10years

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.

 


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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.

 


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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.


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).

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.

 


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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.


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.

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.

 


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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.


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).

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.


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.

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.

 


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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.


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.

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


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.


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.

 


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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.


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.

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.


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.

 


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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.


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.

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.

 


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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.

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.
  • 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.


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.


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.


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.

 

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Real Life Stories

Alison's story (46, QLD)

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This story is about my mum’s ordeal with bowel cancer. She was diagnosed in 2005 at the age of 73, but her diagnosis had taken some time.  Her rectal bleeding was initially thought to be haemorrhoids, and the GP gave her a cream to treat the condition, but the bleeding persisted and, when she finally had a colonoscopy two months later, they found advanced bowel cancer....

Lorna's story (56, NSW)

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As a registered nurse for over 30 years, I understand the value of good health and pride myself in maintaining a healthy lifestyle. I see my GP every year for routine blood tests and always attend for routine mammogram when requested. However, when the bowel screening test arrived, I put it in a cupboard until I had time....

Vicki S' story (36, QLD)

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I was diagnosed with bowel cancer in 1999 at 36 years of age. Twelve months prior to my diagnosis I had visited my GP and raised concerns about weight loss, rectal bleeding, changes in my bowel habit, stomach pain and feeling tired. My GP told me it was stress-related. After numerous visits I felt like I a hypochondriac so I stopped going to the doctor to report the same symptoms and accepted it was stress (even though I didn’t feel it was stress related). I was a single mother with two young children so I told myself...

Sinead's story (31, NSW)

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I was only 26 when I went to my doctor concerned about changes in my bowel habits and feeling very tired. My doctor put it down to stress which frustrated me because I felt I wasn’t being listened to. I went to the ED and remember crying saying, “I know there is something wrong with me”. Coming from a medical background (registered nurse) I demanded to speak with a gastro specialist. The doctor who came along spoke and listened to me as human being, he was empathetic and asked the right questions. He s...

Dale's story (49, TAS)

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Us men rarely go to doctors, let alone get our proper checks. But I recommend to all other men to please listen to your doctor and do exactly what they tell you. Put your faith and trust in them and you will be managed appropriately. I was diagnosed with Bowel Cancer in 2011. Passing blood made me go to my GP to have a check-up. My GP suggested doing a Digital Rectal Examination and having a colonoscopy....

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I was diagnosed with bowel cancer in 1993 at the age of 47.  I had taken a Rotary Bowelscan test (FOBT) and, when it returned a positive result in May, my GP referred me to a specialist.  I was given a colonoscopy in June and told I had a 10 per cent chance of having cancer… turns out, I was in that unlucky 10 per cent!  In July I had a bowel resection.  Looking back, it all happened so quickly.   I felt I coped really well with the cancer at the time but I experienced more problems about se...

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Maureen's story (55, QLD)

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When Maureen received a screening kit in the mail just after her 55th birthday, she had no reservations about doing the test. “It was just too simple not to do. The test was hygienic, quick to complete and extremely straight-forward,” she said. Just as well, because ultimately this unusual birthday present saved her life.  When the test returned a positive result, Maureen was not overly concerned as she had read in the accompanying booklet that the presence of blood may be due to conditions other than ca...

Michelle's story (35, VIC)

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It’s not so long ago I went to the GP and told her about a few concerns I had and the symptoms that I was experiencing, which my GP considered not to be a big deal. The GP thought it was possibly haemorrhoids. I decided that I could allow myself to be more relieved, seeing as I had expressed my concerns but the GP had predominantly dismissed it being anything serious…. after all....

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Moya's story (69, NSW)

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Milly's story (30, VIC)

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John S' story (65, NSW)

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Richard's story (63, NSW)

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I successfully beat prostate cancer in 2007 so being diagnosed with bowel cancer so soon after came as a real shock. I did the Rotary bowel cancer test (FOBT) in March 2009 and the results were negative. But later that year, my bowel habits began to change – mainly increased urgency and frequency – and when I twice noticed blood in my stools I decided to take the FOBT again. This time the results were positive.   I was overseas when the results came through in April 2010 so I talked to my GP in Australia...

Hazel's story (58, SA)

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If you have any irregularities in your bowel movements, don’t ignore it. See your GP straight away and don’t be embarrassed! The whole experience of being diagnosed with bowel cancer has been emotionally devastating for me. In February 2010, I noticed blood in my faeces and made an appointment to see my GP. I’d had bleeding from haemorrhoids before but this was different. I had also been experiencing an urgency to open my bowels for a few years which I had put down to my history of haemorrhoids....

