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Medically Verified By: Dr Vipulroy Rathod, Director-Gastroenterology, Fortis Hospital, Mulund
UNDERSTANDING ADVANCEMENTS IN STOMACH CANCER TREATMENT
Gastric (stomach) Cancer is one of the common cancers of digestive system in Southern India. Overall, the exact Gastric Cancer database of India is still not clear, however, it is believed that Gastric Cancer constitutes about nine per cent of all digestive cancers in the world. Asian countries such as Japan, Korea and China have more prevalence. In Asia, it is the second-most common Cancer among men and third-most amongst women.
The common causes of Gastric Cancer include, genetic susceptibility, Helicobacter Pylori (H. Pylori) infection, high salt intake, pickles, salted dried fish, alcohol and tobacco consumption. Though H. Pylori incidences are high in Indian population the incidence of Gastric Cancer is low, more studies are needed as to what gives the population protection, despite H. Pylori infection, that prevents Gastric Cancer.
The best way to diagnose early or advanced gastric cancer is to perform upper GI endoscopy if there are persistent symptoms such as upper abdominal pain and discomfort, heaviness after meals & early satiety with weight loss. Some patients also present with dark coloured stools if there is bleeding from a gastric tumour. With high resolution and magnification Endoscopy with virtual Chromoendoscopy technologies, it is now possible to detect Gastric Cancer in its early stages. Endoscopic Ultrasound (EUS) is a very useful imaging modality which can accurately stage a Gastric Cancer; an advanced care centre would use this in their staging protocols.
In India, vast majority of the Gastric Cancer cases are diagnosed at an advanced stage due to lack of awareness. The traditional treatment of advanced Gastric Cancer differs from centre to centre based on their oncologic protocols. However, patients with advanced, but operable Gastric Cancer, will receive Chemotherapy either before or after surgery for best outcomes. There are cases who present to us in stage IV and these patients require palliative surgery or rarely Endoscopic stent placement or naso-jejunal feeding if surgery too is contraindicated. Early Gastric Cancer can be treated effectively with endoscopic techniques such as EMR (Endoscopic Mucosal Resection) and ESD (Endoscopic Submucosal Dissection)
While the five-year survival rate for this Cancer is approximately 20 percent, survival rates are higher in countries which have screening programs that lead to early detection, and where distal Cancer predominates.
Diet plays a major role in Gastric Carcinogenesis. Globally, it is seen that diet consisting of none or low-starch vegetable including green, yellow vegetables, cruciferous and allium vegetables (Garlic and Onion) and fruits are considered to be probable protective factors. There is a recent decline in the incident of stomach cancer in many countries may be due to higher consumption of fruits and also due to highly reduced intake of salt and preserved foods.
In western countries, Japan and Korea, advances in Gastric Cancer screening and endoscopic technology have made it possible to detect and treat Gastric Cancer at an early stage. Hence, about 40 per cent of Gastric Cancers have been resected via endoscopic treatment in Japan.
Development of newer less invasive diagnostic methods such as liquid biopsies and genetic screening might allow us to predict the high-risk group of patients who will benefit from screening endoscopy and early detection with good outcomes. There is evolving future for Gastric Cancer detection, diagnosis, staging and definitive treatment either curative or palliative, thanks to evolving technologies including Artificial Intelligence (AI) in endoscopy.