Gastrointestinal Cancers

Anal Cancer

Anal cancer is a disease in which malignant (cancer) cells form in the tissues of the anus.

The anus is the end of the large intestine, below the rectum, through which stool (solid waste) leaves the body.

The anus is formed partly from the outer, skin layers of the body and partly from the intestine. Two ring-like muscles, called sphincter muscles, open and close the anal opening to let stool pass out of the body. The anal canal, the part of the anus between the rectum and the anal opening, is about 3.8cm long.

Anatomy of the lower digestive system.
Image courtesy of the National Cancer Institute.

The skin around the outside of the anus is called the perianal area. Tumours in this area are skin tumours, not anal cancer.

Being infected with the human papillomavirus (HPV) can affect the risk of developing anal cancer.

Risk factors include the following:

Being over 50 years old.
Being infected with human papillomavirus (HPV).
Having many sexual partners.
Having receptive anal intercourse (anal sex).
Frequent anal redness, swelling, and soreness.
Having anal fistulas (abnormal openings).
Smoking cigarettes.

Possible signs of anal cancer include bleeding from the anus or rectum or a lump near the anus.These and other symptoms may be caused by anal cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

Bleeding from the anus or rectum.
Pain or pressure in the area around the anus.
Itching or discharge from the anus.
A lump near the anus.
A change in bowel habits.

Tests that examine the rectum and anus are used to detect (find) and diagnose anal cancer.

The following tests and procedures may be used:

Physical exam and history - an exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Digital rectal examination (DRE) - an exam of the anus and rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual.

Anoscopy - an exam of the anus and lower rectum using a short, lighted tube called an anoscope.

Proctoscopy - an exam of the rectum using a short, lighted tube called a proctoscope.

Endo-anal or endorectal ultrasound - a procedure in which an ultrasound transducer (probe) is inserted into the anus or rectum and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

Biopsy - the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If an abnormal area is seen during the anoscopy, a biopsy may be done at that time.

Certain factors affect the prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the following:

The size of the tumour.
Where the tumour is in the anus.
Whether the cancer has spread to the lymph nodes.

The treatment options depend on the following:

The stage of the cancer.
Where the tumour is in the anus.
Whether the patient has human immunodeficiency virus (HIV).
Whether cancer remains after initial treatment or has recurred.

There are different types of treatment for patients with anal cancer.

Different types of treatments are available for patients with anal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used -

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Surgery

Local resection - a surgical procedure in which the tumour is cut from the anus along with some of the healthy tissue around it. Local resection may be used if the cancer is small and has not spread. This procedure may save the sphincter muscles so the patient can still control bowel movements. Tumours that develop in the lower part of the anus can often be removed with local resection.

Abdominoperineal resection – a surgical procedure in which the anus, the rectum, and part of the sigmoid colon are removed through an incision made in the abdomen. The doctor sews the end of the intestine to an opening, called a stoma, made in the surface of the abdomen so body waste can be collected in a disposable bag outside of the body. This is called a colostomy. Lymph nodes that contain cancer may also be removed during this operation.

Having the human immunodeficiency virus can affect treatment of anal cancer.

Cancer therapy can further damage the already weakened immune systems of patients who have the human immunodeficiency virus (HIV). For this reason, patients who have anal cancer and HIV are usually treated with lower doses of anticancer drugs and radiation than patients who do not have HIV.

Other types of treatment are being tested in clinical trials. These include the following -

Radiosensitizers

Radiosensitizers are drugs that make tumour cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumour cells.

Bile Duct Cancer, Extrahepatic

Extrahepatic bile duct cancer is a rare disease in which malignant (cancer) cells form in the part of bile duct that is outside the liver.

A network of bile ducts (tubes) connects the liver and the gallbladder to the small intestine. This network begins in the liver where many small ducts collect bile, a fluid made by the liver to break down fats during digestion. The small ducts come together to form the right and left hepatic bile ducts, which lead out of the liver. The two ducts join outside the liver to become the common hepatic duct. The part of the common hepatic duct that is outside the liver is called the extrahepatic bile duct. The extrahepatic bile duct is joined by a duct from the gallbladder (which stores bile) to form the common bile duct. Bile is released from the gallbladder through the common bile duct into the small intestine when food is being digested.

Having colitis or certain liver diseases can increase the risk of developing extrahepatic bile duct cancer.

Risk factors include having any of the following disorders –

Primary sclerosing cholangitis.
Chronic ulcerative colitis.
Choledochal cysts.
Infection with a Chinese liver fluke parasite.

Possible signs of extrahepatic bile duct cancer include jaundice and pain.

These and other symptoms may be caused by extrahepatic bile duct cancer or by other conditions. A doctor should be consulted if any of the following problems occur –

Jaundice (yellowing of the skin or whites of the eyes).
Pain in the abdomen.
Fever.
Itchy skin.

Tests that examine the bile duct and liver are used to detect (find) and diagnose extrahepatic bile duct cancer.

The following tests and procedures may be used -

Physical exam and history - an exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Ultrasound exam - a procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.

CT scan (CAT scan) - a procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerised tomography, or computerised axial tomography. A spiral or helical CT scan makes detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.

MRI (magnetic resonance imaging) - a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

ERCP (endoscopic retrograde cholangiopancreatography) -
a procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes bile duct cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope is passed through the mouth, ooesophagus, and stomach into the first part of the small intestine.
An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumour, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken and checked under a microscope for signs of cancer.

PTC (percutaneous transhepatic cholangiography) - a procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body.

Biopsy - the removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. The sample may be taken using a thin needle inserted into the duct during an x-ray or ultrasound. This is called a fine-needle aspiration (FNA) biopsy. The biopsy is usually done during PTC or ERCP. Tissue may also be removed during surgery.

