Overview
Gastric cancer originates in the inner lining of the stomach and remains one of the
most common gastrointestinal malignancies in Asia. It develops gradually through a
precancerous cascade beginning with chronic inflammation and atrophic gastritis,
often related to Helicobacter pylori infection.
At Coimbatore Cancer Clinic, our Medical and Surgical Oncologists work
together to deliver precision-based, stage-specific care — integrating advanced
diagnostics, surgery, systemic therapy, and nutrition support.
Causes & Risk Factors
● Chronic H. pylori infection (most significant worldwide factor)
● Dietary factors: salt-preserved, smoked, or pickled foods; low fruit and vegetable intake
● Tobacco and alcohol use
● Genetic factors: familial gastric cancer (CDH1 mutation), Lynch syndrome
● Prior gastric surgery (Billroth II reconstruction)
● Obesity and chronic reflux for tumors of the gastroesophageal junction
Symptoms & Warning Signs
Early stages are often silent; symptoms appear when disease is advanced:
● Persistent indigestion, heartburn, or bloating
● Early satiety (feeling full quickly)
● Unexplained weight loss or loss of appetite
● Nausea or vomiting, occasionally with blood
● Black stools (melena) from internal bleeding
● Fatigue due to anemia
● Abdominal pain or palpable mass in advanced cases
Diagnosis & Investigations
Accurate diagnosis and staging are critical for curative planning.
1. Upper GI endoscopy + biopsy – confirms histology and location.
2. CT scan of chest, abdomen, and pelvis – baseline staging.
3. PET-CT scan – evaluates occult metastasis when surgery is planned.
4. Staging laparoscopy – detects small peritoneal metastases invisible on imaging.
5. Molecular tests: HER2, PD-L1, MSI status, and CLDN18.2 expression (where available).
6. Blood tests: CBC, LFT, CEA and CA 19-9 markers, and nutritional assessment.
Stage-Wise Treatment Approach
Stage I – Early Gastric Cancer
● T1a mucosal lesions: Endoscopic Mucosal Resection (EMR) or Endoscopic Submucosal Dissection (ESD) for selected patients.
● T1b or submucosal disease: Subtotal or total gastrectomy with D2 lymph node dissection.
● Adjuvant therapy decided by pathologic findings (usually not required for T1a).
Stage II – III (Localised Advanced)
● Peri-operative chemotherapy with FLOT regimen (docetaxel + oxaliplatin + leucovorin + 5-FU) — 4 cycles before and 4 after surgery is standard (NCCN 2025 & ESMO 2025).
● Surgery: Subtotal or total gastrectomy with D2 lymphadenectomy.
● Nutritional support and vitamin supplementation are essential post-operatively.
Stage IV (Metastatic or Unresectable)
● Systemic chemotherapy using fluoropyrimidine- and platinum-based combinations (FOLFOX, CAPOX, or FLOT variants).
● HER2-positive tumors: Add trastuzumab to first-line regimen.
● PD-L1-positive tumors: Add nivolumab or pembrolizumab.
● MSI-high tumors: Immune checkpoint blockade alone may be effective.
● Palliation: Endoscopic stenting or bypass surgery to relieve obstruction; palliative radiation for bleeding.
Recurrent Disease
Managed with second-line therapy (irinotecan, paclitaxel + ramucirumab) and clinical
trial enrolment where appropriate.
Recent Advances in Treatment
● Targeted agents: Trastuzumab-deruxtecan (antibody–drug conjugate) improves survival in HER2-positive metastatic disease.
● Immunotherapy: Checkpoint inhibitors (pembrolizumab, nivolumab) in first-line therapy for PD-L1 CPS ≥ 1 or MSI-H tumors.
● Molecular profiling: Emerging targets such as CLDN18.2 and FGFR2 b are changing the landscape of advanced disease.
● Minimally invasive gastrectomy offers faster recovery with equivalent oncologic outcomes.
● Enhanced Recovery After Surgery (ERAS) protocols optimize nutrition and mobilization.
Our Expertise at Coimbatore Cancer Clinic
At our centre, gastric cancer patients benefit from truly multidisciplinary care:
● Gastrointestinal Oncologic Surgeons experienced in laparoscopic and open D2 gastrectomy.
