DIGESTIVE health is often overlooked until discomfort arises, but stomach and oesophageal 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 oesophageal cancers still pose significant health risks, with stomach cancer accounting for 3 in 100 and oesophageal cancer 1 in 100 of all new cancer cases in 2020.
Sunway Medical Centre Velocity (SMCV) Consultant Clinical Oncologist, Dr Hafizah Zaharah Ahmad, emphasised, “Early detection is crucial, but because stomach and oesophageal cancers often present with non-specific symptoms that are often overlooked, they are frequently diagnosed in advanced stages.”
This highlighted the need for early symptom recognition, as late-stage cancer diagnoses had risen from 63.7 per cent to 65.1 per cent, according to the Malaysia National Cancer Registry Report 2017-2021.
Understanding stomach, oesophageal cancers
Stomach and oesophageal cancers develop when abnormal cells grow uncontrollably in the digestive tract.
Stomach cancer primarily affects the stomach’s main body, while oesophageal cancer develops in the oesophagus lining and is often associated with chronic acid reflux and Barrett’s oesophagus — 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 tumours develop at the gastro-oesophageal junction.
“This may include symptoms such as difficulty in swallowing (dysphagia), unexplained weight loss, loss of appetite, persistent heartburn and indigestion, nausea or vomiting, and chest or upper abdominal pain,” she explained.
Dr Hafizah also highlighted that the five-year survival rate for early-stage stomach cancer was 65 to 75 per cent but dropped to 5 to 7 per cent at Stage 4.
Similarly, localised oesophageal cancer has a survival rate of 47 to 55 per cent for early-stage diagnosis but falls to 5 to 6 per cent in advanced stages.
Key risk factors
Stomach and oesophageal 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.
SMCV Consultant Gastroenterologist and Hepatologist, Dr Tan Yu Peng, stressed that individuals with high-risk lifestyles should be proactive about screening as they were at a higher risk to develop oesophageal 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 oesophageal cancer, which starts in the thin, flat cells lining inside the oesophagus,” he said.
On the other hand, those who are obese, smoking, have long-term gastro-oesophageal reflux disease (GERD), or suffer from Barrett’s oesophagus are more likely to develop oesophageal adenocarcinoma which begins in the glandular cells lining the lower oesophagus near the stomach.
For stomach cancer, the risk factors include GERD, those who consume high-fat and low-fibre 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 oesophageal cancer
GERD is a condition where stomach acid frequently flows back into the oesophagus, causing irritation and, over time, increasing the risk of oesophageal cancer.
Persistent acid exposure can lead to Barrett’s oesophagus, a precancerous condition where the oesophagus undergoes abnormal changes.
“Smoking, overeating, excessive alcohol, and even coffee consumption can worsen GERD, making effective management of the condition essential,” Dr Tan said.
While lifestyle modifications and medication often provide relief, he emphasised that persistent or worsening symptoms may require endoscopic or surgical intervention like fundoplication that involves wrapping the top of the stomach around the lower oesophagus to strengthen the lower oesophageal sphincter and prevent acid reflux to reduce complications and improve patient outcomes.
Role of endoscopy in early detection
Endoscopic procedures such as gastroscopy and colonoscopy have significantly improved the ability to diagnose and treat gastrointestinal conditions.
According to Dr Tan, these procedures allow doctors to detect any abnormalities at an early stage and facilitate 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,” he said.
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 oesophageal cancers often overlaps, especially for tumours at the gastro-oesophageal junction, with surgery, chemotherapy, and radiation therapy being the standard approaches depending on the stage and location of the cancer,” Dr Tan explained.
Immunotherapy has shown promise for advanced oesophageal cancer, particularly in PD-L1-positive tumours, 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 to 20 per cent of stomach cancers.
In these cases, anti-HER2 therapy has been proven effective in slowing tumour growth and improving patient outcomes.
Insights from cancer patient’s carer
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 carer 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 emphasised the importance of remembering that life did s not end with cancer; patients could still find joy and fulfilment during and after treatment.
She also highlighted how simple adjustments, such as liquid-based and pureed diets, could help stomach and oesophageal cancer patients maintain their nutrition while ensuring meals remained enjoyable due to the difficulty in swallowing.
Beyond physical health, she stressed that mental and emotional well-being played 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, recognising symptoms early and prioritising regular screenings, individuals can take proactive steps in safeguarding their digestive health, enabling better health outcomes and improving overall quality of life.