Liver function tests - a procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver disease that may be caused by extrahepatic bile duct cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

The stage of the cancer (whether it affects only the bile duct or has spread to other places in the body).
Whether the tumour can be completely removed by surgery.
Whether the tumour is in the upper or lower part of the duct.
Whether the cancer has just been diagnosed or has recurred (come back).

Treatment options may also depend on the symptoms caused by the tumour. Extrahepatic bile duct cancer is usually found after it has spread and can rarely be removed completely by surgery. Palliative therapy may relieve symptoms and improve the patient's quality of life.

There are different types of treatment for patients with extrahepatic bile duct cancer.

Different types of treatment are available for patients with extrahepatic bile duct cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Two types of standard treatment are used -

Surgery

The following types of surgery are used to treat extrahepatic bile duct cancer –

Removal of the bile duct - if the tumour is small and only in the bile duct, the entire bile duct may be removed. A new duct is made by connecting the duct openings in the liver to the intestine. Lymph nodes are removed and viewed under a microscope to see if they contain cancer.

Partial hepatectomy - removal of the part of the liver where cancer is found. The part removed may be a wedge of tissue, an entire lobe, or a larger part of the liver, along with some normal tissue around it.

Whipple procedure - a surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to make digestive juices and insulin.

Surgical biliary bypass - if the tumour cannot be removed but is blocking the small intestine and causing bile to build up in the gallbladder, a biliary bypass may be done. During this operation, the gallbladder or bile duct will be cut and sewn to the small intestine to create a new pathway around the blocked area. This procedure helps to relieve jaundice caused by the build-up of bile.

Stent placement - if the tumour is blocking the bile duct, a stent (a thin tube) may be placed in the duct to drain bile that has built up in the area. The stent may drain to the outside of the body or it may go around the blocked area and drain the bile into the small intestine. The doctor may place the stent during surgery or PTC, or with an endoscope.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

New types of treatment are being tested in clinical trials. These include the following -

Radiation sensitizers

Clinical trials are studying ways to improve the effect of radiation therapy on tumour cells, including the following –

Hyperthermia therapy - a treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation therapy and certain anticancer drugs.

Radiosensitizers - drugs that make tumour cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumour cells.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Biologic therapy

Biological therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defences against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Carcinoid Tumour, Gastrointestinal

A gastrointestinal carcinoid tumour is cancer that forms in the lining of the gastrointestinal tract.

The gastrointestinal tract includes the stomach, small intestine, and large intestine. These organs are part of the digestive system, which processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) in foods that are eaten and helps pass waste material out of the body.

Gastrointestinal carcinoid tumours develop from a certain type of hormone-making cell in the lining of the gastrointestinal tract. These cells produce hormones that help regulate digestive juices and the muscles used in moving food through the stomach and intestines. A gastrointestinal carcinoid tumour may also produce hormones. Carcinoid tumours that start in the rectum (the last several inches of the large intestine) usually do not produce hormones.

Gastrointestinal carcinoid tumours grow slowly. Most of them occur in the appendix (an organ attached to the large intestine), small intestine, and rectum. It is common for more than one tumour to develop in the small intestine. Having a carcinoid tumour increases a person's chance of getting other cancers in the digestive system, either at the same time or later.

Health history can affect the risk of developing gastrointestinal carcinoid tumours.

Risk factors include the following –

Having a family history of multiple endocrine neoplasia type 1 (MEN1) syndrome.
Having certain conditions that affected the stomach’s ability to produce stomach acid, such as atrophic gastritis, pernicious anaemia, or Zollinger-Ellison syndrome.
Smoking tobacco.

A gastrointestinal carcinoid tumour often has no signs in its early stages. Carcinoid syndrome may occur if the tumour spreads to the liver or other parts of the body.

The hormones produced by gastrointestinal carcinoid tumours are usually destroyed by blood and liver enzymes. If the tumour has spread to the liver, however, high amounts of these hormones may remain in the body and cause the following group of symptoms, called carcinoid syndrome –

Redness or a feeling of warmth in the face and neck.
Diarrhoea.
Shortness of breath, fast heartbeat, tiredness, or swelling of the feet and ankles.
Wheezing.
Pain or a feeling of fullness in the abdomen.

These symptoms and others may be caused by gastrointestinal carcinoid tumours or by other conditions. A doctor should be consulted if any of these symptoms occur.

Tests that examine the blood and urine are used to detect (find) and diagnose gastrointestinal carcinoid tumours.

The following tests and procedures may be used –

Complete blood count - a procedure in which a sample of blood is drawn and checked for the following:
- The number of red blood cells, white blood cells, and platelets.
- The amount of haemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the sample made up of red blood cells.
Physical exam and history - an exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Blood chemistry studies - a procedure in which a blood sample is checked to measure the amounts of certain substances, such as hormones, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it. The blood sample is checked to see if it contains a hormone produced by carcinoid tumours. This test is used to help diagnose carcinoid syndrome.
Twenty-four-hour urine test - a test in which a urine sample is checked to measure the amounts of certain substances, such as hormones. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it. The urine sample is checked to see if it contains a hormone produced by carcinoid tumours. This test is used to help diagnose carcinoid syndrome.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following -

Whether the cancer can be completely removed by surgery.
Whether the cancer has spread from the stomach and intestines to other parts of the body, such as the liver or lymph nodes.
The size of the tumour.
Where the tumour is in the gastrointestinal tract.
Whether the cancer is newly diagnosed or has recurred.

