Gastrointestinal Cancers

Gastrointestinal (GI) cancers are cancers of the digestive system, including the oesophagus, stomach, colon and rectum, liver, gallbladder, bile ducts, and pancreas. Together they account for a large share of cancers in India; gallbladder and stomach cancers are notably more common in India than in many Western countries.

Common signs and symptoms

Symptoms vary by organ, but warning signs include:

• Difficulty or pain while swallowing
• Persistent indigestion, vomiting, or early fullness after meals
• A change in bowel habit, blood in the stool, or black stools
• Unexplained weight loss or loss of appetite
• Jaundice (yellowing of eyes and skin) or persistent abdominal pain

Diagnosis

Depending on the site, evaluation may include endoscopy or colonoscopy with biopsy, CT or MRI scans, tumour markers, and PET-CT for staging. Molecular tests (such as MSI, HER2, and RAS/BRAF status) are increasingly used to guide treatment in several GI cancers.

Treatment

GI cancers are managed by a multidisciplinary team of surgeons, radiation oncologists, gastroenterologists, and medical oncologists. Systemic treatment planned by the medical oncologist may include:

• Chemotherapy — before or after surgery to improve the chance of cure, or as the main treatment in advanced disease
• Targeted therapy — chosen according to the tumour’s molecular profile
• Immunotherapy — for selected cancers, particularly those with mismatch-repair deficiency (MSI-high)

The sequence of surgery, chemotherapy, and radiation is planned jointly for each patient, which is why review by a multidisciplinary team before starting treatment is important.