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Surviving GI tract cancers: Dr. Kanchan stresses symptom awareness and regular screenings

Gastrointestinal cancers (GI cancers) account for 26% of the global cancer incidence and 35% of all cancer-related deaths, according to a study published in the journal Gastroenterology. While India has historically experienced a lower incidence of gastrointestinal (GI) cancers compared to Western countries, a marked surge in cases over the last two decades, particularly concerning colorectal and pancreatic cancers, demands our attention. The intrigue of cancer lies in its ability to manipulate cellular division, coaxing cells meant to expire into a deathly process. The enigma deepens when it comes to GI tract cancers residing within the body, their telltale signs hidden from plain sight. Understanding the intricacies of GI cancer prognosis is crucial for effective management and treatment strategies.

Picture this: an unusual lump forms, an accumulation of cells that might either be harmless bystanders (benign or non-cancerous tumours) or malicious infiltrators (malignant or cancerous tumours). 

Ulcers, sores, and bleeding, the aftermath of these cellular conglomerates wreaking havoc. However, the real challenge arises with GI tract cancers, where the symptoms often emerge stealthily in advanced stages—when the tumour has grown substantially to colonize and affect the normal functioning of the neighbouring lymph nodes, organs, or distant territories through metastasis.

As the tally of cases continues its worrisome ascent, we find ourselves grappling with a question. How do we confront this situation? 
In a candid tête-à-tête, the CancerMitr team engaged with the eminent GI tract oncosurgeon, Dr. Kanchan Sachanandani.
Dr Sachanandani, with her profound insights and surgical prowess, navigates us through the labyrinth of GI cancers, unveiling strategies to unearth the disease in its latent stages.

What is India's current status regarding the prevalence of GI tract cancer? Which is the most reported GI tract cancer in India?

The most reported GI tract cancer is colorectal cancer. It is a condition characterised by the presence of cancerous cells in the colon and rectum (the large intestine region). 
Now, here’s the eye-opener, the number of cases is scaling up, no sugarcoating that. We’re witnessing the formidable rise of colorectal cancer, followed by liver cancer. These are those diseases that are usually recorded amongst the elderly as the result of age-related complications. But alcohol abuse and a host of other enigmatic factors are pushing more youngsters into the spotlight.

Based on your experience, at what stage do patients usually come to you with GI tract cancer?

You see, cancer is complex and can be challenging to explain, but allow me to simplify it. We typically categorize cancers into four stages. Stages 1 and 2 are considered early stages, characterised by small, localized tumours. Then there are stages 3 and 4, where the tumour has spread to nearby lymph nodes and distant organs respectively.

A significant number of colorectal cancer patients who seek my expertise are either in their first or second stage. This indicates that the tumour is still relatively small and contained. However, the treatment process remains arduous depending on the tumour’s specific characteristics and location. Picture the colon divided into two sections: the proximal region on the right side (ascending and transverse colons) and the distal colon on the left (descending and sigmoid colon). When the tumour appears in the distal colon, it triggers noticeable symptoms such as altered bowel habits (constipation or diarrhoea) and bleeding. In contrast, a tumour in the proximal colon can lead to indicators like anaemia or unexplained weight loss. These are apparent signals that prompt patients to seek medical attention promptly. We often succeed in catching the tumour early unless it’s a particularly aggressive variety, like a high-grade adenocarcinoma.

Now, when it comes to the pancreatic cancer patients I have dealt with, the majority of them were in advanced stages, marked by metastasis—meaning the tumour has spread beyond its origin. It’s a sobering reality, highlighting the need for heightened awareness and proactive medical intervention.

Why do GI tract cancers, especially pancreatic cancer, have such a low prognosis? Why is pancreatic cancer known as the silent killer?

You see, many of these cancers operate in stealth mode, cunningly avoiding obvious signs and symptoms. It’s a tricky terrain where misdiagnoses can easily occur even with our vigilant tools, like ultrasounds and X-rays.

Pancreatic cancer is the slickest of the lot. As we’re all aware, the pancreas serves as a key player in our body’s insulin-glucagon balance. Imagine it as a three-part ensemble with the head, body, and tail. Trouble brews when a malignant tumour shows up in any of these segments. What I’ve encountered in my professional journey is that a staggering 90% of reported cases focus on the body or tail regions, often discovered when cancer has already spread. Contrastingly, should this menacing growth show up in the head, a telltale sign emerges early on – jaundice – which is characterised by the yellowing of eyes and skin. 

The melancholic truth is that the rest of the symptoms – the abdominal distress, the bloating, the curious stool or urine behaviours, the itchiness under the skin, and the anaemia – show up only in the later stages. Imagine this scenario: a patient in stage 1 or 2 notices abdominal pain, which is an ordinary occurrence for many. It’s easy to dismiss it. Meanwhile, the cancerous cells slowly and stealthily replace the normal workforce, those cells that should be maintaining the blood glucose levels. 

Let’s not forget the nature of these pancreatic tumours, often referred to as adenocarcinomas. They’re relentless, aggressive tumours. It is often the final stop for those patients with stage 3 or stage 4 adenocarcinoma.

Read: From palliative care to cancer recovery: Atul Thakkar shares his father’s cancer journey

A recent research showed that “excess thirst" and “dark yellow urine” are initial signs of silent-killer pancreatic cancer. What is your professional opinion on that?

Yes. Absolutely. Both these symptoms together might set off an alarm, but if you ask me, we can’t entirely depend on them as definitive indicators of pancreatic cancer. It’s a tricky situation. Let me break it down further. Just as we’d expect light-coloured urine after a hydration binge, dark urine doesn’t necessarily scream “pancreatic cancer!” 

