GI Cancer SurgeryDepertment

GI Cancer

This article gives a short account about what cancer is, what tumours are, and how cancers develop and spread. There are individual types of cancer such as breast cancer, prostate cancer, lung cancer, skin cancer, etc.

How much do GI Cancer Surgeries in Bangalore Cost?

The cost of GI Cancer Surgeries depends upon multiple factors. The cost of GI Cancer Surgeries ranges from ₹35,000 to ₹65,000

Understanding Cancer

Cancer is a disease of the cells in the body. There are many different types of cell in the body, and many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and multiply out of control. However, there are often great differences between different types of cancer. For example:

• Some grow and spread more quickly than others.
• Some are easier to treat than others, particularly if diagnosed at an early stage.
• Some respond much better than others to chemotherapy, radiotherapy, or other treatments.
• Some have a better outlook (prognosis) than others.
• For some types of cancer there is a very good chance of being cured.
• For some types of cancer, the outlook is poor.

So, cancer is not just one condition. In each case it is important to know exactly what type of cancer has developed, how large it has become, whether it has spread, and how well the particular type of cancer responds to various treatments. This will enable you to get reliable information on treatment options and outlook

Normal body cells

An insight into cells

The body is made up from millions of tiny cells. Different parts of the body such as organs, bones, muscles, skin, and blood are made up from different specialised cells. Most cells have a centre called a nucleus. The nucleus in each cell contains thousands of genes which are made up from a chemical called DNA.

The genes are like codes which control the functions of the cell. For example, different genes control how the cell makes proteins, or hormones, or other chemicals. Certain genes control when the cell should multiply, and certain genes even control when the cell should die.

Most types of cell in the body divide and multiply from time to time. As old cells wear out or become damaged, new cells are formed to replace them. Some cells normally multiply quickly. For example, you make millions of red blood cells each day as old ones become worn out and are broken down. Some cells do not multiply at all once they are mature – for example, brain cells. Normally, your body only makes the right number of cells that are needed.

Abnormal cells

Sometimes a cell becomes abnormal. This occurs because one (or more) gene in the cell becomes damaged or altered. The abnormal cell may then divide into two, then four, then eight, and so on. Lots of abnormal cells may then develop from the original abnormal cell. These cells do not know when to stop multiplying. A group of abnormal cells may then form. If this group of cells gets bigger, it becomes a large clump of abnormal cells called a tumour.

What are tumours?

A tumour is a lump or growth of tissue made up from abnormal cells. Tumours are divided into two types:
1. Benign and
2. Malignant

Non-cancerous (benign) tumours

These may form in various parts of the body. Benign tumours grow slowly, and do not spread or invade other tissues. They are not cancerous and are not usually life-threatening. They often do no harm if they are left alone. However, some benign tumours can cause problems. For example, some grow quite large and may cause local pressure symptoms, or look unsightly. Also, some benign tumours that arise from cells in hormone glands can make too much hormone, which can cause unwanted effects

Cancerous (malignant) tumours

Malignant tumours tend to grow quite quickly, and invade into nearby tissues and organs, which can cause damage. Tumours normally develop in one original site – the primary tumour. Malignant tumours may also spread to other parts of the body to form secondary tumours (metastases). This happens if some cells break off from the primary tumour and are carried in the bloodstream or lymph channels to other parts of the body. These secondary tumours may then grow, invade and damage nearby tissues, and spread again.

Note: not all cancers form solid tumours. For example, incancer of the blood cells (leukaemia))manyabnormalblood cells are made in the bone marrow and circulate in the bloodstream.

How do cancerous (malignant) tumours grow and spread?

Local growth and damage to nearby tissues

Malignant cells multiply quickly. However, to get larger, a tumour has to develop a blood supply to obtain oxygen and nourishment for the new and dividing cells. In fact, a tumour would not grow bigger than the size of a pinhead if it did not also develop a blood supply. Cancer cells make chemicals that stimulate tiny blood vessels to grow around them which branch off from the existing blood vessels. This ability for cancer cells to stimulate blood vessels to grow is called angiogenesis. Malignant cells have the ability to push through or between normal cells. So, as they divide and multiply, malignant cells invade and damage the local surrounding tissue.

Spread to lymph channels and lymph nodes

Some malignant cells may get into local lymph channels. (The body contains a network of lymph channels which drains the fluid called lymph which bathes and surrounds the body's cells.) The lymph channels drain lymph into lymph glands (called lymph nodes). There are many lymph nodes all over the body. A malignant cell may be carried to a lymph node and there it may become trapped. However, it may multiply and develop into a tumour. This is why lymph nodes that are near to a tumour may enlarge and contain cancerous cells.

Spread to other areas of the body

Some malignant cells may get into a local small blood vessel (capillary). They may then get carried in the bloodstream to other parts of the body. The cells may then multiply to form secondary tumours (metastases) in one or more parts of the body. These secondary tumours may then grow, invade and damage nearby tissues, and spread again.

Why do non-cancerous (benign) tumours not spread to other areas?

