Keeping out cancer

There are no routine screening modalities for stomach cancer due to which there is delayed diagnosis and the burden of the disease continues to be high. Despite cancer registeries noting high numbers, the actual burden could be much more, as many cases do not make it to the institutes on time.

After diagnosis, the management of stomach cancer also poses several challenges because it is aggressive, invades neighbouring tissues at a rapid space and also has a very high rate of local and distant recurrence, explains Dr Chinnababu Sunkavalli, consultant robotic surgical oncologist at Apollo Cancer Hospitals.

Q What is the incidence of stomach cancer in India? Why is it said to be high in southern and eastern India?
Stomach cancer is the fifth most common cancer among men and third-most common among females in Asia and worldwide. The age-adjusted rate (AAR) of gastric cancer among urban registries in India is 3.0-13.2. The incidence is more in the southern and north-eastern states of India. The incidence of gastric cancer in Mizoram has been reported to be the highest in India. The AAR in males and females has been reported at 50.6 and 23.3 respectively.

Q Can stomach cancer be identified early? If not, why?
Not always. The aggressiveness of the disease and need for improvement in therapeutic options is discerned by the fact that gastric cancer is the second most common cause of cancer deaths globally. The high incidence of local and distant recurrence even in patients with completely resectable gastric cancer indicates the systemic spread of cancer very early in the disease. Thus, emphasising the need for multimodality treatment, including surgery, radiotherapy and chemotherapy.

Q Which age group is most affected by gastric cancer? And why does it affect one gender more than the other?
It is the second most common cause of cancer-related deaths among Indian men and women between the ages of 15 and 44. Helicobacter pylori carcinogenesis is low in India. Advanced stage at presentation is a cause of concern.

Men are more commonly affected due to their lifestyle.

Q Why is the problem acute in India? Is it the food habits and lifestyle?
Aetiology of gastric cancer includes Helicobacter pylori infection, diet and lifestyle, tobacco and alcohol consumption and genetic susceptibility. Pickled food, high rice intake, spicy food, excess chilli consumption, consumption of high-temperature foods, smoked, dried or salted meat, the intake of soda and consumption of dried salted fish have emerged as significant dietary risk factors in various parts of India. These practices are prevalent in the southern and eastern states of India, where a higher frequency of gastric cases is also observed.

Q What is the treatment offered in the early stages and also on late diagnosis?
In the early stages, surgery is the treatment of choice. Multimodality treatment like chemotherapy and radiotherapy are required for the advanced stage disease. In the late stage, the disease is usually managed by chemotherapy.

Q What are the preventive methods and from which age must it be followed?
Primary prevention involves diet and lifestyle. Consumption of less pickled food, salt and chilli. Including garlic, vegetables and fruits (rich sources of antioxidants) in one’s diet could probably protect against stomach cancer. You should also avoid tobacco and alcohol.

Q Can stomach cancer be genetic in nature?
Yes, it can be. Single nucleotide polymorphism (SNP) in genes NAT2 (N-acetyltransferase), interlukin-1B,GSTM1 and GSTT1 (Glutathione S-transferase), Pro12Ala peroxisome proliferator-activated receptor, COX (cyclooxygenase) have reported significant association in the development of gastric cancer.

Symptoms to watch out for
a) Fatigue
b) Feeling bloated after eating
c) Feeling full after eating small amounts of food
d) Severe and persistent heartburn
e) Severe and unrelenting indigestion
f) Persistent and inexplicable nausea
g) Stomach pain
h) Persistent vomiting