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CC BY-NC-ND 4.0 · South Asian J Cancer 2016; 05(03): 126-136
DOI: 10.4103/2278-330X.187585
Review Article

Gastrointestinal cancers in India: Treatment perspective

Nikhil Suresh Ghadyalpatil
Department of Medical Oncology, Yashoda Cancer Institute, Hyderabad, Telangana
,
Chopra Supriya
Department of Radiation Oncology, Tata Memorial Center, Mumbai, Maharashtra
,
Patil Prachi
Department of Gastroenterology, Tata Memorial Center, Mumbai, Maharashtra
,
Dsouza Ashwin
Department of GI Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra
,
Saklani Avanish
Department of GI Surgical Oncology, Tata Memorial Center, Mumbai, Maharashtra
› Author Affiliations Financial support and sponsorship: Nil.
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Abstract

GI cancer is not one cancer but is a term for the group of cancers that affect the digestive system including gastric cancer (GC), colorectal cancer (CRC), hepatocellular carcinoma (HCC), esophageal cancer (EC), and pancreatic cancer (PC). Overall, the GI cancers are responsible for more cancers and more deaths from cancer than any other organ. 5 year survival of these cancers remains low compared to western world. Unlike the rest of the world where organ based specialities hepatobiliary, pancreatic, colorectal and esophagogastric exist , these cancers are managed in India by either a gastrointestinal surgeons, surgical oncologist, or a general surgeon with varying outcomes.The aim of this review was to collate data on GI cancers in indian continent. In colorectal cancers, data from tertiary care centres identifies the unique problem of mucinous and signet colorectal cancer. Results of rectal cancer resection in terms of technique (intersphincteric resection, extralevator aper, minimal invasive approach ) to be comparable with world literature. However long term outcome and data regarding colon cancers and nationally is needed. Gastric cancer at presentation are advanced and in surgically resected patients, there is need for a trial to compare chemoradiation vs chemotherapy alone to prevent loco regional recurrence. Data on minimal invasive gastric cancer surgery may be sparse for the same reason. Theree is a lot of data on surgical techniques and perioperatve outcomes in pancreatic cancer. There is a high volume of locally advanced gallbladder cancers with efforts on to decide whether neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy is better for down staging. Considering GI cancers, a heterogeneous disease with site specific treatment options and variable outcomes, the overall data and outcomes are extremely variable. Young patients with pathology unique to the Indian subcontinent (for example, signet ring rectal cancer, GBCs) need focussed attention. Solution for such pathology needs to come from the Indian continent itself. Joint efforts to improve outcomes for GI cancer can be integrated under the national cancer grid program.

Key words

Colorectal cancers - gallbladder cancers - gastric cancers - India - pancreatic cancers


