Gastrointestinal Malignancies

What Are Gastrointestinal Malignancies?

Gastrointestinal malignancies refer to any gastrointestinal cancer. Your gastrointestinal tract is typically 25 feet long and extends from the mouth to the anus. Gastrointestinal cancers are fairly common in the United States, with colorectal cancer being the third leading cause of cancer mortality.

The most common types of gastrointestinal malignancies include:

• Esophageal cancer
• Colorectal cancer 
• Gastric (stomach) cancer
• Pancreatic cancer
• Liver cancer

The DNA mutations that cause malignancies develop for a number of reasons. Sometimes the reasons are genetic, and other times cancer develops because of lifestyle choices and habits. Gastrointestinal malignancies can also develop because of underlying chronic conditions.

What Is Esophageal Cancer?

Your esophagus is the tube that connects the throat (pharynx) to the stomach. About 18,000 new esophageal cancer cases are reported in the U.S. each year. There are two types of esophageal cancer: adenocarcinoma (develops in glandular cells) and squamous-cell carcinoma (develops in squamous cells). A common reason the lining of the esophagus mutates into a malignancy is because of long-term gastroesophageal reflux (GERD). GERD is a type of severe acid reflux that can wear down the esophageal lining over time. GERD is also a cause of Barrett’s esophagus, a disease that also sometimes progresses into a malignancy. Some believe genetics is also an underlying factor in the development of esophageal cancer.

Esophageal cancer can be hard to detect early, as its symptoms typically don’t present until the tumor is more advanced. The first symptom patients often notice is difficulty swallowing (dysphagia). This is usually due to a tumor causing a blockage in the esophagus. Other common symptoms are weakness and fatigue. It’s wise to inform your doctor immediately for a consult if you notice a persistence in difficulty swallowing.

Treatment for esophageal cancer is often a combination of radiation and chemotherapy. Surgery is also utilized if the physician believes it is necessary.

What Is Colorectal Cancer?

Colorectal cancer (cancer of the colon and rectum) is the third leading cause of (cancer death in the United States. Colon cancer and rectal cancer can occur separately, but when both the colon and rectum are affected, it is referred to as colorectal cancer. Colorectal cancer presents as polyps, which can grow on the colon and rectum. Colon cancer is particularly tough to diagnose in its early stages, as it rarely has symptoms until the disease has progressed and possibly metastasized. The American Cancer Society recommends that all adults begin colon cancer screening at age 45. Colonoscopy is the gold standard for colorectal cancer screening, and this is the best way to catch the disease early.

If a patient does experience colorectal cancer symptoms, they typically include:

• Changes in bowel habits
• Unintended weight loss
• Unexplained fatigue 
• Blood in the stool

Finding blood in the stool or any type of gastrointestinal bleeding means you should consult your gastroenterologist or physician immediately. Also, a change in bowel habits could be a marker for several GI disorders, so it’s best to be evaluated.

Your physician will determine the best treatment for you based on the stage of colorectal cancer. Stages range from 0 to IV (most serious), with various substages in between. If you are in the early stages of colorectal cancer, or your doctor finds precancerous polyps during a routine colonoscopy, they can remove the polyps during the procedure with the colonoscope.

For later-stage colorectal cancer, surgery is utilized before chemotherapy and radiation. In the early stages, small portions of the bowel and the tumor itself can be removed. In later stages, your physician may surgically create an opening in your colon (colostomy) or opening in the ileum (ileostomy) as a temporary or permanent route to allow waste to exit from the digestive tract.

What Is Gastric (Stomach) Cancer?

Gastric cancer begins as abnormal cells in the stomach. Gastric cancer can affect any part of the stomach; in the United States, the most commonly affected area is the gastroesophageal junction. This is where the esophagus connects to the stomach.

It’s not clear what causes gastric cancer, but many risk factors increase the chances of development, such as GERD, smoking, obesity, Helicobacter pylori (H. pylori) infection, and poor diet, among others. If untreated, gastric cancer can metastasize and spread to other areas of the body.

