Upper Gastrointestinal Cancers: What to Do In Rural Areas

Which are the upper gastrointestinal cancers?

esophagusGenerally the cancers of the esophagus and stomach are classified as upper gastrointestinal cancers. Overall the cancers of the gastrointestinal tract and accessory organs like pancreas, liver and gall bladder cause more deaths from cancers than any other system in the body.

How common are these cancers?

Stomach cancer is the fourth most common cancer in the World and the second highest contributor to cancer deaths. Cancer of the esophagus is the sixth most common cancer in the world.

South East Asian countries including India were reported to have lower incidence of Stomach cancers although Mizoram has the highest incidence in India and the other Northeastern states also have high incidence. The incidence is so high in Mizoram that it occupies the fifth position in the World.

What are the risk factors for these cancers?

Infection with H. Pylori is one of the significant risk factors. There is an overwhelming positive association between gastrointestinal cancers and consumption of red meat and fat. Cooking of meat released heterocyclic amines which are carcinogenic [substances that cause cancer]. Pyrolylsates are highly carcinogenic substances that are produced during charcoal cooking or smoke curing of meat. Food kept in plastic containers also could be carcinogenic as they contaminate food with bios phenol. A low intake of fresh fruits and high temperature during cooking result in low levels of Vitamin C. Vitamin C protects against cancers. Vegetarian diet has less chance of cancers unless they consume lot of ghee.

Tobacco consumption in any form especially the “Thoibur” or oral tobacco is a very significant contribution to production of cancers in the gastrointestinal tract. Alcohol intake is another factor that contributes to these cancers.

Pernicious anemia, adenomatous polyps, previous gastric surgery and family history of gastric cancers are also risk factors for stomach cancers.

What are the symptoms of upper gastrointestinal cancers?

Often they do not produce symptoms till they are in an advanced stage. Recent changes in bowel habits and loss of appetite might be early symptoms. Some might notice foul smell of eructation and feeling of fullness even after smaller meals. Mild nausea, loss of appetite and heartburn might be early symptoms. However with advanced disease vomiting, weight loss and blood in stools can appear. Jaundice, stomach pain, difficulty in swallowing, fluid in the abdomen etc. are signs of various advanced cancers.

How are these cancers diagnosed?

The best way of diagnosing these cancers are through endoscopic examination and biopsy of the abnormal areas. In many areas [where the incidence is high or more than 3 percent] routine endoscopy for everyone whether symptomatic or not is advised.

Finding blood in stools [occult blood] could also be used as a screening procedure in areas where the incidence is high. Special x-rays with barium were used earlier and special techniques with ultrasound examinations are also available for diagnosis.

What should be done once diagnosed?

Once the diagnosis is confirmed it is important to stage the disease because prognosis and treatment depend on these. If CEA assay is available high levels would indicate metastasis or spread of the cancer cells. CT scans, PET scans and endoscopic ultrasound examinations are non-invasive ways of staging that might not be very accurate and are expensive for rural surgical patients.

In rural areas laparoscopic diagnosis could be used for staging the cancers [4]. The advantage is that the necessary surgical treatment is possible at the same sitting if either operable or the necessary palliative treatment could be offered at the same time.

What are the surgical treatment options?

The surgical treatment is common to all stages and could be in the form of minimal to extensive removal of the stomach and the surrounding lymph nodes to which the cancer spreads. If these are not possible bypass surgeries are carried out to prevent total block. Recently these surgical treatment are possible with laparoscopic or laparoscopy assisted methods which are better than the earlier open surgical methods.

What are the other treatment modalities?

The other treatment forms include chemotherapy or medicines that have been in use for a long time. Some of them could be effective and these are used if spread of tumour is suspected. It is possible to give the chemotherapy in rural hospitals with the necessary precautions. Radiation therapy is used in large centers but might not be very successful. In recent times specific targeted therapy, chemo-radiation therapy etc. are being tried out.

What are the facilities available at SEESHA?

At Karunya Community Hospital and at the places where SEESHA conducts diagnostic and surgical camps facilities for diagnostic laparoscopic surgery and laparoscopy assisted and open surgical methods are available along with chemotherapy facilities. At Bethesda Hospital in Aizawl along with Apollo Hospital Chennai facilities for laparoscopic gastric surgeries are also available. Diagnostic Gastroscopies available during the diagnostic camps even in remote areas.

gnanaraj Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries.

Image: Scheme of digestive tract, with espohagus marked. Source/Author: Olek Remesz. 21 August 2007. Access the original Image information here: https://commons.wikimedia.org/wiki/File:Tractus_intestinalis_esophagus.svg