Stephanie's story (21, QLD)

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I woke from what was supposed to be a routine, last resort colonoscopy and was advised that my undertaking of this small procedure had saved my life. I was diagnosed with bowel cancer last year in October 2012 at the age of 21....

Carolyn's story (45, VIC)

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When I was diagnosed with stage III bowel cancer in 2006, I was 45 years old. I am a wife and a mother of three (now 23, 20 & 16 years old) and an office manager.  I had no family history of bowel cancer and I led a healthy lifestyle before my diagnosis, although I was told further along the process that I carry the HNPCC gene, which is a strong indicator of the disease. ...

Vicki's story (57, NSW)

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Some people are known for their sense of humour, some for their compassion, others for their courage.  Anyone who knew bowel cancer victim Vicki Morris will tell you she was all of this and more. Vicki’s husband Peter writes:  Cancer is one of those things that you think happens to someone else and it is a shock when it comes to your own household.  It doesn’t need to be a death sentence, but the odds are difficult to beat. It takes someone exceptional to deal with it as bravely as Vicki did....

Aly's story (57, VIC)

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It’s hard not having control and not knowing what is happening. I first went to my GP in Nov 2011 after a government bowel screen test sent back a positive result for blood in the stools. My GP recommended a colonoscopy, which I had in late February 2012. I was shocked to find out I had rectal cancer. There was no indication and no family history of bowel cancer either....

Renay's story (41, VIC)

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I used to think cancer was the worst thing that had ever happened to me until it became the best thing. This might sound crazy but it is true. I am a wife and mother to a now 6 year old son. I was diagnosed with bowel cancer in May 2011 at the age of 41. I had been suffering from exhaustion, stomach pain and unusual bowel habits for three or four months and finally saw my GP when the pain started getting much worse....

John's story (40, QLD)

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I started experiencing a change in my bowel habits, stomach pains and rectal bleeding in February 2010 so I saw my GP and was sent for blood tests to investigate the cause of the problems. The results came back normal. However, a month later when the bleeding persisted I was referred for a colonoscopy in mid April. The colonoscopy revealed a 4cm tumour on my sigmoid colon....

Eve's story (51, VIC)

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I have been a vegetarian for over 30 years, have never smoked and have drank very little alcohol – so to get bowel cancer has been such a rude awakening. I feel I no longer have the security of my health and I worry that the cancer could come back at any time… I first started feeling something was wrong in January 2008. I suffer from many auto immune problems, including Sjogren’s syndrome which causes irritable bowel type symptoms (this threw my GP off the scent and complicated the situation even more)....

Steve's story (66, NSW)

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Three weeks prior to my diagnosis I had been sent a National Bowel Screen Kit. I looked at it and thought, “I should really do that one day”. Needless to say, I left the kit on the bench and three weeks later ended up seeing my GP on a Wednesday afternoon for a prescription. At the time I complained of having had a slight pain in my abdomen. The GP asked to examine my abdomen and it was then he felt a mass....

Mary-Anne's story (49, NT)

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When I was diagnosed with bowel cancer on 23 June 2011, I didn’t even ask what stage the cancer was at – I just wanted to know what I had to do to fight it. My initial symptoms were rectal bleeding, a change of bowel habit and stomach pain. Eighteen months prior, I had started bleeding and had a colonoscopy which showed nothing. The last colonoscopy five years prior to that had showed a polyp and an unknown growth, neither of which were diagnosed as a cancer. There is no family history of bowel cancer on eith...

Brent R's story (32, VIC)

1

I’ve seen the effects of bowel cancer first hand and know I never want to go through it. My Dad was diagnosed with bowel cancer in February 2000. He was just 49 years old. He had had some rectal bleeding and back pain so went to the GP who sent him for a colonoscopy. After this plus scans and blood tests, Dad was diagnosed with bowel cancer which had spread to the liver. He had successful surgery to remove the cancer from the bowel but when the surgeons opened him up to remove the tumour from his liver, they discovere...

Lorraine (50, NSW)

1

We all need to know that cancer does not discriminate. I am a healthy fit woman, with no history of bowel cancer in my family, yet it affected me. I was diagnosed with bowel cancer at the age of 50 after participating in the National Bowel Cancer Screening program. I received the positive results approximately two weeks after sending the test away....

Monica's story (85, QLD)

1

My bowel cancer diagnosis was a huge shock. I had been experiencing frequent constipation, a general change in bowel habits and some rectal bleeding, all of which my GP felt needed further investigation. I was referred for a colonoscopy and endoscopy in order to pinpoint the source of the problem....

