Although there is no guarantee that someone may not get either stomach or esophageal cancer, there are definite links between certain factors that increase the chances of getting them. Hence it is important we understand them and act accordingly.
Tobacco and alcohol are the most important factors that can increase the chance of developing esophageal cancers in addition to contributing to other cancers such as the lung, liver, pancreas etc. Hence avoiding or reducing the intake of alcohol and tobacco in any form will be a healthy step forward in attacking the fight against cancer.
Injury to the esophagus as a result of corrosive (acid, alkali) ingestion multiplies the risk of one getting esophageal cancer. Similarly Barrett’s esophagus that is a result of long standing gastro esophageal reflux disease (GERD) has a higher chance of cancer transformation than the native esophagus. GERD is predominantly an increasing problem with modernization of our lifestyle, dietary habits and sedentary lifestyle. Obesity, which is a global epidemic, is also associated with an increased incidence of esophageal cancer. Hence avoidance of alcohol, tobacco, adopting a lifestyle with healthy dietary patterns and frequent exercise that will decrease the chance of GERD and Obesity will all go a long way in promoting health and preventing cancer.
Cancer of the esophagus or stomach can be diagnosed at an early stage only if patients seek the attention of the doctor with symptoms. For that to happen, the major obstacle in India is the lack of awareness in the general population as to who should approach a doctor and when. Symptoms that should alert the common man to the possibility of cancer in the stomach or esophagus include:
• Difficulty in swallowing
• Loss of appetite
• Loss of weight
• Prolonged persistent vomiting
• Lump in the abdomen (tummy)
• Vomiting blood or passing black colored motion
The above symptoms warrant urgent attention and investigation especially in people over the age of 50. Investigations would include some simple blood tests and an endoscopy to look into the inside of the esophagus and stomach.
Upper Gastrointestinal (Upper GI) endoscopy is very sensitive in ruling out the presence or absence of cancer and is also useful in diagnosing other problems like ulcers, acid damage and infections which can be treated with appropriate medicines. Hence an endoscopy is strongly advised in the presence of the above symptoms in all age groups and more importantly in people above 50 years of age.
TREATMENT OF CANCERS OF THE STOMACH AND ESOPHAGUS
Once the disease is confirmed, it is followed by assessment of the spread of the disease, to find if the cancer is at an early or advanced stage. The investigations usually involve CT scans and or some specialized form of scanning and X rays. Once the stage of the cancer is verified the Oncology team which usually comprises of Gastroenterologists, Surgeons, Medical and Radiation Oncologists collaborate on which would be the best treatment suitable for the patient at that particular stage of disease. Very early stages of cancer are potentially curable and complete surgical removal of the cancer with the associated organ involved (partial or complete) is all that may be necessary. Radiation and Chemotherapy alone may be curative at certain sites such as the upper esophagus. However, when the disease is not at an early stage, combined modality of Surgery, Chemotherapy and Radiotherapy may be necessary, and that will be decided by the team treating the patient. This could still result in a cure when aggressively and appropriately managed by a multidisciplinary team at specialized centres that have the team of doctors and facilities to offer these combination therapies. Following the completion of treatment, it is essential that the patients are regularly followed up and seen in the clinics at regular intervals. They may also need scans at specified intervals to look out for recurrence (coming back) of the cancer. Advanced cancers that are beyond a stage of cure are usually managed by placements of endoscopic metal stents to help the swallowing process with or without chemotherapy.