Medicine and Surgery have reached great heights in the modern times. Yet, in the realm of Cancer, there remain many challenges to overcome, many battles to fight.
Being armed with reliable information, is one of the first requirements in preparing for that battle. While there is today no dearth of information, discerning the accuracy and reliability of the information that is available from myriad sources has become a problem. Addressing this issue, Dr. Baiju Senadhipan, one of the leading Keyhole Surgeons of India, takes time out to answer some basic questions about a range of medical issues and their solutions.
In this column, Dr Senadhipan has chosen to answer basic questions about Gastro-Intestinal cancer also known as GI cancer. Different forms of GI cancer that occur commonly are discussed separately in separate sections for ease of reference. The questions that are relevant to all sections appear at the head of the article. The information appears in the form of Frequently Asked Questions (FAQs) and answers to those questions in simple words with the endeavour of aiding you in making an informed choice. Hope you find this helpful.
1. What is Gastro Intestinal cancer?
Gastro intestinal cancer also referred to as GI cancer is a type of cancer that affects any part of the gastro-intestinal tract or its related organs that help in digestion. This includes the food pipe, the stomach, the large and small intestines, the liver, the pancreas, the bile duct, the rectum and the anal canal
2. Can GI Cancer be prevented?
In several cases, the origin of the cancer is related to lifestyle or family history. In many of those cases, taking adequate precautions or screening/checking at regular intervals may prevent the onset of cancer.
Those with a family history of a particular type of cancer can and should take steps to prevent it. For instance, if one has a family history of colorectal cancer, one can get a screening done after the age of 50 to detect the early grown of polyps in the lining of the colon and rectum. If found, these polyps can be removed before they become cancerous.
Regular exercise, a healthy lifestyle, balanced weight, reducing red meat consumption, avoiding alcohol and cigarettes may also help in reducing the risk of cancer.
3. Which form of GI cancer is the most common?
There is no single answer to this question. The incidence and type of cancer which is most prevalent varies from region to region. For instance, cases of GI cancer affecting the food pipe and stomach are more common in the northern part of Kerala and Tamil Nadu. However, colorectal cancers are more common in the southern parts of Kerala and Tamil Nadu.
4. How is GI cancer identified?
GI cancer is detected by a process known as Endoscopy. This is a procedure whereby an endoscope which is a viewing instrument attached onto a tube is inserted into the digestive tract allowing the doctor to examine the digestive tract. This is a non-surgical procedure.
In the event cancer is detected during the Endoscopy, the next stage is Cancer Staging. This is done to determine where in the body the cancer is located, where the tumour has originated, how much it has spread, whether lymph nodes are involved, how severe the cancer is etc. This is done with the help of various procedures like physical examination, pathology tests etc. Imaging tests like CT scan, MRI scan, PET Scan etc. are crucial in the process of cancer staging.
5. What are the treatment options for GI cancer?
Once diagnosed, cancer treatment usually involves surgery, chemotherapy, radiation and other measures. Sometimes these methods are employed singly. Sometimes in conjunction with other methods.
Surgery – In most cases, surgery is the primary option of cancer treatment. By surgery, the part of the organ containing the cancer can be removed. This can be done through open surgery or laparoscopically.
Laparoscopy is also known as keyhole surgery as in this method, a laparoscope which is a viewing instrument with a light is inserted into the patient’s body through miniature incisions in the abdomen which is filled with inert gas. The surgeon operates with special tools while viewing the internal parts on a screen before him. While open surgery requires incisions as large as a palm of an adult hand (6-9 inches), a laparoscopic surgery requires miniature incisions of 1 to 3 rice grains size (5-12mm). This translates into lower chances of infection and shorter recovery periods.
In spite of many scientific publications proving that Keyhole Cancer Surgery gives better patient benefits than Open Surgery, only few centers in India such as ours currently perform cancer surgery through laparoscopic methods and it is necessary to select a center where the surgeons are qualified, competent and experienced to perform keyhole surgery for cancer. If the cancer has not spread, surgery is often the only solution required.
