Q1. What are the symptoms of early oesophageal and gastric cancers?
Early oesophageal and gastric cancers are usually relatively small on presentation and may be asymptomatic. Usually, these cancers are detected through screening gastroscopies. As the tumour grows, patients with oesophageal cancer may have difficulty eating and swallowing. Swallowing will be difficult with solid foods and better with liquid foods. Additionally, patients may also complain of blood-stained vomitus. If the cancer affects the surrounding tissues, it may also involve the vocal cords leading to hoarseness.
Early gastric cancer is also usually asymptomatic. As the tumour grows, patients may experience upper abdominal discomfort that is similar to pain experienced in dyspepsia. Patients may have stomach pain or bloating, followed by a sense of indigestion. When the tumour grows, patients may also experience a lack of appetite and weight loss. Both oesophageal and gastric cancers at the early stage do not present with obvious symptoms.
Q2. What are the risk factors for oesophageal and gastric cancers?
Both oesophageal and gastric cancers share common risk factors. Smoking and alcohol consumption can increase the likelihood of developing these types of cancers. For oesophageal cancers, a history of head and neck cancer and long-term gastro-oesophageal reflux may result in change of oesophageal mucosa increasing the risk of cancer. In the case of gastric cancer, infection with Helicobacter pylori is the most common risk factor and may also increase the risk of developing gastric ulcers.
Q3. How are early oesophageal and gastric cancers diagnosed?
A comprehensive review of patients’ medical history is usually performed to evaluate potential risk factors. We will also assess the presence of symptoms that may be related to oesophageal and gastric cancers. Gastroscopy is usually performed for diagnosis. During gastroscopy, the throat, oesophagus, stomach and the duodenum are examined. The latest gastroscope is equipped with new technologies such as special filters and magnifying lenses, which aid in the clear and efficient diagnosis of early oesophageal and gastric cancers. Biopsy samples may be taken in cases of uncertainty. Once cancer is diagnosed, further examinations will be arranged to determine the staging of the cancer.
For early-stage cancer, most cases are classified as stage one. Related examinations such as endoscopic ultrasound, computed tomography (CT) scan and positron emission tomography scan can allow cancer staging with high precision.
Q4. What are the treatment options for early oesophageal and gastric cancers?
Surgery with complete resection of the tumour results in the highest likelihood of a cure and hence it is the first choice of treatment. Conventional surgery may involve removal of parts of the oesophagus or stomach. However, if the cancer is at the early stage, newer minimally invasive options including endoscopic resection, can be considered to remove the tumour. Endoscopic resections allow removal of the mucosa containing the tumour and preserve the organ. Furthermore, no external wounds will be created during surgery leading to less pain and faster recovery.
If endoscopic resection is not suitable, minimally invasive surgery can be considered as an alternative to conventional open surgery. For early-stage cancers, these treatment methods can result in quicker recovery.
Q5. What is the prognosis for early oesophageal and gastric cancers?
Given the risk of recurrence in early-stage cancer, regular postoperative surveillance is important. Within the first year after surgery, endoscopic examinations are performed every few months for any signs of recurrence at the site of resection. It should be followed by CT scan a year after surgery to detect potential recurrence in other areas. In general, treatment for early-stage cancer has a high chance of success with the five-year survival rates exceeding 90%. It is strongly recommended to have regular health check-ups and seek early medical attention if any problems arise.
Patients can resume normal eating habits as their organs remain intact after surgery. However, we should try to reverse risk factors such as smoking and alcohol intake. It is strongly advised for long-term smokers and drinkers to discontinue these habits. Patients infected with Helicobacter pylori should have the bacteria eradicated. In most cases, the impact on daily life is minimal after recovery.
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