How common are digestive cancers?
Professor Pierre Michel: More than 5 million French people are taken care of for a digestive pathology each year. Among them, 1 million are affected by serious chronic pathologies, mainly digestive cancers (44%): esophagus, stomach, liver, pancreas, bile ducts, small intestine, colon, rectum and anus. Projections envisage an increase of 8% over the next 8 years.
With 45,000 new cases per year, colorectal cancer is the third most common cancer. But the National Cancer Institute report of July 2019 shows a decrease in the incidence (number of new cases per year) and mortality of this cancer linked to organized screening. According to projections, a 17% reduction in its incidence is estimated between 2016 and 2024. On the other hand, that of liver and pancreatic cancers is increasing continuously, with a doubling of the number of new cases of pancreatic cancer in 10 years. , while pancreatic adenocarcinomas are expected to become the second leading cause of cancer death by 2030 in Western countries. As for primary liver cancer, it is the leading cause of death in patients suffering from cirrhosis.
How do you explain their progress?
Father Dominique Thabut: It is mainly linked to the increase in metabolic risks: 12 million French people are at risk of metabolic syndrome characterized by the presence of several health problems – abnormalities in lipid or carbohydrate metabolism, high blood pressure or excess weight which increase the risk of diabetes type 2, heart disease, stroke and chronic liver disease.
In France, there are 7% diabetics and 16% obese. However, nearly 50 to 70% of them have hepatic abnormalities linked to fatty liver.
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What progress has been made in terms of early diagnosis?
Professor Pierre Michel: Today, hepato-gastroenterologists perform digestive endoscopy for the early diagnosis of digestive cancers. This is the case for cancers of the esophagus and stomach, for which this examination is offered early in the event of digestive symptoms and/or people at risk: for the esophagus, gastro-oesophageal reflux and consumption alcohol and tobacco; for stomach, family history. Similarly, the more frequent recourse to interventional endoscopy of the digestive tract or bilio-pancreatic makes it possible to avoid more invasive surgical procedures, which often cause morbidity or even mortality.
In addition, only 30% of French people do mass screening for colorectal cancer from the age of 50. This stool blood test is to be performed once every 2 years. It makes it possible to detect at an early stage, with the immunological test and colonoscopy, precancerous lesions and cancers, most often of small size. As for patients with chronic liver disease (fibrosis, cirrhosis), they are monitored by ultrasound to detect early primary liver cancer. On the other hand, there is currently no effective pancreatic cancer screening strategy.
In terms of technological advances, what is the contribution of artificial intelligence in medical imaging?
Father Dominique Thabut: Advances in artificial intelligence in medical imaging in hepato-gastroenterology have an impact on the diagnosis and management of patients, while providing assistance to medical practice. Thanks to zoom powers of up to 150 times, it helps to better detect and characterize digestive tumors, which should eventually make it possible to obtain more precise and efficient diagnoses with shorter delays, while avoiding the too frequent recourse to longer histological examinations (analysis of biological tissues). With, in addition, more comfort for the patients. In the context of colorectal cancer screening, artificial intelligence would make it possible to predict the benign or malignant character of the polyp and to remove it with accuracy.
Also, some artificial intelligence techniques are being developed to help specify liver tumors.
What are the advances in immunotherapy treatments?
Professor Julien Taieb: Certain forms of digestive cancers with specific biological characteristics (less than 10% of metastatic cancers of the pancreas and colon) and concealed tumor cells, not recognized by the immune defense system, are very sensitive to treatment by immunotherapy.
Under its action, the immune system recognizes tumor cells and becomes capable of destroying them. Immunotherapy enriches the possibilities of targeted treatments according to the characteristics of the cancers (stomach, colon, etc.), and therefore more suitable, with improved chances of survival. Participating in therapeutic clinical trials makes it possible to benefit from state-of-the-art treatments with regular follow-up while waiting for open access to all patients, as is now the case for other cancers (lung, melanoma, ENT) .
Our Experts:
- Pr Pierre Michel, hepato-gastroenterologist at the University Hospital Center of Rouen, president of the French-speaking Federation of Digestive Oncology.
- Pre Dominique Thabut, hepato-gastroenterologist, head of service at Pitié-Salpêtrière, in Paris.
- Pr Julien Taieb, hepato-gastroenterologist at the Georges-Pompidou European Hospital in Paris, specializing in digestive oncology.