Publication History

Article published online:
28 December 2020

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  • References

  • 1 Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86.
  • 2 Pai VD, De Souza A, Patil P, Engineer R, Arya S, Saklani A. Intersphincteric resection and hand-sewn coloanal anastomosis for low rectal cancer: Short-term outcomes in the Indian setting. Indian J Gastroenterol 2015;34:23-8.
  • 3 Shrikhande SV, Bodhankar YD, Suradkar K, Goel M, Shukla PJ. Perioperative outcomes after ultra low anterior resection in the era of neoadjuvant chemoradiotherapy. Indian J Gastroenterol 2013;32:90-7.
  • 4 Bujko K, Kepka L, Michalski W, Nowacki MP. Does rectal cancer shrinkage induced by preoperative radio (chemo) therapy increase the likelihood of anterior resection? A systematic review of randomised trials. Radiother Oncol 2006;80:4-12.
  • 5 McCarthy K, Pearson K, Fulton R, Hewitt J. Pre-operative chemoradiation for non-metastatic locally advanced rectal cancer. Cochrane Database Syst Rev 2012;12:CD008368.
  • 6 Pai VD, Engineer R, Patil PS, Arya S, Desouza AL, Saklani AP. Selective extra levator versus conventional abdomino perineal resection: Experience from a tertiary-care center. J Gastrointest Oncol 2016;7:354-9.
  • 7 Vallam KC, Desouza A, Bal M, Patil P, Engineer R, Saklani A. Adenocarcinoma of the rectum - A composite of three different subtypes with varying outcomes? Clin Colorectal Cancer 2016;15:e47-52.
  • 8 Deodhar KK, Budukh A, Ramadwar M, Bal MM, Shrikhande SV. Are we achieving the benchmark of retrieving 12 lymph nodes in colorectal carcinoma specimens? Experience from a tertiary referral center in India and review of literature. Indian J Pathol Microbiol 2012;55:38-42.
  • 9 Kim TH, Jeong SY, Choi DH, Kim DY, Jung KH, Moon SH, et al. Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol 2008;15:729-37.
  • 10 Sinukumar S, Engineer R, Saklani A. Preliminary experience with lateral pelvic lymph node dissection in locally advanced rectal cancer. Indian J Gastroenterol 2015;34:320-4.
  • 11 Gomes RM, Bhandare M, Desouza A, Bal M, Saklani AP. Role of intraoperative frozen section for assessing distal resection margin after anterior resection. Int J Colorectal Dis 2015;30:1081-9.
  • 12 Maas M, Nelemans PJ, Valentini V, Das P, Rödel C, Kuo LJ, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: A pooled analysis of individual patient data. Lancet Oncol 2010;11:835-44.
  • 13 Habr-Gama A, Sabbaga J, Gama-Rodrigues J, São Julião GP, Proscurshim I, Bailão Aguilar P, et al. Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: Are we getting closer to anal cancer management? Dis Colon Rectum 2013;56:1109-17.
  • 14 Sinukumar S, Patil P, Engineer R, Desouza A, Saklani A. Clinical outcome of patients with complete pathological response to neoadjuvant chemoradiotherapy for locally advanced rectal cancers: The Indian scenario. Gastroenterol Res Pract 2014;2014:867841.
  • 15 Barreto SG, Chaubal GN, Talole S, DeSouza A, Suradkar K, Gaikwad V, et al. Rectal cancer in young Indians - Are these cancers different compared to their older counterparts? Indian J Gastroenterol 2014;33:146-50.
  • 16 Ayloor Seshadri R, Kondaveeti SS, Jayanand SB, John A, Rajendranath R, Arumugam V, et al. Complete clinical response to neoadjuvant chemoradiation in rectal cancers: Can surgery be avoided? Hepatogastroenterology 2013;60:410-4.
  • 17 Vallam KC, Engineer R, Desouza A, Patil P, Saklani A. High nodal positivity rates even in good clinical responders after chemoradiation of rectal cancer: Is organ preservation feasible? Colorectal Dis 2015. Doi:1111/codi.13114. [Epub ahead of print].
  • 18 Prakash K, Varma D, Rajan M, Kamlesh NP, Zacharias P, Ganesh Narayanan R, et al. Laparoscopic colonic resection for rectosigmoid colonic tumours: A retrospective analysis and comparison with open resection. Indian J Surg 2010;72:318-22.
