Stomach Cancer Screening

Open surgery requires a big cut to be made, and the surgeon has to reach into your body to cut the parts out. For keyhole surgery, incisions are made and instruments reach into your body to make the cuts rather than a surgeon’s hands. In that sense, keyhole surgery is a much harder surgery to perform. But the main thing is to make sure that we get rid of all the cancer. So technically the risk of keyhole surgery depends on the difficulty in finding the angle to cut the stomach out and doing the surgery in a confined space compared to open surgery.

Once you diagnose the cancer, there’s no option. Surgery is a must, it’s not like buying a car -- do I have that or not have that? When you get diagnosed with cancer, be it stomach cancer or colon cancer, there is essentially one option only. Look, here are the plain facts -- you’ve got cancer. It’s deciding how far the cancer has gone and whether I, as a specialist, can help you. Or do I refer you to a colleague who can offer you chemotherapy, or if we can’t do anything we can only manage the symptoms?

No, not really. When you come to a specialist, it’s more of going through your symptoms and your risk factors. If it’s bloating and nothing more, then we look at the risk factors. If you’re 20 years old, no family history, and just bloating for a short period of time, stomach cancer will be the last thing on my mind. Whereas if you’re 50, you have acid reflux that’s constantly there despite medications, then it’s more worrying.

We know that turmeric and certain things are anti-carcinogenic. And we know some of the remedies, some of the pills do have turmeric. I don’t think it’s that in itself, but the Indians have a lower incidence of gastric cancer. The flip side of this is that the Indians have a higher incidence of colon cancer. There’s genetic relevance, and diet certainly has an impact on the risk. Certain parts of China, where the food intake is of a certain type, the risk of gastric cancer is higher. In Japan, the H. pylori infection rate is higher, so that’s one thing that we know.

It goes back to staging. When we say staging, when we do the operation -- has the cancer spread further? Although we see it, it depends whether it has gone microscopic -- little cells that moved away beyond where we excise. One of the things that we really know is that after we take the stomach away, we send it to a laboratory to have it looked at. They chop it into little pieces and look at it in detail, see if there are any cancer cells elsewhere. That will give an indication of how likely it is to come back. Another thing is what type of cancer it is.

It all boils down to staging, how advanced they are. Stage 1 is very good, we do the surgery straight away, we don’t even do chemotherapy. We do the surgery, it’s clear, you don’t have to do chemo afterwards. From that point of view, their recovery is very fast. They eat a little less because we just cut two-thirds of the stomach away. Most people after 2-3 months, they’re more or less back to normal. We just keep an eye on them over the next 5 years or so. Stage 2 is a little more advanced, the cancer has gone through the layers of the stomach more.

Recently there’s been a development in the blood test we have, because if you look at -- what a lot of people talk about are treatment markers, so plethysmograph may be part of your screening test. For colon cancers and some of the cancers, there are what we call tumour markers, which help to kind of sift through the causes. In stomach cancer, recently in the last 6 years, they developed a blood test which is slowly being wheeled out in Singapore. It looks at the hormone level called pepsinogen. It’s a compound that’s produced in the stomach.

There are a few factors. First, obesity. For Caucasians, they’re much bigger so their disease patterns are a lot different. For Caucasians in Western countries, it’s not so much stomach cancer but cancer in the food pipe. For Asians, it’s more of the food we have and the genetic component we have as a race. Smoking and alcohol intake is slightly higher. So these all compounds to make stomach cancer more common in our part of the world. Also, H. pylori infections are more common on our side of the world.

Other countries like Japan and Korea have a huge incidence of stomach cancer, and that’s because of H. pylori and genetics. In Singapore, we don’t have as much incidence, so the focus is not on stomach cancer. If the GP does the normal treatment, hopefully, he doesn’t miss it and says you need to be seen by a specialist. Or you report that it doesn’t seem to be settling and you’re losing appetite, then your GP might agree and say let’s have it checked out. It’s quite easy, just go for an endoscopy.

In a sense, yes. It’s really trying to say “this is persisting”. You go and see a GP and are given the normal remedies. If all the bloating hasn’t resolved after a week or two and the acid reflux is still there even after taking the acid medication, those are the warning signs. Subsequently, the GP needs to send you for screening regardless of age or family history. If it’s persistent, you should just go and have it seen to.