● Medical Oncologists skilled in modern peri-operative chemotherapy and targeted/immunotherapy protocols.
● Radiologists and Pathologists for precise staging and molecular analysis.
● Nutritionists and rehabilitation specialists to optimize post-treatment recovery.
Each case is discussed in our Tumor Board, ensuring a personalized treatment plan
based on international guidelines and individual needs.
When to Consult
Any patient above 40 years with persistent indigestion, early satiety, or unexplained
weight loss should seek specialist evaluation.
Early diagnosis can transform outcomes and allow curative treatment.
Age cut-off for staging is 55 years (special rule in thyroid cancer).
FAQs
Disclaimer
This content is for educational purposes only and does not replace medical
consultation.
For personalized evaluation and treatment, please book an appointment at
Coimbatore Cancer Clinic.
Esophageal and Gastroesophageal Junction Cancer
Overview
Esophageal cancer originates in the inner lining of the esophagus—the tube carrying
food from the throat to the stomach. Globally, it is one of the top ten causes of
cancer-related mortality.
Two major histologic types dominate:
● Squamous cell carcinoma (upper/mid-esophagus, linked to tobacco and
alcohol)
● Adenocarcinoma (lower esophagus/GE junction, linked to reflux and obesity)
At Coimbatore Cancer Clinic, our multidisciplinary tumor board—comprising
medical, surgical, and radiation oncologists—plans each case based on stage,
tumor biology, and patient condition.
Causes & Risk Factors
● Chronic tobacco and alcohol use
● Gastroesophageal reflux disease (GERD) and Barrett’s esophagus
● Obesity and Western dietary habits
● HPV infection (for squamous type)
● Nutritional deficiency (low fruit, high nitrosamine diet)
● Prior caustic injury or achalasia
Symptoms & Warning Signs
● Progressive difficulty swallowing solids → liquids
● Unintentional weight loss
● Chest or throat pain, hoarseness, cough
● Regurgitation of food or blood-stained saliva
● Persistent heartburn or choking sensation
Early-stage disease is often silent; hence, high-risk individuals (chronic reflux,
smokers) benefit from surveillance endoscopy.
Diagnosis & Investigations
A comprehensive diagnostic work-up ensures accurate staging and optimal
treatment selection:
● Upper GI endoscopy and biopsy – confirm histology and location
● Endoscopic ultrasound (EUS) – local depth of invasion (T stage) and nearby nodes
● Contrast CT chest/abdomen – evaluate spread
● PET-CT – detect occult metastasis
● Bronchoscopy – for upper/mid lesions to assess tracheal involvement
Molecular tests such as HER2, PD-L1, and MSI status increasingly guide systemic
therapy choices.
Stage-Wise Treatment Approach
Stage I (Early Lesions)
● T1a (mucosal): Managed with Endoscopic Mucosal Resection (EMR) or
Endoscopic Submucosal Dissection (ESD)—organ-preserving and
curative.
● T1b or submucosal invasion: Requires surgical esophagectomy with
lymph node dissection; minimally invasive techniques reduce morbidity.
Stage II–III (Locally Advanced)
● Standard of care: Neoadjuvant chemoradiation (CROSS
regimen—carboplatin + paclitaxel + radiation) followed by esophagectomy.
● Selected GEJ adenocarcinomas may receive peri-operative FLOT
chemotherapy (5-FU, leucovorin, oxaliplatin, docetaxel).
● Definitive chemoradiation is an option for cervical esophagus or nonsurgical
candidates.
Stage IV (Metastatic / Unresectable)
● Systemic therapy using platinum/fluoropyrimidine combinations.
● For HER2-positive tumors → trastuzumab ± chemotherapy.
● For PD-L1 positive tumors → pembrolizumab or nivolumab added to first-line therapy.
● Palliative stenting or radiation relieves dysphagia.
Recurrent Disease
● Immunotherapy or targeted therapy per molecular profile.
● Clinical trial enrollment encouraged for novel drugs.
Recent Advances in Treatment
● Minimally invasive & robotic esophagectomy lowering complications.