  • 19 Seshadri RA, Srinivasan A, Tapkire R, Swaminathan R. Laparoscopic versus open surgery for rectal cancer after neoadjuvant chemoradiation: A matched case-control study of short-term outcomes. Surg Endosc 2012;26:154-61.
  • 20 Sinukumar S, Menezes JL, Desouza A, Saklani A. Clinical outcomes of patients undergoing laparoscopic vs open surgery for rectal cancers. Gut 2015;64 Suppl 1:A373.3-A374.
  • 21 Sinukumar S, Mehta S, Ostwal V, Jatal S, Saklani A. Impact of type of surgery (laparoscopic versus open) on the time to initiation of adjuvant chemotherapy in operable rectal cancers. Indian J Gastroenterol 2015;34:310-3.
  • 22 Prakash K, Kamalesh NP, Pramil K, Vipin IS, Sylesh A, Jacob M. Does case selection and outcome following laparoscopic colorectal resection change after initial learning curve? Analysis of 235 consecutive elective laparoscopic colorectal resections. J Minim Access Surg 2013;9:99-103.
  • 23 Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, et al. Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: A retrospective, population-based study. Lancet Oncol 2015;16:161-8.
  • 24 Engineer R, Basu T, Chopra S, Arya S, Patil P, Mehta S, et al. Factors influencing response to neoadjuvant chemoradiation and outcomes in rectal cancer patients: Tertiary Indian cancer hospital experience. J Gastrointest Oncol 2015;6:155-64.
  • 25 Engineer R, Mohandas KM, Shukla PJ, Shrikhande SV, Mahantshetty U, Chopra S, et al. Escalated radiation dose alone vs. concurrent chemoradiation for locally advanced and unresectable rectal cancers: Results from phase II randomized study. Int J Colorectal Dis 2013;28:959-66.
  • 26 Saha A, Ghosh SK, Roy C, Saha ML, Choudhury KB, Chatterjee K. A randomized controlled pilot study to compare capecitabine-oxaliplatin with 5-FU-leucovorin as neoadjuvant concurrent chemoradiation in locally advanced adenocarcinoma of rectum. J Cancer Res Ther 2015;11:88-93.
  • 27 Sirohi B, Barreto SG, Patkar S, Gupta A, DeSouza A, Talole S, et al. Down-staging following neoadjuvant chemo-radiotherapy for locally advanced rectal cancer: Does timing of surgery really matter? Indian J Med Paediatr Oncol 2014;35:263-6.
  • 28 Shrikhande SV, Barreto SG, Talole SD, Vinchurkar K, Annaiah S, Suradkar K, et al. D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy. World J Surg Oncol 2013;11:31.
  • 29 Hadi R, Mohanti BK, Pathy S, Rath GK, Shukla NK, Deo SV, et al. Gastric cancer: A retrospective analysis from AIIMS, New Delhi. Gulf J Oncolog 2012;(12):11-6.
  • 30 Chopra S, Agarwal A, Engineer R, Dora T, Thomas B, Sonawone S, et al. Intensity modulated radiation therapy (IMRT) is not superior to three-dimensional conformal radiation (3DCRT) for adjuvant gastric radiation: A matched pair analysis. J Cancer Res Ther 2015;11:623-9.
  • 31 Sirohi B, Barreto SG, Singh A, Batra S, Mittra A, Rastogia S, et al. Epirubicin, oxaliplatin, and capectabine is just as "MAGIC"al as epirubicin, cisplatin, and fluorouracil perioperative chemotherapy for resectable locally advanced gastro-oesophageal cancer. J Cancer Res Ther 2014;10:866-70.
  • 32 Sirohi B, Rastogi S, Dawood S, Talole S, Ramadwar M, Shetty N, et al. Treatment of patients with advanced gastric cancer: Experience from an Indian tertiary cancer center. Med Oncol 2014;31:138.
  • 33 Kurumboor P, Palaniswami KN, Pramil K, George D, Ponnambathayil S, Varma D, et al. Octreotide does not prevent pancreatic fistula following pancreatoduodenectomy in patients with soft pancreas and non-dilated duct: A prospective randomized controlled trial. J Gastrointest Surg 2015;19:2038-44.
  • 34 D′souza MA, Singh K, Hawaldar RV, Shukla PJ, Shrikhande SV. The vascular stapler in uncinate process division during pancreaticoduodenectomy: Technical considerations and results. Dig Surg 2010;27:175-81.
