Since chemotherapy can offer only a limited amount of help in fighting gastroesophageal cancers, a growing emphasis on prevention — as well as on the development of immunotherapies — will be extremely important.
FOR PATIENTS DIAGNOSED with gastrointestinal (GI) cancers, prognoses are often very hard to accept: Many of these malignancies are detected in later stages and can’t be treated nearly as effectively as we would like.
But understanding a cancer is the key to more effectively treating it — or, better yet, preventing it — and progress is being made in those areas. Particularly in gastric and esophageal cancers, we now have enough evidence to make a big difference through prevention.
We know that obesity contributes to both of these cancers; this is similar to the trend in liver cancer, where obesity can lead to a “fatty liver” and resulting inflammation, which can then spark cancer. Based on this evidence and more that is being gathered, we should have an opportunity, going forward, to help stem the tide of gastroesophageal cancers through awareness and prevention.
Specifically, we know that some esophageal cancers are preceded by a condition called Barrett’s esophagus. This can begin with obesity, which leads to reflux and then to Barrett’s esophagus; that condition, in turn, makes changes in the lining of the esophagus that sets cells on a course toward cancer. But when we’re aware that Barrett’s esophagus has developed, there are new developments to help prevent cancer from arising. Doctors can use radiofrequency ablation to remove diseased sections of the esophageal lining, or, in cases where Barrett’s esophagus is too widespread to allow this, surgeons can prophylactically remove part of a patient’s esophagus.
In gastric cancer, removal of all or part of the stomach is a common treatment for earlier-stage disease. But in the rare cases when someone’s inherited genetics predict a high chance that they will develop gastric cancer, this surgery can be used as a prevention technique. It’s something to be strongly considered in people with the CDH1 gene mutation, which can lead to both lobular breast cancer and diffuse gastric cancers. The strategy is aggressive, but it’s quite possible, after a period of adjustment, to live a normal life without a stomach.
Because these GI diseases cause only vague symptoms, the kind that also commonly occur in people who are healthy, cases are often not detected early in the United States. Things are different in countries like Japan and Korea, where gastroesophageal cancers are more common. There, education and vigilance are prioritized. People are taught the importance of avoiding alcohol and tobacco, eating a diet that emphasizes fruits and vegetables and getting checked by a doctor if they are experiencing reflux. As a result, cancers are caught earlier, treated more aggressive surgically and associated with better outcomes. In the meantime, early-detection blood and saliva tests are being developed that could further contribute to prevention efforts.
Since chemotherapy can offer only a limited amount of help in fighting gastroesophageal cancers, a growing emphasis on prevention — as well as on the development of immunotherapies — will be extremely important here in America over the next couple of years. Treating gastric and esophageal cancers as one category of disease — gastroesophageal cancer — may unite more advocates in these efforts, speeding progress along.
DEBU TRIPATHY, MDEditor-in-ChiefProfessor of MedicineChair, Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer Center