ABSTRACT

Objective: This study aims to explore the clinico-demographic profile of patients diagnosed
with gastrointestinal (GI) malignancies at a tertiary care center, with a focus on the patterns
of presentation, risk factors, and associated demographic features.

Methods: Conducted as a cross-sectional study over 18 months, the research included 100
patients diagnosed with GI malignancies. Data were collected through detailed histories,
physical examinations, and diagnostic evaluations. Socio-economic data, presenting
symptoms, comorbidities, and lifestyle factors were also analyzed.

Results: The study revealed that 46% of cases were in individuals aged over 60, with a
predominance of males (63%). Abdominal pain (64%) was the most frequent presenting
symptom, followed by weight loss (26%). Socio-economic analysis showed a higher
incidence among patients in lower income groups. Commonly observed risk factors included
alcohol use (54%) and smoking (68%). Adenocarcinoma was the most frequently diagnosed
malignancy (74%), with esophageal carcinoma representing the highest incidence among
specific cancer types.

Conclusion: The findings underscore the demographic and clinical factors associated with GI
malignancies, highlighting the need for targeted screening and intervention strategies.
Awareness programs and early diagnostic approaches, especially for high-risk groups, are
essential for improving outcomes in the affected population.
Introduction:

Gastrointestinal (GI) malignancies encompass a group of aggressive cancers that affect the
digestive system, including the esophagus, stomach, liver, pancreas, and intestines. These
cancers are among the leading causes of cancer-related deaths globally, with substantial
impacts on both men and women. Notably, the incidence of GI malignancies has been rising
due to factors such as increased life expectancy, changes in lifestyle, and environmental
exposures. In India, where this study is based, GI cancers are particularly prevalent, with
varying rates and distributions across regions. The burden of these malignancies is
compounded by limited early detection and screening, which often leads to late-stage
diagnoses and poorer prognoses.

Studies indicate that GI cancers exhibit distinct demographic and clinical patterns. Factors
such as age, gender, socio-economic status, smoking, alcohol consumption, and dietary habits
have been associated with the incidence and progression of these malignancies. However,
most patients in India present with advanced stages of the disease, often due to a lack of
awareness and access to early diagnostic services. Additionally, the unique socio-economic
and cultural landscape in regions like Uttarakhand contributes to specific risk factors and
patient profiles that may differ from those observed in other areas.

This study aims to analyze the clinico-demographic profile of GI malignancy patients

presenting to a tertiary care center in Uttarakhand. By examining age, gender, socio-
economic status, risk factors, and clinical presentations, the research seeks to identify patterns
that could inform more effective screening, preventive measures, and treatment strategies for
this population. The findings may contribute to region-specific insights, ultimately enhancing
the understanding of GI malignancy trends and aiding in the development of targeted
interventions.

Review of Literature:

E. Fredericks et al. investigated biomarkers in colorectal cancer, identifying β-catenin as a

significant driver in carcinogenesis, beyond APC's role, with elevated PPARγ levels showing
anticarcinogenic effects. Suggested further evaluation of COX-2's role in post-transcriptional
regulation for colorectal cancer. J. Yao et al. analyzed circulating tumor DNA (ctDNA)
mutations in metastatic colorectal cancer using next-generation sequencing, finding that
RAS/BRAF mutations correlate with poorer progression-free survival, suggesting these as
important prognostic markers. N. Currey et al. used an animal model to explore the impact of
microsatellite instability (MSI) on colorectal cancer. Findings showed that sulindac treatment
reversed MSI increases in carcinogen-treated Msh2-KO mice, providing insights into MSI's
role in tumorigenesis and potential prevention strategies. I. S. Yu and W. Y. Cheung
reviewed prognostic biomarkers and therapeutic approaches for pancreatic adenocarcinoma,
emphasizing a need for biomarker optimization to improve treatment outcomes and future
guidelines. J. Maues et al. explored MYC-regulated gene expression in gastric cancer cell
lines, identifying key genes influenced by MYC across different gastric cancer subtypes,
which may guide future therapeutic targeting. Mohanalakshmi et al. examined biochemical
markers in gastric cancer patients, noting elevated levels of markers like CEA, CA19-9, and
CA72-4, which could aid in predicting patient outcomes and monitoring treatment response.
Manoharan et al. investigated lifestyle impacts on lipid profiles in gastric cancer patients,
finding that smoking and dietary factors correlate with lower levels of lipids and may
influence cancer development. Craig et al. studied smoking's impact on lipid profiles,
showing smokers have lower HDL cholesterol and higher LDL and total cholesterol, which
could elevate cardiovascular disease risk.