Treatment options also depend on whether the cancer is causing symptoms. Most gastrointestinal carcinoid tumours are slow-growing and can be treated and often cured. Even when not cured, many patients may live for a long time.

There are different types of treatment for patients with gastrointestinal carcinoid tumours.

Different types of treatment are available for patients with gastrointestinal carcinoid tumours. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Seven types of standard treatment are used -

Surgery

Treatment of gastrointestinal carcinoid tumours usually includes surgery. One of the following surgical procedures may be used –

Appendectomy - removal of the appendix.
Fulguration - use of an electric current to burn away the tumour using a special tool.
Cryosurgery - a treatment that uses an instrument to freeze and destroy abnormal tissues, , such as carcinoma in situ. This type of treatment is also called cryotherapy. The doctor may use ultrasound to guide the instrument.
Resection - surgery to remove part or all of the organ that contains cancer. Resection of the tumour and a small amount of normal tissue around it is called a local excision.
Bowel resection and anastomosis - removal of the bowel tumour and a small section of healthy bowel on each side. The healthy parts of the bowel are then sewn together (anastomosis). Lymph nodes are removed and checked by a pathologist to see if they contain cancer.
Radiofrequency ablation - the use of a special probe with tiny electrodes that release high-energy radio waves (similar to microwaves) that kill cancer cells. The probe may be inserted through the skin or through an incision (cut) in the abdomen.
Hepatic resection - surgery to remove part or all of the liver.
Hepatic artery ligation or embolisation - a procedure to ligate (tie off) or embolise (block) the hepatic artery, the main blood vessel that brings blood into the liver. Blocking the flow of blood to the liver helps kill cancer cells growing there.

Chemoembolisation of the hepatic artery is a type of regional chemotherapy that may be used to treat a gastrointestinal carcinoid tumour that has spread to the liver. The anticancer drug is injected into the hepatic artery through a catheter (thin tube). The drug is mixed with a substance that embolises (blocks) the artery, cutting off blood flow to the tumour. Most of the anticancer drug is trapped near the tumour and only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on the substance used to block the artery. The tumour is prevented from getting the oxygen and nutrients it needs to grow. The liver continues to receive blood from the hepatic portal vein, which carries blood from the stomach and intestine.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Percutaneous ethanol injection

Percutaneous ethanol injection is a cancer treatment in which a small needle is used to inject ethanol (alcohol) directly into a tumour to kill cancer cells. This procedure is also called intratumoral ethanol injection.

Biologic therapy

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defences against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.

Other drug therapy

MIBG (metaiodobenzylguanidine) is sometimes used, with or without radioactive iodine (I131), to lessen the symptoms of gastrointestinal carcinoid tumours.

Gallbladder Cancer

Gallbladder cancer is a disease in which malignant (cancer) cells form in the tissues of the gallbladder.

Gallbladder cancer is a rare disease in which malignant (cancer) cells are found in the tissues of the gallbladder. The gallbladder is a pear-shaped organ that lies just under the liver in the upper abdomen. The gallbladder stores bile, a fluid made by the liver to digest fat. When food is being broken down in the stomach and intestines, bile is released from the gallbladder through a tube called the common bile duct, which connects the gallbladder and liver to the first part of the small intestine.

The wall of the gallbladder has 3 main layers of tissue.

Mucosal (innermost) layer.
Muscularis (middle, muscle) layer.
Serosal (outer) layer.

Between these layers is supporting connective tissue. Primary gallbladder cancer starts in the innermost layer and spreads through the outer layers as it grows.

Being female can increase the risk of developing gallbladder cancer.

Possible signs of gallbladder cancer include jaundice, pain, and fever.

These and other symptoms may be caused by gallbladder cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur –

Jaundice (yellowing of the skin and whites of the eyes).
Pain above the stomach.
Fever.
Nausea and vomiting.
Bloating.
Lumps in the abdomen.

Gallbladder cancer is difficult to detect (find) and diagnose early.

Gallbladder cancer is difficult to detect and diagnose for the following reasons –

There aren't any noticeable signs or symptoms in the early stages of gallbladder cancer.
The symptoms of gallbladder cancer, when present, are like the symptoms of many other illnesses.
The gallbladder is hidden behind the liver.

Gallbladder cancer is sometimes found when the gallbladder is removed for other reasons. Patients with gallstones rarely develop gallbladder cancer.

Tests that examine the gallbladder and nearby organs are used to detect (find), diagnose, and stage gallbladder cancer.

Procedures that create pictures of the gallbladder and the area around it help diagnose gallbladder cancer and show how far the cancer has spread. The process used to find out if cancer cells have spread within and around the gallbladder is called staging.

In order to plan treatment, it is important to know if the gallbladder cancer can be removed by surgery. Tests and procedures to detect, diagnose, and stage gallbladder cancer are usually done at the same time. The following tests and procedures may be used -

Physical exam and history - an exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Ultrasound exam - a procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. An abdominal ultrasound is done to diagnose gallbladder cancer.

Liver function tests - a procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver disease that may be caused by gallbladder cancer.

Carcinoembryonic antigen (CEA) assay - a test that measures the level of CEA in the blood. CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of gallbladder cancer or other conditions.

CA 19-9 assay - a test that measures the level of CA 19-9 in the blood. CA 19-9 is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of gallbladder cancer or other conditions.

CT scan (CAT scan) - a procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerised tomography, or computerised axial tomography.

Blood chemistry studies - a procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.

Chest x-ray - an x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

MRI (magnetic resonance imaging) - a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). A dye may be injected into the gallbladder area so the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine will show up better in the image. This procedure is called MRCP (magnetic resonance cholangiopancreatography). To create detailed pictures of blood vessels near the gallbladder, the dye is injected into a vein. This procedure is called MRA (magnetic resonance angiography).

