Did you know? A bacterial infection that affects up to 31% of Singaporeans is a risk factor for stomach cancer.
Known as Helicobacter pylori (H. pylori), this bacterium is commonly transmitted through saliva. While the majority of people infected with H. pylori do not experience any symptoms, the bacterium does increase the risk of stomach cancer.
While much attention is often given to Helicobacter pylori (H. pylori) in discussions around stomach health, the broader and more pressing issue of gastric cancer often remains under the radar — until it’s too late. In Singapore, gastric cancer is among the top 10 most common cancers in both men and women, yet its early symptoms are vague and non-specific, often mimicking minor digestive issues.
This makes it a silent killer, frequently diagnosed at advanced stages when treatment becomes more complex and survival rates drop dramatically. In fact, advanced gastric cancer has one of the poorest 5-year survival rates among all major cancers in Singapore, at less than 10%.
Still, there is hope — and reason to act. As Dr Choo Su Pin, Medical Oncologist at Curie Oncology, emphasises, early detection and personalised treatment options can significantly improve a patient’s quality of life, even in advanced stages. In this interview, Dr Choo helps us understand how H. pylori increases cancer risk, who is most vulnerable, and what treatment options are available today that go beyond just prolonging life — they aim to restore comfort, dignity, and empowerment.
Q: How do you find out if you have H. pylori? Can you eliminate it?
There are several ways to test for H. pylori (HP):
A non-invasive method through a urea breath test
Through a biopsy from a gastroscopy
Through stool and blood, which are less commonly used
Yes, HP can be eliminated in most cases with up to two weeks of double antibiotics and a proton pump inhibitor to reduce gastric acid. Eradicating HP can reduce risk of gastric cancer by up to 50%.
Q: How does H. pylori increase the risk of stomach cancer?
H. pylori is a group 1 carcinogen and can cause cancer through inflammation, alteration of the gastric environment and gastric microbiome, DNA damage and effects on the immune microenvironment.
Q: Are there other risk factors in addition to H. pylori that may lead to stomach cancer? Who is at-risk of stomach cancer?
Yes, smokers, people with intestinal metaplasia or gastric atrophy, family history of stomach cancer and those of East Asian ethnicity are at increased risk of stomach cancer, especially if they have HP infection too.
Q: Stomach cancer has such common symptoms such as nausea, poor appetite and abdominal pain. If I have these symptoms, when should I be worried and seek medical help?
If symptoms such as nausea, poor appetite and abdominal pain persist for weeks and cannot be otherwise explained, medical help should be sought.
Other tell-tale symptoms of gastric cancer may be black tarry stools (malena), difficulty swallowing (dysphagia), vomiting blood (hematemesis) and feeling full easily (early satiety).
Q: What’s the difference in survival rates for early vs late-stage stomach cancer?
Early-stage stomach cancers are usually potentially curable with surgery, combined with chemotherapy and immunotherapy. Whereas with stage 4 stomach cancers, 5-year survival rates are less than 10%. Early detection is key.
Q: What are the treatments available for late-stage stomach cancer patients?
Chemotherapy, immunotherapy and targeted therapies are the mainstay treatments. The optimal combination depends on the molecular profile of the gastric cancer.
For example, patients with microsatellite instable gastric cancer do very well with immunotherapy alone but they are a rarer population.
For the majority, backbone chemotherapy is required with the addition of targeted therapy. For example, patients with CLDN18.2 over expression benefit from chemotherapy in combination with anti-CLDN18.2 antibody, while patients with HER2 over expressed gastric cancers benefit from the combination of chemotherapy with anti-HER2 antibody plus immunotherapy if certain factors are met.
Gastric cancer may be a silent and often overlooked threat, but greater awareness, early detection, and access to personalised treatment options can make a real difference — not just in survival, but in how patients live through their diagnosis. As Dr Choo Su Pin highlights, even in advanced stages, treatment plays a crucial role in improving quality of life and restoring a sense of control. By understanding the risks, recognising the symptoms, and encouraging timely medical attention, we can take important steps toward reducing the impact of this challenging disease in Singapore.
Images: Envato
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