Stacey B's story (29, WA)

1

I went to my GP in early 2009 complaining of tiredness and lethargy, rectal bleeding and a change in my bowel habits.  But because of my age and the fact that I had recently given birth, I was given only a blood test and told that further investigation wouldn’t be necessary.  The blood test showed low iron levels so my tiredness was put down to that....

Jo's story (45, NSW)

1

I was diagnosed with bowel cancer at 44 years old.   I went to see my GP after about twelve months of changed bowel habits and intermittent rectal bleeding, which I assumed was caused by haemorrhoids.  The pain I had been experiencing on and off had become quite bad, so I wanted to talk to my GP about other treatment options.  I was given a colonoscopy as part of this visit – and that’s when they discovered the tumour in my rectum....

Mandi's story (29, NSW )

1

I was diagnosed with bowel cancer at 24 years old, just before I was due to leave for Europe with a group of girlfriends after finishing university. I had experienced some bleeding from my rectum only one week prior to this time, but at the time I really wasn’t too fussed about getting it looked at because I was so excited about my European adventure, and because of my age....

Ben's story (28, VIC)

1

I was 28 when I was diagnosed with bowel cancer in January 2011. I’d had rectal bleeding, changed bowel habits and stomach pain for a while but had put off investigating the symptoms – I was living in China at the time so I figured it was either an intestinal infection that I couldn't seem to shake or a reaction to something I’d eaten. ...

Amanda's story (37,WA)

1

My mum was in her mid to late 40s when she was diagnosed with bowel cancer. She died at the age of 50, when I was 27, 11 years ago this year. Mum had experienced symptoms for some time, starting with bowel upsets, stomach pain and changes in her bowel habits. The doctors suggested it was gastro, then Irritable Bowel Syndrome - you name it, they suggested it. When I look back it felt as though they were fobbing her off. They never suggested looking into what was causing the problems....

Rachel's story (40, QLD)

1

I had noticed some blood in the toilet for about a month but thought it was due to constipation. I was working fulltime and have four children to look after – being so busy I just carried on and didn't dwell on it. One morning, however, I thought I had diarrhoea but all I could see was a lot of old blood in the toilet bowl. I left my husband with the kids at home and took myself straight off to hospital.Staff at the hospital found evidence of bleeding with no obvious cause. The doctor said he would write a referral...

Mary's story (43, VIC)

1

Unlike many people, I had severe symptoms for some time before I got my diagnosis. For four weeks during the time of seeing my doctor and being diagnosed I had very bad stomach pains and was completely unable to eat.  My condition continued to deteriorate all the time – the stomach pain came and went, becoming sharper and more intense as time passed, and I was generally very sick. By the end of this 4 week period, I was unable to walk.   During this time I saw four GPs, each of whom had a different opinion...

Jane's story (41, QLD)

1

In early November 2010 I noticed some weight loss and a change in my bowel habits, including rectal bleeding. I went to the doctor in mid-November and was diagnosed with anaemia and booked in for a colonoscopy later that month. I was told on the day of the colonoscopy that I had bowel cancer. The next step was surgery, a high anterior resection, which was done in mid-December. It all happened so quickly that I didn’t really have time to dwell on what was going on, but it never occurred to me before my diagnosis tha...

Janice's story (29, NSW)

1

 My father was a fit and healthy man. He ate well, never smoked, almost never drank to excess and played a lot of sports. As a result of old work and football injuries, he suffered from chronic knee and back pain for many years. He also suffered frequent digestive upsets, which he rationalised to be a side-effect of the anti-inflammatory medication he needed to take for his pain....

Margaret's story (50, VIC)

1

I was diagnosed with bowel cancer in 2007 at the age of 50. I had been noticing changes in my bowel habits for some time but it wasn’t until my abdomen was severely distended and I lost the use of my bowels that I was admitted to hospital. I was on holiday in Port Douglas at the time, so I was taken to Mossman Hospital....

Adam's story (25, NSW)

1

I was diagnosed with stage 3 bowel cancer two years ago at the age of 23.  I had been experiencing a range of symptoms for about five years, including rectal bleeding, mucous in my stools, diarrhoea, stomach pain and cramps to changes in my bowel habits.    Coincidentally, my mother was also having these problems, so we were both seeing a doctor to try to discover their cause....