● Immunotherapy integration (nivolumab in adjuvant setting, pembrolizumab in metastatic).
● Molecular profiling to tailor therapy (HER2, MSI, PD-L1).
● Enhanced recovery protocols for early mobilization and nutrition.
Our Expertise at Coimbatore Cancer Clinic
Our team offers:
● Expertise in laparoscopic and thoracoscopic esophagectomy
● Access to molecular profiling for targeted and immunotherapies
● Seamless integration of nutrition, physiotherapy, and psychosocial support
● Multidisciplinary tumor board discussions to individualize each plan
Our surgical and medical oncologists collaborate to balance cure rates, quality of life,
and safety.
When to Consult
Any progressive swallowing difficulty or unexplained weight loss warrants immediate
evaluation.
Early consultation allows curative, organ-preserving options.
Disclaimer
This information is for patient education and should not replace professional
consultation.
For personalized advice, book an appointment at Coimbatore Cancer Clinic.
Small Bowel Adenocarcinoma
Overview
Small bowel adenocarcinoma (SBA) is a rare gastrointestinal cancer arising from the
epithelial lining of the small intestine — most often the duodenum (first part),
followed by the jejunum and ileum.
Despite the small intestine accounting for nearly 75% of the digestive tract length,
cancers here are uncommon, representing less than 5% of all gastrointestinal
malignancies.
Because symptoms are often vague and mimic benign conditions, diagnosis is
frequently delayed until the disease is advanced.
At Coimbatore Cancer Clinic, we emphasize early recognition, precise imaging,
advanced surgical resection, and modern systemic therapies, ensuring
evidence-based, multidisciplinary management consistent with NCCN 2025 and
ESMO 2025 guidelines.
Causes & Risk Factors
The development of small bowel adenocarcinoma is linked to chronic inflammation,
genetic predisposition, and environmental influences.
Key risk factors include:
● Inflammatory bowel diseases such as Crohn’s disease (especially involving the terminal ileum).
● Celiac disease, due to chronic mucosal inflammation.
● Hereditary syndromes including Lynch syndrome (HNPCC), Familial Adenomatous Polyposis (FAP), and Peutz–Jeghers syndrome.
● Dietary patterns high in red or processed meat, animal fat, or refined sugars.
● Smoking and alcohol use, which contribute to oxidative mucosal injury.
● Prior abdominal radiation or chronic bile reflux.
Symptoms & Warning Signs
Small bowel adenocarcinoma may present with a wide range of non-specific
symptoms that often overlap with common gastrointestinal issues.
Typical symptoms include:
● Intermittent abdominal pain or cramping
● Unexplained iron-deficiency anemia due to chronic bleeding
● Nausea, vomiting, or early satiety
● Gastrointestinal bleeding (visible or occult)
● Unintended weight loss or fatigue
● Bowel obstruction (late presentation)
● Jaundice, if the duodenum is involved near the bile duct
Because these symptoms evolve slowly, patients frequently experience a diagnostic
delay of several months — highlighting the importance of specialist evaluation for
persistent unexplained abdominal symptoms.
Diagnosis & Investigations
A combination of endoscopic, radiologic, and molecular studies is essential to
confirm the diagnosis and define the extent of disease.
1. CT Enterography or MR Enterography: Specialized imaging provides detailed visualization of the small intestine, helping detect wall thickening, obstruction, or masses.
2. Capsule Endoscopy / Double-Balloon Enteroscopy: Enables direct visualization and biopsy of lesions beyond the reach of standard endoscopes.
3. Upper GI Endoscopy and Colonoscopy: To exclude synchronous lesions and evaluate adjacent structures.
4. Biopsy: Confirms adenocarcinoma histology and differentiation.
5. Staging Workup: PET-CT or CT chest/abdomen/pelvis identifies lymph node involvement or metastases.
6. Molecular and Genetic Profiling:
o MSI/MMR testing (important for Lynch syndrome and immunotherapy eligibility).
o KRAS, NRAS, BRAF mutations and NTRK fusions guide targeted therapy decisions.