Chemotherapy – Chemotherapy is a method of stopping the cancer from spreading. It is done using medicines which kill the cancer cells and stop them from multiplying. This is usually done after surgery.
Radiation therapy – Radiation is a method that uses high-energy X-ray beams to kill cancer cells. This method is used along with surgery when the surgery alone is not sufficient for treatment.
While this section provides a general overview of cancer treatment, scroll down to read treatment options with reference to each specific form of cancer.
The following section deals with the different types of GI cancer that are most common and answers questions relevant to each type of cancer.
FOOD PIPE CANCER
6. What is food pipe cancer and what are its causes?
The food pipe is the organ that connects the mouth to the stomach. It passes through the neck and chest. This is also known as Oesophageal cancer.
There are two major types of cancer that affect the food pipe. It may be squamous cancer i.e. affecting the skin or it may be adeno cancer which is a cancer that forms in the mucus secreting glands of the oesophagus.
Smoked and spicy food play a role in causing this type of cancer. Smoking may also be a factor that contributes to the patient developing this form of cancer.
7. What are the symptoms of food pipe cancer?
The main symptom of cancer affecting the food pipe is difficulty in swallowing. However, this may be observed in the advanced stages while early stages may not appear to have any clear symptoms. Although pain is rare in food pipe cancer, it is more common in the later stages. The patient may also suffer from indigestion or unexplained weight loss.
When one observes cough during swallowing, it may be indicative of infiltration of the cancer to adjacent organs like the lungs.
8. Is Food pipe cancer curable?
If the cancer is detected at an early stage, it is curable. However, if the disease has progressed and it has been diagnosed much later, it may not be curable.
9. What are treatments available?
Treatment for cancer depends on the stage of the disease and the presence of any other disease, illness or complications.
Usually, the treatment options are Surgery, Radiotherapy and/or Chemotherapy as explained above. This may be required by itself or in combination with other procedures.
10. What are the different surgical options available?
Surgery for treatment of cancer in the food pipe involves removal of the food pipe either in part or in full. It is replaced by a tube recreated by taking out a part of the stomach. This can be done in multiple ways. The most common way is by opening the neck, chest and abdomen. Such open surgery approach causes painful and long recovery period for patients.
The same surgery can also be done by the keyhole method where patients experience minimal pain and discomfort during recovery period and get well much quicker compared to open surgery. However, cancer surgery through the keyhole method is currently being done only at about 4-5 centres in India. Our center is one of the key centers routinely performing food pipe cancer surgery through keyhole or laparoscopic methods.
11. What can be done if surgery is not possible or the patient is amenable to surgery?
If the patient cannot be operated upon for some reason, a stent can be put across the tumour to get relief from the problem of dysphagia (difficulty in swallowing) without removing the tumour.
STOMACH CANCER
12. What is Stomach cancer? And what are its causes?
Stomach cancer is the development of cancerous cells within the lining of the stomach. This is also called gastric cancer.
This form of cancer may occur due to the presence of stomach polyps or abnormal grown in the stomach, repeated ulcers in the region, other tumours in the digestive tract etc. While genetic factors cannot be discounted, other factors like smoking, lack of exercise, an improper diet etc. add to the risk associated with stomach cancer.
13. What are the symptoms of Stomach Cancer?
Often, stomach cancer does not have any symptoms at all. Aversion to food is one of the most observable symptoms of stomach cancer. Early satiety or fullness, pain and/or vomiting after meals, vomiting of blood or blood stained stools are other possible symptoms of stomach cancer. Sometimes the patient may suffer from anaemia with no other symptoms.
14. How is stomach cancer diagnosed?
Most often, an endoscopy is done to diagnose stomach cancer. Further process of cancer staging is done by conducting imaging tests such as CT scan, MRI scan, Endoscopic Ultrasound etc.
