Gastrointestinal Cancer Treatment in Delhi, India

Gastrointestinal Cancer refers to any cancer that begins in the digestive system, which includes the oesophagus, stomach, small intestine, colon, rectum, liver, gallbladder, and pancreas. It is a common type of cancer worldwide, with various subtypes based on the specific location within the digestive system where cancer originates.

Gastrointestinal cancer refers to a group of malignancies that can develop in different parts of the digestive system. Each type of gastrointestinal cancer is characterised by its specific location, risk factors, symptoms, and treatment approaches. Here are some of the most common types of gastrointestinal cancer.

Anal Cancer: Anal cancer starts at the anus, the end part of the digestive tract. It is an uncommon type of cancer. 

Bile Duct Cancer: Also called Cholangiocarcinoma, bile duct cancer is a rare type that affects the bile ducts, which are tubes extending from the liver to the small intestine. 

Colon Cancer: Colon cancer arises in the colon, i.e. part of the large intestine. 

Oesophageal Cancer: Oesophageal Cancer is cancer that begins in the oesophagus/food pipe. 

Gallbladder Cancer: Gallbladder Cancer is a type of cancer that affects the gallbladder, an organ under the liver that stores bile juice.

Gastrointestinal Stromal Tumours: Gastrointestinal Stromal Tumour is a rare type of cancer that begins in cells of the Gastrointestinal Tract (GIT). It can affect any part of the GIT but most commonly affects the stomach and intestine.

Liver Cancer: Liver Cancer is a type of cancer that affects the liver. It is not a very common type of cancer, but it can prove to be life-threatening. 

Pancreatic Cancer: Pancreatic Cancer is a cancer that begins in pancreatic cells. The pancreas is the organ that releases hormones that control blood glucose levels and digestive enzymes. It does not cause symptoms in the early stages; hence diagnosis is challenging. 

Rectal Cancer: Rectal Cancer is a type of cancer that begins in the rectum and can result in constipation, diarrhoea or blood in faeces.

Small Intestine Cancer: Small Intestine Cancer is a rare type of cancer that begins in the small intestine. It mainly occurs in the duodenum or ileum part of the small intestine.

Stomach (Gastric) Cancer: Stomach (Gastric) Cancer is also called gastric cancer and is one of the most common types of cancer that begins in stomach cells.

Gastrointestinal cancer, like many other types of cancer, is staged to determine the extent of its spread within the body. Staging helps oncologists plan the most appropriate treatment and assess the prognosis (outlook) for the patient. The specific staging system used can vary depending on the type of gastrointestinal cancer, but a common system is the TNM staging system, which assesses the tumour (T), lymph nodes (N), and metastasis (M). Staging typically involves a combination of imaging tests (such as CT scans, MRI, PET scans), endoscopic procedures, and sometimes surgical exploration to determine the extent of the disease.

Here's an overview of the stages of gastrointestinal cancer:

Stage 0 (Carcinoma in Situ): In this stage, cancer cells are only found in the top layer of the inner lining of the gastrointestinal tract. They have not invaded deeper layers or spread to nearby lymph nodes or distant organs.

Stage I: At this stage, cancer is localised to the inner layers of the gastrointestinal tract but has not spread to nearby lymph nodes or other organs. It is often referred to as early-stage cancer.

Stage II: In this stage, cancer has penetrated more deeply into the wall of the gastrointestinal tract but has not yet spread to nearby lymph nodes or distant organs.

Stage III: Cancer at this stage has usually invaded nearby lymph nodes but has not spread to distant organs. It may have penetrated through the wall of the gastrointestinal tract to nearby tissues or organs.

Stage IV: This is an advanced stage where cancer has spread to distant organs or tissues. It may have metastasized to the liver, lungs, bones, or other distant parts of the body. Stage IV gastrointestinal cancer is often considered incurable, but treatment can still help manage symptoms and improve the patient's quality of life.

Recurrent: Recurrent gastrointestinal cancer means the cancer has come back after a period of initial treatment, either at or near the original site or in distant parts of the body.

Specific stages and criteria gastrointestinal cancer may vary depending on the sub-type of cancer (e.g., esophageal, stomach, colorectal) and the staging system used.

The signs and symptoms of gastrointestinal cancer vary depending on the type of cancer and its stage. Some common signs and symptoms of gastrointestinal cancer include:

Abdominal Pain or Discomfort: Persistent pain or discomfort in the abdomen, which may be dull or sharp.

Changes in Bowel Habits: This may include diarrhoea, constipation, or changes in the size or shape of stool.

Blood in Stool: This may be visible as bright red or dark, tarry stools.

Difficulty Swallowing: This may occur if the cancer is in the oesophagus or stomach.

Unexplained Weight Loss: This may occur if the cancer is causing a loss of appetite or if the cancer is affecting the body's ability to absorb nutrients.

Nausea and Vomiting: These symptoms may occur if the cancer is affecting the stomach or small intestine.