ERCP (endoscopic retrograde cholangiopancreatography) - a procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes gallbladder cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope (a thin, lighted tube) is passed through the mouth, ooesophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the bile ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumour, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken.

Biopsy - the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy may be done after surgery to remove the tumour. If the tumour clearly cannot be removed by surgery, the biopsy may be done using a fine needle to remove cells from the tumour.

Laparoscopy - a surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy. The laparoscopy helps to determine if the cancer is within the gallbladder only or has spread to nearby tissues and if it can be removed by surgery.

PTC (percutaneous transhepatic cholangiography) - a procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body.

Certain factors affect the prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following –

The stage of the cancer (whether the cancer has spread from the gallbladder to other places in the body).
Whether the cancer can be completely removed by surgery.
The type of gallbladder cancer (how the cancer cell looks under a microscope).
Whether the cancer has just been diagnosed or has recurred (come back).

Treatment may also depend on the age and general health of the patient and whether the cancer is causing symptoms.

Gallbladder cancer can be cured only if it is found before it has spread, when it can be removed by surgery. If the cancer has spread, palliative treatment can improve the patient's quality of life by controlling the symptoms and complications of this disease.

There are different types of treatment for patients with gallbladder cancer.

Different types of treatments are available for patients with gall bladder cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Three types of standard treatment are used -

Surgery

Gallbladder cancer may be treated with a cholecystectomy, surgery to remove the gallbladder and some of the tissues around it. Nearby lymph nodes may be removed. A laparoscope is sometimes used to guide gallbladder surgery. The laparoscope is attached to a video camera and inserted through an incision (port) in the abdomen. Surgical instruments are inserted through other ports to perform the surgery. Because there is a risk that gallbladder cancer cells may spread to these ports, tissue surrounding the port sites may also be removed.

If the cancer has spread and cannot be removed, the following types of palliative surgery may relieve symptoms –

Surgical biliary bypass - if the tumour is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the gallbladder or bile duct will be cut and sewn to the small intestine to create a new pathway around the blocked area.

Endoscopic stent placement - if the tumour is blocking the bile duct, surgery may be done to put in a stent (a thin, flexible tube) to drain bile that has built up in the area. The stent may be placed through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.

Percutaneous transhepatic biliary drainage - a procedure done to drain bile when there is a blockage and endoscopic stent placement is not possible. An x-ray of the liver and bile ducts is done to locate the blockage. Images made by ultrasound are used to guide placement of a stent, which is left in the liver to drain bile into the small intestine or a collection bag outside the body. This procedure may be done to relieve jaundice before surgery.

New types of treatment are being tested in clinical trials. These include the following -

Radiosensitizers

Radiosensitizers are drugs that make tumour cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumour cells.

Liver Cancer

Liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver.

The liver is one of the largest organs in the body. It has four l0obes and fills the upper right side of the abdomen inside the rib cage. The liver has many important functions, including –

Filtering harmful substances from the blood so they can be passed from the body in stools and urine.
Making bile to help digest fats from food.
Storing glycogen (sugar), which the body uses for energy.

This summary refers to the treatment of primary liver cancer (cancer that begins in the liver). Treatment of metastatic liver cancer, which is cancer that begins in other parts of the body and spreads to the liver, is not discussed in this summary. Primary liver cancer can occur in both adults and children. Treatment for children, however, is different than treatment for adults.

Having hepatitis or cirrhosis can affect the risk of developing adult primary liver cancer.

The following are possible risk factors for adult primary liver cancer –

Having hepatitis B and/or hepatitis C.
Having a close relative with both hepatitis and liver cancer.
Having cirrhosis.
Eating foods tainted with aflatoxin (poison from a fungus that can grow on foods, such as grains and nuts, that have not been stored properly).

Possible signs of adult primary liver cancer include a lump or pain on the right side.

These symptoms may be caused by swelling of the liver. These and other symptoms may be caused by adult primary liver cancer or by other conditions. A doctor should be consulted if any of the following problems occur –

A hard lump on the right side just below the rib cage.
Discomfort in the upper abdomen on the right side.
Pain around the right shoulder blade.
Unexplained weight loss.
Jaundice (yellowing of the skin and whites of the eyes).
Unusual tiredness.
Nausea.
Loss of appetite.

Tests that examine the liver and the blood are used to detect (find) and diagnose adult primary liver cancer.

The following tests and procedures may be used –

Physical exam and history - an exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Serum tumour marker test - a procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumour cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumour markers. An increased level of alpha-fetoprotein (AFP) in the blood may be a sign of liver cancer. Other cancers and certain non-cancerous conditions, including cirrhosis and hepatitis, may also increase AFP levels.

Complete blood count (CBC) - a procedure in which a sample of blood is drawn and checked for the following –
- The number of red blood cells, white blood cells, and platelets.
- The amount of haemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the blood sample made up of red blood cells.
Laproscopy - a surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.
Biopsy - the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The sample may be taken using a thin needle inserted into the liver during an x-ray or ultrasound. This is called a fine-needle aspiration (FNA) biopsy.

CT scan (CAT scan) - a procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerised tomography, or computerised axial tomography.

MRI (magnetic resonance imaging) - a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Ultrasound exam - a procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following -

The stage of the cancer (the size of the tumour, whether it affects part or all of the liver, or has spread to other places in the body).
How well the liver is working.
The patient’s general health, including whether there is cirrhosis of the liver.

Prognosis is also affected by alpha-fetoprotein (AFP) levels.

There are different types of treatment for patients with primary liver cancer.