Antonia's story (62, QLD)

1

I had not been feeling well for a couple of months, tired, lost weight, feeling sick, and then I had 2 episodes of rectal bleeding, the second worse than the first. I went to my GP, after having done some research. I wanted a referral for a colonoscopy. My GP was initially hesitant to refer me on as he thought it was possibly only haemorrhoids, I knew this wasn’t correct. I had blood tests and I was referred to a general surgeon for a colonoscopy. A week after the colonoscopy, the specialist looking after me told...

Ann's story (37, ACT)

1

I was diagnosed with bowel cancer at the age of 37, totally unexpected at such a young age. The only real experience I’d had with the disease was watching my grandfather live with a colostomy bag after the removal of his bowel when I was a child. But I no longer consider this an ‘old man’s disease’....

Anis' story (72, NSW)

1

This story is about my father who was diagnosed with bowel cancer three days before Christmas in 2010 and passed away just five weeks later.   Dad was a young 72-year-old – he was healthy and active, ate well, enjoyed long walks, wouldn’t hesitate to climb up on the roof if necessary, and had never even been to hospital – so his diagnosis was a shock. He had lost his appetite and begun to lose weight about a month before his diagnosis but his doctor didn’t think it was a problem; in fact, he th...

Felicity's story (38, VIC)

1

In August 2010 my life changed forever.  Nothing can prepare you for a bowel cancer diagnosis at just 38 years old.   I had been given what I thought was a routine colonoscopy to investigate the cause of my iron deficiency, which my doctor thought was probably due to an ulcer. But as I lay in bed in the recovery room after being told they had found a tumour, I remember thinking: ‘I’m too young.  I have a husband and two young boys.  This can’t be happening to me’.  ...

Warren's story (31, ACT)

1

I am 31 years old and happily married with two children (3 years and 18 months old) and another little boy on the way, due any time now. I'm an Australian  Federal Police Officer currently attached to the Specialist Response and Security Tactical Response Team. Bowel cancer was the last thing on my mind when I started to experience small amounts of rectal bleeding. ...

Sandra's story (49, SA)

1

In 2008 I had lap band surgery to help reverse obesity. Since having the surgery, I have had routine blood tests every six months. Prior to one check-up appointment, I noticed a speck of blood in the toilet so during my consultation with my GP (and after she had written a referral for my bariatric specialist) I told her about the blood in the toilet. Straightaway she added this piece of information to the referral just to be sure....

Andrew's story (22, VIC)

1

In April 2010, I suffered a huge amount of bleeding when I went to the toilet.  I had no warning signs – it just happened out of the blue.  It was so bad that I went straight to the emergency ward at the hospital.  I think they thought it was just haemorrhoids so I was given a DRE (digital rectal examination) and the doctor took some blood and sent me home. ...

Martin's story (60, NSW)

1

My name is Martin and I’m a happily married father of three and grandfather of one, working as a General Manager in the building industry. I want people to hear my story so that they understand that bowel cancer can happen to anyone at any time. I was sent the bowel screen test kit in 2006. I took the test and the results came back negative. In mid-April 2011, I noticed blood in my stools and thankfully I acted immediately. I am normally a procrastinator, but in this instance I acted swiftly. I saw my GP straightaway...

Eileen's story (50, NSW)

1

Even though there is a history of bowel cancer in the family, I never thought it would happen to me. My diet had been considerably healthy throughout my life and I had previously used a Rotary Bowelscan kit, which had come back clear. This all changed in July 2007 when I was diagnosed with Dukes stage 3 bowel cancer....

Donna's story (45, QLD)

1

I would recommend for anyone reading this to please listen to your body, take notice of your symptoms and get it followed up with your doctor. We all need to push to get looked at when we think there is a problem, because like me, there probably is.  For a couple of years I had experienced bowel changes, which I mentioned to my GP but I was told my symptoms were related to others things. I was tested for coeliac disease as my brother is a coeliac; however, no further tests were done....

Gayle's story (53, QLD)

1

In 2000 I was diagnosed with pneumonia. While I was in hospital the specialist did a cancer marker test which came back really high. However the subsequent colonoscopy was not very clear as the prep had not been very effective. In September 2011 I underwent a second colonoscopy as I was experiencing continual bad diarrhoea. During the procedure a carcinoid tumour was discovered....

Sharon's story (47, QLD)

1

My journey with bowel cancer came as a surprise to me, even though I have an extensive family history of the disease due to Lynch Syndrome (a type of inherited cancer of the digestive tract). My mother, brother and uncle have all had bowel cancer and survived to tell the tale. I suppose I thought it wouldn’t happen to me as I have always been healthy, eaten lots of fruit and veggies plus I’m quite a positive person....

