Dr Amit Maydeo, Chairman, Baldota Institute of Digestive Sciences, Global Hospital Mumbai speaks on how detection of GI cancers by cholangioscopic direct visualisation can completely change patient’s life, offering the patient a complete cure
Over the years, while people are addressing lifestyle diseases such as diabetes, hypertension, and heart failure with advanced therapeutic solutions, certain diseases such as gastrointestinal (GI) cancer are often unheard. The lack of awareness about the need for early diagnosis has led to it becoming the 4th most prevalent forms of cancer in India. A total of 57,394 new cases of GI cancer were documented in India, last year. The immediate symptoms are difficulty in swallowing, discomfort in the abdomen, constant indigestion, and dark stools with or without blood, etc.
GI cancer is a broad term wherein the treatment of hepatoma-pancreato-biliary (HPB) cancer is different from luminal cancer – oesophagus, stomach, duodenum, small intestine and colon. As the name suggests, HPB cancer includes bile duct, gall bladder, liver and pancreas. While there is considerable awareness – along with advances around luminal cancer, but the diagnosis of HPB cancer remains a challenge. More so, because the warning signs often remain silent. In fact, approximately 90 per cent of the patients are detected with GI cancer only at a progressive stage.
Hence, it’s about time that we raise awareness on the need for understanding the disease profile better and addressing it with innovative diagnostic solutions. The theme for the 2019 World Digestive Health Day (WDHD) is ‘Early Diagnosis and Treatment of GI Cancer’. The objective of the theme resonates with India’s needs i.e. countering the huge disease burden. With a special focus on the need for maintaining a healthy digestive tract, India can further its efforts towards addressing GI cancer by building a holistic healthcare ecosystem that encourages people to opt for smarter treatment options.
Diagnostic innovations to the rescue
Marking a shift from existing technologies, a leap in the tracking of initial signs of biliary tract cancer, cholangioscopy has emerged as one of the most trusted ways. Over the past decade, there has been advancement in medical technology relevant for cancer diagnosis wherein, personalise medicine has come to the fore. Through personalised medicine, individual treatment is suggested to the patient based on the analysis of tissue sample. The same can be done by using cholangioscopy.
As a minimally invasive procedure, cholangioscopy helps in differentiating between the kinds of cancers, helping a doctor to recommend the appropriate treatment. It allows a doctor to enter the bile duct and get direct visualisation to differentiate between the cancer and stricture by extracting the tissue for biopsy and accurate treatment. Using a thin, flexible tube with a tiny 1mm-wide video camera at the end, a doctor can carefully observe the inner lining of the bile duct. If any suspicious area is found, a small piece of tissue is extracted from that site (biopsy) for laboratory examination.
While the imaging techniques such as, CT and MRI scan, have also evolved which helps to stage the diagnosis better, but we need analysis of tissue for improved prognosis. Previously, if there was suspicion of biliary duct cancer in a patient, a surgical procedure would be performed to extract the tissue for biopsy. It means the patient would be on bed rest for minimum of three weeks. Now we have equipment like, cholangioscopy, a daycare procedure which allows the doctor to perform pre-operative diagnosis.
Here, there is no requirement of any major surgery involving cutting open of the abdominal muscles. This means quicker healing and improved cosmetic results. The new generation of direct visualisation has enhanced the clinical efficacy of the procedure by allowing doctors to identify not just between the cancerous and non-cancerous diseases but also identify different stages of cancer. For a person with the aforementioned symptoms, counting on the latest diagnostic solutions is the key. As they say, ‘safety saves’, it’s time to address the disease by consulting a gastroenterologist on time. What we need is to raise awareness on the importance of digestive health of a person a norm.
The advent of cholangioscopy has made a big impact in clinical management of patient who are suspected of having bile duct cancer.
Early detection of cancer by cholangioscopic direct visualisation can completely change patient’s life, offering the patient a complete cure.