7. Laboratory Tests: CBC, liver function, and tumor markers (CEA, CA 19-9) to support staging and monitoring.
Stage-Wise Treatment Approach
Stage I – Early, Localized Disease
● Surgery is curative in the majority of cases.
o Duodenal tumors: Pancreaticoduodenectomy (Whipple procedure) or segmental resection with clear margins and regional lymphadenectomy.
o Jejunal/Ileal tumors: Segmental small bowel resection with mesenteric node clearance.
● Adjuvant chemotherapy is generally not required for low-risk, node-negative cases.
Stage II – Locally Advanced Disease
● Surgery with complete en bloc resection and adequate node harvest (≥ 8 nodes) is essential.
● Adjuvant chemotherapy (typically FOLFOX or CAPOX for 6 months) is recommended for high-risk features such as T4 lesions, lymphovascular invasion, or inadequate nodal yield.
● Surveillance with CT and CEA every 6 months for the first 2 years.
Stage III – Node-Positive Disease
● Surgery + Adjuvant Chemotherapy
o FOLFOX or CAPOX for 6 months remains the global standard.
o For MSI-high tumors, adjuvant immunotherapy trials are emerging.
Stage IV – Metastatic or Unresectable Disease
● Systemic Chemotherapy: FOLFOX, CAPOX, or FOLFIRI regimens as in colorectal cancer.
● Targeted Therapy:
o Anti-EGFR or VEGF therapy in RAS wild-type tumors (extrapolated from colon data).
● Immunotherapy:
o Pembrolizumab or nivolumab for MSI-high / dMMR tumors can achieve durable control.
● Palliative Surgery or Stenting:
o For obstruction, perforation, or bleeding not controlled by medical therapy.
Recurrent Disease
● Management depends on pattern and extent.
o Isolated recurrence → surgical re-resection when feasible.
o Disseminated disease → systemic therapy and palliative care.
Recent Advances in Treatment
● Comprehensive Genomic Profiling:
Next-generation sequencing identifies actionable mutations (MSI-H, NTRK, BRAF) opening options for targeted therapy.
● Checkpoint Inhibitors:
Dramatic efficacy in MSI-H tumors, transforming prognosis for a subset of patients.
● Minimally Invasive Surgery:
Laparoscopic or robotic resections reduce recovery time without compromising outcomes.
● Enhanced Recovery Protocols (ERAS):
Evidence-based perioperative care minimizing pain, infection, and hospital stay.
● Circulating Tumor DNA (ctDNA):
Emerging as a non-invasive tool for detecting residual disease after surgery.
Our Expertise at Coimbatore Cancer Clinic
At Coimbatore Cancer Clinic, our approach to small bowel cancers is personalized
and multidisciplinary.
Each case is discussed in a dedicated GI Tumor Board involving:
● Surgical Oncologists skilled in advanced laparoscopic and open resections of duodenal, jejunal, and ileal tumors.
● Medical Oncologists implementing NCCN-aligned chemotherapy and immunotherapy protocols.
● Gastroenterologists and Interventional Radiologists for diagnostic precision and stenting when needed.
● Pathologists performing MSI and molecular testing to enable precision oncology.
● Nutrition and Rehabilitation Specialists to ensure optimal recovery and quality of life.
Our team emphasizes not only survival but also functional recovery, gut health, and
long-term well-being.
When to Consult
Persistent or unexplained abdominal discomfort, chronic anemia, or blood in stool
should prompt evaluation — especially in patients with Crohn’s disease, celiac
disease, or family history of gastrointestinal cancers.
Early detection can transform outcomes in this otherwise silent disease.
Frequently Asked Questions (FAQs)
Disclaimer
This information is for educational purposes only and should not replace a medical
consultation.
For individualized advice, diagnosis, and treatment, please contact Coimbatore
Cancer Clinic, where our team of medical and surgical oncologists provides
evidence-based, compassionate care.
Colon Cancer
Overview
Colon cancer originates in the inner lining of the large intestine and usually develops
from benign polyps that undergo malignant transformation over several years. It is
one of the most common and preventable cancers worldwide.
