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.
Any cancer that starts in the anus or the skin around the
anus is called anal cancer. To read more on Anal
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 >>>
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 cancer is a rare type of cancer. There are fewer
than 3000 new cases in the US each year. To read more on Gallbladder
Gastrointestinal Carcinoid Tumors
A gastrointestinal carcinoid tumor is cancer that forms in
the lining of the gastrointestinal tract.
To read more on Gastrointestinal Carcinoid
Liver and Bile Duct
Cancer of the liver is also called hepatocellular or hepatic
cancer. To read more on Liver Cancer
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
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 >>>
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
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
- 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
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:
- Radiofrequency ablation remains experimental
- 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
- 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
- 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:
- 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.
- 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.
- Liver tumors are supplied principally by the arteries in the liver, which
are the blood vessels into which the active chemotherapy agent is administered.
- The likelihood of tumor shrinkage is greater following intra-arterial
chemotherapy administration directly into the liver compared to intravenous
- 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