Different types of treatments are available for patients with primary liver cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Four types of standard treatment are used -

Surgery

The following types of surgery may be used to treat liver cancer –

Cryosurgery - a treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy. The doctor may use ultrasound to guide the instrument.

Partial hepatectomy - removal of the part of the liver where cancer is found. The part removed may be a wedge of tissue, an entire lobe, or a larger portion of the liver, along with some of the healthy tissue around it. The remaining liver tissue takes over the functions of the liver.

Total hepatectomy and liver transplant - removal of the entire liver and replacement with a healthy donated liver. A liver transplant may be done when the disease is in the liver only and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is given as needed.

Radiofrequency ablation - the use of a special probe with tiny electrodes that kill cancer cells. Sometimes the probe is inserted directly through the skin and only local anaesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in the hospital with general anaesthesia.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Radiation therapy is given in different ways –

External radiation therapy uses a machine outside the body to send radiation toward the cancer.

Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Drugs called radiosensitizers may be given with the radiation therapy to make the cancer cells more sensitive to radiation therapy.

Radiation may be delivered to the tumour using radiolabeled antibodies. Radioactive substances are attached to antibodies made in the laboratory. These antibodies, which target tumour cells, are injected into the body and the tumour cells are killed by the radioactive substance.

The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Regional chemotherapy is usually used to treat liver cancer. A small pump containing anticancer drugs may be placed in the body. The pump puts the drugs directly into the blood vessels that go to the tumour.

Another type of regional chemotherapy is chemoembolisation of the hepatic artery. The anticancer drug is injected into the hepatic artery through a catheter (thin tube). The drug is mixed with a substance that blocks the artery, cutting off blood flow to the tumour. Most of the anticancer drug is trapped near the tumour and only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on the substance used to block the artery. The tumour is prevented from getting the oxygen and nutrients it needs to grow. The liver continues to receive blood from the hepatic portal vein, which carries blood from the stomach and intestine.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Percutaneous ethanol injection

Percutaneous ethanol injection is a cancer treatment in which a small needle is used to inject ethanol (alcohol) directly into a tumour to kill cancer cells. The procedure may be done once or twice a week. Usually local anaesthesia is used, but if the patient has many tumours in the liver, general anaesthesia may be needed.

New types of treatment are being tested in clinical trials.

Hyperthermia therapy

Hyperthermia therapy is a type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. Because some cancer cells are more sensitive to heat than normal cells are, the cancer cells die and the tumour shrinks.

Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects side effects of cancer treatment.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment will be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests.

Oesophageal Cancer

Oesophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the ooesophagus.

The oesophagus is the hollow, muscular tube that moves food and liquid from the throat to the stomach. The wall of the oesophagus is made up of several layers of tissue, including mucous membrane, muscle, and connective tissue. Oesophageal cancer starts at the inside lining of the oesophagus and spreads outward through the other layers as it grows.

The stomach and the oesophageal are part of the upper digestive system.
Image courtesy of the National Cancer Institute.

The two most common forms of oesophageal cancer are named for the type of cells that become malignant (cancerous) –

Squamous cell carcinoma - cancer that forms in squamous cells, the thin, flat cells lining the oesophagus. This cancer is most often found in the upper and middle part of the oesophagus, but can occur anywhere along the oesophagus. This is also called epidermoid carcinoma.

Adenocarcinoma - cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the oesophagus produce and release fluids such as mucus. Adenocarcinomas usually form in the lower part of the oesophagus, near the stomach.

Smoking, heavy alcohol use, and Barrett oesophagus can affect the risk of developing oesophageal cancer.

Risk factors include the following –

Tobacco use.
Heavy alcohol use.
Barrett oesophagus - a condition in which the cells lining the lower part of the oesophagus have changed or been replaced with abnormal cells that could lead to cancer of the oesophagus. Gastric reflux (the backing up of stomach contents into the lower section of the oesophagus) may irritate the oesophagus and, over time, cause Barrett oesophagus.
Older age.
Being male.

The most common signs of oesophageal cancer are painful or difficult swallowing and weight loss.

These and other symptoms may be caused by oesophageal cancer or by other conditions. A doctor should be consulted if any of the following problems occur –

Painful or difficult swallowing.
Weight loss.
Pain behind the breastbone.
Hoarseness and cough.
Indigestion and heartburn.

Tests that examine the oesophagus are used to detect (find) and diagnose oesophageal cancer.

The following tests and procedures may be used –

Chest x-ray - an x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Barium swallow - a series of x-rays of the oesophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the oesophagus and x-rays are taken. This procedure is also called an upper GI series.

Barium swallow. The patient swallows barium liquid and it flows through the oesophagus and into the stomach.
X-rays are taken to look for abnormal areas. Image courtesy of the National Cancer Institute.

Esophagoscopy - a procedure to look inside the oesophagus to check for abnormal areas. An esophagoscope (a thin, lighted tube) is inserted through the mouth or nose and down the throat into the oesophagus. Tissue samples may be taken for biopsy.

Esophagoscopy. A thin, lighted tube is inserted through the mouth and into the oesophagus to look for abnormal areas.
Image courtesy of the National Cancer Institute.

Biopsy - the removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. The biopsy is usually done during an esophagoscopy. Sometimes a biopsy shows changes in the oesophagus that are not cancer but may lead to cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following –

The stage of the cancer (whether it affects part of the oesophagus, involves the whole oesophagus, or has spread to other places in the body).
The size of the tumour.
The patient’s general health.

When oesophageal cancer is found very early, there is a better chance of recovery. Oesophageal cancer is often in an advanced stage when it is diagnosed. At later stages, oesophageal cancer can be treated but rarely can be cured.