  • 35 Sanjay P, Takaori K, Govil S, Shrikhande SV, Windsor JA. ′Artery-first′ approaches to pancreatoduodenectomy. Br J Surg 2012;99:1027-35.
  • 36 Shrikhande SV, Barreto SG, Bodhankar YD, Suradkar K, Shetty G, Hawaldar R, et al. Superior mesenteric artery first combined with uncinate process approach versus uncinate process first approach in pancreatoduodenectomy: A comparative study evaluating perioperative outcomes. Langenbecks Arch Surg 2011;396:1205-12.
  • 37 Shrikhande SV, Barreto SG, Somashekar BA, Suradkar K, Shetty GS, Talole S, et al. Evolution of pancreatoduodenectomy in a tertiary cancer center in India: Improved results from service reconfiguration. Pancreatology 2013;13:63-71.
  • 38 Engineer R, Arya S, Supriya C, Mehta S, Patil P, Goel M, et al. High dose concurrent chemo-radiation in locally advanced pancreatic cancers with tomotherapy based IMRT: A phase II study. Ann Oncol 2013;24 Suppl 4:iv50-1.
  • 39 Selvakumar VP, Zaidi S, Pande P, Goel A, Kumar K. Resection after neoadjuvant chemotherapy in advanced carcinoma of the gallbladder: A retrospective study. Indian J Surg Oncol 2015;6:16-9.
  • 40 Agarwal AK, Javed A, Kalayarasan R, Sakhuja P. Minimally invasive versus the conventional open surgical approach of a radical cholecystectomy for gallbladder cancer: A retrospective comparative study. HPB (Oxford) 2015;17:536-41.
  • 41 Agarwal AK, Kalayarasan R, Javed A, Gupta N, Nag HH. The role of staging laparoscopy in primary gall bladder cancer - An analysis of 409 patients: A prospective study to evaluate the role of staging laparoscopy in the management of gallbladder cancer. Ann Surg 2013;258:318-23.
  • 42 Mahantshetty UM, Palled SR, Engineer R, Homkar G, Shrivastava SK, Shukla PJ. Adjuvant radiation therapy in gall bladder cancers: 10 years experience at Tata Memorial Hospital. J Cancer Res Ther 2006;2:52-6.
  • 43 Agrawal S, Gupta PK, Rastogi N, Lawrence A, Kumari N, Das KJ, et al. Outcomes of adjuvant chemoradiation and predictors of survival after extended cholecystectomy in gall bladder carcinoma: A single institution experience from an endemic region. J Gastrointest Cancer 2015;46:48-53.
  • 44 Engineer R, Wadasadawala T, Mehta S, Mahantshetty U, Purandare N, Rangarajan V, et al. Chemoradiation for unresectable gall bladder cancer: Time to review historic nihilism? J Gastrointest Cancer 2011;42:222-7.
  • 45 Engineer R, Goel M, Chopra S, Patil P, Purandare N, Rangarajan V, et al. Neoadjuvant Chemoradiation Followed by Surgery for Locally Advanced Gallbladder Cancers: A New Paradigm. Ann Surg Oncol 2016. [Epub ahead of print] PMID:27075323.
  • 46 Sirohi B, Mitra A, Jagannath P, Singh A, Ramadvar M, Kulkarni S, et al. Neoadjuvant chemotherapy in patients with locally advanced gallbladder cancer. Future Oncol 2015;11:1501-9.
  • 47 Sharma A, Dwary AD, Mohanti BK, Deo SV, Pal S, Sreenivas V, et al. Best supportive care compared with chemotherapy for unresectable gall bladder cancer: A randomized controlled study. J Clin Oncol 2010;28:4581-6.
  • 48 Doval DC, Sekhon JS, Gupta SK, Fuloria J, Shukla VK, Gupta S, et al. A phase II study of gemcitabine and cisplatin in chemotherapy-naive, unresectable gall bladder cancer. Br J Cancer 2004;90:1516-20.
  • 49 Sharma A, Mohanti B, Raina V, Shukla N, Pal S, Dwary A, et al. A phase II study of gemcitabine and oxaliplatin (Oxigem) in unresectable gall bladder cancer. Cancer Chemother Pharmacol 2010;65:497-502.
  • 50 Gangopadhyay A, Nath P, Biswas J. Reduced dose intensity of chemotherapy may not lead to inferior palliation in locally advanced carcinoma of the gall bladder: An experience from a regional cancer centre in Eastern India. J Gastrointest Cancer 2015;46:297-300.
  • 51 Sirohi B, Rastogi S, Singh A, Sheth V, Dawood S, Talole S, et al. Use of gemcitabine-platinum in Indian patients with advanced gall bladder cancer. Future Oncol 2015;11:1191-200.
