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Tests, Treatments and Therapies for Gastrointestinal Cancer at the University of Colorado Cancer Center

No two people – or gastrointestinal cancer cases – are alike.

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To partner with our team of experts and create your individual treatment plan, call (720) 848-0300 to make an appointment today.

As a world leader in cancer research, we pull from a vast array of resources to properly evaluate your situation and create a plan to fit your exact needs and preferences.

An expert team assembled for you

An expert team of medical and support specialists is assembled for you, and stays with you from initial diagnostic testing to your post-treatment follow-up.

And, at each step, you are kept at the very center of your own care decisions.

The same expert teams and the specialists within them are also available to render second opinions about the state and courses of the disease in patients who are in the care of other caregivers.

Staging and Detection Tests

Once a cancer has been diagnosed, it is very important to know where the cancer may have spread. This is the “stage” of the cancer; the lower the number, the less it has spread.  Knowing the stage allows a medical team to determine the best possible treatment plan for you.

Types of Staging Tests

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

 

Barium swallow – You swallow barium liquid, which flows through the esophagus and into the stomach. X-rays are taken to identify abnormal areas.

 

Biopsy – The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.

 

Blood, urine and stool samples – The doctor may take these tests to check for bilirubin and other substances. Bilirubin is a substance that passes from the liver to the gallbladder to the intestine. Tumor blockage may cause the level of bilirubin in the blood, stool or urine to become very high.

 

Chest X-ray – An X-ray of the organs and bones inside the chest. An X-ray is actually an energy beam that can go through the body and be reflected on film, making a picture of areas inside the body.

 

Colonoscopy – A procedure to look inside the rectum and colon for abnormal areas. A thin, lighted tube, called a colonoscope, is inserted through the rectum into the colon.

 

Complete blood count (CBC) – A blood sample is drawn, and the number of red and white blood cells, platelets and hemoglobin are recorded.

 

Digital rectal exam – 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.

 

Esophagoscopy – A thin, lighted tube is inserted through the mouth and into the esophagus to look for and biopsy abnormal areas.

 

Fecal occult blood test – A test to check stool (solid waste) for blood that can only be seen with a microscope.

 

Liver function tests – A blood sample is checked to measure the amounts of certain substances released into the blood by the liver.

 

Proctoscopy – An exam of the rectum using a short, lighted tube called a proctoscope.

 

Serum tumor marker test – A blood sample is examined to measure the amounts of certain substances released into the blood. These substances (called “tumor markers”) can indicate cancer when found in increased levels.

 

Sigmoidoscopy – A procedure to look inside the rectum and lower colon with a thin, lighted tube for abnormal areas.

Scans and Procedures

Barium enema (lower GI series) – While you lie on an X-ray table, barium liquid is put into the rectum and flows through the colon. A radiologist takes X-rays to look for abnormal areas.

 

Bronchoscopy – A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.

 

Capsule endoscopy (pill endoscopy) – The patient swallows a small pill, which identifies sources of bleeding that can’t be found in any other way.

 

CT scan (computed tomography) – An X-ray procedure that creates detailed, highly accurate cross-sectional body images.

 

Doppler ultrasound – A type of ultrasound that uses differences in the ultrasound echoes to measure the speed and direction of blood flow.

 

Endoscopic retrograde cholangiopancreatography (ERCP) – A thin, lighted tube, called an endoscope is passed through the mouth and stomach, down into the first part of the small intestine. After injecting dye through the catheter into the ducts, the doctor takes X-rays to see if the ducts are narrowed or blocked by a tumor or other condition.

 

Endoscopic ultrasound (EUS) –  A procedure in which 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, which form a picture of body tissues called a sonogram.

 

Laparoscopy – A surgical procedure to look at the organs inside the abdomen to check for signs of disease.

 

Laparotomy/laparoscopy – A surgical procedure in which a small incision (or cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease.

 

Laryngoscopy – A procedure in which the doctor examines the larynx (voice box) with a mirror or with a laryngoscope (a thin, lighted tube).

 

Magnetic Resonance Imaging (MRI) – An imaging technique that provides detailed images of body structures. It uses a magnetic field instead of the X-rays used in a CT scan. It can measure the size (or change in size) of tumors or organs like the lymph nodes, liver and spleen.

