Smoking increases the risk of stomach cancer: Dr Vikas Roashan

Gastrointestinal (GI) cancer is an umbrella term used to describe cancers that affect the digestive system. It includes colorectal cancer (CRC), gastric cancer, liver cancer, esophageal cancer, and pancreatic cancer. It has been reported to be a very common malignant tumor in Kashmir.

In conversation with Rising Kashmir’s health correspondent Pair of Mansour, Senior Consultant at the American Oncology Institute (AOI) Acharya Shri Chander College of Medical Sciences (ASCOMS) Jammu, Dr Vikas Roashan, talks about the causes, symptoms, detection, treatment and impact of cancer of the gastrointestinal tract.


What is gastrointestinal cancer?

Cancer of the gastrointestinal tract is an umbrella term used to describe cancers that affect the digestive system. It includes colorectal cancer (CRC), gastric cancer, liver cancer, esophageal cancer, and pancreatic cancer. Less common gastrointestinal cancers include those affecting the anus, appendix, bile ducts, gallbladder and small intestine, gastrointestinal neuroendocrine tumors (NETs) and stromal tumors (GIST), which occur are distinguished by their original cell type.

What are its risk factors?

Certain factors increase the risk of stomach cancer: gastroesophageal reflux disease (GERD), obesity, increased salt intake and high consumption of smoked foods, less consumption of fruits and vegetables, family history of malignant tumors, Helicobacter infection pylori, inflammation of the stomach, smoking, alcohol and polyps.

What are the ways to prevent it?

Fruits and vegetables should be added to the diet every day. Choose a wide variety of colorful fruits and vegetables. Maintain a healthy weight. If you are obese, try to strategize to lose weight. Try to plan exercises to reduce weight. The recommended exercise time is 150 minutes per week.

Cut down on salt and smoked foods. Protect your stomach by limiting these foods. These foods contain harmful chemicals which lead to the development of cancer.

What is the role of smoking in gastrointestinal cancer? Is this a contributing factor?

Smoking increases the risk of stomach cancer, as well as many other types of cancer. Quitting smoking is very difficult, so ask your doctor for advice. Quitting smoking requires medical advice and help.

Should people with a strong family history of stomach cancer consider tests, such as endoscopy, to look for signs?

The stomach has a lot of space, so in the early stages of stomach cancer, many patients have little or no symptoms. For this reason, stomach cancer is difficult to detect and doctors often detect the disease at more advanced stages because at this stage it is more difficult to treat.

A team of stomach cancer experts will use a variety of tools and tests designed to diagnose stomach cancer, assess the disease, and develop your personalized treatment plan.

In addition, laboratory tests will be done throughout your treatment and imaging tests will be used to examine your response to treatment and modify your plan if necessary.

How long does it take to develop stomach cancer?

The doubling time for stomach cancer is about 11 months for early lesions and six months for advanced stages. In three years, early stomach cancer progresses to advanced cancer. In the early stages, 50% of patients survive.

What should a patient do if he is diagnosed with such cancer?

After the initial diagnosis, the patient should undergo blood tests, local endoscopy, metastatic evaluation to see if the disease is localized or metastatic, and finally, depending on the histopathology, treatment is started. The patient should eat well during treatment and maintain a healthy weight.

What advice should be given to the general population to avoid stomach / stomach cancer?

The message to the masses is to avoid risk factors like smoking, reduce alcohol intake, maintain weight, increase fruits and vegetables in the diet, and exercise regularly.

Are there many myths in society about cancer patients? What is your message to the people?

There is a common myth that we should reduce sugar intake during cancer treatment because cancer uses sugar for growth, but it is not; carbohydrates should be taken according to body weight and needs. They are just patients. We need to give them more love and care.

How to reduce the burden of cancer?

Thirty to fifty percent of cancers can be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies. The burden of cancer can also be reduced with early detection of cancer and appropriate treatment and care for patients who develop cancer. Many cancers have a good chance of being cured if they are diagnosed early and treated appropriately.

What treatment is available at J&K for stomach cancer?

There are different types of treatment modalities for patients with stomach cancer. Seven types of treatment are used for the management of stomach cancer, including surgery, endoscopic mucosal resection (EMR), chemotherapy, radiation therapy, radiochemotherapy, targeted therapies, and immunotherapies.

New treatment techniques are being tested in different clinical trials (not available in J&K).