  • 52 Chatni SS, Sainani RS, Mehta SA, Mohandas KM. Infusion chemotherapy with cisplatinum and fluorouracil in the treatment of locally-advanced and metastatic gallbladder cancer. J Cancer Res Ther 2008;4:151-5.
  • 53 Sikora SS, Balachandran P, Dimri K, Rastogi N, Kumar A, Saxena R, et al. Adjuvant chemo-radiotherapy in ampullary cancers. Eur J Surg Oncol 2005;31:158-63.
  • 54 Kalyani ND, Engineer R, Chaudhari S, Dharia T, Shetty N, Supriya C, et al. Efficacy and clinical outcomes of radiotherapy with or without chemotherapy in inoperable or post-operative high-risk cholangiocarcinoma. J Clin Oncol 2013;31:273.
  • 55 Singh V, Kapoor R, Solanki KK, Singh G, Verma GR, Sharma SC. Endoscopic intraluminal brachytherapy and metal stent in malignant hilar biliary obstruction: A pilot study. Liver Int 2007;27:347-52.
  • 56 Deo SV, Shukla NK, Raina V, Mohanti BK, Sharan R, Kar M, et al. Organ-preserving multimodality management of squamous cell carcinoma of anal canal. Indian J Gastroenterol 2005;24:201-4.
  • 57 Hadi R, Mohanti BK, Pathy S, Shukla NK, Deo SV, Sharma A, et al. Disease profile and treatment results of anal canal SCC: Experience from AIIMS, New Delhi. Gulf J Oncolog 2011;10:27-32.
  • 58 Kapoor R, Khosla D, Shukla AK, Kumar R, Gupta R, Oinam AS, et al. Dosimetric and clinical outcome in image-based high-dose-rate interstitial brachytherapy for anal cancer. Brachytherapy 2014;13:388-93.
  • 59 Engineer R, Mallik S, Mahantshetty U, Shrivastava S. Impact of radiation dose on locoregional control and survival on squamous cell carcinoma of anal canal. Radiother Oncol 2010;95:283-7.
  • 60 Pande SB, Doval DC, Pavithran K, Sharma JB, Shirali R, Jena A. Gemcitabine and cisplatin-based combination chemotherapy in advanced hepatocellular carcinoma: An Indian experience. Indian J Med Paediatr Oncol 2012;33:42-7.
  • 61 Parikh PM, Fuloria J, Babu G, Doval DC, Awasthy BS, Pai VR, et al. A phase II study of gemcitabine and cisplatin in patients with advanced hepatocellular carcinoma. Trop Gastroenterol 2005;26:115-8.
  • 62 Shrikhande SV, Marda SS, Suradkar K, Arya S, Shetty GS, Bal M, et al. Gastrointestinal stromal tumors: Case series of 29 patients defining the role of imatinib prior to surgery. World J Surg 2012;36:864-71.
  • 63 Ashraf M, Jha J, Choudhry A, Aggarwal B, Nayak S, Chakraborty J, et al. Neoadjuvant and adjuvant therapy with imatinib for locally advanced gastrointestinal stromal tumors in Eastern Indian patients. Asian Pac J Cancer Prev 2011;12:2059-64.
  • 64 Seshadri RA, Rajendranath R. Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors. J Cancer Res Ther 2009;5:267-71.
  • 65 Das D, Ganguly S, Deb AR, Aich RK. Neoodjuvant imatinib mesylate for advanced primary and metastactic/recurrent gastro-intestinal stromal tumour (GIST). J Indian Med Assoc 2013;111:21-3.
  • 66 Bhalgami R, Manish K, Patil P, Mehta S, Mohandas KM. Clinicopathological study of 113 gastrointestinal stromal tumors. Indian J Gastroenterol 2013;32:22-7.
  • 67 Lakshmi VA, Chacko RT, Kurian S. Gastrointestinal stromal tumors: A 7-year experience from a tertiary care hospital. Indian J Pathol Microbiol 2010;53:628-33.
  • 68 Kapoor R, Khosla D, Kumar P, Kumar N, Bera A. Five-year follow up of patients with gastrointestinal stromal tumor: Recurrence-free survival by risk group. Asia Pac J Clin Oncol 2013;9:40-6.
  • 69 Rajappa S, Muppavarapu KM, Uppin S, Digumarti R. Gastrointestinal stromal tumors: A single institution experience of 50 cases. Indian J Gastroenterol 2007;26:225-9.
  • 70 Amarapurkar DN, Juneja MP, Patel ND, Amarapurkar AD, Amarapurkar PD. A retrospective clinico-pathological analysis of neuroendocrine tumors of the gastrointestinal tract. Trop Gastroenterol 2010;31:101-4.
  • 71 Kamboj M, Gandhi JS, Gupta G, Sharma A, Pasricha S, Mehta A, et al. Neuroendocrine carcinoma of gall bladder: A series of 19 cases with review of literature. J Gastrointest Cancer 2015;46:356-64.