At Coimbatore Cancer Clinic, our multidisciplinary team provides end-to-end care
— from screening and minimally invasive surgery to advanced targeted and
immunotherapy
Causes & Risk Factors
● Age > 45 years
● Diet: high red/processed meat, low fibre, fruits & vegetables
● Family history / Hereditary syndromes: FAP, Lynch syndrome
● Inflammatory bowel disease: Crohn’s, Ulcerative colitis
● Obesity, sedentary lifestyle, smoking, alcohol
● Type 2 diabetes mellitus
Symptoms
● Rectal bleeding / blood-stained stool
● Change in bowel habits (constipation ↔ diarrhoea)
● Unexplained anaemia & fatigue
● Abdominal pain, bloating, or obstruction
● Weight loss or loss of appetite
Diagnosis & Investigations
1. Colonoscopy + biopsy – confirms diagnosis, assesses extent.
2. CT chest/abdomen/pelvis or PET-CT – staging.
3. CEA tumour marker – baseline & follow-up.
4. Molecular tests: MSI/MMR, RAS, BRAF, NTRK.
5. Genetic counselling for familial syndromes.
Stage-Wise Treatment
Stage I
● Curative surgery (colectomy + lymphadenectomy).
● No adjuvant chemotherapy required in most cases.
Stage II
● Surgery is primary treatment.
● Adjuvant chemotherapy (FOLFOX/CAPOX) for high-risk features (T4, poor
differentiation, < 12 nodes).
Stage III
● Surgery + adjuvant chemotherapy for 6 months (FOLFOX or CAPOX).
● Laparoscopic approach preferred for early recovery.
Stage IV (Metastatic)
● Systemic therapy: fluoropyrimidine + oxaliplatin/irinotecan.
● Targeted agents: bevacizumab (anti-VEGF) or cetuximab/panitumumab (anti-EGFR for RAS-WT).
● Oligometastatic disease: curative resection of liver/lung metastases.
● MSI-high: immunotherapy first line (pembrolizumab / nivolumab).
Recent Advances
● Immunotherapy and checkpoint inhibitors for MSI-H tumours.
● ctDNA testing to monitor minimal residual disease.
● Targeted biologics tailored to RAS/BRAF status.
● Robotic and laparoscopic colectomy reducing morbidity.
Our Expertise at Coimbatore Cancer Clinic
● Specialised colorectal surgeons performing D3 lymphadenectomy with nerve preservation.
● Medical oncologists experienced in modern chemotherapy & targeted protocols.
● Integrated rehabilitation & stoma care support.
When to Consult
Persistent rectal bleeding, anaemia, or change in bowel habits warrants evaluation,
especially after age 45.
FAQs
Disclaimer
Educational content only; consult our oncology team for personalised care.
Rectal Cancer
Overview
Rectal cancer arises in the final 15 cm of the large intestine and requires a
specialised multimodality approach for cure and sphincter preservation.
Our team at Coimbatore Cancer Clinic coordinates state-of-the-art MRI-based
staging, chemoradiation, and nerve-sparing surgery to achieve excellent outcomes
with organ preservation whenever possible.
Causes & Risk Factors
Same as colon cancer, with higher risk from: chronic inflammation, polyps, and
family history.
Symptoms
● Bleeding per rectum
● Mucus discharge or tenesmus
● Change in bowel frequency or calibre
● Pelvic pain or pressure
Diagnosis & Investigations
● Digital rectal exam and rigid proctoscopy.
● Colonoscopy + biopsy.
● MRI pelvis (TME planning).
● CT/PET-CT for metastasis.
● CEA tumour marker.
Stage-Wise Treatment
Early (T1–T2, N0)
● Transanal local excision for T1 lesions meeting criteria.
● Low anterior resection (LAR) for upper rectal tumours.
Locally Advanced (T3/T4 or N+)
● Neoadjuvant chemoradiation (5-FU/capecitabine + IMRT) → surgery after
8–12 weeks.
● Surgery: Total Mesorectal Excision (TME) with nerve preservation.
● Adjuvant chemotherapy (FOLFOX/CAPOX) for 6 months.
Stage IV
● Systemic therapy similar to colon cancer
● Palliative radiation for bleeding/pain.
