Rising Cancer Cases In Malaysia Stress The Importance Of Proactive Digestive Health Care

KUALA LUMPUR, Feb 7 (Bernama) -- Digestive health is often overlooked until discomfort arises, but stomach and oesophageal cancers remind us of the importance of proactive care in managing our digestive health and well-being.

According to a statement by Sunway Medical Centre Velocity (SMCV), data from the Ministry of Health (MoH) showed that cancer was the third leading cause of death in Malaysia in 2022.

Although stomach and oesophageal cancers are not among the most common, they still pose significant health risks, with stomach cancer accounting for 3 in 100 and oesophageal cancer 1 in 100 of all new cancer cases in 2020.

SMCV Consultant Clinical Oncologist Dr Hafizah Zaharah Ahmad emphasised that while early detection is crucial, these cancers often present with non-specific symptoms that are frequently overlooked, leading to late diagnoses at advanced stages.

“This highlights the need for early symptom recognition, as late-stage cancer diagnoses have risen from 63.7 to 65.1 per cent, according to the Malaysia National Cancer Registry Report 2017-2021,” she added.

Additionally, stomach and oesophageal cancers develop when abnormal cells grow uncontrollably in the digestive tract, with stomach cancer primarily affecting the stomach’s main body while oesophageal cancer develops in the oesophagus lining which is often associated with chronic acid reflux and Barrett’s oesophagus, a condition in which the lining of the food pipe changes due to prolonged acid reflux.

Dr Hafizah Zaharah noted that both cancers can present with similar symptoms, especially when tumours develop at the gastroesophageal junction. These symptoms may include difficulty swallowing (dysphagia), unexplained weight loss, loss of appetite, persistent heartburn and indigestion, nausea or vomiting, and chest or upper abdominal pain.

“The five-year survival rate for early-stage stomach cancer is 65 to 75 per cent but drops to five to seven per cent at Stage 4. Similarly, localised oesophageal cancer has a survival rate of 47 to 55 per cent for early stage diagnosis but falls to five to six per cent in advanced stages,” she added.

Although stomach and oesophageal cancers are more prevalent in older adults, with six in 10 new stomach cancer cases are diagnosed in individuals aged 65 and above. However, age is not the only factor as lifestyle choices and underlying medical conditions also contribute to an increased risk.

SMCV Consultant Gastroenterologist and Hepatologist Dr Tan Yu Peng explained that individuals with high-risk lifestyles should be proactive about screening as they are at a higher risk of developing oesophageal and stomach cancers.

“Those who smoke heavily, chew betel nuts (a habit linked to cancer-causing effects due to the presence of harmful chemicals), frequently consume very hot liquids, binge drink alcohol or regularly eat preserved foods are more susceptible to squamous oesophageal cancer which starts in the thin, flat cells lining inside the oesophagus,” he said.

On the other hand, those who are obese, smoking, have long-term gastroesophageal reflux disease (GERD) or suffer from Barrett’s oesophagus are more likely to develop oesophageal adenocarcinoma which begins in the glandular cells lining the lower oesophagus near the stomach.

For stomach cancer, the risk factors include GERD, those who consume high-fat and low-fibre diets, frequent consumption of smoked foods and Helicobacter pylori infections caused by bacteria in the stomach lining which could lead to gastritis and increasing the risk of peptic ulcers and stomach cancer.

Moreover, individuals with a family history of stomach cancer should also be particularly vigilant and consider early screening to manage their risk. Dr Tan also explained how GERD is a condition where stomach acid frequently flows back into the oesophagus, causing irritation and, over time, increasing the risk of oesophageal cancer.

“Persistent acid exposure can lead to Barrett’s oesophagus, a precancerous condition where the oesophagus undergoes abnormal changes. Smoking, overeating, excessive alcohol and even coffee consumption can worsen GERD, making effective management of the condition essential,” he added.

While lifestyle modifications and medication often provide relief, Dr Tan emphasised that persistent or worsening symptoms may require endoscopic or surgical intervention like fundoplication that involves wrapping the top of the stomach around the lower oesophagus to strengthen its sphincter and prevent acid reflux to reduce complications and improve patient outcomes.

Dr Tan said endoscopic procedures such as gastroscopy and colonoscopy have significantly improved the ability to diagnose and treat gastrointestinal conditions as these procedures allow doctors to detect any abnormalities at an early stage and facilitate timely intervention.

“Gastroscopy enables detailed examination of the stomach lining, while colonoscopy provides insights into the health of the colon, helping to identify potential cancerous growths or inflammations,” he explained.

Therefore, he said regular screenings are strongly recommended for individuals over 50 years old or those over 40 with a family history of gastric or colorectal cancer. In countries with a high prevalence of these cancers, such as Japan and South Korea, upper endoscopies are recommended to be done from age 40 and repeated every three years.

“Whereas in Malaysia, screening is still primarily focused on individuals with gastric issues, a strong family history of cancer, or those exhibiting warning symptoms for cancer such as difficulty swallowing, bleeding, unexplained weight loss, or abdominal pain.

“Treatment for stomach and oesophageal cancers often overlaps, especially for tumours at the gastroesophageal junction, with surgery, chemotherapy, and radiation therapy being the standard approaches depending on the stage and location of the cancer,” he added.

Immunotherapy has shown promise for advanced oesophageal cancer, particularly in PD-L1-positive tumours, improving survival rates when chemotherapy is ineffective. In stomach cancer, targeted therapies are increasingly used for patients with specific genetic mutations, such as HER2-positive cases, which account for 10-20 per cent of stomach cancers.

“In these cases, anti-HER2 therapy has been proven effective in slowing tumour growth and improving patient outcomes,” Dr Hafizah Zaharah said.

It is important to note that a cancer diagnosis not only affects the patient but also has a profound impact on their loved ones. A caregiver of a stomach cancer patient at SMCV shared how her family’s diagnosis drastically changed their life, but with adaptation and support, they found ways to cope.

She emphasised the importance of remembering that life does not end with cancer, patients can still find joy and fulfilment during and after treatment. She also highlighted how simple adjustments, such as liquid-based and pureed diets, can help stomach and oesophageal cancer patients maintain their nutrition while ensuring meals remain enjoyable due to the difficulty in swallowing.

Beyond physical health, she stressed that mental and emotional well-being plays a crucial role in navigating the treatment process, making support and encouragement from loved ones invaluable.

Early detection, lifestyle modifications, and routine screenings are key in improving outcomes for stomach and oesophageal cancers. Although these cancers are not the most common in Malaysia, the high rate of late-stage diagnoses underscores the need for greater awareness.

By staying informed, recognising symptoms early, and prioritising regular screenings, individuals can take proactive steps in safeguarding their digestive health, enabling better health outcomes and improving overall quality of life.

-- BERNAMA

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