Jaundice: Jaundice may occur if the cancer is affecting the liver or gallbladder and can cause yellowing of the skin and eyes.

Fatigue: This may occur if the cancer is causing anaemia or if the body is fighting cancer.

It is important to note that some gastrointestinal cancers may not cause symptoms until they have advanced to later stages. If you experience any persistent gastrointestinal symptoms, speak with a liver specialist in Delhi to determine the cause and appropriate course of gastrointestinal cancer treatment.

Gastrointestinal cancers encompass a group of malignancies affecting various parts of the digestive system, and their development can be attributed to a range of factors. Understanding the causes and risk factors associated with these cancers is crucial for both prevention and early detection.

Smoking: Smoking tobacco is one of the most common risk factors for several gastrointestinal cancers, including esophageal, stomach, and pancreatic cancer. The harmful chemicals in tobacco smoke can damage the cells lining the digestive tract, potentially leading to cancerous growths.

Excessive Alcohol Consumption: Consuming alcohol in excessive amounts over a prolonged period is linked to an increased risk of gastrointestinal cancers, particularly those affecting the mouth, throat, oesophagus, and liver. Alcohol can irritate and damage the tissues in these areas, making them more susceptible to cancerous changes.

Age: While gastrointestinal cancers can affect individuals of any age, the risk tends to increase with age. Regular screening and health check-ups are, therefore, highly recommended as one gets older.

High Animal Fat Diet: A diet rich in animal fats, such as those found in red meat and high-fat dairy products, has been associated with an elevated risk of colorectal cancer. Diets high in saturated fats may promote inflammation and contribute to the development of cancerous lesions in the digestive tract.

High Salt Intake: Excessive salt consumption, often linked to a diet high in processed and preserved foods, has been implicated in the development of stomach cancer. High salt intake can damage the stomach's lining and increase the risk of cancerous changes.

Chronic Pancreatitis: Individuals with a history of chronic pancreatitis, an inflammatory condition of the pancreas, are at a higher risk of developing pancreatic cancer. Inflammation in the pancreas can lead to cellular changes that may progress to cancer over time.

Obesity: Obesity is a known risk factor for several gastrointestinal cancers, including esophageal, stomach, and colorectal cancer. It is thought to promote cancer development through chronic inflammation and hormonal changes associated with excess body fat.

In the face of these risk factors, it's essential to emphasise the importance of early detection and effective treatment for gastrointestinal cancers. At Max Hospital in Delhi, India, our multidisciplinary team of experienced specialists, including gastroenterologists, radiation oncologists, and medical oncologists is well-equipped to provide comprehensive care for gastrointestinal cancer patients. We offer state-of-the-art diagnostic techniques, personalised treatment plans, and a multidisciplinary approach to address this challenging disease. Our goal is not only to treat gastrointestinal cancer effectively but also to support patients through their journey towards recovery, ensuring the best possible outcome and quality of life.

The diagnosis of gastrointestinal cancer typically involves several steps, including:

Medical History and Physical Exam: The specialist will ask about any symptoms you are experiencing, as well as your medical history, family history, and any risk factors for gastrointestinal cancer. They will also perform a physical examination, which may include a rectal examination.

Imaging Tests: Imaging tests such as CT scans, MRI scans, and ultrasounds may be used to look for signs of cancer in the digestive system.

Biopsy: It involves taking a tissue sample from the suspected cancerous area and examining it under a microscope to determine if cancer cells are present. This may be done during an endoscopy, in which a flexible tube with a camera on end is inserted into the digestive tract, or during surgery.

Blood Tests: It may be used to look for certain markers that are associated with gastrointestinal cancer, such as CA 19-9 for pancreatic cancer and CEA for colorectal cancer.

Gastrointestinal cancer treatment depends on the type of cancer, the stage of cancer, and the overall health of the patient. The most common types of gastrointestinal cancers include colon cancer, rectal cancer, gastric cancer, pancreatic cancer, liver cancer, and esophageal cancer. Treatment options include surgery, radiation therapy, chemotherapy, immunotherapy, or a combination of these treatments.

Surgery

Surgery is an important treatment option for gastrointestinal cancer. The type of surgery performed for gastrointestinal cancer depends on the location and stage of the cancer. Surgery may be done to remove cancer, relieve symptoms, or prevent cancer from spreading. 

Commonly Prescribed Gastrointestinal Cancer Surgeries

Colectomy: This is a surgery to remove part or all of the colon (large intestine) and is commonly performed for colon cancer. 

Gastrectomy: This is a surgery to remove part or all of the stomach and is commonly performed for stomach cancer.

Esophagectomy: This is a surgery to remove part or all of the oesophagus and is commonly performed for esophageal cancer.

Whipple Procedure: This is a surgery to remove the head of the pancreas, gall bladder and a part of the small intestine. It is commonly performed for cancers of the pancreas, distal bile duct or duodenum.