Aims & Objectives:

The primary aim of this study is to examine the clinico-demographic profile of patients
diagnosed with gastrointestinal (GI) malignancies who are treated at a tertiary care center.
This research seeks to identify key demographic factors, such as age, gender, socio-economic
status, and lifestyle habits, that are associated with the incidence and progression of GI
cancers. By analyzing clinical presentations, including common symptoms, comorbidities,
and risk factors like smoking and alcohol use, the study aims to provide a comprehensive
overview of patient profiles and patterns of malignancy within this population. Additionally,
the research strives to assess the prevalence and distribution of various types of GI cancers,
thereby contributing to a better understanding of the disease burden in this region. Ultimately,
these findings are expected to aid in developing targeted screening and intervention
strategies, improving early detection, and guiding healthcare planning for more effective
management of GI malignancies in the community.

Material & Methodology:

This cross-sectional study was conducted over an 18-month period at a tertiary care center,
involving 100 patients who were histologically diagnosed with gastrointestinal malignancies.
Patients were recruited from the emergency department, outpatient department, and inpatient
wards. Inclusion criteria included all consenting patients with confirmed GI cancer diagnoses,
while those who refused consent were excluded. Data were collected through a structured
proforma, recording demographic information, clinical presentations, and relevant medical
histories, including lifestyle factors like smoking, alcohol use, and diet. Each patient
underwent a comprehensive physical examination, including assessment of vital signs and
body mass index (BMI), as well as systemic examination of major organ systems. Baseline
laboratory investigations, including hematological and biochemical profiles, were performed
for all patients. Data were analyzed using statistical software to explore correlations between
demographic and clinical variables and the types of GI cancers. Ethical approval was
obtained from the Institutional Ethics Committee, and the study adhered to the principles
outlined in the Declaration of Helsinki.

Results:

This study involved 100 patients diagnosed with gastrointestinal (GI) malignancies at a
tertiary care center. The analysis focuses on various clinical and demographic factors,
including age, gender, socio-economic status, presenting symptoms, comorbidities, personal
habits, and laboratory findings. The results reveal important patterns and correlations that can
inform early detection strategies, risk factor assessment, and targeted interventions.

Analyzing age and gender showed a higher prevalence of GI malignancies in individuals over
60 years, with this age group comprising 46% of the cases. This finding aligns with existing
literature, as GI cancers are known to be more common in older adults due to cumulative
genetic and environmental exposures. Additionally, the male-to-female ratio was 63:37,
suggesting that males are at higher risk. This could be partly due to lifestyle factors such as
higher rates of smoking and alcohol use among males, which are established risk factors for
GI cancers. Table 1 presents the socio-economic status of the selected patients.
 Table 1: Socio-Economic Status of the Selected
Patients.
Socio-Economic Status N %
I (Upper class) 08 08
II (Upper middle class) 11 11
III (Middle class) 20 20
IV (Lower middle class) 29 29
V (Lower class) 32 32

Table 1 reveals that a large proportion of patients (32%) belonged to the lower class, with
limited access to healthcare. Lower socio-economic status is often associated with higher
exposure to risk factors like tobacco, poor diet, and occupational hazards, which may explain
the greater incidence of GI cancers in this class. Similarly, the upper class depicted the lowest
incident. The selected study subjects often presented some complaints, as depicted in Figure
1, with abdominal pain being the most common complaint. It was followed by weight loss
(26%), painful bowel movements (20%), and nausea/vomiting (18%). These symptoms are
common in GI malignancies but are often nonspecific, highlighting the need for thorough
evaluation when they present, especially in high-risk demographics. The variety of presenting
symptoms reflects the complex nature of GI cancers, which can mimic other gastrointestinal
conditions. The prominence of abdominal pain as a primary symptom emphasizes the need
for heightened awareness among clinicians, as this could lead to early suspicion and timely
diagnosis of GI malignancies.