● Oligometastatic resection where feasible.
Recent Advances
● Total Neoadjuvant Therapy (TNT): delivers all therapy pre-surgery, improving pathologic response.
● Watch-and-Wait Protocol: organ preservation after complete clinical response.
● Robotic TME: precision nerve preserving approach.
● Intra-operative radiation for recurrent disease.
Our Expertise
● MRI-guided treatment planning.
● Oncosurgeons skilled in sphincter-saving procedures.
● Medical oncologists experienced in TNT protocols.
● Rehabilitation & stoma care program.
When to Consult
Any rectal bleeding or altered bowel pattern should prompt screening and early
referral.
FAQs
Occurs especially in:
Disclaimer
Educational only; consult Coimbatore Cancer Clinic for personalised assessment.
Anal Carcinoma
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Anal Carcinoma
Overview
Anal carcinoma is a cancer arising from the tissues of the anal canal or margin.
Unlike rectal cancer, which originates higher up in the large intestine, anal cancer
has a strong viral association — particularly with human papillomavirus (HPV).
It is relatively uncommon but highly curable with non-surgical treatment.
At Coimbatore Cancer Clinic, our multidisciplinary team integrates
chemoradiation, immunotherapy, and rehabilitation approaches to achieve
excellent cure rates while preserving sphincter function and quality of life.
Causes & Risk Factors
● HPV infection (types 16 & 18 — strongest factor)
● Smoking
● Multiple sexual partners or receptive anal intercourse
● Chronic anal irritation / fissures / fistulas
● Immunosuppression (HIV infection, post-transplant)
● History of genital warts or cervical/vulvar dysplasia
Symptoms & Warning Signs
● Rectal bleeding or spotting on toilet paper
● Anal pain, itching, or burning
● Lump or ulcer near the anus
● Mucus discharge or irritation
● Change in stool calibre
● In advanced cases: groin swelling from nodal spread
Diagnosis & Investigations
1. Digital rectal examination — first essential step.
2. Anoscopy or proctoscopy with biopsy — confirms histology.
3. MRI pelvis — assesses local spread, sphincter involvement.
4. CT chest/abdomen/pelvis or PET-CT — evaluates nodal and distant metastases.
5. HIV and HPV testing — prognostic implications.
Stage-Wise Treatment
Stage I–III (Localized and Locally Advanced)
● Concurrent chemoradiation (Nigro protocol) is curative in > 80 %:
o Chemotherapy: 5-FU (or capecitabine) + mitomycin-C
o Radiation: IMRT / VMAT 50–54 Gy over 5 weeks
● No surgery initially — tumour and nodes often regress completely.
Post-Treatment Evaluation
● Response assessment at 8–12 weeks by MRI or clinical exam.
● Persistent disease may continue to regress up to 6 months.
Persistent / Recurrent Disease
● Abdominoperineal resection (APR) is performed only if residual disease
remains after chemoradiation.
● Systemic therapy (cisplatin + 5-FU) or immunotherapy (nivolumab,
pembrolizumab) for metastatic cases.
Recent Advances
● IMRT & image-guided RT drastically reduce bowel and skin toxicity.
● Checkpoint inhibitors now approved for refractory or metastatic disease.
● HPV vaccination (for both sexes) prevents majority of anal cancers.
● Organ-preserving protocols mean most patients avoid permanent stomas.
Our Expertise at Coimbatore Cancer Clinic
Our anal cancer program emphasizes:
● Expert medical and radiation oncologists following NCCN-based protocols.
● Use of advanced radiation planning (IMRT / VMAT) for precision delivery.
● Rehabilitation and continence support post-therapy.
● HPV counselling and vaccination services for prevention.
When to Consult
Any persistent anal bleeding, discomfort, or growth near the anus should be
evaluated immediately. Early chemoradiation ensures near-total cure with organ
preservation.
Disclaimer
Educational material only; consult our specialists at Coimbatore Cancer Clinic for
tailored evaluation.
Hepatocellular Carcinoma (Liver Cancer)
Overview
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a
major cause of cancer deaths in Asia.
It usually develops in patients with chronic liver disease or cirrhosis, often due to
viral hepatitis B or C.
