Source: Cancer Resource Room

Cancers of the gastrointestinal system are located in the digestive organs. They are esophagus, stomach, small bowel or small intestine, colon and rectum and anus. Other organs that aid in digestion, produce hormones or clean the blood. These are liver and bile ducts, gallbladder, pancreas.

Anus
Any cancer that starts in the anus or the skin around the anus is called anal cancer. To read more on Anal Cancer >>>

Colon and Rectum
Cancers of the colon (large intestine) and rectum are most common in adults over 50 years old.
To read more on Colon Cancer >>>
To read more on Rectal Cancer >>>

Esophagus
The esophagus is part of the digestive system. It is a tube going through the chest between the throat and stomach. Cancer of the esophagus occurs in older adults. To read more about Esophageal Cancer >>>

Gallbladder
Gallbladder cancer is a rare type of cancer. There are fewer than 3000 new cases in the US each year. To read more on Gallbladder Cancer >>>

Gastrointestinal Carcinoid Tumors
A gastrointestinal carcinoid tumor is cancer that forms in the lining of the gastrointestinal tract. To read more on Gastrointestinal Carcinoid Tumors >>>

Liver and Bile Duct
Cancer of the liver is also called hepatocellular or hepatic cancer. To read more on Liver Cancer >>>

Pancreas
The pancreas is a small organ in the mid-portion of the body behind the stomach and small intestine. It is an organ that aids in digestion and manages the sugar level of the blood. To read more on Pancreatic Cancer >>>

Stomach
Gastric cancer is a tumor in the stomach. Cancer of the stomach causes pain, nausea, poor appetite, weight loss and sometimes vomiting. To read more on Stomach Cancer >>>

Small Bowel or Small Intestine
Any cancer that starts in the small bowel (small intestine) is called small bowel cancer. To read more on Small Bowel Cancer >>>


What’s New in Gastrointestinal Cancers?

Discovery of Critical Genes in Pancreatic Cancer...

Recent research conducted by Sarah P. Thayer, MD, PhD and Mattthias Hebrok, PhD, of the UCSF, led to the recent discovery of the first critical gene in pancreatic cancer.

For many reasons, pancreatic cancer is one of the most challenging malignancies. There is no screening test to detect the disease early, when treatment would be more effective. In addition, there are few known risk factors (other than smoking) to avoid. Moreover, the symptoms are vague and rarely occur until the disease is far advanced, when therapies are usually futile. As a result, pancreatic cancer, which will be diagnosed in an estimated 30,700 people in the U.S. this year, has a five-year survival rate of less than four percent.

Despite the significant challenges posed by this disease, there is room for hope. Research conducted by Sarah P. Thayer, MD, PhD, of the Massachusetts General Hospital Department of Surgery, and Matthias Hebrok, PhD, of the University of California at San Francisco, led to the recent discovery of the first critical gene in pancreatic cancer. According to Thayer, this research is in its early stages and is not ready for clinical application. But it represents an important first step in the quest to understand pancreatic cancer at its most basic level—knowledge that may someday lead to more effective, targeted therapies and perhaps a way to screen for the disease at an early, treatable, stage.

Thayer and Hebrok discovered that a genetic pathway called hedgehog signaling, when misregulated, appears to play an early and critical role in initiating and maintaining pancreatic cancer. Hedgehog signaling is an essential pathway during embryonic development of the pancreas, but inappropriate activation of this signaling has been implicated in several types of cancer.

The next steps in Thayer’s research are to evaluate inhibitors of hedgehog signaling as potential therapeutic agents, and to determine whether the hedgehog signaling molecule can be used for early detection.

Their findings were reported in the October 23, 2003 issue of the journal Nature.

New Surgical Oncology procedures for... Liver Resection

New techniques used to minimize blood loss during surgery including use of radiofrequency energy during dissection, use of ultrasonic dissection, and use of surgical staplers have reduced the instances in which blood transfusions are required. For patients with unresectable liver tumors, surgical treatment options include liver transplantation, radiofrequency ablation, ethanol injection, chemoembolization, and insertion of hepatic arterial infusion pumps. The surgical oncology team is also poised to launch new clinical trials involving:

• Hyperthermic isolated perfusion of the liver with Melphalan as an extension of a clinical trial in the Surgery Branch at the National Cancer Institute.
• Developing gene therapies for unresectable liver tumors, and is poised to launch a clinical trial of Herpes simplex viral treatment of liver tumors
• The development of living-related liver transplant program by Dr. Cosimi and Dr. Hertl have enabled this team to offer liver transplantation to suitable patients in a more timely fashion and avoid relatively long wait times associated with cadaveric organs.
• This team has worked also together with colleagues in radiology to develop the most sensitive tests for detection of liver tumors, as well as tests that allow precise mapping of liver volumes for operative planning.
• This team is also experienced in performance of intraoperative ultrasound examination of the liver, which has been demonstrated to be the most sensitive method for detection of liver tumors.
• To watch a streaming video of this procedure >>>

Radiofrequency Ablation of Liver Tumors…a minimally invasive procedure for liver biopsy.

