cancer primarily affects the stomach’s main body, oesophageal cancer develops in the oesophageal epithelial lining and is often associated with Barrett’s oesophagus due to chronic acid reflux. “The symptoms of both cancers can be similar, particularly when the tumours develop at the gastroesophageal junction,” said Hafizah.

Symptoms that may indicate stomach and oesophageal cancers:
·       difficulty in swallowing (dysphagia)
·       unexplained weight loss
·       loss of appetite
·       persistent heart burn and indigestion
·       nausea or vomiting
·       chest or upper abdominal pain

Older persons are at a higher risk of stomach and oesophageal cancers, with about 60 percent of new cases diagnosed in those aged 65 and above. Apart from advanced age, lifestyle choices and underlying conditions also lead to a higher risk. Consultant gastroenterologist and hepatologist, Dr Tan Yu Peng highlighted that individuals with high-risk lifestyles should be regularly screened.

“Those who smoke heavily, chew betel nuts, frequently consume very hot liquids, binge drink alcohol, or regularly eat preserved foods are more susceptible to squamous oesophageal cancer which starts in the thin, flat cells lining the oesophagus,” said Tan. On the other hand, obesity, smoking, chronic gastroesophageal reflux disease (GERD), and Barrett’s oesophagus are risk factors for oesophageal adenocarcinoma, which starts to form in the glandular cells lining the lower oesophagus near the stomach.

For stomach cancer, the risk factors include GERD, high-fat and low-fibre diets, frequent consumption of smoked foods, and Helicobacter pylori infection. Infection caused by H. pylori bacteria in the stomach lining leads to gastritis and increases the risk of peptic ulcers and stomach cancer. Individuals with a family history of stomach cancer should be regularly screened to manage their risk.

Risk factors for stomach and oesophageal cancers:
·       Family history
·       Age ≥65
·       Smoking
·       Betel nut chewing
·       Frequent consumption of very hot liquids, and preserved and smoked foods
·       Excessive consumption of alcohol
·       Obesity
·       Chronic GERD
·       Barrett’s oesophagus
·       High-fat and low-fibre diets
·       Helicobacter pylori infection

 
Patients with chronic GERD, a condition where stomach acid frequently flows back into the oesophagus, experience oesophageal irritation and a higher risk of Barrett’s oesophagus, a precancerous condition where the oesophagus undergoes abnormal changes. Smoking, overeating, and excessive consumption of alcohol and caffeine can worsen GERD. While lifestyle modifications and medication often provide relief, Tan emphasised that persistent or worsening symptoms may require endoscopic or surgical intervention such as fundoplication that involves wrapping the top of the stomach around the lower oesophagus to strengthen the lower oesophageal sphincter and prevent acid reflux.

Endoscopy useful in early detection
Endoscopic procedures such as gastroscopy and colonoscopy have significantly improved the ability to diagnose and treat gastrointestinal conditions. According to Tan, these procedures allow doctors to detect any abnormalities at an early stage and facilitate timely intervention. Gastroscopy enables investigation of the oesophageal and stomach lining, while colonoscopy can identify potential cancerous growths or inflammation in the colon.

Regular endoscopic screenings are strongly recommended for individuals aged above 50 and those above 40 with a family history of gastric or colorectal cancer, said Tan. In Malaysia, screening is primarily focused on individuals with gastric issues, a strong family history of cancer, or those experiencing warning symptoms for cancer such as difficulty swallowing, bleeding, unexplained weight loss, or abdominal pain.

“Treatment for stomach and oesophageal cancers often overlaps, especially for tumours at the gastroesophageal junction, with surgery, chemotherapy, and radiation therapy being the standard approaches depending on the stage and location of the cancer,” said Tan. Immunotherapy is promising for advanced oesophageal cancer, particularly in PD-L1-positive tumours, since it improves survival rates when chemotherapy is ineffective. In stomach cancer, targeted therapies are increasingly used for patients with specific genetic mutations, such as HER2-positive cases, which account for 10 percent to 20 percent of stomach cancers. In these cases, anti-HER2 therapy has been proven effective in slowing tumour growth and improving patient outcomes.

Reassuring caregivers
It is important to note that a cancer diagnosis affects the patient as well as their loved ones who become their caregiver. While a cancer diagnosis drastically changes the life of the entire family, adaptation and support help them cope. Caregivers should be gently reassured that life does not end with cancer, and patients can still find joy and fulfilment during and after treatment.

Caregivers should be guided on making simple adjustments such as liquid-based and pureed diets, which can help patients with stomach and oesophageal cancers maintain their nutrition while enjoying their meals despite having difficulty in swallowing. Support and encouragement for patients are also invaluable since their mental and emotional well-being play a crucial role in navigating the treatment process.

In summary, early detection, lifestyle modifications, and routine screenings are key in improving outcomes for stomach and oesophageal cancers. The high rate of late-stage diagnoses underscores the need for greater awareness. Individuals should be advised to take proactive steps such as staying informed, recognising symptoms early, and prioritising regular screenings in safeguarding their digestive health, enabling better health outcomes and improving overall quality of life.