Dr. Prithvi Priyadarshini Shivalingaiah

“We provide a comprehensive and multidisciplinary care for gastric cancer”

Clemenceau Medical Center, Dubai is a state-of-the-art medical center designed to offer patients one of the most innovative treatments and technologies available in the region. “Hospitals” magazine met with Dr Prithvi Priyadarshini Shivalingaiah, MBBS, MD, DNB, DM, MBA, PGDMLE Gastoenterologist at Clemenceau Medical Center, Dubai, who talked about the developments and advanced techniques in treating gastric cancer available at CMC Dubai.

What are the early warning signs of gastric cancer? 

 Gastric cancer can happen in any part of the stomach. Stomach cancers can be silent till it grows into advanced cancer. Warning signs and symptoms are – feeling full after eating small amounts of food, loss of appetite, pain in the upper part of abdomen, gaseous distension of abdomen, difficulty in swallowing (cancer is in the junction between food pipe and stomach). Anaemia (low hemoglobin) due to loss of blood from ulcer can be accompanied by melena, which is dark tarry stools due to loss of blood from stomach ulcer. Loss of weight, indigestion, nausea and vomiting and fatigue are other symptoms.  

How does it usually start? What are the risk factors? 

Stomach cancer is when cells in the stomach start to grow out of control. Stomach is an important part of the digestive tract which is like a pouch and has different parts like fundus, body, antrum and pylorus. Cancer can happen in any part of the stomach. 

Risk factors include smoking, growths of noncancerous cells in the stomach, called polyps, family history of stomach cancer. Family history of genetic syndromes that increase the risk of stomach cancer and other cancers, such as hereditary diffuse gastric cancer, Lynch syndrome, juvenile polyposis syndrome, Peutz-Jeghers syndrome and familial adenomatous polyposis.  The increased use of refrigeration for food storage, which has led to people eating salted and smoked foods and infection with Helicobacter pylori (H pylori) bacteria are also known risk factors.  

 What are the stages of gastric cancer? 

The stomach wall has 5 layers: The layers are important in determining the stage (extent) of the cancer, which can affect a person’s treatment options and prognosis . As cancer grows from the mucosa into deeper layers, the stage becomes more advanced and treatment might need to be more extensive. There are stages 0 (localised) to stage 4  (being advanced cancer). Cancer cells in the stomach can invade and destroy healthy body tissue. They might start to grow deeper into the wall of the stomach. In time, cancer cells can break away and spread to other parts of the body. When cancer cells spread to another part of the body it’s called metastasis. 

What are the tests that used to diagnose gastric cancer? 

Early detection, diagnosis and staging is the key step in the treatment. Endoscopy with biopsy is the most reliable and accurate test for gastrointestinal conditions, especially ones in the inner lining of the stomach . Advanced endoscopic techniques lead to earlier detection of gastric cancer, which aids in the complete treatment. Biopsies and microscopic examination help in identifying the type of cancer. 

Imaging modalities like CT or CAT (computed axial tomography) scans, PET (positron emission tomography) scans, MRI (magnetic resonance imaging) play a significant role in staging and identifying metastasis and activity. 

Endoscopic Ultrasound is a test that combines the endoscope with ultrasound, a soundwave generating imaging probe that provides detailed images and information about your digestive tract. It is especially useful in seeing the middle and outer layers beyond the inner lining. This test helps to see the depth of the tumor and whether it has spread with maximum specificity.  

What are the new treatments available in Dubai at Clemenceau Medical Center? 

At Clemenceau Medical Center, we provide a complete, comprehensive and multidisciplinary care for gastric cancer with involvement of Gastroenterologist, Surgeon, Medical oncologist, Radiologist, Pathologist and a dedicated team of trained nurses. Early cancer detection and removal by advanced endoscopic procedures like EUS followed by resections (endoscopic mucosal resection or endoscopic submucosal dissection) are available. Advanced imaging modalities like CT, MRI and PET scans are of valuable addition at our center. Surgical options are advanced and precise with use of robotic surgery. A dedicated chemotherapy unit is maintained and monitored by medical oncologists where care is individualised.  

In case of advanced cancer which is beyond surgery,  skilful endoscopic procedure which involves placement of a stent that goes into the  stomach to allow food to pass through is also done at Clemenceau Medical Center. We aim at providing early treatment and a good palliative care when required.  

 The most effective treatment method for patients with early gastric cancer is resection, which is endoscopy or surgery to remove the cancer. The exact type of procedure will depend on the cancer’s stage and where it is located.  Surgery is the first option if stomach cancer hasn’t spread which involves removing cancer from the lining of the stomach All or part of your stomach (a partial or total gastrectomy).  

Treatment depends on where the cancer is in your stomach, how far it has grown or spread (the stage), the type of cancer, how abnormal the cells look under a microscope (the grade), whether the cancer has spread to another part of the body and general health and level of fitness.  

Studies have  shown that chemotherapy before and after surgery, or giving chemotherapy and radiation after surgery, improves outcomes. It is important to complete therapy to get the best results. 

For more information visit our page: https://cmcdubai.ae/services/gastroenterology