Each year a group of cancers kills more Australians than prostate and breast cancers combined. More than 24,000 Australians are diagnosed with it each year and, with lower survival rates than other well-known cancers, 33 Australians die of it each day. Yet you are unlikely to hear about gut or gastrointestinal cancers. In Australasia these cancers remain under-represented in awareness and funding campaigns – with groups such as Gastro-intestinal Cancer Research left to champion the cause.
“People don’t want to talk about cancer because it is a threatening disease,” medical oncologist Michael Findlay says. “The mortality figures for gut cancers are grim.”
As with other cancers, we need to take the time to care for our bodies and, with gastrointestinal cancer in particular, we need to talk. Unfortunately, as Findlay points out, “a lot of people don’t particularly want to talk about their bowels.”
He explains our gut simply: “You have an oesophagus, which leads to your stomach, which leads to your duodenum and into the small bowel, the small bowel into the large bowel, into the rectum and then your anus.”
Our liver is also included as it creates bile to help digest the fat we eat, as is the pancreas as it creates the enzymes that break down glucose and proteins.
Cancers of the gut can arise in each of those areas and they are often hard to spot. But Findlay says there should be no blame whatsoever placed on patients who don’t notice warning signs. “It is a difficult bunch of cancers to detect,” he says.
“Most of the cancers arise within the normal lining of the gut,” Findlay explains. “The most common type in the gut is bowel cancer, but we also see stomach, oesophagus and pancreatic.”
Findlay says there are very rarely early warning signs. “Because gut cancers are by and large happening inside you, things may get quite big before they become noticeable.”
For example, in the colon – also known as the large bowel – the first symptom you might notice is that the colon is blocked because a tumour has grown large enough to block it.
“A recent study showed about 20 to 25 per cent of people present for the first time in the emergency department with a bowel blockage.
“Earlier stages that might have been ignored is blood or mucus in a bowel motion or you might have a change in bowel habits. You can get pain; you can get a need to run to the toilet urgently,” he says.
“Another symptom might be anaemia – that’s because a tumour can leak blood. And if you leak blood for a year or more, your body can’t keep up with the production.
“If you have an oesophageal cancer – the oesophagus is quite a narrow tube and if you have a little bit of roughening on the inside of the tube where cancer has grown, you might find when you try and eat, food can catch on the way down. If you are getting that trouble then you are not going to be eating well and so you will lose weight – that is often a sign of both oesophageal and stomach cancer.
“With the pancreas, the first symptom might be a sudden onset of jaundice – you go yellow, itchy and bowel motions go pale; urine goes dark. You can also get pain the back or in the top part of your stomach.”
This all makes tough but necessary reading, Findlay says.
Grant Baker would agree. About 10 years ago he was feeling fine, very comfortable in his position as an executive chairman and happy with his family life. But he had started experiencing “some pretty bad stomach cramps which were usually accompanied by bouts of nausea”.
Looking back to that time, he says, “I chose to ignore them for as long as possible, but the cramps kept getting stronger and came more regularly.”
Baker finally got to the stage where he could no longer ignore the pain and visited his doctor to find out what was wrong.
“He gave me a physical examination which didn’t show any problems, and organised a blood test as a further precautionary check. At my follow-up appointment, he told me that my CEA markers [indicators of cancer] were normal but my red blood cell count was slightly low.”
He had a colonoscopy a few days later and was diagnosed with bowel cancer. “That same day I was introduced to a surgeon who said I would have to have surgery immediately as a cancerous tumour was almost totally blocking my colon.”
Baker underwent surgery, and about a third of his colon was removed along with 45 lymph nodes. Unfortunately the cancer had spread, which meant a six-month course of chemotherapy was also needed.
“The only long-term side effect with the chemo is that it has some impact on the nerves in a patient’s fingertips and feet,” says Baker. “So in my case and many others, a lot of feeling and sensation in those areas is missing.”
More Research Needed
Baker is now free of the disease and has gone on to be a champion for the cause, fundraising hundreds of millions of dollars to go towards research.
Much of that research is ongoing and includes clinical trials such as the SCOT (Short Course Oncology Therapy) Trial, which seeks to determine whether half the current standard chemotherapy for bowel cancer might be less toxic and as effective as the usual six-month course.
When it comes to pancreatic cancer, trials are under way to test the effectiveness of a blood test before, and after, someone has their pancreatic cancer removed in order to detect a mutated DNA. It is hoped this may lead to the opportunity to detect this cancer earlier, while it is still removable, therefore potentially increasing survival rates.
In gastric or stomach cancer, researchers are investigating whether the addition of radiation treatment before a patient’s surgery can improve outcomes. Another study looking at treatment for rectal cancer investigated whether laparoscopic surgery could be better than open surgery, with the idea that a minimally invasive procedure means patients can get out of hospital earlier.
What We Need
At this point in time, there is little screening available for gastrointestinal cancers other than bowel cancer. In Australia, people over the age of 50 are encouraged to screen for bowel cancer every one to two years. This often involves a faecal immunochemical test (also called a faecal occult blood test), which can detect small amounts of blood in bowel movements. It does not test for the cancer itself, so if blood is detected a patient will immediately be referred for a colonoscopy.
Clearly, early detection is an essential part of survival. People who are diagnosed with bowel cancer and receive treatment when it is at an early stage have a 90 per cent chance of surviving five years – that compares to about an eight per cent survival rate if the disease has become widespread.
Another important aspect in the scenario is prevention. Bowel Cancer Australia points out that, while no cancer is completely preventable, it is estimated that changes in diet and physical activity could reduce the incidence of bowel cancer by up to 75 per cent. But, as the causes of gastrointestinal cancer are still up for debate, there is no clear connection.
Diet is thought to be a significant influence in gut cancers, but Findlay says we don’t yet fully understand the relationship. “Diet is important, but we still get people who have the perfect diet who get colon cancer.”
He says the microbiome – the cocktail of bugs in our gut – is thought to be a key factor, but even more crucial is an awareness of the cancers and a willingness to talk. If we start that discussion, he says, we break down the cultural stigma and we take a step closer to finding a cure..
Tips for Prevention
• Be physically active for at least 30 minutes every day.
• Eat at least five servings of a variety of non-starchy vegetables and of fruits every day.
• Try to incorporate relatively unprocessed grains with every meal.
• Limit refined starchy foods in your diet.
• If you eat red meat, consume less than 500g a week, and avoid processed meats (meat preserved by smoking, curing or salting, or addition of chemical preservatives).
• Consume energy-dense foods sparingly.
• Avoid sugary drinks, this principally refers to drinks with added sugars but fruit juices should also be limited.
• Consume fast foods sparingly, if at all.
• Limit your consumption of alcoholic drinks to no more than two drinks a day for men and one drink a day for women.
Symptoms to look out for
Colorectal or bowel cancer: A persistent change in bowel habits (constipation and/or diarrhoea), blood in stools, tiredness and weight loss.
Oesophagus: Difficulty or pain with swallowing, new or worsening heartburn or reflux.
Pancreatic: Jaundice, pain in the upper abdomen, loss of appetite, change in bowel habits.
Stomach: Loss of appetite and/or weight loss, filling up easily with eating, swelling abdomen.
If you have any concerns at all, visit your doctor.