Treatment depends on the stage of the cancer. With radiation, chemotherapy, immunotherapy, targeted drug therapy, palliative (supportive) care, and surgery, gastric cancer can be treated. The common types of surgery for gastric cancer include:

• Endoscopy to remove tumors from the stomach lining (early stage)
• Subtotal gastrectomy (removing part of the stomach)
• Total gastrectomy (removing all of the stomach; often used when the cancer is located in the body of the stomach and not the gastroesophageal junction)

Your physician may also remove the lymph nodes in your abdomen to have them tested for cancer.

What Is Pancreatic Cancer?

Your pancreas is a pear-shaped organ located behind the stomach. Its function is to aid in digestion by producing digestive juices and insulin. Pancreatic cancer begins as abnormal cells in the pancreas that multiply and spread. Around 57,000 people in the U.S. each year are diagnosed with pancreatic cancer.

Like many other gastrointestinal malignancies, symptoms often don’t appear until the disease progresses. Also, many gastrointestinal cancer symptoms are similar to those of other gastrointestinal disturbances or stomach upset, so sometimes they get ignored. Common symptoms of pancreatic cancer include:

• Abdominal pain
• Unintentional weight loss
• Jaundice (yellowing of the skin and eyes)
• Loss of appetite
• Chalky, white stools

There are two types of pancreatic cancer: adenocarcinoma (pancreatic exocrine cancer), and

islet cell cancer (pancreatic endocrine cancer). Adenocarcinomas are the far more common type and begin in the ducts of the pancreas, however, it is harder to treat because symptoms only appear in the late stages.

Islet cell cancer develops in the pancreatic cells responsible for hormone production. This type may exhibit symptoms early on because of hormonal changes, and it is easier to treat. However, islet cell cancer is less common than adenocarcinomas. Treatment for pancreatic cancer can include chemotherapy, radiation, and surgery, depending on the cancer’s placement and stage.

What Is Liver Cancer?

Like other GI cancers, liver cancer begins with the development of abnormal cells. However, liver cancer is an uncommon disease when it begins in the liver. Liver cancer is more often caused by other metastasized cancers that have spread to the liver. The most common type of primary liver cancer is hepatocellular carcinoma; less commonly, intrahepatic cholangiocarcinoma or hepatoblastoma.

Signs and symptoms typically are not experienced until liver cancer is in its later stages. Symptoms include:

• Nausea and vomiting
• Unintended weight loss
• Pain in the upper abdomen
• Unexplained fatigue
• Jaundice 
• Abdominal swelling 
• Chalky, white stools

Liver cancer is diagnosed by stages, either from stage I through IV or A through D. Treatment depends on the stage and location and can include surgery to remove the tumor or liver transplant surgery. Other less invasive forms of treatment include immunotherapy, radiation therapy, targeted drug therapy, chemotherapy, and palliative care.

Am I at Risk for Gastrointestinal Malignancies?

While the risk factors for each type of gastrointestinal differ slightly, there are several that are common for all GI malignancies, including:

• Smoking
• Heavy alcohol use
• H. pylori infection
• Gastritis
• Diabetes
• Being male
• A diet high in salt
• A diet low in vegetables and fruits
• Diabetes 

You can help prevent the development of gastrointestinal cancer by quitting smoking, limiting alcohol usage, and having a proper diet and exercise regimen.

How Are Most Gastrointestinal Malignancies Diagnosed?

Each type of malignancy has different diagnostic tests in order to diagnose the disease, however, many gastrointestinal malignancies are discovered one of two ways: endoscopic procedures and radiographic imaging by computed tomography (CT scan), magnetic resonance imaging (MRI), and ultrasound.

Upper endoscopy is an outpatient, noninvasive procedure that uses a thin tube inserted into the throat. A small camera is attached to the end, giving your gastroenterologist a view of your throat, esophagus, stomach, and top part of the small intestine (duodenum). Upper endoscopic procedures vary, and other instruments can be used with the endoscope to diagnose and treat disease.

Colonoscopy is a procedure that inserts a long, thin tube into the anus and rectum in order to examine the large intestine (colon). The colonoscope also has a small camera attached, which allows the doctor to view any colon abnormalities.