Mr X is a 52-year-old Chinese man who came to see me a few years ago with a complaint of generalised discomfort of his tummy for six months. His appetite had been poor and he had been losing weight.
On further questioning he had a change in his bowel habits. Normally his bowel openings were daily but for the past 2 months, he had been suffering from constipation. On other days his stools would be watery mixed with some blood (Altered bowel habit).
After a complete physical examination and blood test, he proceeded with a colonoscopy (a device which can directly visualise your large intestine which is passed through the anal opening). The results revealed a tumour suspicious of cancer of the rectum. Biopsy (samples from cancer) was obtained and seen under microscope and the diagnosis of cancer of the rectum was confirmed.
A CT scan of the whole body was done to exclude whether the cancer had spread to other areas of the body (metastasis). Unfortunately, Mr X’s cancer has spread and with chemotherapy he managed to survive for a year.
Just like Mr X, some of us might have one or more symptoms such as losing weight and appetite, changes in bowel habit, tummy pain or distention. What do we do? Some seek doctors’ advice, some are scared to see a doctor and some just ignore or neglect it. Which type of person are you?
Gastro-intestinal Cancers are one of the most common cancers causing deaths today. Most people come late to see a doctor when cure is impossible. In the United States, everyone gets a colonoscopy after the age of 50 years to detect colon cancers early. In Malaysia, we do not have this screening protocol but access to a doctor is easy and necessary investigations can be done promptly.
Here are top five cancers of the gastrointestinal tract:
OESOPHAGEAL CANCER
These are cancers which involve the oesophageal, the swallowing pipe that joins the mouth to the stomach. Long-standing acid reflux can lead to this. Smoking, alcohol, strong family history are risk factors too.
Symptoms include heartburn, chest pain, difficulty in swallowing or painful swallowing and vomiting blood. Patients may lose weight and appetite. An upper endoscopy to look at youroesophagus and biopsy can clinch the diagnosis. Barrett’s Esophagitis a pre-cancerous condition that can be diagnosed on endoscopy and confirmed with a biopsy
Upper endoscopy aka OGDS (Oesophago-gastro-duodenoscopy) and colonoscopy are low risk procedures done under conscious sedation, which means the patient is conscious but will not be aware of the procedure. Most of the time, the patient will not remember what happened after the procedure.
STOMACH CANCER
This is the 4th most common cancer in the world. Patients usually complain of upper tummy pain, discomfort, distention, bloated, feeling fullness after small feeds. Vomiting blood and black stools indicate bleeding from the cancers. Along with physical examination and blood tests, an upper endoscopy is essential to clinch the diagnosis.
Helicobacter Pylori (H Pylori) is bacteria in the stomach that can cause stomach cancer. Studies have shown that 50% of the world’s population has H pylori in their stomachs. Only 2/3rd of this population will have stomach pain and discomfort. The remaining 1/3rd will not have any complains.
This bacteria/stomach germ can cause stomach cancer and also stomach ulcers and inflammation of the stomach (Gastritis).
During endoscopy we can check for H Pylori bacteria. We also can do urease breath test and H pylori antibody test through a blood test.
A low fibre diet, tobacco and alcohol and others are risk factors for stomach cancer.
COLONIC CANCER
This includes rectal and anal cancer. Low fibre diet, high fat intake, chronic inflammatory conditions of the colon and rectum-like inflammatory bowel disease can predispose to colon cancers.
Altered bowel habits, bloody stools, painful motion, weight loss and poor appetite are some of the complaints. Positive family history of colon cancer or any other cancer is important too.
A colonoscopy would be vital for these patients.
PANCREATIC CANCER
This is a cancer of the pancreas. The pancreas is responsible for producing many enzymes and hormones. Symptoms include severe to moderate upper tummy pain which radiates to the back of the body, weight loss and reduced appetite, jaundice (yellowish discolouration of the white of your eyes) and diarrhoea. A CT Scan or MRI of the pancreas is vital investigations for diagnosis.
PRIMARY LIVER CANCERS
These are common cancers, usually caused by Hepatitis B and Hepatitis C infections. Patients usually complain of pain below the right rib, jaundice, and weight and appetite loss.
Regular screening of your blood for hepatitis B and Hepatitis C is essential. If you have a family history of Hepatitis B or liver problems like liver cancers and liver failure, I will strongly advise to see a doctor and get yourself checked.
Prevention is better than cure if you are not too late. If you think you or anyone that you know may have the above symptoms, please visit your doctor for advice.