At Coimbatore Cancer Clinic, we provide comprehensive hepatobiliary oncology
— combining early detection, liver-directed therapies, systemic immunotherapy, and
transplant coordination in collaboration with regional liver centers.
Causes & Risk Factors
● Chronic HBV or HCV infection
● Alcoholic cirrhosis
● Non-alcoholic fatty liver disease (NAFLD)
● Aflatoxin exposure
● Hemochromatosis or metabolic liver diseases
● Male gender, age > 50, diabetes
Symptoms
● Right upper-quadrant pain or heaviness
● Loss of appetite and weight
● Jaundice and dark urine
● Abdominal swelling / ascites
● Fatigue or early satiety
Diagnosis & Investigations
1. Triphasic CT or MRI liver — characteristic arterial enhancement + washout pattern diagnostic.
2. AFP (alpha-fetoprotein) tumour marker.
3. Liver function tests and viral hepatitis profile.
4. PET-CT for metastasis (selected cases).
5. BCLC staging (Barcelona Clinic Liver Cancer) used to guide therapy.
6. Biopsy only if imaging is inconclusive.
Stage-Wise Treatment (BCLC System)
Stage 0 – A (Very Early / Early)
● Curative intent:
o Surgical resection for solitary lesion & preserved liver function.
o Liver transplantation if within Milan criteria (≤ 3 nodules ≤ 3 cm).
o Radiofrequency / Microwave ablation for small (< 2 cm) tumours.
Stage B (Intermediate)
● Transarterial chemoembolisation (TACE) or radioembolisation (TARE) —
controls tumour and preserves function.
Stage C (Advanced)
● Systemic therapy:
o First-line: Atezolizumab + Bevacizumab or Durvalumab + Tremelimumab.
o Alternatives: Lenvatinib or Sorafenib.
o Second-line: Cabozantinib, Regorafenib, or Immunotherapy monotherapy.
Stage D (End-Stage)
● Supportive / palliative care to maintain comfort and nutrition.
Recent Advances
● Dual-checkpoint immunotherapy improved median survival beyond 20 months.
● Image-guided ablation combined with TACE increases cure rates.
● Biomarker-based patient selection improving precision.
● Minimally invasive hepatic resections for selected patients.
Our Expertise
● Integrated liver clinic with hepatologists, surgeons, and oncologists.
● Interventional radiology support for TACE/TARE/ablation.
● Systemic therapy aligned with NCCN & ESMO standards.
● Nutritional and supportive liver-care programs.
When to Consult
Any cirrhotic or hepatitis-positive patient with new liver lesions, weight loss, or
jaundice should be assessed promptly for early intervention.
Disclaimer
Educational purpose only; management must be individualized.
Biliary Tract (Cholangiocarcinoma & Gallbladder) Cancer
Overview
Biliary tract cancers include intrahepatic, perihilar, and distal
cholangiocarcinomas as well as gallbladder carcinoma.
Though uncommon, these tumours are highly aggressive and often diagnosed late.
At Coimbatore Cancer Clinic, our GI oncology team offers precision diagnosis,
advanced surgery, targeted therapies, and molecular testing to personalize
treatment.
Causes & Risk Factors
● Primary sclerosing cholangitis (PSC)
● Choledochal cysts / bile duct anomalies
● Liver fluke infection (Clonorchis, Opisthorchis)
● Chronic biliary stones / cholecystitis
● HBV/HCV infection
● Genetic predisposition
Symptoms
● Painless jaundice
● Itching (pruritus)
● Dark urine / pale stools
● Abdominal pain, weight loss
● Fever (with cholangitis)
Diagnosis & Investigations
1. MRCP (Magnetic Resonance Cholangiopancreatography) — delineates biliary anatomy.
2. CT / MRI for local and metastatic staging.
3. ERCP / EUS biopsy for tissue confirmation.
4. PET-CT when surgery considered.
5. Molecular profiling: FGFR2, IDH1, HER2, BRAF, MSI.
6. Tumour markers: CA 19-9, CEA.
Stage-Wise Treatment
Resectable Disease
● Surgical resection with negative margins + regional lymphadenectomy.
