1. Gastrointestinal cancer is one of the most prevalent with a 25% of new cases of cancer worldwide per year, being colorectal cancer the most common. The risk factors can be divided in modifiable and non-modifiable. Modifiable risk factors for GI cancer are: obesity, alcohol intake, smoking, eating fried foods and not eating enough fiber in the diet (fruits, cereals, vegetables). On the other side, non-modifiable risk factors are: age over 50 years old, genetic conditions, H. pylori infection, gastric ulcers and gastro-esophageal reflux disease (GERD). 2. It is recommended to do a colonoscopy in men after 50 years old every 5 to 10 years (the frequency depends of the clinical story of the patient). If the patient has gastric symptoms they should perform a gastroscopy also. Although gastroscopy is not part of screening like colonoscopy, it can be performed at age 50 and then monitored by your PCP. 3. Every clinician should know at least the basics for such a common disease. Patients sometimes come to see us for a problem but when we do the physical exam and check imaging and lab tests we must be capable of knowing if anything else is wrong and send the patient to the proper specialist if the problem is outside our area of expertise. In this case the patient may come to visit for constipation or diarrhea, heartburn, abdominal bloating, if we limit ourselves just to treat the symptom without digging in. If this patient has in fact an oncologic disease we are wasting time that could be crucial for the patient diagnosis and treatment. 4. First, we must know the age of onset of this type of cancer. If a patient over 50 years old comes to the office we should check if they are doing their screening for GI cancer and their family medical history. We should also check for any of the early symptoms as heartburn, blood in the feces, abdominal pain, bloating, constipation or diarrhea, fullness after eating. If any of those symptoms are present, we should be on the alert and refer the patient to the appropriate specialist, in this case a gastroenterologist.
Early-onset gastric cancers are on the rise, but they don't get as much attention as they should, and we now see people 45 years old come down with colorectal cancers. It's the commonest type; prior to this era, where we see gastric cancers earlier, family history was the big factor, but now we have other novel risk factors like diet and sedentary lifestyle practices.GI symptoms can be tricky, especially when you don't have a high index of suspicion. Any change in bowel habit, coupled with a family history, is very important, especially in people less than 40. For people above 40, or even younger persons with early satiety, they should be investigated thoroughly.Patients may not be able to tie their symptoms to whatever their parents had. It's left for the doctor to ask the right questions. A patient wouldn't easily tie early satiety to cancer in a first-degree relative, but a good history and quick evaluation can improve the timing of diagnosis.
Current Screening Recommendations and Methods Colorectal cancer screening has been moved to a starting age of 45 for average-risk adults to mirror the increased prevalence of cancers occurring at an earlier age. Now, screening comprises colonoscopy, stool-based tests, and, in limited instances, imaging. Those with a personal or family history of colorectal cancer—or people affected by certain genetic syndromes—may need to begin screening at an even earlier age and undergo screenings more often. Close adherence to prevailing guidelines, paired with an assessment of individual risk factors, is critical to effective early detection.
A lot of early-onset GI cancers are presented in individuals under the age of 50 who are not subject to the typical risk profile, so that they can be detected later. A significant contribution can be explained by lifestyle behaviours such as a bad diet, obesity, alcohol, and smoking. However, I have also encountered cases of younger patients without any obvious risk factors. One of the patients presented in her thirties with recurrent bloating and pain in the stomach, which was not dramatic enough to choose a more invasive investigation, but after some pressure, an early gastric tumour was revealed. It has also taught me that we should never disregard symptoms because the individual is young or exhibits other signs of good health. Clinicians ought to be cautious of chronic symptomology such as unexplained anaemia, rectal bleeding, bowel habit, non-responsive reflux, or unexplained weight loss. Early screening is challenging, as the guidelines have not yet been established. However, catching up fully, being proactive about referrals, and stimulating family history conversations is worthwhile. When clinically it feels on the wrong side of the bed, it is worth a look. A slight suspicion at an early stage can do a great deal.