Cells that make up benign tumours are different to cancerous (malignant) cells. Cells in benign tumours tend to be quite similar to normal cells. They do not invade local tissues. A benign tumour often grows slowly within a capsule or within normal cells which surround the tumour. A benign tumour tends to look and feel smooth and regular and have a well-defined edge. This is unlike a malignant tumour which may look craggy and irregular, and its edges tend to be mixed up with the nearby normal cells and tissue.

Types of cancer

Local growth and damage to nearby tissues

There are more than 100 different types of cancer. Each type is classified by the type of cell the cancer originates from – for example, a breast cell, a lung cell, etc. Each type of cancer generally falls into one of three categories:

1. Carcinomas are cancers that arise from cells which line a body surface, or the lining of a gland – for example, the skin, or the lining of the gut, mouth, cervix, airways, etc.

2. Sarcomas are cancers that arise from cells which make up the connective tissues such as bones or muscles. For example, an osteosarcoma is a cancer of bone tissue.

3. Leukaemias and lymphomas are cancers of cells in bone marrow and lymph glands (lymph nodes). For example, leukaemia is a cancer of cells that make white blood cells.

Carcinoma in situ

A carcinoma in situ is the very early stage of a cancer when the abnormal cancer cells are confined to their original site. At this stage no tumour has grown and no cancer cells have spread. It may be that many cancers remain at this dormant stage for months, or even years, before they start to grow and spread into a proper cancer. This may be because the cells of the carcinoma in situ do not have the ability to stimulate new blood vessels (see above under 'Local growth and damage to nearby tissues' – angiogenesis). If they cannot stimulate new blood vessels to grow then the cancer itself cannot grow or spread.

It is thought that one or more of the cells in a carcinoma in situ may then mutate after some time (some genes may be altered). This then gives them the ability to make chemicals to stimulate new blood vessels. The cancer then grows and spreads as described above.

A carcinoma in situ contains only a small number of cells and is usually too small to be detected by scans or X-rays. However, some screening tests may detect a carcinoma in situ. For example, some cells from an abnormal cervical screening test, looked at under the microscope, may show carcinoma in situ. These cells can then be destroyed by treatment which prevents cancer from developing. Sometimes a small sample (a biopsy) taken from a part of the body may show a carcinoma in situ

Grounds of cancer

Each cancer is thought to first start from one abnormal cell. What seems to happen is that certain vital genes which control how cells divide and multiply are damaged or altered. This makes the cell abnormal. If the abnormal cell survives it may multiply out of control into a cancerous (malignant) tumour.

We all have a risk of developing cancer. Many cancers seem to develop for no apparent reason. However, certain risk factors are known to increase the chance that one or more of your cells will become abnormal and lead to cancer. Risk factors include the following:

Chemical carcinogens

A carcinogen is something (chemical, radiation, etc) that can damage a cell and make it more likely to turn into a cancerous cell. As a general rule, the more the exposure to a carcinogen, the greater the risk. Well known examples of carcinogens include:

Smokers are more likely to developlung cancer, mouth cancer, throat cancer, oesophageal cancer, bladder cancer and pancreatic cancer..Smoking is thought to cause about aquarter of all cancers. About 1 in 10 smokers die from lung cancer. The heavier you smoke, the greater the risk. If you stop smoking, your risk goes down considerably.

Workplace chemicals
Chemicals such as asbestos, benzene, formaldehyde, etc. If you have worked with thesewithout protection you have an increased risk of developing certain cancers. For example, a cancer called mesotheliomais linked to past exposure to asbestos.

The older you become, the more likely you will develop a cancer. This is probably due to an accumulation of damage to cells in the body over time. Also, the body's defences against abnormal cells may become less good as you become older. For example, the ability to repair damaged cells, and the immune system which may destroy abnormal cells, may become less efficient with age. So, eventually one damaged cell may manage to survive and multiply out of control into a cancer. Most cancers develop in older people.

Lifestyle factors
Diet and other lifestyle factors can alter the risk of developing cancer. For example:

If you eat a lot of fruit and vegetables you have a reduced risk of developing certain cancers.

The exact way in which they protect against cancer is not fully understood. These foods are rich in vitamins and minerals, and also contain chemicals called antioxidants. They may protect against damaging chemicals that get into the body. We should all eat at least five portions of fruit and vegetables per day (some experts recommend even more).

Eating too much fatty food possibly increases the risk of developing certain cancers. The risk of developing certain cancers is increased by obesity, lack of regular exercise (physical activity), and drinking a lot of alcohol. For example, one large research study (cited below) followed up over 55,000 people for 10 years.

It looked at lifestyle factors and rates of cancer. The study concluded that by following recommendations on keeping physically active, keeping weight in check, not smoking, drinking alcohol in moderation and having a healthy diet, the risk of developing bowel cancer could be reduced by as much as 23%. But, the study found that even improvement in some of these lifestyle factors had some reduction in risk.

Radiation is a carcinogen. For example, exposure to radioactive materials and nuclear fallout can increase the risk of developing cancer of the blood cells (leukaemia) and other cancers. Too much sun exposure and sunburn (radiation from UVA and UVB) increase the risk of developing skin cancer. The larger the dose of radiation, the greater the risk of developing cancer. But note: the risk from small doses such as from a single X-ray test, is very small.