 

PET scan (positron emission tomography) – An imaging test used to highlight cancer in different parts of the body. A short-lived radioactive substance is injected prior to the scan. Cancerous tissue will build up more of the substance and appear brighter than normal tissue on the PET images. Other non-cancerous tissues, such as areas of inflammation, may also “light up.”

 

Percutaneous transhepatic cholangiography (PTC) – A dye is injected through a thin needle inserted through the skin into the liver. The dye makes the bile ducts show up on X-rays so the doctor can see if the ducts are narrowed or blocked by a tumor or other condition.

 

Radionuclide scans – These scans use small amounts of radioactivity and special cameras to locate carcinoid tumors.

 

Thoracoscopy – A surgical procedure similar to laparoscopy and performed to look at the organs inside the chest to check for abnormal areas.

 

Virtual colonoscopy (a colonography or CT colonography) – Uses CT scans to make a series of pictures of the colon. A computer puts the pictures together to create detailed images that may show anything that seems unusual on the inside surface of the colon.

Treatments & Therapy

Cancer treatments vary greatly from person to person. Your medical team may use a combination of chemotherapy, drug therapy, blood and marrow transplants, radiation or new targeted therapy to treat or control your cancer, customized uniquely for you.

Surgery - by Cancer Type

Anal Cancer – Surgical options range from local excision to abdominoperineal resection and groin dissection.

 

Colorectal Cancer – Surgical options include cryosurgery, local excision, radiofrequency ablation, resection or resection and colostomy.

 

Esophagus Cancer – Surgical options range from local excision to complete abdominoperineal resection.

 

Bile Duct Cancer – If the disease is caught early, surgeons can remove the bile duct and nearby lymph nodes. Other options include a partial hepatectomy, the whipple procedure, surgical biliary bypass or the placement of a stent.

 

GI Carcinoid Tumors – Surgical options depend on where and how severe gastrointestinal tumors are. The options can include fulguration, artery ligation or embolization, radiofrequency ablation, appendectomy, partial hepatectomy or bowel resection and anastomosis.

 

Liver Cancer – Treatment options for liver cancer include chemoembolization, a percutaneous ethanol injection, regional chemotherapy, radiofrequency ablation, partial or total hepatectomy with liver transplant.

 

Pancreatic Cancer – Surgical options include surgical bypass, distal or total pancreatectomy, or the placement of a stent.

 

Small Intestine Cancer – Surgical options include surgical bypass or resection of the small intestine.

 

Stomach Cancer – Surgery may include subtotal or total gastroectomy, endoluminal stent placement or electrocautery.

Surgical Procedures

Abdominoperineal resection – A 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 made in the surface of the abdomen so body waste can be collected in a disposable colostomy bag outside of the body.

 

Appendectomy – Your appendix is removed, sometimes laparascopically, using small incisions.

 

Bile duct removal – If the cancer is found at a very early stage, surgeons can remove the tumor, bile duct and nearby lymph nodes. Then they reconstruct a new duct by sewing a piece of intestine to the liver.

 

Bowel resection and anastomosis – The bowel tumor is removed, along with a small section of healthy bowel surrounding it. The healthy parts of the bowel are then sewn together. Lymph nodes are removed and checked for cancer.

 

Chemoembolization – An anti-cancer drug is injected into the hepatic artery through a thin tube called a catheter.

 

Cryosurgery – A treatment that uses an instrument to freeze and destroy abnormal tissue.

 

Electrocautery – An electrical current that creates heat used to remove lesions or control bleeding.

 

Endoluminal stent placement – A procedure to insert a thin, expandable tube called a stent to keep a passage open for nutrition.

 

Fulguration – Use of a special tool that employs an electric current to burn away the tumor.

 

Gastrectomy (subtotal) – Removal of the part of the stomach that contains cancer, nearby lymph nodes, parts of other tissues and organs near the tumor. The spleen may also be removed.

 

Gastrectomy (total) – Removal of the entire stomach, nearby lymph nodes, parts of the esophagus, small intestines and other tissues near the tumor. The spleen may also be removed.

 

Groin dissection – If after chemotherapy or radiation, cancer is found in the lymph nodes of the groins, the cancerous lymph nodes are surgically removed.