Peter F's story (41, NSW)

1

Buying a $40 FOBT kit is so much cheaper when compared to your life. I was diagnosed with bowel cancer at the age of 40 after finally getting around to using an FOBT kit. I had purchased the kit in June 2012 and it sat in my cupboard until I finally used it in early September. The results came back positive....

Ian's story (65, QLD)

1

“It’s an unusual birthday present, but it is probably the best gift I have received.” Ian, a retired merchant seaman, never thought the simple act of emptying his post box would ultimately save his life. At 65, Ian, like many Australians, was unaware the risk of developing bowel cancer increased with age. He was physically fit and believed he was in good health. As an active fisherman determined to make the most of his retirement, bowel cancer was the last thing on Ian’s mind....

Barbara's story (60, NSW)

1

I had a bowel cancer test in November 2006 which came back all clear, therefore when symptoms started occurring in February 2007 I ignored them, at the age of 57, blamed my new job, the change of lunch hours etc. Initially the symptoms were changes in my bowel habits, rectal bleeding with froth and bubbles. Eventually the symptoms started to get serious, with some stomach pain, a heaviness in the back passage and generally feeling uncomfortable. In September 2007 I couldn’t ignore any of this any longer....

Geoffrey's story (70, NSW)

1

Six years ago at 64, I began to notice blood in my stool and reported it straight away to my GP, who referred me to a colorectal surgeon.  A colonoscopy revealed cancer and an operation was recommended as my best option. I’d estimate that from the moment I noticed the blood to finally being operated on took no more than six weeks, which isn’t very long to come to terms with the fact of bowel cancer.  I was given an ileostomy during surgery, which also took some getting used to....

Karen's story (45, NSW)

1

In summary, over the last two years I have had three operations, two colonoscopies, six weeks of chemoadiation, four months of chemotherapy, an ileostomy, a hernia on my bowel surgery scar, gone through instant menopause and had to give up work. However, since going through bowel cancer, all my tests have been clear and my last CT is in September 2013, which will be two years since the operation....

Ron's story (60, VIC)

1

I’d had rectal bleeding and unusual bowel habits for six to eight weeks before going to see my GP in 2008. I was 60 at the time. My GP gave me an internal examination but found nothing. Nonetheless, he was insistent that I see a specialist and made the call while I sat in his surgery, getting me an appointment for the very next day.  I had a colonoscopy within the week and was diagnosed with stage III bowel cancer.  I had a CT scan the next day, then an ultrasound for tumour staging....

Nicole's story (41, VIC)

1

My mother passed away with breast cancer when I was 10, so I have always been diligent with screening and looking after my health.  I would go to my doctor on a regular basis to make sure everything was all OK.   In February of this year I had been quite tired, had a lot of back and abdominal pain so I went for a check-up with my GP.  Blood tests taken read an Hb of 72 so I was called immediately to go to hospital for a blood transfusion.  From there I underwent a colonoscopy and gastroscopy to find out...

Robert's story (61, NSW)

1

When I was diagnosed with Bowel Cancer I was 61 years old, fit and healthy (at least I thought I was).  I was working in the entertainment industry with a part time job as a spruiker (sales motivator) and also did freelance work in the entertainment industry as a DJ/MC for various events. Approximately 6 years ago, during a prostate check at the local GP, my doctor found a mass on my appendix, protruding into my bowel, fortunately this was benign, however I still required a resection to the right side of my large bowel...

Katie's story (35, WA)

1

My brother Jeff was just 31 when he was diagnosed with bowel cancer. He passed away nearly two years later in June 2013. He left behind his beautiful wife Nicole and two gorgeous daughters, aged six and four. Jeff did not have any symptoms that rang any alarm bells until he started to feel like he had no energy. He looked pale and we urged him to visit his doctor for some blood tests which showed him to be anaemic. He then had a colonoscopy and gastroscopy, which showed up a large doughnut- shaped tumour in his colon....

Alan's story (48, WA)

1

I got my Rotary bowel test kit from a chemist in 2009. The staff was giving them away so I thought I might as well do one. Two weeks later, the results of the test were sent to my GP and they were positive. I was on holiday in New Zealand when I received an email from the surgery asking me to contact my doctor as soon as possible. When I got back, I went straight to my doctor and was told I had bowel cancer....

Sandy's story (38, NSW)

1

Was it not for me having a totally random check-up back in 1999, I would not be alive today.  Still to this day I’m not quite sure what got me to go and have a check up as I was fit and healthy, but what happened next still amazes me. My Gastroenterologist calls me the “luckiest girl in the world” as having that check up saved my life.  Being told at 28 years old that had I not come in for a check-up I would have only had a couple of years to live was a huge wake up call for me.   So to me...

