Introduction
Cancer is the leading cause of death in Japan, accounting for approximately one in three deaths from cancer and cancer incidence of one in two people, according to the ‘Cancer Statistics’ of Japan published in 2023; lung cancer is the leading cause of death from malignant tumours, colorectal cancer is the second leading cause and stomach cancer is the third leading cause (Table 1).
Lung cancer is the most common cancer in men and colorectal cancer is the most common cancer in women. Colorectal, lung and stomach cancers are also the most common cancers in terms of the number of affected people (men and women combined) (Table 2).
Cancer is classified into clinical stages I – IV according to the degree of progression. Most cancers detected at stage I can be cured completely by endoscopic surgery, mini-surgery or radiotherapy; at stage II, surgery (mostly surgery alone), radiotherapy and chemotherapy cure more than two-thirds of cases, although some cases may recur; at stage III, surgery (mostly surgery), radiotherapy and chemotherapy cure more than two-thirds of cases, although some may recur. Stage IV cancers are basically considered unresectable and are treated with chemotherapy and radiotherapy, but in the majority of cases a cure is difficult. However, in chemotherapy, new molecular targeted drugs and immune checkpoint inhibitors have been developed, and cancer gene panel testing has been approved (2019), which has significantly improved treatment outcomes. For example, there has been a gradual increase in the number of cases of stage IV cancer surviving for 10-20 years or more, and in cases of stage IV cancer where the cancer has shrunk to stage 1 or 2 with chemotherapy, making it resectable. In addition, new effective treatment drugs are often approved while the patient is surviving in the treatment with chemotherapy.
New cancer treatments at Tokushima University Hospital
This special article introduces new initiatives at the hospital on the following five topics.
- 1) Evolving endoscopic treatment of gastric cancer – a major change with the advent of endoscopic submucosal dissection (ESD)
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Gastric cancer detected at an early stage through medical examinations can be completely cured by endoscopically removing only the cancerous part. This section describes endoscopic treatment for early gastric cancer as a typical example of endoscopic treatment.
- 2) Drug therapy for lung cancer
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Traditionally, lung cancer had been known as a cancer with a poor prognosis, but it is a representative cancer for which treatment outcomes have greatly improved with the advent of molecular targeted drugs and immune checkpoint inhibitors. Similarly for other cancers, the number of cases achieving long-term survival with these drugs is gradually increasing.
- 3) Development of optimised high-precision radiotherapy
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Radiotherapy has also made significant progress. Radiotherapy is used for all types of cancer, but is particularly common in breast, head and neck, prostate, cervical and oesophageal cancer.
- 4) Early-stage breast cancer, new radiotherapy to preserve the beauty of the breast
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In early-stage breast cancer, radiotherapy is now able to cure the disease completely while preserving the beauty of the breast.
- 5) Genomic medicine for cancer
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Since the cancer gene panel test was approved in Japan in 2019, the number of such tests has been increasing every year across the country including Tokushima University Hospital. At present (2023), it is estimated that only about 10% of patients who undergo a cancer gene panel test actually find an effective therapeutic drug and receive that treatment. However, new molecular-targeted drugs are being developed (and approved) one after another, and the percentage is gradually increasing every year. This section explains the approach taken at Tokushima University Hospital.
As described above, cancer treatment methods are evolving day by day, so please do not give up, even if you have stage IV cancer, and visit the Tokushima University Hospital for a consultation.