● Adjuvant therapy: Capecitabine 6 months (Category 1 NCCN).
● Biliary drainage pre-op if cholestatic.
Unresectable / Locally Advanced
● Gemcitabine + Cisplatin + Durvalumab (standard first-line 2024).
● Locoregional therapies: Photodynamic, SBRT, or TACE for selected
intrahepatic lesions.
Metastatic
● Continue systemic therapy.
● Targeted agents:
o FGFR2 fusion → Pemigatinib / Futibatinib
o IDH1 mutation → Ivosidenib
o MSI-H → Immunotherapy
o HER2 amplified → Trastuzumab-based
Recent Advances
● Immunotherapy now part of first-line treatment.
● Precision medicine via FGFR2 & IDH1 inhibitors improving outcomes.
● Minimally invasive surgery and advanced stenting for palliation.
Our Expertise
● Hepato-biliary surgical team experienced in complex resections.
● Interventional radiology for stenting & localized therapy.
● Medical oncology for targeted / immunotherapy.
● Comprehensive molecular diagnostics in collaboration with accredited
labs.
When to Consult
Painless jaundice or unexplained itching should prompt immediate evaluation —
early biliary decompression and multidisciplinary planning improve survival.
Disclaimer
Informational; consult Coimbatore Cancer Clinic for personalized advice.
Pancreatic Adenocarcinoma
Overview
Pancreatic adenocarcinoma arises from the exocrine ducts of the pancreas and is
known for its aggressive nature and late presentation.
Though challenging, outcomes have improved significantly with modern
chemotherapy, precision surgery, and immunogenomic research.
At Coimbatore Cancer Clinic, we employ an integrated approach emphasizing
early diagnosis, neoadjuvant therapy, minimally invasive surgery, and
comprehensive supportive care.
Causes & Risk Factors
● Smoking (2–3× risk)
● Chronic pancreatitis
● Family history / genetic syndromes (BRCA1/2, PALB2)
● Obesity, diabetes mellitus
● Age > 60 years
● High-fat diet / alcohol abuse
Symptoms
● Jaundice, dark urine, pale stools
● Upper-abdominal or back pain
● Loss of appetite, weight loss
● Nausea, vomiting, fatigue
● New-onset diabetes
● Depression (can precede symptoms)
Diagnosis & Investigations
1. CT pancreas protocol or MRI — defines tumour extent, vascular invasion.
2. EUS-guided biopsy — confirms adenocarcinoma.
3. CA 19-9 tumour marker for baseline.
4. PET-CT for occult metastases.
5. Molecular profiling: BRCA1/2, PALB2, MSI, KRAS G12C (where applicable).
Stage-Wise Treatment
Resectable
● Surgical resection (Whipple procedure or distal pancreatectomy).
● Adjuvant chemotherapy: modified FOLFIRINOX (Category 1 NCCN).
● ERAS protocol for recovery.
Borderline Resectable / Locally Advanced
● Neoadjuvant chemotherapy ± radiation to downstage.
● Surgery after good response.
Metastatic
● Systemic therapy: FOLFIRINOX or Gemcitabine + Nab-Paclitaxel.
● BRCA/PALB2 mutations: PARP inhibitors (Olaparib) for maintenance.
● MSI-H: Immunotherapy.
● Palliation: Endoscopic stenting for jaundice / pain management / nutrition.
Recent Advances
● Molecular testing now standard for precision therapy.
● Neoadjuvant therapy improves surgical outcomes.
● Minimally invasive pancreatic resections reduce morbidity.
● New drug classes: KRAS G12C inhibitors (in trials).
Our Expertise
● Pancreatic surgeons skilled in complex resections and vascular reconstruction.
● Medical oncologists providing evidence-based systemic therapy.
● Pain and nutrition teams ensuring holistic recovery.
● Close coordination with interventional endoscopy and gastroenterology for stenting and palliation.
When to Consult
Persistent jaundice, unexplained back pain, or weight loss should trigger immediate
evaluation — early intervention may allow curative surgery.
Disclaimer
Educational content; treatment should be individualised after multidisciplinary
assessment.
