GI Cancers
with Robert Donegan, MD
What are some other GI cancers?
Gastrointestinal (GI) cancers account for about 25 percent of all cancer cases. They are a group of cancers that arise from the esophagus, stomach, colon, pancreas, gall bladder, rectum or liver. “The term ‘GI cancers’ encompass a wide variety of cancers and each type is different in terms of prognosis and treatment,” says Robert Donegan, MD, Medical Oncologist and Hematologist at GBMC.
The types of GI cancers are outlined below:
Esophageal Cancer
Symptoms of esophageal cancer may include difficulty or pain when swallowing, unexplained weight loss and darkness of the stools due to bleeding. Chronic heartburn may increase risk, however smoking and alcohol consumption are clearly the major risk factors for the disease. “The combination of the two greatly increases a person’s risk for developing esophageal cancer,” says Dr. Donegan. “The greatest way to prevent this cancer is to avoid alcohol and especially avoid smoking.”
Esophageal cancer is most commonly diagnosed through upper endoscopy when a biopsy is performed. A multidisciplinary approach is ideal in treating this cancer and involves the combined efforts of the gastroenterologist, surgeon and medical and radiation oncologists. “When the patient has an early stage cancer, treatment may involve surgery, possibly followed by chemotherapy and radiation. However, with more advanced cancers, surgery is often not feasible, at least initially. These patients are often treated with chemotherapy and/or radiation therapy,” says Dr. Donegan.
Stomach Cancer
Symptoms of stomach (also called gastric) cancer may include abdominal fullness or pain, early fullness after eating, unexplained weight loss and black stools that reflect stomach bleeding. Dietary and lifestyle factors may account for up to half of all gastric cancers. Infection with the bacteria that causes stomach ulcers is also an important risk factor. “Stomach cancer is much more common in Asian cultures than it is in the American culture because of the increased consumption of heavily salted and pickled foods as well as genetic factors,” says Dr. Donegan.
Diagnosis is typically made by an upper endoscopy and a biopsy. In more advanced stages, the diagnosis may be suggested by findings on a CT scan. Like esophageal cancer, a coordinated multidisciplinary approach is preferred when treating stomach cancer. “When the cancer is confined to the stomach or adjacent lymph nodes, surgical removal of the tumor is recommended. In addition to surgery, chemotherapy, with or without radiation therapy, may also be recommended to lower the risk of an eventual recurrence,” says Dr. Donegan. “If appropriate, more advanced cancers are generally treated with chemotherapy.”
Colorectal Cancer
Symptoms of colorectal cancer may include rectal bleeding, abdominal pain and a change in bowel habits. Risk factors include age, inflammatory bowel disease and a family history of colon cancer. The cancer is most typically diagnosed during a colonoscopy. Colon cancer develops from polyps and can therefore be prevented by the removal of pre-cancerous polyps during the colonoscopy. “This is why colon cancer screening is so important. The detection and removal of polyps saves thousands of lives each year,” says Dr. Donegan. “The earlier the cancer is detected, the better the chance for the patient to be cured.”
According to Dr. Donegan, treatment of colorectal cancer varies depending upon the stage and location of the disease. “When the cancer is in its earliest stage and confined to the colon, it is usually treated with surgery alone. If the cancer has spread to the surrounding lymph nodes, chemotherapy following surgery is often recommended since it lowers the chances of a recurrence,” he says. “For cancers of the rectum, radiation and chemotherapy are administered in addition to the surgery.”
More advanced cancers may be treated with chemotherapy as well as surgery when appropriate. “In the last decade, several new and more effective medications have emerged for the treatment of colon cancer. These include several ‘targeted agents’ designed to specifically interfere with cancer growth. Combined with the integrated treatment approach, these medicines have resulted in significant improvements in survival,” says Dr. Donegan.
Liver Cancer
Liver cancer (also called hepatocellular carcinoma or hepatoma) is one of the most common cancers worldwide, primarily due to Hepatitis C infection in the developing countries and especially in China. Symptoms of the cancer may include unexplained weight loss, jaundice and abdominal pain or fullness in the upper right side of the abdomen. Risk factors include male gender, age and a history of chronic liver disease, especially cirrhosis. The diagnosis is usually established by a biopsy following a CT scan.
According to Dr. Donegan, the best treatment for liver cancer is surgery. “In order to have a chance to be cured, surgery is necessary, but unfortunately many are not candidates because of poor liver function, the location of the cancer or the presence of multiple tumors within the liver,” he says. “If the patient is not a candidate for surgery, there are other options that may slow the inevitable growth of the cancer. These include stereotactic radiotherapy, hepatic artery embolization (which delivers chemotherapy directly into the blood flow that feeds the tumor) and radiofrequency ablation,” says Dr. Donegan.
This year, the oral drug Sunitinib has become an exciting new addition to the treatment of liver cancer. “Sunitinib is the first drug that has ever been shown to potentially improve the length of survival of patients with advanced liver cancer,” says Dr. Donegan.
At GBMC, the latest advancements are available to help patients diagnosed with GI cancers. “Our busy clinical trial program allows patients to be part of emerging therapies that are showing promise,” says Dr. Donegan. “We know this is just the beginning of greater things to come for our patients.”
