Prioritizing digestive health: Early detection in stomach and esophageal cancersMarch 8, 2025
Stomach cancer accounts for 3 out of every 100 new cancer cases, while esophageal cancer accounts for 1 out of every 100 new cancer cases in 2020.
Digestive health is often overlooked until discomfort arises, but stomach and esophageal cancers remind us of the importance of proactive care in managing our digestive health. In Malaysia, cancer was the third leading cause of death in 2022, rising from fourth place in 2021, according to the Ministry of Health.
While not among the most common cancers, stomach and esophageal cancers still pose significant health risks, with stomach cancer accounting for 3 in 100 and esophageal cancer 1 in 100 of all new cancer cases in 2020. Early detection is crucial, but because stomach and esophageal cancers often present with non-specific symptoms which are often overlooked, they are frequently diagnosed in advanced stages. This highlights the need for early symptom recognition, as late-stage cancer diagnoses have risen from 63.7% to 65.1%, according to the Malaysia National Cancer Registry Report 2017-2021. Understanding stomach and esophageal cancers Stomach and esophageal cancers develop when abnormal cells grow uncontrollably in the digestive tract. Stomach cancer primarily affects the stomach’s main body, while esophageal cancer develops in the esophagus lining and is often associated with chronic acid reflux and Barrett’s esophagus — a condition in which the lining of the food pipe changes due to prolonged acid reflux. The symptoms of both cancers can be similar, particularly when the tumors develop at the gastroesophageal junction. This may include symptoms such as difficulty in swallowing (dysphagia), unexplained weight loss, loss of appetite, persistent heart burn and indigestion, nausea or vomiting, chest or upper abdominal pain. The five-year survival rate for early-stage stomach cancer is 65%-75% but drops to 5-7% at Stage 4. Similarly, localized esophageal cancer has a survival rate of 47-55% for early-stage diagnosis but falls to 5-6% in advanced stages. Key risk factors of stomach and esophageal cancers Stomach and esophageal cancers are more prevalent in older adults, with 6 in 10 new stomach cancer cases diagnosed in individuals aged 65 and above. However, age is not the only factor, as lifestyle choices and underlying conditions also contribute to an increased risk. Individuals with high-risk lifestyles should be proactive about screening as they are at a higher risk to develop esophageal and stomach cancers. Those who smoke heavily, chew betel nuts (a habit linked to cancer-causing effects due to the presence of harmful chemicals), frequently consume very hot liquids, binge drink alcohol, or regularly eat preserved foods are more susceptible to squamous esophageal cancer which starts in the thin, flat cells lining inside the esophagus. On the other hand, those who are obese, smoking, have long-term gastroesophageal reflux disease (GERD), or suffer from Barrett's esophagus are more likely to develop esophageal adenocarcinoma which begins in the glandular cells lining the lower esophagus near the stomach. For stomach cancer, the risk factors include GERD, those who consume high-fat and low-fiber diets, frequent consumption of smoked foods, and Helicobacter pylori infections caused by bacteria in the stomach lining, leading to gastritis and increasing the risk of peptic ulcers and stomach cancer. Individuals with a family history of stomach cancer should also be particularly vigilant and consider early screening to manage their risk. GERD and its link to esophageal cancer GERD is a condition where stomach acid frequently flows back into the esophagus, causing irritation and, over time, increasing the risk of esophageal cancer. Persistent acid exposure can lead to Barrett’s esophagus, a precancerous condition where the esophagus undergoes abnormal changes. Smoking, overeating, excessive alcohol and even coffee consumption can worsen GERD, making effective management of the condition essential. While lifestyle modifications and medication often provide relief, persistent or worsening symptoms may require endoscopic or surgical intervention like fundoplication that involves wrapping the top of the stomach around the lower esophagus to strengthen the lower esophageal sphincter and prevent acid reflux to reduce complications and improve patient outcomes. The role of endoscopy in early detection Endoscopic procedures such as gastroscopy and colonoscopy have significantly improved the ability to diagnose and treat gastrointestinal conditions. These procedures allow doctors to detect any abnormalities at an early stage and facilitating timely intervention. Gastroscopy enables detailed examination of the stomach lining, while colonoscopy provides insights into the health of the colon, helping to identify potential cancerous growths or inflammation. Regular screenings are strongly recommended for individuals over 50 years old or those over 40 with a family history of gastric or colorectal cancer. In countries with a high prevalence of these cancers, such as Japan and South Korea, upper endoscopies are recommended to be done from age 40 and repeated every three years. Whereas in Malaysia, screening is still primarily focused on individuals with gastric issues, a strong family history of cancer, or those exhibiting warning symptoms for cancer such as difficulty swallowing, bleeding, unexplained weight loss, or abdominal pain. Treatment options Treatment for stomach and esophageal cancers often overlaps, especially for tumors at the gastroesophageal junction, with surgery, chemotherapy, and radiation therapy being the standard approaches depending on the stage and location of the cancer. Immunotherapy has shown promise for advanced esophageal cancer, particularly in PD-L1-positive tumors, improving survival rates when chemotherapy is ineffective. In stomach cancer, targeted therapies are increasingly used for patients with specific genetic mutations, such as HER2-positive cases, which account for 10-20% of stomach cancers. In these cases, anti-HER2 therapy has been proven effective in slowing tumor growth and improving patient outcomes. Insights from a cancer patient caregiver It is important to note that a cancer diagnosis not only affects the patient but also has a profound impact on their loved ones. A caregiver of a cancer patient at SMCV shared how her family’s diagnosis drastically changed their life, but with adaptation and support, they found ways to cope. She emphasized the importance of remembering that life does not end with cancer, patients can still find joy and fulfilment during and after treatment. She also highlighted how simple adjustments, such as liquid-based and pureed diets, can help stomach and esophageal cancer patients maintain their nutrition while ensuring meals remain enjoyable due to the difficulty in swallowing. Beyond physical health, she stressed that mental and emotional well-being play a crucial role in navigating the treatment process, making support and encouragement from loved ones invaluable. Early detection, lifestyle modifications, and routine screenings are key in improving outcomes for stomach and oesophageal cancers. Although these cancers are not the most common in Malaysia, the high rate of late-stage diagnoses underscores the need for greater awareness. By staying informed, recognizing symptoms early, and prioritizing regular screenings, individuals can take proactive steps in safeguarding their digestive health, enabling better health outcomes and improving overall quality of life. |
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