Indigestion, Abdominal Pain and Gastric Problems - Can it be Cancer?

As a Gastrointestinal oncologist and surgeon, one of the most difficult things is seeing patients in whom cancer has spread beyond the point of cure. Had the disease been diagnosed earlier, there could have been a possibility of a cure.

Why do gastrointestinal cancers present at an advanced stage? Are there any signs and symptoms which could warn us?

The digestive system

Organs of the gastrointestinal or digestive system include oesophagus (food pipe), stomach, small intestine, large intestine (colon and rectum), appendix, gallbladder, bile duct, pancreas and liver. Cancer can afflict any of these organs. When viewed under the microscope, we can see that these cancers can be of various types. The types are adenocarcinoma, squamous cell carcinoma, neuroendocrine tumour and gastrointestinal stromal tumour (GIST).

Gastrointestinal cancers include

• Oesophageal cancer
• Stomach cancer
• Colon and rectum (large intestine) cancer
• Gallbladder cancer
• Bile duct cancer (cholangiocarcinoma)
• Pancreatic cancer
• Liver cancer (hepatocellular carcinoma)
• Neuroendocrine tumours
• Gastrointestinal stromal tumours
• Abdominal sarcomas
• Appendicular tumours

Safety - boon or bane

Our gastrointestinal organs are inside the abdomen and protected with the abdominal wall. Multiple layers of muscle and strong tissue make up the abdominal wall. Similarly, the oesophagus is in the chest, protected by the strong rib cage. This ensures the safety of our GI organs. But it also makes it difficult for us to detect diseases and cancers in any of these organs.

Heads up

Symptoms are our body’s way of alerting us that something is wrong.

The symptoms of gastrointestinal diseases including cancer are difficulty in swallowing, pain abdomen, recurrent vomiting, unexplained weight loss, loss of appetite, blood in vomitus, blood in the stool, altered bowel habits (change in frequency or consistency of stools), persistent abdominal discomfort, feeling of incomplete evacuation, weakness or fatigue, worsening indigestion or heartburn, Jaundice, clay-coloured stools, itching, recent-onset diabetes, a lump in the abdomen and/or change in voice.

Warning signs of gastrointestinal cancer

• Difficulty in swallowing
• Abdominal pain
• Recurrent vomiting
• Unexplained weight loss
• Loss of appetite
• Blood in vomitus
• Blood in stool
• Altered bowel habits
• Narrow stools
• Weakness or fatigue
• Persistent abdominal discomfort
• The feeling of incomplete evacuation
• Worsening indigestion or heartburn
• Jaundice
• Clay colour stools
• Itching
• Recent onset diabetes
• Lump in the abdomen
• Low red blood cell count (anaemia)
• Change in voice

GI-HPB cancers

As a group, gastrointestinal cancers are the most common cancers globally. Each of these gastrointestinal cancer present with a set of signs and symptoms. Some of them are unique to each cancer, while some overlap with other cancers. Symptoms like weight loss and loss of appetite are common to all cancers.

Delay in diagnosis

Unfortunately, these symptoms often occur when the disease reaches an advanced stage. In early stages, the symptoms either do not occur or are mild and hence we ignore them. Many of these symptoms also occur in mild to moderate common digestive diseases, which affect us from time to time.

The likelihood of a minor disease causing your symptom is much more. It is less likely that your symptom will be because of a serious illness like cancer. The result is that we diagnose these cancers at an advanced stage most of the time.

Are you at risk?

Risk factors are something that increases the chance of someone getting a disease.

In the case of GI cancers, risk factors will increase the chance of someone getting cancer. More the number of risk factors–higher the likelihood. The presence of a risk factor does not mean that the person will always get the disease. While some people will get the disease even in the absence of risk factors.

Common risk factors for these cancers include

• Increasing age
• Family history of gastrointestinal cancer
• Smoking and alcoholism
• A diet deficient in fruits and vegetables
• Obesity

What to do?

There is possibly not much harm in ignoring an occasional mild abdominal discomfort or gastric trouble.

However, be worried if any of these symptoms occur regularly. Besides, they seem to get worse and they don’t go away.

Consult your doctor immediately. Based on these symptoms and physical examination, he or she will order investigations. This will help find out the cause of these symptoms. Usually and hopefully the cause will be a minor disease. But sometimes there will be cancer lurking in the shadow and we will detect it in time, at a stage where they can still be cured.

Stay Alert! Stay Healthy!
Happy living!