There are different types of treatment for patients with oesophageal cancer.

Different types of treatment are available for patients with oesophageal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Five types of standard treatment are used -

Surgery

Surgery is the most common treatment for cancer of the oesophagus. Part of the oesophagus may be removed in an operation called an oesophagectomy.

The doctor will connect the remaining healthy part of the oesophagus to the stomach so the patient can still swallow. A plastic tube or part of the intestine may be used to make the connection. Lymph nodes near the oesophagus may also be removed and viewed under a microscope to see if they contain cancer. If the oesophagus is partly blocked by the tumour, an expandable metal stent (tube) may be placed inside the oesophagus to help keep it open.

A plastic tube may be inserted into the oesophagus to keep it open during radiation therapy. This is called intraluminal intubation and dilation.

Laser therapy

Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.

Electrocoagulation

Electrocoagulation is the use of an electric current to kill cancer cells.

Other types of treatment are being tested in clinical trials.

Patients have special nutritional needs during treatment for oesophageal cancer.

Many people with oesophageal cancer find it hard to eat because they have difficulty swallowing. The oesophagus may be narrowed by the tumour or as a side effect of treatment. Some patients may receive nutrients directly into a vein. Others may need a feeding tube (a flexible plastic tube that is passed through the nose or mouth into the stomach) until they are able to eat on their own.

Pancreatic Cancer

Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas.

The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The pancreas lies behind the stomach and in front of the spine.

The pancreas has two main jobs in the body –

To produce juices that help digest (break down) food.
To produce hormones, such as insulin and glucagon, that help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food.

The digestive juices are produced by exocrine pancreas cells and the hormones are produced by endocrine pancreas cells. About 95% of pancreatic cancers begin in exocrine cells.

The following are possible risk factors for pancreatic cancer –

Smoking.
Long-standing diabetes.
Chronic pancreatitis.
Certain hereditary conditions, such as hereditary pancreatitis, multiple endocrine neoplasia type 1 syndrome, hereditary non-polyposis colon cancer (HNPCC; Lynch syndrome), von Hippel-Lindau syndrome, ataxia-telangiectasia, and the familial atypical multiple mole melanoma syndrome (FAMMM).

Possible signs of pancreatic cancer include jaundice, pain, and weight loss.

These and other symptoms may be caused by pancreatic cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur –

Jaundice (yellowing of the skin and whites of the eyes).
Pain in the upper or middle abdomen and back.
Unexplained weight loss.
Loss of appetite.
Fatigue.

Pancreatic cancer is difficult to detect (find) and diagnose early.

Pancreatic cancer is difficult to detect and diagnose for the following reasons

There aren’t any noticeable signs or symptoms in the early stages of pancreatic cancer.
The signs of pancreatic cancer, when present, are like the signs of many other illnesses.
The pancreas is hidden behind other organs such as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts.

Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer.

Pancreatic cancer is usually diagnosed with tests and procedures that produce pictures of the pancreas and the area around it. The process used to find out if cancer cells have spread within and around the pancreas is called staging. Tests and procedures to detect, diagnose, and stage pancreatic cancer are usually done at the same time. In order to plan treatment, it is important to know the stage of the disease and whether or not the pancreatic cancer can be removed by surgery.

The following tests and procedures may be used –

Chest x-ray - an x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Physical exam and history - an exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

CT scan (CAT scan) - a procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerised tomography, or computerised axial tomography. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.

MRI (magnetic resonance imaging) - a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

PET scan (positron emission tomography scan) - a procedure to find malignant tumour cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumour cells show up brighter in the picture because they are more active and take up more glucose than normal cells.

Endoscopic ultrasound (EUS) - a procedure in which an endoscope (a thin, lighted tube) is inserted into the body. The endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.

Laparoscopy - a surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.

Endoscopic retrograde cholangiopancreatography (ERCP) - a procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope (a thin, lighted tube) is passed through the mouth, oesophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumour, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken.

Percutaneous transhepatic cholangiography (PTC) - a procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. This test is done only if ERCP cannot be done.

Biopsy - the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. There are several ways to do a biopsy for pancreatic cancer. A fine needle may be inserted into the pancreas during an x-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy (a surgical incision made in the wall of the abdomen).

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following –

Whether or not the tumour can be removed by surgery.
The stage of the cancer (the size of the tumour and whether the cancer has spread outside the pancreas to nearby tissues or lymph nodes or to other places in the body).
The patient’s general health.
Whether the cancer has just been diagnosed or has recurred (come back).

Pancreatic cancer can be controlled only if it is found before it has spread, when it can be removed by surgery. If the cancer has spread, palliative treatment can improve the patient's quality of life by controlling the symptoms and complications of this disease.

There are different types of treatment for patients with pancreatic cancer.

Different types of treatment are available for patients with pancreatic cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Three types of standard treatment are used -

Surgery

One of the following types of surgery may be used to take out the tumour –

Whipple procedure - a surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin.

Total pancreatectomy - this operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes.

Distal pancreatectomy - the body and the tail of the pancreas and usually the spleen are removed.

If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms –

Surgical biliary bypass - if cancer is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area.

Endoscopic stent placement - if the tumour is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.

Gastric bypass - if the tumour is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.

Other types of treatment are being tested in clinical trials. These include the following -

There are treatments for pain caused by pancreatic cancer.

Pain can occur when the tumour presses on nerves or other organs near the pancreas. When pain medicine is not enough, there are treatments that act on nerves in the abdomen to relieve the pain. The doctor may inject medicine into the area around affected nerves or may cut the nerves to block the feeling of pain. Radiation therapy with or without chemotherapy can also help relieve pain by shrinking the tumour.