Some treatments are standard (those currently in use), and some are tested in clinical trials. A clinical trial is a study aimed at improving current treatment programs or obtaining vital information about new treatment techniques for cancer patients. When clinical trials show that a new treatment is better than the standard treatment, the new treatment can become the standard treatment. Therefore, patients may want to consider participating in a clinical trial. Some clinical trials only recruit patients who have not received cancer treatment.

Different types of treatments available to patients


Surgery is a common treatment technique for all stages of gastric cancer. The following types of surgery can be used:

• Subtotal gastrectomy when a surgeon removes part of the stomach containing cancer, nearby lymph nodes, and parts of other tissues and organs near the tumor.

• Total gastrectomy involves the removal of the entire stomach, nearby lymph nodes, and parts of the digestive tract, small intestine, and other tissue near the tumor.

If the tumor is blocking the stomach, but the cancer cannot be completely removed with standard surgery, the following techniques can be used:

Ø Stent placement: a technique for inserting a stent (a thin, stretchable tube) to keep a passage (such as arteries or esophagus) open. For tumors that block the passage of the stomach, the operation may involve placing a tube from the digestive tract to the stomach or from the stomach to the small intestine to help the patient eat normally and maintain weight.

Ø Endoluminal laser therapy: This is a procedure in which an endoscope (light tube) with a laser attached to it is inserted into the body. This laser will act like a knife to remove the cancer.

Ø Gastrojejunostomy: a procedure in which part of the stomach along with the cancer is removed, which blocks the passage and the ends are connected. This allows food and medicine to pass from the stomach to the small intestine.

Endoscopic mucosal resection (EMN)

Endoscopic mucosal resection is a technique that uses an endoscope to remove early-stage cancer from the inner lining of the digestive tract. An endoscope is a thin tube with a light source and a lens for viewing.


Chemotherapy is a technique for treating cancer that uses drugs to stop the proliferation of cancer cells. It stops the growth of cancer by killing cancer cells. Chemotherapy is usually given intravenously (through the vein via a drip) or by mouth. The drug reaches the tumor through the bloodstream. Chemotherapy is given depending on the stage, the severity of the disease and the type of cancer being treated.

Sometimes regional chemotherapy is used, also called intraperitoneal chemotherapy. Cancer drugs are placed directly into the peritoneal space through the tubes in intraperitoneal chemotherapy.

Surgeons use HIPEC after completing surgery in which heated chemotherapy is given directly into the peritoneal cavity.


Radiation therapy is a cancer treatment technique that uses high-energy X-rays or other types of radiation to treat cancer. It works by killing tumor cells; there are two techniques for administering radiotherapy, external radiotherapy and brachytherapy. For gastrointestinal cancers, generally, EBRT is used.


Sometimes radiation therapy is combined with chemotherapy to enhance the effect of both modalities. This technique improves the action of radiation.

Chemoradiation therapy can be added before or after surgery for cancer management. It is given after surgery to reduce the risk of local recurrence. When given before surgery, chemotherapy helps shrink the tumor and helps the surgeon remove the cancer.

Targeted therapy

In targeted therapy, drugs are used to identify and attack specific cancer cells. Targeted therapies generally cause less damage to normal cells than chemotherapy or radiation therapy. Monoclonal antibodies and multi-kinase inhibitors (IMKs) are types of targeted therapy used in the treatment of stomach cancer.

Monoclonal antibodies

Monoclonal antibodies made in the laboratory to treat many diseases, including cancer. As a treatment for cancer, these proteins can attach to a particular target on cancer cells, which can help cancer cells to grow. Antibodies can kill cancer cells, block their growth, or stop them from spreading. Monoclonal antibodies are administered intravenously. Targeted therapy can be used on its own and sometimes in combination with other carrier drugs, chemotherapy, or radioactive materials.

There are different types of monoclonal antibodies

· Trastuzumab (Herceptin) blocks the effect of the growth factor protein HER2, which sends regulatory growth signals to gastric cancer cells.

Ramucirumab blocks the effect of specific proteins, including vascular endothelial growth factors. It can help control cancer cells and can kill cells as well. It also prevents the growth of new blood vessels that cancer needs to grow.

Trastuzumab and ramucirumab are used to treat stage IV gastric cancer and gastric cancer that cannot be removed with surgery or has come back.

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