Figure 1: Presenting Complaints of the Study Subjects

Constipation 6
Diarrhoea 6
Dysphagia 6
Bloating 6
Anorexia 6
Malena 7
Hematemesis 11
Rectal bleeding 10
Nausea and vomiting 18
Painful bowel movement 20
Weight loss 26
Abdominal pain 64
0 10 20 30 40 50 60 70

Table 2 presents the comorbidities observed, indicating that patients with GI malignancies
may also have underlying chronic conditions. Hypertension (12%) and diabetes mellitus
(10%) were the most common comorbidities observed. This association suggests that patients
with certain comorbidities may be at an elevated risk for developing GI cancers or may
experience worse outcomes due to their underlying health status. Chronic conditions can
complicate cancer treatment and prognosis, underscoring the importance of managing
comorbidities in patients with GI malignancies.
 Table 2: Distribution of co-morbidities
in cases
Comorbidity N*
Dyslipidemia 6
Hypertension 12
Diabetes Mellitus 10
Chronic Obstructive Pulmonary
3
Disease
Hypothyroidism 3
Chronic Liver Disease 4

Regarding the risk factors and personal habits, as depicted in Figure 2, a significant number
of patients reported smoking (68%) and alcohol use (54%). These lifestyle habits have been
consistently linked to the development of GI malignancies, particularly esophageal and
gastric cancers. The data reinforce the importance of lifestyle modification programs aimed at
reducing tobacco and alcohol use, which could play a preventive role in reducing GI cancer
incidence. The incidence of tobacco use was 38% which was also noticeable. However, the
incidence of Drug Abuser is lower at 4%.

Figure 2: Distribution of Study Subjects with Reference to their

Personal History

55
45
35
25
15
5
Drug Abuser Smoking Tobacco Alcohol use
Male 4 48 30 54
Female 0 20 8 0

Only a small percentage of patients (2%) reported a family history of GI malignancies,

suggesting that lifestyle and environmental factors might have a stronger influence on cancer
development than genetic predisposition in this cohort.

Table 3 outlines the distribution of lymphadenopathy across various anatomical locations.

Lymphadenopathy was not detected in 68% patients, while 8% and 1% patients had cervical
and pre-tracheal lymphadenopathy, respectively. The most prevalent form was left
supraclavicular lymphadenopathy (17%). The presence of lymphadenopathy is often
indicative of metastasis, signifying more advanced disease stages in these patients.
 Table 3: Distribution of Study Subjects with
respect to Lymphadenopathy
Lymphadenopathy N*

Absent 68

Cervical 8

Left supraclavicular 17

Pre-tracheal 1

Axillary 6

Aortic and para-aortic 4

Mediastinal 1

Retroperitoneal 4

Table 4: Baseline Investigations of the Cases

Investigations Minimum Maximum Mean Std. Deviation
Haemoglobin(g/dL) 5.84 13.6 12.52 6.75
TLC (cells/mm³) 3100.00 18076.00 9274.29 1654.59
Platelets (× 10³/μL) 66.12 283.00 206.92 26.39
ESR (mm/hr) 3.81 5.80 4.98 0.54
Potassium(meq/L) 2.80 6.96 5.60 0.25
S. Sodium (meq/L) 128.00 148.00 138.79 5.33
Total Bilirubin (mg/dl) 0.8 11 5.96 3.19
AST/ALT Ratio 0.10 3.60 0.41 0.65
T. Protein (g/dL) 4.23 10.25 8.01 1.32
S. Albumin (g/dL) 0.94 4.40 2.59 0.82
PT/INR 1.75 4 1.97 0.07
S. Amylase (U/L) 235.02 445.36 256.75 87.56
S. Lipase (U/L) 65.00 108.00 86.47 62.52

Table 11 summarizes the results of baseline investigations. Haemoglobin levels range

from 5.84 to 13.6 g/dL. The mean hemoglobin level was 12.52 g/dL, with many patients
showing signs of anemia, a common condition in cancer patients due to chronic illness and
potential blood loss from GI lesions. Additionally, the total leukocyte count varied widely,
from 3100.00 to 18076.00 cells/mm³, with a mean value of 9274.29 cells/mm³. Platelet count
ranges from 66.12 to 283.00 × 10³/μL, with a mean of 206.92 × 10³/μL.
 Figure 3: Histopathological Examination Findings in Cases