It may indicate possibilities like an infection, dehydration due to external factors, or potential issues with the pancreas, bile duct, or liver.

Now, picture this scenario: someone has these symptoms. It’s not a solo act; they might have other symptoms like fever, perhaps even hepatitis, or those side effects from various medications. It’s a multi-layered puzzle, and while these signs do raise an eyebrow, they’re part of a larger landscape.

What I’d personally recommend is to keep a watchful eye, especially if you tick certain boxes — like obesity, a family history of pancreatic cancer, abrupt onset of diabetes, or a history of pancreatitis. These factors spotlight the need for routine screenings to catch any potential tumours early on. It’s a safeguard, a measure to ensure we’re ahead of the game.

What are the common risk factors associated with GI tract cancers?

Obesity is the primary risk factor, followed closely by the habits we nurture—unhealthy diets, which include those sugar-loaded carbs. Consuming excess red meat is like giving colorectal cancer an open invitation.
Other culprits include Helicobacter pylori which could set the stage for stomach cancer. A long history of acid reflux increases the risk of esophageal cancer. A family history of pancreatic or stomach cancer can increase the risk of developing the disease.

And when we dive into the rare, mysterious conditions like Familial Adenomatous Polyposis (FAP), they’re the villains behind colon cancer’s rise. While we can be vigilant about these risks, it’s not always in our hands. That being said, we do wield power over certain behaviours, like taming our sugar cravings, quitting smoking habits, alcohol, and red meat.

A patient suffered from high-grade adenocarcinoma of the intestine. She relapsed less than a month after her treatment. Why do patients relapse that fast?

Adenocarcinoma is a very aggressive tumour. Even after treatment, they might hang around, lurking in the bloodstream or settling in lymph nodes, biding their time before spreading to other body parts.
Here’s where we take the reins: diet and lifestyle. Think of it as building a fortress against a potential return. Patients become architects of their own defence, reinforcing their immune system with a healthy dose of fibre, vitamins, and minerals. Better to cut down or completely say no to red meat and refined sugar. Why? Because cancer feeds on sugar—it’s their fuel, and we’re tightening the supply.
Some tumours succumb to the trio of surgery, chemotherapy, and radiation. Others? They tend to demand persistent attention even after treatment. So it is imperative to take a calculated approach to tackle any given situation.

A famous Hollywood actor, Chadwick Boseman, died due to adenocarcinoma of the colon. Our research showed that Black people are more vulnerable to colon cancer when compared to white or brown people. How does race come into play here?

Race significantly influences cancer prevalence. Colorectal cancer strikes black individuals more than white individuals. In India, Bihar and parts of the North form a gallbladder cancer hotspot, while Kashmir and the North East see an esophageal cancer belt. Various factors contribute, like high soil arsenic causing gallbladder cancer in Bihar. In Kashmir and the North East, weather and smoked meat consumption drive esophageal cancer rates. In Mizoram, 25-26 per 100,000 suffer from esophageal cancer.

Genetics also factor in. Cancer’s grip isn’t uniform, with obstacles hindering prevention, detection, treatment, and survival. Grim statistics reveal more cancer-related deaths among black individuals compared to whites or browns. It’s a complex interplay of elements, painting a picture of cancer’s unequal impact.

What are the initial signs of GI tract cancer?

That’s the important question. Catching the GI tract cancer in it’s initial stage is a challenge. And it depends on where the tumour is. Acid reflux points to stomach issues while swallowing hiccups might signal esophageal concerns. Pancreatic, liver, gallbladder, and bile duct cancers often announce themselves through jaundice. 

Then comes the commonly reported symptom: an odd loss of appetite. It might be subtle, but coupled with it, patients might shed up to 10 kilos in just 2-3 months—far from normal. Patients require immediate medical attention in such scenarios.

What diagnostic tests and imaging studies are necessary to assess the condition accurately?

I’m aware that many patients opt for routine USG screening, although not all early-stage cancers are detectable that way. To catch the disease at its inception, the initial step involves comprehensive blood tests—complete blood count, liver function, lipid profile, among others. Deviations in these markers signal potential concerns. Urine and stool tests also play a role. Additionally, sonography is recommended.
Here’s how the doctors proceed: They begin by inquiring about symptoms, followed by a physical examination. A thorough history is taken, encompassing lifestyle and family background. Based on these, they recommend appropriate tests or scans for deeper investigation. If anything noteworthy surfaces, further steps include tumour markers, CT scans, or MRI scans. It’s a systematic process, a cascade of assessments aimed at unveiling potential threats.

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Dr. Kanchan Sachanandani

Dr. Kanchan Sachanandani

GastroIntestinal Surgeon
● M.Ch (Surgical Gastroenterology)

Dr. Kanchan Sachanandani is a distinguished GastroIntestinal Surgeon with 14 years of exceptional expertise in the field. She is based in Washermenpet, Chennai and is associated with esteemed institutions, including Government Stanley Medical College in Washermenpet, Chennai, Jupiter Hospital in Thane West, Thane, and Jupiter Specialty Clinic in Thane, Thane. Dr. Sachanandani’s educational journey encompasses significant achievements, having obtained her MBBS from MAHARASHTRA UNIVERSITY in 2009, M.S. in General Surgery from Lokmanya Tilak Municipal Medical College, Sion, Mumbai, in 2015, and MCh in Surgical Gastroenterology/G.I. Surgery from Stanley Medical College & Hospital, Chennai, in 2020. Her dedication and comprehensive training reflect her commitment to delivering exceptional patient care and advancing the field of Gastrointestinal Surgery.