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The Crucial Role of Upper Endoscopy in Managing Stomach Cancer  

Delayed Detection of Stomach Cancer

Are you aware that stomach cancer claims the lives of 300 to 500 people in Singapore annually? Even though the local incidence of stomach cancer has declined compared to the post-war years, partly because of heightened public awareness about the cancer, stomach cancer continues to be prevalent in Singapore.

Stomach cancer, also known as gastric cancer, is a condition defined by the development of malignant cancer cells (or tumours) in the stomach lining, leading to a range of symptoms and physiological implications which can be potentially deadly if left untreated.

Stomach cancer tends to remain asymptomatic during its initial stages. Consequently, two-thirds of stomach cancer cases remain undiagnosed until the cancer has become advanced, reducing the chances of effective treatment and speedy recovery.

Nevertheless, a recent discovery in diagnostic research conducted by Duke-NUS Medical School, National University Hospital (NUH), and the National University of Singapore’s Yong Loo Lin School of Medicine, offers the potential for earlier detection of stomach cancer. The breakthrough, highlighted in a December 2023 Straits Times article, unveiled a crucial genetic factor linked to changes in the stomach’s mucous lining. To be precise, individuals with intestinal metaplasia, a cellular change in the stomach's mucous membrane often resulting from chronic gastritis (inflammation of the stomach lining), have a sixfold increased risk of developing stomach cancer.

In light of this discovery, doctors are encouraged to order genetic tests, such as straightforward and cost-effective blood tests, to identify individuals at a significantly high risk of getting stomach cancer. This advancement holds the promise of enabling at-risk patients to receive an earlier confirmed diagnosis and timelier treatment, leading to accelerated recovery and an overall enhancement in their quality of life. It provides valuable clinical data that could aid precision prevention (preventing diseases with a highly targeted and individualised approach) and precision treatment (tailoring treatment by considering factors such as a person's genetic makeup, lifestyle, and environment) of stomach cancer.

Risk Factors for Stomach Cancer

Aside from the aforementioned risk factor of preexisting stomach conditions such as chronic gastritis, there are other key risk factors which have proven to contribute to its development:

  • Family History of Stomach Cancer: People with a family history of stomach cancer or specific genetic inclinations may face an elevated risk. Genetic counselling and screening initiatives are vital for identifying and effectively managing this heightened risk.
  • Helicobacter pylori infection: Another complication of frequent consumption of salted and processed foods is an elevated risk of H. pylori exposure. This bacterium significantly increases the risk of stomach cancer as it weakens the cellular lining of the stomach. 
  • Dietary Habits: Smoked, salted, or pickled foods are commonly found throughout Singapore. Frequent consumption of such foods allegedly contributes to an elevated risk for the development of stomach cancer.
  • Tobacco and Alcohol Consumption: Smoking and excessive alcohol use are well-established risk factors, prompting public health campaigns in Singapore to raise awareness about their dangers. 

Red Flags that Could Indicate Stomach Cancer

Stomach cancer is often labelled as a ‘silent enemy’ as it typically goes unnoticed until it reaches advanced stages, posing significant risks to its patient’s health. Understanding the signs of stomach cancer is crucial for early detection:

  • Prolonged indigestion
  • Unexpected weight loss
  • Abdominal pain and nausea
  • Long-term acid reflux and heartburn
  • Difficulty swallowing

According to General Surgeon Dr Aaron Poh who has a subspeciality in Colorectal surgery, the presence of these symptoms does not necessarily mean that you have stomach cancer, as some stomach cancer patients do not have these symptoms upon their diagnosis. As such, if you are experiencing persistent issues with your stomach, such as chronic gastritis, you need to identify the root cause of your issues and treat them promptly.

Precision Prevention Through Timely Detection of Stomach Cancer

Also known as EGD (Esophagogastroduodenoscopy) and upper endoscopy, gastroscopy facilitates the early detection of stomach cancer. Gastroscopy is a medical procedure involving a gastrointestinal specialist who evaluates the oesophagus (the tube linking the throat and stomach), stomach, and small intestine (duodenum). This safe, minimally invasive examination is conducted using a slender and flexible device known as an endoscope.

The following points highlight the various capabilities of gastroscopy in managing stomach cancer. 

Detecting Precancerous Lesions and Stomach Cancer

Gastroscopy allows for the direct visualisation of the stomach lining, enabling the identification of precancerous lesions such as intestinal metaplasia or high-grade dysplasia or carcinoma-in-situ. Detecting these early warning signs offers a window of opportunity for intervention before any tumour develops. 

Out of the existing screening technologies currently available, gastroscopy also stands out as being the most sensitive test for detecting stomach cancer. This means that it excels in accurately identifying individuals with gastric cancer (true positives) while minimising the chance of false negatives.

Screening High-Risk Individuals

Precision prevention involves tailoring screening advice based on individual risk profiles. Your colorectal surgeon may recommend that patients with the aforementioned risk factors or any history of chronic stomach issues undergo regular upper endoscopy screenings. This targeted screening approach allows surgeons to monitor high-risk individuals closely and detect stomach abnormalities at their earliest stages, while lowering the risk of unnecessary screenings for those with low risk. 

Creating Tailored Surveillance Programmes

Utilising clinical data from upper endoscopy, colorectal surgeons can design personalised monitoring plans for those at high risk of developing stomach cancer, advising more frequent surveillance for such patients.

Precision Diagnostics and Treatment 

Treatment for non-cancerous polyps or ulcers: If a polyp is detected, your colorectal surgeon may choose to perform a biopsy or remove the polyp during the endoscopic procedure. Polypectomy, Electrocautery, or laser-based treatments are some of the common procedures used to remove polyps.

Localised treatment of early-stage cancer

When stomach cancer is detected at an early stage, upper endoscopy can be used as a precise tool for localised treatment. Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) can be performed to remove small, localised tumours without the risks involved in invasive surgeries. Localised treatments also allow for a faster postoperative recovery period in comparison to traditional invasive surgeries. 

Visit Alpine Surgical Practice 

If you are grappling with persistent stomach issues such as indigestion, unexplained weight loss, or chronic discomfort, taking action now can make a significant difference. Early detection and understanding of the root cause of your symptoms can pave the way for effective management and improved gut well-being. Contact Alpine Surgical Practice today to schedule a consultation with Consultant General Surgeon Dr Aaron Poh, who has double subspecialties in Colorectal and Trauma Surgery. 

Alpine Surgical Practice offers a comprehensive gut health screening package that would help you understand more about your gut health and the underlying causes of your stomach issues. 

References

  1. Gupta R, Reddy DN. Endoscopic stent placement combined with tumor ablation therapy. Gastrointestinal Intervention. 2015;4(1):27-30.
    doi:https://doi.org/10.1016/j.gii.2015.05.001
  2. Information NC for B, Pike USNL of M 8600 R, MD B, Usa 20894. What Happens during a Gastroscopy? Institute for Quality and Efficiency in Health Care (IQWiG); 2015.
    https://www.ncbi.nlm.nih.gov/books/NBK310264/
  3. Sitarz R, Skierucha M, Mielko J, Offerhaus J, Maciejewski R, Polkowski W. Gastric cancer: epidemiology, prevention, classification, and treatment. Cancer Management and Research. 2018;Volume 10:239-248.
    doi:https://doi.org/10.2147/cmar.s149619
  4. Tan J. Local research on stomach cancer makes breakthrough in potential early detection. The Straits Times.
    https://www.straitstimes.com/singapore/local-research-on-stomach-cancer-makes-breakthrough-in-potential-early-detection. Published December 20, 2023. Accessed January 2, 2024.
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