Carol's story (63, QLD)

1

The main symptom that led to my diagnosis of bowel cancer was a change in my bowel habits, which I discussed with my GP. I was referred to a gynaecologist who diagnosed a uterine prolapse, which affects the working of the bowel, and was sent to a physiotherapist who put together an exercise program for me to help with the problem. When I went back to the gynaecologist after 12 months as requested, I was still having bowel problems so he recommended a colonoscopy....

Kym's story (33, VIC)

1

I was diagnosed with bowel cancer in May 2010 at the age of 31. My bowel habits had started to change about two years before, including small amounts of blood on the toilet paper, but I had been told earlier that I had a haemorrhoid so I thought that might explain the bleeding. I was also diagnosed with anaemia just before I fell pregnant about a year after; I would later learn that anaemia can be an indicator of bowel cancer. It wasn’t until two months after giving birth that I went to see my GP about the bleeding,...

Chelsea's story (38, WA)

1

It was very frightening to realise I might die and leave my two small children (aged 1 and 4 at diagnosis) without their mum after being diagnosed with Stage 3 rectal cancer at the age of 37 in April 2012. I noticed occasional rectal bleeding and after about six weeks I went to my GP. She didn’t think it was urgent but recommended a colonoscopy. After a six week wait and a substantial increase in rectal bleeding, the colonoscopy showed a tumour in my mid to low rectum, plus two polyps in my bowel. Over the next few...

Lisa's story (41, NSW)

1

I had rectal bleeding and abdomen pain for a year and a half before finally going back to my GP to tell her I thought the diagnosis of piles was wrong! At one point, there was so much blood and mucous that I thought I had haemorrhaged. My GP finally referred me to another doctor who gave me a colonoscopy in January 2008, where he discovered a tumour and a number of polyps, which were removed....

Peter's story (62, QLD)

1

I was first diagnosed with a hernia, which seemed to explain the changes in my bowel habits and the stomach pains I had been experiencing. But in the lead up to the Easter long weekend in 2009, I started feeling pretty unwell. We had family arriving so I didn’t really want to make a fuss – we were meant to be enjoying Good Friday together, after all – but I felt much worse as the day went on and started vomiting....

Joy's story (39, NSW)

1

In May 2011 Mum began losing weight and starting experiencing pain on the right side of her abdomen. A colonoscopy discovered a large mass and she was diagnosed with stage 4 bowel cancer. She was 66. Mum was treated with surgery and has since had chemotherapy. Sadly three months ago she started finding it difficult to speak. It seemed as though her nerves were not working effectively, causing her to not be able to eat or talk properly. At that point I didn’t have a good feeling about things so we went back to Mum&rsqu...

Eve's story (22, SA)

1

In 2005 when I was 14, my father was diagnosed with stage 3 bowel cancer.  Dad was just 38 at the time and given a low chance of surviving five years.  That was eight years ago and he is still with us, happy and healthy today.   Finding out dad had bowel cancer was a complete shock.  Following his diagnosis, he underwent surgery and half of his large intestine was removed.  He then was prescribed Xeloda as chemotherapy and, like most cancer patients, experienced a lot of difficulty with the treatme...

Paula's story (54, WA)

1

I was diagnosed in 2008 when I was 54. I had been complaining to doctors for years about various symptoms but I was never sent for tests – not even a bowel screen – until I started bleeding from the rectum. I’ve been an athlete for more than 26 years, competing in marathons, triathlons, even an IronMan event. When you run a lot, diarrhoea is quite common, so everyone – including doctors – kept telling me that my various symptoms were the result of an intense training schedule. I knew things wer...

Ella's story (35, ACT)

1

At the age of 35 I started experiencing rectal bleeding so my GP recommended I have a colonoscopy. The colonoscopy confirmed three growths located within my bowel. After seeing my GP it all happened within weeks, it all seemed so fast yet very professional. After being diagnosed I was required to undergo radiation and chemotherapy. Two weeks before Christmas I commenced my radiation cycle which included trips to radiology every day for 6 weeks and chemotherapy in a tablet form, which included 3 pills, twice a day....

Lynette's story (73, VIC)

1

I was diagnosed with bowel cancer at 72 – just two weeks shy of my 73rd birthday. I’d experienced a little bit of rectal bleeding, but initially thought it was nothing and would go away. When it didn’t, I visited my GP who recommended a colonoscopy....

