Screening for Gastrointestinal cancer – The when and why?
Pace Hospitals
Unlike breast and cervical cancer routine screening is not mandatory for gastrointestinal (GI) cancers. In the western world, entire population is screened for colon cancer once in 5 years. Likewise, in the far east countries like Japan screening for esophageal and stomach cancer is performed. However, in India the incidence of these cancers is much lower and there is no clear recommendation for routine population screening. Only selected groups of at risk individuals for some GI cancers need screening for that particular cancer. The screening frequency and modalities vary for individual cancers and are best decided by the gastroenterologist.
Oesophageal cancer
Patients with longstanding reflux disease and new onset difficulty in swallowing, patients with esophageal disease like esophgeal stricture, esophageal motility disorders need screening for esophgeal cancer. Chronic smokers and alcoholics are also at risk.
Gastric cancer
Patients with family history, Hpylori associated atrophic gastritis, prolonged reflux disease, elderly individuals with low haemoglobin, weight loss, gastrointestinal bleeding and persistent upper abdominal pain need to be screened.
Pancreatic cancer
Patients with family history Patients with chronic pancreatitis especially alcoholic and hereditary chronic pancreatitis, Lynch syndrome. Patients with Jaundice and itching.
Intestinal cancer
Family history of intestinal cancer, patients with inflammatory bowel disease like ulcerative colitis/ crohns disease, Patients with gastrointestinal polyps. Patients with past history of radiation need screening. Patients with history of treated colon cancer are at risk of developing cancer at a new location
Liver cancer
Patients with chronic liver disease secondary to hepatitis B, Hepatitis C, Alcohol, hemochromatosis is highly prone to developing liver cancer. Liver cirrhosis leads to cancer.Likewise, Non-alcoholic fatty liver disease (NAFLD) predisposes to cancer. All these patients need ultrasound and blood tests at 6 monthly intervals for early detection.
Gallbladder and biliary cancer
Some parts of Northern India like the cow belt region are endemic for Gallbladder cancer. Gallstones are associated with gall bladder cancer but a causative relation is not established. Patients with Liver stones (hepatolithiasis), repeated attacks of bile infection (cholangitis), bile duct anomalies such as bile duct cysts, narrowing (strictures ) and choedochal cyst are at risk for biliary cancer and should get treated with liver specialist.
GI CANCER - AT RISK FAMILIES
The following features (if more than 2) if present should make you consider going to a gastroenterologist for genetic testing and early screening for gastrointestinal cancer.
- GI or Gynaecological Cancer diagnosed at an unusually young age (less than 50)
- Cancer in two generations of family
- Cancer in 2 or more first / second degree relatives
- Developing more than 1 type of cancer (sometime / separately) in life time
- Cancer in index patient / first degree relative with proven genetic mutation
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