Liver Resection: It is used to remove part of the liver and is commonly performed for liver cancer.

Radical Cholecystectomy: This is a surgery to remove the gallbladder and is commonly performed for gallbladder cancer.

Colostomy or ileostomy: In some cases, the surgeon may create a new opening in the abdomen to allow waste to exit the body if part of the colon or rectum is removed. This is called a colostomy or ileostomy.

In addition to these surgeries, other procedures, such as endoscopic resection, which involves removing small tumours through a flexible tube inserted into the digestive tract, may be used for some gastrointestinal cancers. The choice of surgery will depend on various factors such as the location and size of the tumour, the patient's overall health and medical history.

Surgical Techniques to Treat Gastrointestinal Cancer

Different surgical techniques can be used depending on the type and stage of the cancer. The three main types of surgery used in gastrointestinal cancer treatment are open surgery, laparoscopic surgery, and robotic surgery.

Open Surgery: In open surgery, a large incision is made in the abdomen to access the cancerous tissue. This is the traditional surgical method and is still commonly used for gastrointestinal cancer treatment. The surgeon can remove the cancerous tissue along with any nearby lymph nodes and blood vessels. Open surgery is often used when the cancer is advanced or when the tumour is too large to be removed using other methods.

Laparoscopic Surgery: Laparoscopic surgery, also known as minimally invasive surgery, is a newer technique that involves making several small incisions in the abdomen. A laparoscope, a thin tube with a camera and light at the end, is inserted through one of the incisions. The surgeon uses the images from the laparoscope to guide the surgical instruments to remove the cancerous tissue. Laparoscopic surgery offers a shorter recovery time and fewer complications than open surgery.

Robotic Surgery: It is similar to laparoscopic surgery, but instead of using handheld instruments, the surgeon uses robotic arms to perform the procedure. The surgeon controls the robotic arms from a console, which offers a more precise and stable surgical field. Robotic surgery can be used for more complex gastrointestinal procedures and offers a faster recovery time and less postoperative pain than open surgery.

Chemotherapy

Chemotherapy involves the usage of drugs to kill cancer cells or stop them from growing. It can be given orally, through an IV, or as a combination of both.Chemotherapy is often used in conjunction with surgery and radiation therapy.

Radiation Therapy

Radiation therapy utilises high-energy radiation to damage cancer cells. It may be given externally or internally and is often used in conjunction with surgery and chemotherapy.

Immunotherapy

It is a type of cancer treatment that stimulates the body's immune system to fight cancer. It works by boosting the immune system's ability to recognise and attack cancer cells.

Targeted therapy

Targeted therapy is a type of cancer treatment that utilises drugs to target specific molecules or proteins that are involved in the growth and spread of cancer cells.

Palliative care

It is focused on improving the quality of life for people with advanced cancer. It can include pain management, emotional and spiritual support, and help with other symptoms.

The choice of gastrointestinal cancer treatment depends on factors, including the type and stage of cancer, the patient's overall health, and their treatment preferences. A multidisciplinary team of doctors, including surgeons, medical oncologists, radiation oncologists, and other healthcare professionals, work together to develop a treatment plan that is tailored to the patient's needs.

Reviewed by Dr Nikhil Aggarwal, Director - Cancer Care / Oncology, Surgical Oncology, Gastrointestinal & Hepatobiliary Oncology, Gastro Intestinal & Hepatopancreatobiliary Surgical Oncology, Robotic Surgery on 15-Dec-2023.

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Can Gastrointestinal Cancer be cured?
The chances of recovery are higher when gastrointestinal cancer is detected at an early stage. However, it is often already advanced by the time it is discovered, making it challenging to achieve a cure. While treatment options are available, curing gastrointestinal cancer in its later stages is rare.

What should I include in my diet during Gastrointestinal Cancer treatment?
It is important to maintain a well-balanced diet during gastrointestinal cancer treatment. Consuming a variety of nutrient-rich foods can aid in recovery and overall health maintenance.

What role does Chemotherapy play in treating Gastrointestinal Cancer?
Chemotherapy works by killing cancer cells or slowing down their growth. It is commonly used in the treatment of gastrointestinal cancer, either as a standalone treatment or in combination with surgery or radiation therapy.

How long does it take to recover from Gastrointestinal Cancer surgery?
The recovery time after gastrointestinal cancer surgery varies depending on the extent of the procedure. It can take several weeks to several months for a full recovery.

What are the potential long-term effects of Gastrointestinal Cancer treatment?
The long-term effects of gastrointestinal cancer treatment can vary from person to person. They may include fatigue, difficulty swallowing, and changes in bowel habits, among other possible effects.

Review

Reviewed by Dr. Nitin Leekha, Director -  Cancer Care / Oncology, Surgical Oncology, Gynecologic Oncology, Robotic Surgery, Breast Cancer, Head & Neck Oncology, Uro-Oncology, Thoracic Oncology.