Patients with pancreatic cancer have special nutritional needs.

Surgery to remove the pancreas may interfere with the production of pancreatic enzymes that help to digest food. As a result, patients may have problems digesting food and absorbing nutrients into the body. To prevent malnutrition, the doctor may prescribe medicines that replace these enzymes.

Small Intestine Cancer

Small intestine cancer is a rare disease in which malignant (cancer) cells form in the tissues of the small intestine.

The small intestine is part of the body’s digestive system, which also includes the oesophagus, stomach, and large intestine. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The small intestine is a long tube that connects the stomach to the large intestine. It folds many times to fit inside the abdomen.

Anatomy of the lower digestive system, showing the colon and other organs.
Image courtesy of the National Cancer Institute.

There are five types of small intestine cancer.

The types of cancer found in the small intestine are adenocarcinoma, sarcoma, carcinoid tumours, gastrointestinal stromal tumour, and lymphoma.

This summary discusses adenocarcinoma and leiomyosarcoma (a type of sarcoma).

Adenocarcinoma starts in glandular cells in the lining of the small intestine and is the most common type of small intestine cancer. Most of these tumours occur in the part of the small intestine near the stomach. They may grow and block the intestine.

Leiomyosarcoma starts in the smooth muscle cells of the small intestine. Most of these tumours occur in the part of the small intestine near the large intestine.

Diet and health history can affect the risk of developing small intestine cancer.

Risk factors include the following –

Eating a high-fat diet.
Having Crohn disease.
Having celiac disease.
Having familial adenomatous polyposis (FAP).

Possible signs of small intestine cancer include abdominal pain and unexplained weight loss.

These and other symptoms may be caused by small intestine cancer or by other conditions. A doctor should be consulted if any of the following problems occur –

Pain or cramps in the middle of the abdomen.
Weight loss with no known reason.
A lump in the abdomen.
Blood in the stool.

Tests that examine the small intestine are used to detect (find), diagnose, and stage small intestine cancer.

Procedures that create pictures of the small intestine and the area around it help diagnose small intestine cancer and show how far the cancer has spread. The process used to find out if cancer cells have spread within and around the small intestine is called staging.

In order to plan treatment, it is important to know the type of small intestine cancer and whether the tumour can be removed by surgery. Tests and procedures to detect, diagnose, and stage small intestine cancer are usually done at the same time. The following tests and procedures may be used –

Physical exam and history - an exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Blood chemistry studies - a procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.

Liver function tests - a procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver disease that may be caused by small intestine cancer.

Abdominal x-ray - an x-ray of the organs in the abdomen. An x-ray is a type of energy beam that can go through the body onto film, making a picture of areas inside the body.

Barium enema - a series of x-rays of the lower gastrointestinal (GI) tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.

Barium enema procedure. The patient lies on an x-ray table. Barium liquid is put into the rectum and flows through the colon.
X-rays are taken to look for abnormal areas. Image courtesy of the National Cancer Institute.

Faecal Occult Blood Test - a test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.

Faecal Occult Blood Test (FOBT) kit to check for blood in stool. Image courtesy of the National Cancer Institute.

Upper endoscopy - a procedure to look at the inside of the oesophagus, stomach, and duodenum (first part of the small intestine, near the stomach). An endoscope (a thin, lighted tube) is inserted through the mouth and into the oesophagus, stomach, and duodenum. Tissue samples may be taken for biopsy.

Upper GI series with small bowel follow-through - a series of x-rays of the oesophagus, stomach, and small bowel. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the oesophagus, stomach, and small bowel. X-rays are taken at different times as the barium travels through the upper GI tract and small bowel.

Biopsy - the removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. This may be done during the endoscopy. The sample is checked by a pathologist to see if it contains cancer cells.

CT scan (CAT scan) - a procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerised tomography, or computerised axial tomography.

Lymph node biopsy - the removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.

Laparotomy - a surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken for biopsy.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following –

The type of small intestine cancer.
Whether the cancer has spread to other places in the body.
Whether the cancer can be completely removed by surgery.
Whether the cancer is newly diagnosed or has recurred.

There are different types of treatment for patients with small intestine cancer.

Different types of treatments are available for patients with small intestine cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Three types of standard treatment are used -

Surgery

Surgery is the most common treatment of small intestine cancer. One of the following types of surgery may be done –

Resection - surgery to remove part or all of an organ that contains cancer. The resection may include the small intestine and nearby organs (if the cancer has spread). The doctor may remove the section of the small intestine that contains cancer and perform an anastomosis (joining the cut ends of the intestine together). The doctor will usually remove lymph nodes near the small intestine and examine them under a microscope to see whether they contain cancer.

Bypass - surgery to allow food in the small intestine to go around (bypass) a tumour that is blocking the intestine but cannot be removed.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that are left.

Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Other types of treatment are being tested in clinical trials. These include the following -

Biologic therapy

Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defences against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Radiation therapy with radiosensitizers

Radiosensitizers are drugs that make tumour cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumour cells.

Stomach (Gastric) Cancer

Gastric cancer is a disease in which malignant (cancer) cells form in the lining of the stomach.

The stomach is a J-shaped organ in the upper abdomen. It is part of the digestive system, which processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) in foods that are eaten and helps pass waste material out of the body. Food moves from the throat to the stomach through a hollow, muscular tube called the oesophagus. After leaving the stomach, partly-digested food passes into the small intestine and then into the large intestine.