 

Hepatectomy (partial) – If the tumor has spread to the liver, surgeons can remove the involved part of the liver, the bile duct and lymph nodes near the tumor. Then they reconstruct a new duct by sewing a piece of intestine to the liver.

 

Hepatectomy and liver transplant – Removal of the entire liver and replacement with a healthy donated liver.

 

Hepatic artery ligation or embolization –  A procedure which blocks off the main blood vessel that brings blood into the liver. Blocking the flow of blood to the liver helps kill the cancer cells growing there.

 

Hepatic resection – The surgical oncologist removes part or all of the liver.

 

Local excision – If the cancer is found at a very early stage, it can be removed without cutting into the abdomen.

 

Pancreatectomy (distal) – The surgical oncologist removes the pancreas’s body and tail if the tumor is in either of these parts, as well as the spleen.

 

Pancreatectomy (total) – The surgical oncologist removes the entire pancreas, the gall bladder, the spleen, the common bile duct and parts of the stomach and small intestine.

 

Percutaneous ethanol injection – A small needle is used to inject ethanol (alcohol) directly into a tumor to kill cancer cells.

 

Radiofrequency ablation (cryotherapy) – The use of a special probe with tiny electrodes that kill cancer cells.

 

Regional chemotherapy – A small pump may be placed in the body to deliver anti-cancer drugs directly into the blood vessels that go to the tumor.

 

Resection – Surgically removing the cancer and a small amount of healthy tissue around it.

 

Resection and colostomy – If the doctor is not able to sew the colon or rectum back together, a stoma (an opening) is made on the outside of the body for waste to pass through. A colostomy bag is placed around the stoma to collect the waste.

 

Stent placement – A thin tube called a stent may be placed in the duct to drain bile that has built up in the area.

 

Surgical bypass – When a tumor cannot be removed, surgeons can create a new pathway around the blocked area to let fluids pass through the digestive tract.

 

Whipple procedure – Surgeons remove the bile duct, the head of the pancreas, the gallbladder, and parts of the small intestine and stomach, then reconstruct the digestive system to allow you to eat a regular diet.

Non-Surgical Procedures

Chemotherapy involves using drugs that slow down, damage or kill cancer cells. This may involve single drugs or combinations of drugs taken intravenously or by mouth. Chemotherapy is often taken in cycles lasting three or four weeks. Your team may also prescribe drugs and other treatments to reduce or eliminate side effects associated with chemotherapy.

 

Radiation Therapy ("Radiotherapy") involves using X-rays and other types of medical radiation aimed at specific parts of the body. Radiation is used to kill cancer cells, prevent them from developing or recurring, and ease many of the symptoms caused by cancer. It can be used together with chemotherapy for certain cancers (this is called “chemo-radiotherapy”).

 

Targeted Therapies are anti-cancer drugs or other substances that directly interfere with cancer growth and progression on a molecular level. They may be taken (with few side effects) on their own or in combination with standard chemotherapy. Many new targeted therapies, including vaccines and gene therapies, are currently in development.

 

Hormone Therapy. Some hormones can cause certain cancers to grow. Hormone therapy removes hormones, or blocks their action and stops cancer cells from growing. 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.

 

MIBG (metaiodobenzylguanidine) is a drug therapy that is sometimes used with or without radioactive iodine to lessen symptoms of gastrointestinal carcinoid tumors.

Clinical Trials

Your medical team may also recommend that you participate in a clinical trial. The University of Colorado Hospital and the University of Colorado Cancer Center conduct hundreds of clinical trials in an ongoing effort to discover and deliver more effective treatment. They can provide access to the latest drugs and vaccines years before they are more widely available.

As a ”health care city” where the hospital is surrounded by a great medical school, some of the most inventive researchers in the world and even private research companies developing drugs and processes,  our goal is to get new treatments to patients who will benefit from them as quickly as possible.

Other types of treatments being tested in clinical trials include:

  • Biologic therapy (biotherapy or immunotherapy) – 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 defenses against cancer.
  • Hyperthermia therapy – A treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells. It can also make cancer cells more sensitive to the effects of radiation therapy and certain anticancer drugs.
  • Radiosensitizers – Drugs that make tumor cells more sensitive to radiation therapy.

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