Brent C's story (64, NSW)

1

Prior to her diagnosis in 2006, my wife’s concerns about her health were dismissed as a trivial condition because her only symptoms were occasional and very slight rectal bleeding. Each time she raised her concerns with her GP, the GP thought the bleeding was related to other things such as beetroot (we ate a lot of vegetables) or haemorrhoids. However after insisting, her GP finally ordered a colonoscopy which showed my wife had late stage bowel cancer, with metastases in the liver and lungs (stage 4)....

Howard's story (52, QLD)

1

I was diagnosed with bowel cancer in February 2010 at the age of 51.  I was seeing a specialist at Toowoomba Hospital about my renal condition.  He asked if there were any other health problems; I mentioned the blood in my stool, which I had seen off and on for the last six years.  I didn’t think it that important, as I had had ulcerative colitis over the years.  My GP did not think it was a concern.  Also I had recently done a FOBT test as part of the National Bowel Cancer Screening...

Stacey B's story (36, WA)

1

My husband Peter was diagnosed with bowel cancer in June 2012 at age 36. He was referred for a colonoscopy by our GP as he had been experiencing rectal bleeding and a consistent change to his bowel habits. The colonoscopy results found a tumour which was biopsied and confirmed to be cancerous. Peter was then sent for a CT scan and MRI to confirm locations and check for the possibilities of metastasis....

Damien's story (26, VIC)

1

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....

Rick's story (63, NSW)

1

I was diagnosed with advanced bowel cancer in September 2011 after seeing my GP about a very small amount of blood being present on my toilet paper. ** The GP asked me to get a home testing kit from the chemist, conduct the test and return it to him. The test showed it was a positive result so I was referred to another doctor to conduct a colonoscopy. The colonoscopy took place on September 26 and the results showed two tumours in my large bowel. I was booked in for a CT scan the next day. After the scan my doctor told...

Hollie's story (24, WA)

1

Despite experiencing horrible stomach pains and bloating and visiting a few different GPs about my symptoms, I was told I had IBS and female problems. My mother has Crohns so I finally found a GP who would send me for a colonoscopy to test me for this. After being on the waiting list for a while I finally had a colonoscopy in April 2011; however, it had to be abandoned due to the extreme pain I suffered during the procedure. I was scheduled to have another colonoscopy as they had found a polyp during the first procedure. Th...

Russell's story (72, NSW)

1

Let me introduce you to an insidious silent killer.   My name is Russ and I have been a Rotarian for 42 years.  It was 1996 when I was asked to take on the role of District Chairman for Rotary Bowelscan, a project designed to raise community awareness of bowel cancer and encourage early detection.  With the participation of pharmacies around Australia, Rotary Bowelscan sells test kits designed to detect blood in the stool, which is one of the best early indicators of bowel cancer. ...

Kylie's story (36, QLD)

1

I had been seeing bright red blood in my stools for between four and six weeks before I saw a doctor.   Because a similar thing had happened after my children (now four and six years old) were born, the experience wasn’t totally unfamiliar to me.  I felt otherwise OK and my energy levels were normal. Nothing felt unusual or different. I had a sigmoidoscopy on my doctor’s orders on 19 April 2010 and they found a growth which they biopsied....

Bobby's story (57, NSW)

1

My message to anyone out there reading this would be to stay positive and keep moving forward. Despite what I’ve been through I feel better now than I have in a long time. Prior to my diagnosis, I hadn’t been feeling well for some time. A driving holiday to Melbourne prompted me to see a doctor. I was fine sitting down but as soon as I stood up I had to rush to a toilet. Back in Sydney my GP sent me off for blood tests and a CT scan. The results showed my tumour markers were up so things were not looking good. A...

Trevor's story (40, QLD)

1

Life was quite normal, albeit very busy with a young family and a very time consuming career.  Things changed for me one night when I experienced severe stomach pains after eating a chicken sandwich and immediately self-diagnosed myself with "food poisoning."  The next morning I was severely sick and started to vomit. At this stage I thought I was getting better as I had got it all out of my system....

Gillian's story (62, VIC)

1

I was diagnosed with bowel cancer at 58 years old. I’d had dull stomach pain and occasional bleeding for several months but it wasn’t until I saw a lot of blood in the toilet that I booked an appointment with my GP.  He sent me for a colonoscopy and I was referred to a surgeon within a week. I was very shocked when I was told I had cancer, but I tried to remain positive throughout my treatment and I really think that helped me cope....