Some viruses are linked to certain cancers. For example, people with persistent infection with the hepatitis B virus or the hepatitis C virus have an increased risk of developing cancer of liver. Another example is the link between the human papillomavirus (HPV) and cervical cancer . Most (possibly all) women who develop cervical cancer have been infected with a strain (subtype) of HPV at some point in their lives. However, most viruses and viral infections are not linked to cancer.

Immune system
People with a poor immune system have an increased risk of developing certain cancers. For example, people with AIDS, or people on immunosuppressive therapy.

Your genetic 'makeup'
Some cancers have a strong genetic link. For example, in certain childhood cancers the abnormal gene or genes that may trigger a cell to become abnormal and cancerous (malignant) are inherited. Other types of cancer may have some genetic factor which is less clear-cut. It may be that in some people their genetic 'makeup' means that they are less resistant to the effect of carcinogens or other factors such as diet.

Identification of cancer

If a cancer is suspected from your symptoms

Your doctor will examine you to look for abnormalities such as a lump under the skin, or an enlarged liver. You may be referred for tests such as X-rays, scans, blood tests, endoscopy, bronchoscopy, etc. depending on where the suspected cancer is situated. These tests can often find the site of a suspected cancer. However, a sample (biopsy) is often needed to be certain that the abnormality is a cancer and not something else – such as a non-cancerous (benign) tumour.

A biopsy is a procedure where a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope or tested in other ways to detect abnormal cells. Sometimes it is easy to obtain a biopsy. For example, from a lump on the skin which may be a skin cancer. However, it can be difficult to obtain a biopsy from deeper tissues and it may require specialised procedures.

Therapeutic alternatives for cancer
Treatment options vary, depending on the type of cancer and how far it has grown and spread. (staging). Briefly, the three most common treatments are:

It may be possible to cut out a cancerous (malignant) tumour.

This is a treatment that uses anti-cancer medicines to kill cancer cells, or to stopthem from multiplying. There are various different types of medicines used for chemotherapy. The medicine or combination of medicines selected depends on the type of cancer being treated.

This is a treatment that uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. More recently, other treatments have been introduced which include:

Stem cell transplant
High-dose chemotherapy may damage bone marrow cells and lead to blood problems. However, if you receive healthy bone marrow after the chemotherapy then this helps to overcome this problem.

Hormone therapy
This is the use of medicines to block the effects of hormones. This treatment maybe used for cancers that are hormone-sensitive such as some cancers of the breast, prostate and womb (uterus).

Some treatments can boost the immune system to help to fight cancer. More specific immunotherapy involves injections of antibodies which aim to attack and destroy certain types of cancer cells. Research is underway to try to find vaccines that would stimulate your own immune system to make antibodies against cancer cells.

Gene therapy
This is a new area of possible treatments. Research is underway to find ways of blocking, repairing or replacing abnormal genes in cancer cells.

Special techniques
These can sometimes be used to cut off the blood supply to tumours. The tumour then dies. For some cancers, a combination of two or more treatments may be used. A range of other treatments may also be used to ease cancer-related symptoms such as pain.

The Prognosis for people with cancer

Some cancers are more aggressive and grow more quickly than others. Some cancers are more likely to spread to other parts of the body. Some cancers respond to treatment better than others. Therefore, it is not possible give an overall outlook (prognosis). See the information about the individual types of cancer for further details. As a general rule, the outlook is usually better the earlier a cancer is detected and treated.

Objectives of treatment
The aims of treatment can vary, depending on the cancer type, size, spread, etc. For example: Treatment aims to cure the cancer in many cases. With modern medicines and therapies, many cancers can be cured, particularly if they are treated in the early stages of the disease. (Doctors tend to use the word remission rather than the word cured. Remission means there is no evidence of cancer following treatment. If you are in remission, you may be cured. However, in some cases a cancer returns months or years later. This is why doctors are sometimes reluctant to use the word cured.) Treatment may aim to control the cancer. If a cure is not realistic, with treatment it is often possible to limit the growth or spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time. Treatment may aim to ease symptoms in some cases. Even if a cure is not possible, a course of radiotherapy, an operation, or other techniques may be used to reduce the size of a cancer, which may ease symptoms such as pain. If a cancer is advanced then you may require treatments such as nutritional supplements, painkillers, or other techniques to help keep you free of pain or other symptoms.

Dr Maruthesh Gowda has trained in cancer surgery from the beginning of his career itself in The UK from 2004. He has extensive training in all type of cancer surgery for all gastrointestinal cancer like Oesophageal cancer, stomach cancer, Liver cancer, bile duct cancer, Pancreatic cancer, Colon cancer, Rectal cancer, anal canal cancer, appendicular cancer, breast cancer and many more.

He has extensive training under world renowned surgeons in different hospitals across The United Kingdom for 10 years and has been practising in India since 2014 offering complex cancer surgery for wide range of cancer conditions