2% 3%
22%
Adenocarcinoma
Squamous cell carcinoma
Neuroendocrine tumor
others

73%

Figure 3 reveals Histopathological Examination findings in the study. The study

identified adenocarcinoma as the most prevalent type of gastrointestinal (GI) malignancy,
comprising 71% of cases. This finding is consistent with global data, where
adenocarcinomas are the most frequently observed histological type in GI cancers (Siegel et.
al. (2023), Arnold et. al. (2020), Ilic M & Ilic I (2022)). Among diagnosis of the study cases,
esophageal carcinoma was the most frequently diagnosed (33%), followed by gastric
cancer (24%) and carcinoma gallblader (16%). Hepatocellular carcinoma, and pancreatic
carcinoma represented 3% and 10% of the diagnoses. This has been represented in Figure 5.

Table 5: Distribution of Cases According to

their Diagnosis
Esophageal Carcinoma 33
Gastric Carcinoma 24
Carcinoma Gallbladder 16
Hepatocellular Carcinoma 3
Pancreatic Carcinoma 10
Colorectal Carcinoma 14

Table 6 and Table 7 provide detailed view of Age wise and Gender wise distribution of
carcinomas, respectively. Table 6 explores the distribution of various types of
gastrointestinal cancers across three age groups: below 40 years, 40–60 years, and over 60
years. For esophageal carcinoma, the distribution appears relatively even across age groups,
with p = 0.073, suggesting no significant age-based difference. Gastric carcinoma shows a
slight increase in cases with age, especially in individuals over 60, but with p = 0.253, this
trend is not statistically significant. Similarly, gallbladder cancer cases increase modestly
with age; however, the high p-value of 0.819 indicates no significant trend. Hepatocellular
carcinoma cases remain uniformly low across all age groups, with only one case in each,
reflecting no age impact (p = 0.772). Pancreatic carcinoma is somewhat more common in
middle and older age groups, yet this distribution is not statistically meaningful (p = 0.581).
Finally, colorectal carcinoma cases increase modestly with age, though the high p-value of
0.913 indicates no statistically significant difference across age groups. Overall, none of the
cancers show significant age-related distribution differences in this dataset.

Table 6: Age wise Distribution of Carcinomas

Age group (years)
Diagnosis p value
<40 40-60 >60
Esophageal Carcinoma 10 11 12 0.073
Gastric carcinoma 2 8 14 0.253
Ca gallbladder 2 6 8 0.819
Hepatocellular
1 1 1 0.772
Carcinoma
Pancreatic Carcinoma 1 5 4 0.581
Colorectal carcinoma 2 5 7 0.913
Table 7: Gender wise Distribution of Carcinomas
Gender
Diagnosis p value
Male Female
Esophageal Carcinoma 18(54.54%) 15(45.45%) 0.219
Gastric carcinoma 18(75%) 6(24%) 0.162
Ca gallbladder 10(62.50%) 6(37.50%) 0.964
Hepatocellular
2(66.66%) 1(33.33%) 0.894
Carcinoma
Pancreatic Carcinoma 6(60%) 4(40%) 0.836
Colorectal carcinoma 9(64.28%) 5(35.71%) 0.914

The data in Table 7 summarizes the distribution of various carcinomas by gender, alongside
p-values to determine if any observed differences are statistically significant. Esophageal
carcinoma shows a slight male predominance (54.54% male, 45.45% female), but this
difference is not statistically significant (p = 0.219). Gastric carcinoma also appears more
common in males (75% male, 24% female), yet the p-value of 0.162 indicates this gender
difference is not significant. Gallbladder cancer has a similar trend, with 62.5% of cases in
males and 37.5% in females (p = 0.964), showing no significant gender difference.
Hepatocellular carcinoma cases are slightly more common in males (66.66%) compared to
females (33.33%), though not significantly so (p = 0.894). Pancreatic carcinoma, with 60% in
males and 40% in females, also shows no statistically significant difference by gender (p =
0.836). Colorectal carcinoma has a slight male predominance (64.28% male, 35.71% female),
but this too is not statistically meaningful (p = 0.914). Overall, none of the carcinoma types
demonstrate significant gender-based distribution differences in this dataset.