Radiofrequency ablation is a treatment that can be applied to some liver tumors that are unresectable. The technique involves placement of a thin electrode (similar to a needle) into the center of a liver tumor, usually with the assistance of either CAT scan or ultrasound imaging. The electrode can be inserted through the skin often times, such that an operation is not required, much as a liver biopsy can be performed without the need for an operation. Local anesthesia is commonly used to minimize the discomfort of electrode insertion. The electrode is then connected to an electrical generator, and as current passes from the electrode tip to a grounding pad, the tumor is heated to a point where it is destroyed. This portion of the procedure generally does not produce any discomfort. During the procedure, vital signs, tumor temperature, and electrical properties of the tumor are monitored. The efficacy of treatment is assessed by CAT scan one month following treatment. Re-treatments are often necessary. Risks of the procedure include bleeding, although this is extremely rare.

In November of 1996, Dr. Kenneth Tanabe and Dr. Nahum Goldberg performed the first radiofrequency ablation of a patient with a liver tumor in the United States. This history-making procedure was performed in the operating rooms of the Massachusetts General Hospital as part of an Institutional Research Board approved clinical research protocol. The experimental procedure was deemed a success in both efficacy and safety. Following this initial trial, researchers in the Division of Surgical Oncology at the Massachusetts General Hospital have continued to lead the way in making cutting edge advances in this field. Nonetheless, it is important to point out that:

1. Radiofrequency ablation remains experimental
2. Radiofrequency ablation is not a substitute for resection (surgical removal) whenever possible, as removal of the tumor is considered the "gold standard" for treatment in appropriate patients
3. The chances of successful (complete) tumor destruction is about 75% -- less for tumors larger than 3 cm and more for tumors smaller than 3 cm
4. It is exceedingly rare that pateints with liver metastases from cancer of the pancreas, lungs, stomach, or esophagus are candidates for radiofrequency ablation unless they have no more than two tumors measuring no more than 4.0 cm in size.

Dr. Tanabe and colleagues are setting up a national trial of this technique sponsored by the American College of Surgeons and the National Cancer Institute.

If you feel that you may be a candidate for radiofrequency ablation of your liver tumor, please have your physician contact Kenneth Tanabe, MD at 617-724-3868 or James C. Cusack, MD at 617-724-4093.

Hepatic Arterial Infusion Chemotherapy for Colon and Rectal Carcinoma Liver Metastases to enhance the effectiveness of chemotherapy.

Colon and rectal cancers unfortunately often spread to the liver. However, it is well known that these cancers may spread to the liver and only the liver, without spread to other sites. Chemotherapy agents such as Camptosar® (CPT-11; irinotecan), 5-FU, and leucovorin are used most commonly to treat this form of cancer. These agents are commonly administered into a vein (intravenously). An attractive alternative is to administer chemotherapy directly into the arteries that feed the liver. The advantages of this approach are:

1. A high rate (99%) of chemotherapy drug extraction by the liver on first passage of blood through the liver leads to higher chemotherapy drug concentrations in the tumors than can be achieved with intravenous drug administration.
2. A high rate (99%) of chemotherapy drug extraction by the liver on first passage of blood through the liver leads to lower levels of drug in tissues outside the liver (e.g. bone marrow and gut), which reduces side effects of bone marrow suppression or nausea.
3. Liver tumors are supplied principally by the arteries in the liver, which are the blood vessels into which the active chemotherapy agent is administered.
4. The likelihood of tumor shrinkage is greater following intra-arterial chemotherapy administration directly into the liver compared to intravenous adminisration.
5. Patients whose tumors have increased in size despite treatment with 5-FU or Camptosar® (CPT-11; irinotecan) still shrink in response to intraarterial chemotherapy in roughly 50% of instances.

In an attempt to improve upon past results with intra-arterial administration of chemotherapy, we have initiated a clinical trial that combines intra-arterial chemotherapy with systemic (intravenous) chemotherapy administration. FUDR (floxuridine) and 5-FU are administered intra-arterially, while Camptosar® (CPT-11; irinotecan) is adminstered intravenously. It is hoped that this treatment will be more effective than administration of any of these compounds alone or together via an intravenous route. Patients with colon or rectal cancer spread to the liver that are eligible for this clinical trial will have a small infusion pump (roughly the size of a hockey puck) inserted surgically into their abdomen to administer the chemotherapy. Patients that are not eligible for this trial may still benefit from intra-arterial administration of FUDR (without systemic administration of Camptosar).

If you feel that you may be a candidate for hepatic arterial infusion chemotherapy for your liver tumor, please have your physician contact Kenneth Tanabe, MD at 617-724-3868 or James C. Cusack, MD at 617-724-4093.

For more information, contact the Division of Surgical Oncology.

To Search Pub Med on gastrointestinal cancers, please see below.