15. Is stomach cancer curable?
Where diagnosis has taken place early and the patient has received proper treatment, there is a reasonable chance of cure. Stomach cancer has otherwise been observed to be one of the most difficult cancers to cure.
16. How is stomach cancer treated?
The main element of treatment in the case of stomach cancer is Surgery. It is important that the surgery is performed by an experienced surgical team with proper equipment and a sound anatomical knowledge.
17. Can surgery to treat stomach cancer be performed through keyhole methods?
Yes. It is possible to operate for stomach cancer through laparoscopic or keyhole procedures. However, it is important that the surgeon is experienced and the center has the necessary equipment for conducting a laparoscopic procedure. Currently only about 4-5 centres in India have the capability of performing laparoscopic surgery for the treatment of cancer. Our center is one amongst them who have performed a large number of stomach cancer keyhole surgeries with excellent results.
PANCREATIC CANCER
18. What is Pancreatic Cancer and what are its causes?
When cells in the pancreas begin to multiply in an abnormal manner, it results in a tumour being formed in the pancreas. This is pancreatic cancer.
Smoking, drinking, obesity, diabetes and other lifestyle related factors may be responsible for pancreatic cancer. Hereditary factors also have a role to play in increasing the risk involved.
Pancreatic cancer has been observed to be common in the coastal belt of Tamil Nadu. Not so much in Kerala.
19. What are the symptoms of Pancreatic cancer?
Common symptoms of pancreatic cancer are upper abdominal pain after meals, back pain and occasional vomiting. Some patients may suffer from jaundice or experience itching and weight loss.
20. What is the method of treatment in case of Pancreatic Cancer?
Surgery is the primary method of treating Pancreatic Cancer.
Pancreatic surgery is one of the few complex surgeries performed in the abdomen region. It requires a professional surgical team with a deep anatomical understanding of the area with particular experience in performing pancreatic surgery.
This surgery can also be done using keyhole methods provided the surgeon is well experienced in both conventional and laparoscopic pancreatic surgery. There are currently only about 4-5 centres that are capable of performing keyhole surgery for cancer in India. We are one amongst them who have successfully performed a large number of Keyhole Pancreatic Surgeries with excellent long term results.
Radiation and chemotherapy are also selectively used in pancreatic cancer.
LIVER CANCER
21. What is a liver cancer?
Liver cancer involves the presence of a tumour in the liver. The tumour may be benign i.e. harmless or malignant i.e. cancerous. A malignant tumour may be metastatic i.e. spread to the liver from elsewhere in the body or originating from the liver itself. Cancer that originates in the liver is known as liver cancer.
The most common cancer originating from the liver is the Hepato Cellular Cancer. It usually occurs in the back ground of Cirrhosis.
22. What are the symptoms of liver cancer?
Liver cancer does not ordinarily produce clear symptoms. Often, a patient with liver cancer may have been living with it for years before it is detected.
However, symptoms that have been observed in the case liver cancer may include sudden weight loss, pain or a lump in the abdomen, fever, jaundice, loss of appetite.
23. How is this form of cancer treated?
The surgery for hepatocellular carcinomas involves partial liver resection (i.e. removal of a part of the liver) or occasionally, a liver transplant. Minor and Major liver resections can be done by conventional as well keyhole surgery though the later involves sophisticated instruments and experienced personnel
Liver metastases can be resected by removing part of the liver. Sometimes even up to half the liver is removed. The patient can continue to live a normal life despite removal of part of the liver. This sort of resection is especially done when the primary cause of the cancer has spread to the liver from the Colon or the Rectum.
COLORECTAL CANCER
24. What is colorectal cancer and what are its symptoms?
Colorectal cancer is cancer affecting the colon or the rectum i.e. parts of the large intestine. It begins with the grown of pre-cancerous polyps in the lining of the colon and the rectum. Polyps are small mushroom like growth resulting from the unhealthy division and reproduction of cells lining the colon wall. These polyps can become cancerous with time and invade the colon wall.