Christine's story (54, QLD)

1

Kim was diagnosed with bowel cancer in June 2012 and passed away on 8th May 2013. We are just coming up to 6 months since his passing and I am here to share his dreadful journey. Kim was being treated for constipation, no bleeding or anything to let us know there was a problem. After 10 days he started vomiting and I took him to the hospital in Brisbane. He spent a week in hospital to clear his bowel, then a big op to remove a large cancer in his bowel that had burst through the bowel wall. He had chemo 24/7 but still h...

Stacey's story (35, SA)

1

My symptoms were fairly vague.  In January 2010 I had one incident of a very upset tummy, I had had slight rectal bleeding for about 8 months but put it down to having haemorrhoids from having had a baby in the past year, and my bowel movements had been more regular. I was actually at the GP in January 2010 about getting my moles checked for cancer when right at the end I mentioned the above symptoms.  My GP who I now thank for my life, said that at my age I should have nothing and immediately referred me to a gas...

Richard (48, NT)

1

I was diagnosed with bowel cancer in 2007. Ironically, I had just given up smoking and was trying to get fit. I was even riding my bike to work for exercise but I was feeling more and more tired. That’s when I knew something was wrong. Three months prior to my diagnosis, I had been experiencing stomach pains and eventually I ended up in the emergency department of hospital.   The doctors there thought I had Crohn’s disease and arranged for me to have a CT scan. That’s when they discovered the tumour....

Cris' story (34, QLD)

1

I was only two years old when I lost my grandmother to bowel cancer. My Grandmother and my Auntie, were both diagnosed at ages 60 and 40 years respectively. By the time my grandmother was diagnosed, the cancer was terminal. My Auntie was checked out for bowel cancer due to the high family history of the disease. I was here in Australia when she was diagnosed with bowel cancer in Brazil. She had the chance to fight it but could not stand the pain caused by the radiotherapy treatments. I was fortunate enough to be able to vis...

Helen's story (44, QLD)

1

My experience with bowel cancer began with a niggly pain, not unlike wind pain, that lasted for about 10 days. I had always suffered with endometriosis so I put the pain down to that. Thankfully my husband encouraged me to go and get checked out. When the doctor examined my tummy it was very painful. The doctor diagnosed me as having a burst appendix and before I knew it, I was flown out from our small town to the nearest teaching hospital. I spent three days there on intravenous antibiotics to reduce what they thought...

Seher's story (30, NSW)

1

My family was shocked by the news in April 2011 when first told my Dad had bowel cancer. It was difficult to process as my Dad is such a healthy man. Initially my Dad went to his GP to have a check up on his prostate. It was after his assessment that the GP was concerned Dad’s bowel may require further investigation. After discussing his health with his doctor it was apparent Dad had experienced a change in his bowel habits, was anaemic and had noticed gradual weight loss....

Cherie's story (24, WA)

1

I was diagnosed with bowel cancer at the age of 24. Over the period of a few months, I noticed that the urge to go to the toilet was becoming more frequent but I assumed that was because I was pregnant. The other key symptom was severe pain in my tailbone area. I would later find out that this was where the tumour was, though at the time it was also attributed to pregnancy....

Kersti's story (56, NSW)

1

My story with bowel cancer began in February 2009 but if I’m honest, it began much earlier with symptoms of rectal bleeding and constipation which I didn’t follow up on with my GP. After my mum died, I went through a stage of not looking after myself; just lying on the lounge, eating way too much pizza and drinking excessively. I kept putting my symptoms down to haemorrhoids, bad diet and grief. My constipation was so bad I was twice forced to go to hospital. Scans were done but nothing showed up. On my third vis...

Kathy's story (47, WA)

1

During a routine pap smear in August 2011, I mentioned to my doctor that I’d had an uncle who died from bowel cancer at only 51. Immediately the doctor suggested I give a stool sample and, when the results came back positive, a colonoscopy was arranged. A small tumour was found during the procedure, which fortunately was only at stage one. My doctors recommended surgery to remove the tumour as my best option so I went ahead with an operation. No stoma was required. I started chemotherapy after surgery to help minimise...

Are you at risk?

           
Both men and women are at risk of developing bowel cancer.  The risk is greater if you -

  • are aged 50 years and over; or
     
  • have a personal or family history of bowel cancer or polyps; or
     
  • have had an inflammatory bowel disease such as Crohn’s disease or ulcerative colitis.

There is emerging evidence regarding type 2 diabetes as a potential risk factor for bowel cancer, however further research is required.

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Healthy eating can be a challenge, particularly for bowel cancer patients.  Making things easier and providing practical support is really important to us here at BCA, so check out the helpful high and low fibre recipes, put together by Nutrition Adviser, Teresa.

We also have a range of nutritional resources developed specifically for bowel cancer patients.