The rising burden of gastrointestinal cancers

Dr Elisabete Weiderpass, Director of the International Agency for Research on Cancer (IARC), opened the debate with some thought-provoking statistics. Globally, there are approximately 20 million new cases of cancer each year, causing around 10 million deaths. Gastrointestinal cancers account for 24% of all new cancer cases and are responsible for a disproportionate percentage (34%) of cancer-related deaths worldwide.

These numbers reflect the significant burden of malignant tumours such as colorectal, stomach, liver, pancreas and gallbladder cancers. “The total number of people developing these cancers is increasing globally” explained Dr Weiderpass, attributing this increase mainly to population growth and ageing. Of particular concern is the increase in the incidence of colorectal cancer among younger populations. Dr Weiderpass noted that in 27 of the 50 countries examined, colorectal cancer rates are rising in patients under the age of 50, signalling a trend with potentially profound implications for public health.

Cancer cases are rising, even among young people

Professor Michel Ducreux (Gustave Roussy, France) expanded on the phenomenon of early-onset colorectal cancer. Initially, it was hypothesized that hereditary syndromes, such as Lynch syndrome, might explain the increased rates in younger patients due to microsatellite instability (MSI) tumors. However, detailed analyses revealed that the majority of these early-onset cancers are microsatellite stable (MSS), often presenting as advanced, aggressive disease.

“This is not MSI cancer, it is MSS cancer, and often a very advanced disease” Prof. Ducreux stressed. This discovery implies that young-onset colorectal cancer may represent a biologically distinct entity requiring unique therapeutic approaches. He emphasized that survival outcomes in these patients can vary, and ongoing research is critical to understanding underlying mechanisms.

H. pylori infection and dietary factors in gastric cancer risk

Dr. Elizabeth Smyth (Oxford University Hospitals NHS Foundation Trust, UK) discussed gastric cancer, highlighting the well-established role of Helicobacter pylori infection, particularly in distal gastric cancers. As countries develop and H. pylori prevalence decreases, associated gastric cancer rates also decline.

However, lifestyle factors remain crucial. Diets high in salt, alcohol consumption, tobacco use, and limited access to fresh fruits and vegetables contribute significantly to gastric cancer risk. Dr. Smyth underscored that modifiable risk factors continue to play a central role in prevention efforts.

Furthermore, Dr. Smyth elaborated on the rising incidence of gastroesophageal junction cancers, more associated with obesity and acid reflux than with dietary factors, demonstrating how cancer epidemiology is evolving in parallel with lifestyle shifts globally.

Advances in pancreatic and liver cancer

Pancreatic cancer remains one of the deadliest malignancies due to late diagnosis and inherent resistance to treatment. Prof. Ducreux highlighted emerging research into KRAS mutations and novel KRAS inhibitors as a potential breakthrough, offering hope for targeted therapies in a field historically bereft of significant progress.

Dr. Lorenza Rimassa (IRCCS Humanitas Research Hospital, Italy) further emphasized the biological aggressiveness of pancreatic cancer. Most diagnoses occur at advanced stages, often when patients present with vague symptoms like weight loss or abdominal pain. Even when tumors are initially resectable, relapse rates remain high, underscoring the urgent need for more effective systemic therapies and precision medicine strategies.

Dr. Rimassa also presented significant updates on hepatocellular carcinoma (HCC), the most common primary liver cancer. She described recent phase III data demonstrating that combining local regional therapies, such as transarterial chemoembolization (TACE), with immunotherapies improves outcomes in intermediate-stage HCC.

Equally promising is the emergence of precision medicine in HCC. Dr. Rimassa referenced ongoing research into molecular targets such as FGF19 overexpression and GPC3, which could transform the therapeutic landscape. Although no reliable biomarkers currently guide treatment selection in HCC, these studies indicate a shift towards more tailored therapeutic approaches.

Quality of life of cancer patients

Dr. Elizabeth Smyth emphasized that oncology’s mission is not solely to extend survival but also to help patients live well. Patient-reported outcomes are critical to understanding the true impact of treatment beyond imaging or survival statistics.

Quality of life is typically assessed using validated questionnaires that explore multiple domains, including physical symptoms, emotional well-being, and social functioning. Dr. Smyth noted that this information can reveal how treatments affect patients’ daily lives, energy levels, and ability to maintain relationships and normal activities.

New digital technologies, such as wearable devices, are increasingly being explored as complementary tools. These can objectively track activity levels, sleep patterns, and other indicators of well-being, offering insights beyond traditional patient questionnaires.

Importantly, Dr. Smyth highlighted that QoL data are now a crucial part of evaluating the value of new cancer therapies. Frameworks like the ESMO Magnitude of Clinical Benefit Scale (MCBS) are incorporating QoL measures alongside survival outcomes to determine whether treatments truly improve patients’ lives. The future of oncology, she stressed, lies in ensuring patients not only live longer but also maintain good quality of life throughout their care.

Looking ahead

Dr. Ducreux emphasised the need for greater education, noting that young people often consider themselves invulnerable to cancer. Changing this mindset is critical to promoting early diagnosis and improving outcomes.
At the end of the briefing, the speakers reflected on the urgent need to translate scientific discoveries into clinical practice. From liquid biopsies and circulating tumour DNA (ctDNA) for early diagnosis and monitoring of minimal residual disease to new immunotherapies and targeted treatments, the future of gastrointestinal oncology is very promising.

However, the speakers collectively cautioned that innovation must be accompanied by strategies to ensure equitable access, particularly in resource-limited settings. With the global incidence of cancer continuing to rise, the integration of prevention, early diagnosis, personalised therapies and patient-centred care will be essential to changing the trajectory of gastrointestinal cancers worldwide.

Ducreux M, Rimassa L, Smyth E, Weiderpass E, Lamarca E. The rising burden of gastrointestinal cancers: insights and innovations to control the impact. ESMO Virtual Press Briefing. Thursday 3 July, from 13:00-13:45 CEST.