The stomach and oesophagus are part of the upper digestive system. Image courtesy of the National Cancer Institute

The wall of the stomach is made up of 3 layers of tissue: the mucosal (innermost) layer, the muscularis (middle) layer, and the serosal (outermost) layer. Gastric cancer begins in the cells lining the mucosal layer and spreads through the outer layers as it grows.

Stromal tumours of the stomach begin in supporting connective tissue and are treated differently from gastric cancer.

Age, diet, and stomach disease can affect the risk of developing gastric cancer.

Risk factors for gastric cancer include the following:

Having any of the following medical conditions:
- Helicobacter pylori (H. pylori) infection of the stomach.
- Chronic gastritis (inflammation of the stomach).
- Pernicious anaemia.
- Intestinal metaplasis (a condition in which the normal stomach lining is replaced with the cells that line the intestines).
- Familial adenomatous polyposis (FAP) or gastric polyps.
Eating a diet high in salted, smoked foods and low in fruits and vegetables.
Eating foods that have not been prepared or stored properly.
Being older or male.
Smoking cigarettes.
Having a mother, father, sister, or brother who has had stomach cancer.

Possible signs of gastric cancer include indigestion and stomach discomfort or pain.

These and other symptoms may be caused by gastric cancer. Other conditions may cause the same symptoms.

In the early stages of gastric cancer, the following symptoms may occur –

Indigestion and stomach discomfort.
A bloated feeling after eating.
Mild nausea.
Loss of appetite.
Heartburn.

In more advanced stages of gastric cancer, the following symptoms may occur:

Blood in the stool.
Vomiting.
Weight loss for no known reason.
Stomach pain.
Jaundice (yellowing of eyes and skin).
Ascites (build-up of fluid in the abdomen).
Trouble swallowing.

A doctor should be consulted if any of these problems occur.

Tests that examine the stomach and oesophagus are used to detect (find) and diagnose gastric cancer.

The following tests and procedures may be used:

Physical exam and history - an exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Blood chemistry studies - a procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.

Complete blood count (CBC) - a procedure in which a sample of blood is drawn and checked for the following -
- The number of red blood cells, white blood cells, and platelets.
- The amount of haemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the sample made up of red blood cells.

Upper endoscopy - a procedure to look inside the oesophagus, stomach, and duodenum (first part of the small intestine) to check for abnormal areas. An endoscope (a thin, lighted tube) is passed through the mouth and down the throat into the oesophagus.

Upper endoscopy. A thin, lighted tube is inserted through the mouth to look for abnormal areas in the oesophagus, stomach, and first part of the small intestine. Image courtesy of the National Cancer Institute.

Faecal occult blood test - a test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.

Barium swallow - a series of x-rays of the oesophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the oesophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.

Biopsy - the removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. A biopsy of the stomach is usually done during the endoscopy.

CT scan (CAT scan) - a procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerised tomography, or computerised axial tomography.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following –

The stage and extent of the cancer (whether it is in the stomach only or has spread to lymph nodes or other places in the body).
The patient’s general health.

When gastric cancer is found very early, there is a better chance of recovery. Gastric cancer is often in an advanced stage when it is diagnosed. At later stages, gastric cancer can be treated but rarely can be cured.

There are different types of treatment for patients with gastric cancer.

Different types of treatments are available for patients with gastric cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Four types of standard treatment are used -

Surgery

Surgery is a common treatment of all stages of gastric cancer. The following types of surgery may be used –

Subtotal gastrectomy - removal of the part of the stomach that contains cancer, nearby lymph nodes, and parts of other tissues and organs near the tumour. The spleen may be removed. The spleen is an organ in the upper abdomen that filters the blood and removes old blood cells.

Total gastrectomy - removal of the entire stomach, nearby lymph nodes, and parts of the oesophagus, small intestine, and other tissues near the tumour. The spleen may be removed. The oesophagus is connected to the small intestine so the patient can continue to eat and swallow.

If the tumour is blocking the stomach but the cancer cannot be completely removed by standard surgery, the following procedures may be used –

Endoluminal stent placement - a procedure to insert a stent (a thin, expandable tube) in order to keep a passage (such as arteries or the oesophagus) open. For tumours blocking the passage into or out of the stomach, surgery may be done to place a stent from the oesophagus to the stomach or from the stomach to the small intestine to allow the patient to eat normally.

Endoluminal laser therapy - a procedure in which an endoscope (a thin, lighted tube) with a laser attached is inserted into the body. A laser is an intense beam of light that can be used as a knife.

Chemoradiation

Chemoradiation combines chemotherapy and radiation therapy to increase the effects of both. Chemoradiation treatment given after surgery to increase the chances of a cure is called adjuvant therapy. If it is given before surgery, it is called neo-adjuvant therapy.

Gastrointestinal Cancers

Follow us on

Request a Kit

All Australians aged 50 & over, who do not have symptoms or a family history of bowel cancer, are encouraged to undertake bowel cancer screening.

Request your test kit today!

Make a Donation

moneybox Help us raise awareness and promote early diagnosis, which will save lives! Donate Now.

A Healthy Community

Bowel cancer is something people don’t like to talk about; it’s a conversation killer. Our aim is to stop people dying of embarrassment.

Click here for more information.

Real Life Stories

Damien's story (26, VIC)

When I was first diagnosed with bowel cancer I did not have enough time to feel ‘sad’ or ‘worry’ too much. I am naturally an optimistic person and an ‘action man’. “I can get through this!” I thought to myself. Prior to my diagnosis at age 26, I had been experiencing dull pains in my pelvic area for 3 to 4 years, extending up through to my belly button and around to the right side of my body....

Gastrointestinal Cancers

Follow us on

Request a Kit

Make a Donation

A Healthy Community

Real Life Stories

Are you at risk?

Video Gallery