One of the most prominent symptoms of colorectal cancer is rectal bleeding or block and mucus discharge. Abdominal pain and distension are also common symptoms. In some cases, it results in anaemia alone or rapid weight loss.
25. What are the causes of colorectal cancer?
Colorectal cancer can arise from hereditary factors.
It has been observed to run in families passing genetically from one generation to the next.
The causes may also be related to one’s lifestyle. Spicy, smoked and canned food increase the risk of colorectal cancer. Meat and a non-vegetarian diet have also been observed to increase the risk of colorectal cancer. Obesity, lack of exercise and cigarette smoking may also make one more susceptible to this form of cancer.
Sometimes, the cancer may be sporadic or random that has occurred as a result of gene mutation or random genetic changes that have taken place in the colon or the rectum.
26. Can colorectal cancer be prevented?
Those with a family history of colorectal cancer can and should take steps to prevent the onset of this form of cancer. One can get a screening done after the age of 50 to detect the early grown of polyps in the lining of the colon and rectum. If found, these polyps can be removed before they become cancerous.
Further, regular exercise, a healthy lifestyle, avoiding meat, alcohol and cigarettes may also help in preventing colorectal cancer.
27. How is colorectal cancer diagnosed?
This form of cancer is diagnosed mainly by performing a colonoscopy that involves the insertion of a viewing scope through the inner lining of the large intestine. Thereafter a CT scan and an MRI scan helps in staging.
28. What is the method of treatment for colorectal cancer?
Surgery is the primary solution for colorectal cancer. This can be completely cured if detected sufficiently early. Even metastatic tumours i.e. where the cancer has spread to other parts can be cured with sufficiently positive results.
Radiotherapy is used prior to surgery especially when the disease is locally advanced in the case of lower rectal cancer. Chemotherapy is also used in advanced colorectal cancer.
Sometimes a colostomy is also performed in the case of colorectal cancer. A colostomy is a surgical procedure that involves the creation of an opening known as stoma by pulling the healthy end of the large intestine through an incision in the abdomen wall and suturing it in place. This stoma or opening provides an alternative channel for the feces to be expelled from the body. This procedure may be reversed if necessary in the future.
Laparoscopy has emerged as the treatment of choice for colorectal cancer all over the world. While the results of laparoscopic surgery for colorectal cancer have been met with great success, it is important to note that it should be done by experienced surgeons. Our center is one of the premier centers in India performing colorectal surgeries laparoscopically.
With judicious use of laparoscopy one can avoid a permanent colostomy.
29. What is Colostomy? Can a patient avoid it
As you know food after digestion is discarded by us every morning in toilet. Stools get discharged from anus through the anal opening during defecation.
Sometime a tumor may grow inside rectum close to anus.
When patient undergoes surgery to remove such a tumor, the diseased part of rectum with tumor first gets removed. Then the healthy end of the rectum has to be sewn back to the anus so that the path for stools to get discharged every morning through anus is left intact.
Rectum is located in pelvic area. Pelvic area resembles a bottle neck with very limited space.
If the Surgeon is doing an open surgery, there may not be enough space for two hands of surgeon to suture rectum back to the anus after removing the tumour.
Then the surgeon may do a Colostomy which involves the creation of an opening known as stoma by pulling the healthy end of the large intestine through an incision in the abdomen wall and suturing it in place. In parallel, surgeon may also suture and close anal hole forever.
The stoma or opening on lower abdomen provides an alternative channel for the feces to be expelled from the body into a bag worn by patients through out the day.
But this is a huge lifestyle compromise for the patient. Instead of defecting in a commode, now the patient feces will be collected by the bag that they need to wear on their body.
A keyhole surgery in combination of a Circular stapler can avoid Colostomy in most such cases by restoring anal continuity.Such patients can enjoy normal quality of life by being able to go to the toilet for defecation like everyone else.
