A better understanding of digestive cancers

In photo during the BUSINESSWORLD Insights’ Cancer Care in the New Normal (clockwise, from top left) are moderator Patricia Mirasol of BusinessWorld; and cancer specialists from Singapore Dr. Foo Kian Fong, Senior Consultant in Medical Oncology at Parkway Cancer Centre; Dr. Liau Kui Hin, Senior Consultant Surgeon at Mount Elizabeth Novena Hospital; and Dr. Chua Tju Siang, Senior Consultant Gastroenterologist at Mount Elizabeth Hospital.

Advanced diagnosis and treatment of digestive cancers highlighted in recent BusinessWorld Insights webinar

While cancer is known to potentially strike one’s heart or lungs, it can also attack within one’s digestive system, including the liver, gallbladder, bile duct, and pancreas.

In fact, according to data from World Health Organization, colorectal and liver cancers are among the top five cancers in the Philippines. World Cancer Research Fund, meanwhile, noted that cancer in the digestive system is the fourth common type of cancer occurring in men and the seventh most commonly occurring cancer in women.

No wonder digestive cancers should be another area of concern for many with regards to cancer, and taking care of our gut should not be overlooked.

Last March 10, BusinessWorld, in partnership with Mount Elizabeth Hospital and Parkway Cancer Centre (PCC), held a webinar that gathered cancer specialists from Singapore to discuss digestive cancers as well as the latest breakthroughs in diagnosing and treating these diseases.

Digestive cancer in brief
According to Dr. Foo Kian Fong, Senior Consultant in Medical Oncology at PCC, the risk factors of digestive cancers include age, genetic factors, family history, and underlying conditions. There are also lifestyle factors, such as alcohol, obesity, high-fat diet, smoking, physical inactivity, and lack of sleep.

For liver cancer, in particular, risk factors include hepatitis B or C; liver cirrhosis or hardening of liver; a fatty liver; and hereditary hemochromatosis or the overabsorption of iron.

According to Dr. Chua Tju Siang, Senior Consultant Gastroenterologist at Mount Elizabeth Hospital, digestive cancers hardly have symptoms in their early stages. These can be limited to gastric discomfort, stomach pain, or even change in bowel habits (e.g., from once a day to thrice in two weeks). Digestive cancers become more apparent when pain is already being felt.

“For liver and pancreatic cancers, jaundice is a problem, wherein the obstruction of the bile duct leads to the yellowing of the skin and the eyes,” Dr. Chua said, adding that suggested weight loss not assisted by any regimen and swallowing with pain can be other symptoms for advanced digestive cancers.

Briefing about pancreatic and gastroenteropancreatic neuroendocrine tumors (GEP-NETs), Dr. Liau Kui Hin, Senior Consultant Surgeon at Mount Elizabeth Novena Hospital, pointed out that the pancreas consists of two types of organs — one to aid in digestion and the other to regulate body functions/metabolism. Both functions can be compromised when cancer enters either organ.

“Majority of cancer we see, about 90%, come from the mother cells that produce digestive juice, or the organ that is responsible for digestion. This is called adenocarcinoma,” Dr. Liau explained. “The other type of cancer, which we call neuroendocrine tumor of the pancreas, is a tumor whose mother cell comes from neuroendocrine cells.”

Advanced diagnosis
Like any type of cancer, successful treatment of digestive cancers require an effective diagnosis; and recent advances in diagnostic methods have improved accuracy.

Endoscopy, a method usually used for diagnosing the digestive tract, esophagus, colon, and stomach has extremely advanced, Dr. Chua noted, with 4K scopes and zoom scopes providing clearer views.

There is also endoscopic ultrasound that improves the diagnosis in the pancreas, gallbladder, and bile duct which are in an area found difficult to obtain a biopsy. “[T]his helps us evaluate the pancreas, especially if we see mass, we can take biopsy and confirm that this is indeed pancreatic cancer or not,” the gastroenterologist added.

Aside from endoscopic diagnoses, other advanced procedures include endoscopic submucosal dissection, which can remove stomach cancer from the surface and hence preserve the organ; and endoscopy for palliation, which can deal with pancreatic cancer when it obstructs nearby organs.

Dr. Chua noted that Mount Elizabeth Hospital in Singapore is very equipped with advanced technology for diagnostic procedures. “Since 2006, we started introducing endoscopic ultrasound. Not so long ago, we’ve upgraded it into a better version,” he said. “[Our technologies] are all very good at producing a [good] environment to carry out these procedures.”

Advanced surgery
Likewise, treatment of digestive cancers has improved with the advancement of surgical techniques. Dr. Liau noted that whereas before, the instruments they used were heavy and cumbersome, now they are using smaller tools and apply advanced techniques such as keyhole surgery — all of which can also be availed at Mount Elizabeth Hospital.

With keyhole or laparoscopic surgery, which is enabled through advancements in miniaturization and nanotechnology, tumors can be better removed while bleeding can be controlled.

“The advancement in surgical technology provides safer operations with improved outcomes in term of lower mortality from the operations and better long term survival rate,” the surgeon added, noting that Whipple operation with mortality more than 20% has since been reduced to less than 3% to 5% in the recent years in centers with experienced pancreatic surgeon.

For Dr. Foo, advanced diagnosis and surgery altogether help in better identifying and, eventually, managing digestive cancers.

“Advances in biomolecular technology help us subtype the different types of cancers, which also helps us in the management. Advances in immunology help us treat patients through immunotherapy and extending their survival,” he added.

While there are now improved ways to diagnose and treat digestive cancer, prevention through a healthy lifestyle is nevertheless better, as the doctors stressed.

Dr. Chua noted that foods that may increase the risk of digestive cancers include fatty foods, red meat, and processed meat. The International Agency for Research on Cancer classified processed meat as ‘carcinogenic to humans,’ while red meat was classified ‘probably carcinogenic to humans.’

On the other hand, the gastroenterologist continued, cruciferous vegetables have been shown to reduce the risk of esophageal and colon cancers.

Exercising helps as well, noting that walking or cycling for an hour can reduce one’s risk of colon cancer by about 10% to 15%.

In addition, Dr. Liau pointed out that tackling food safety will also help address digestive cancers as environments are still vulnerable to pollution and so food can get contaminated.

“Majority of the cancers come from the digestive and respiratory systems, and this really impresses on us that we are living in a polluted environment, and the food that we take may not be 100% secure and safe. We need to mitigate some of these risks,” he explained.

For inquiries, please contact Parkway Hospitals Singapore — Manila office located at G/F-B, Marco Polo Hotel, Meralco Avenue and Sapphire Street, Ortigas Center, Pasig City 1600, e-mail manila.ph@parkwaypantai.com or call 0917-526-7576.