Gastrointestinal Cancer and Treatment

Neuroendocrine tumors (NET) grow in the lining of the intestines, specifically in the tissue that produces hormones. They can also appear in other organs, such as the pancreas and liver. Generally, NETs in the digestive tract have their hormones destroyed before spreading further to other parts of the body. However, symptoms may still occur. These symptoms are usually in the form of changing hormone levels, with the exact hormone affected dependent on the tumor location. This condition is referred to as carcinoid syndrome.

Risk factors for carcinoid tumors include gastritis, or inflammation of the stomach, and female gender, although males are almost equally affected. Also, certain genetic syndromes, like multiple endocrine neoplasia and neurofibromatosis, increase the likelihood of developing carcinoid syndrome.

About 28.5% of carcinoid tumors are found in the small intestine, 5% in the appendix, and 14% in the rectum. The colon is the location for about 5-7% of these tumors, 4% are in the stomach, 1% in the pancreas, 28% in the lungs and less than 1% in the liver. About 8% of tumors are found in other organs.

Treatment may be in the form of specialized chemotherapy and/or surgical removal of the tumors. For carcinoid tumors near the liver, hepatic artery embolization may be employed. Niacin treatment is often used as a supportive therapy.

The colon, or large intestine, composes a large portion of the digestive tract. Colon cancer is extremely common and is the second most common malignancy seen in Israel. Unfortunately, colorectal cancer has very few early warning signs other than sometimes blood in the stool. Instead, it is usually caught through screening examinations. In fact, regular screening has been shown to reduce the rate of colorectal cancer by one-half.

Smoking, obesity, and a poor diet that is high in fat and low in fiber are all risk factors for colorectal cancer. Also, the presence of colon polyps is a warning sign of increased risk.

Diagnosis is made through pathologic examination of biopsies taken during a colonoscopy. Blood tests are also used.

Treatment is determined by the location and degree of cancer. Local cancer is typically removed with surgery, along with nearby lymph nodes to prevent spread of the cancer. For more advanced cancers, or to ensure the complete eradication of local cancers, chemotherapy is used. Treatment may be with conventional chemotherapy drugs, biologic agents, or a combination of both.

Additionally, Sheba Medical Center is engaged in several clinical studies of novel treatments for colorectal cancer. We also provide hyperthermic intraperitoneal chemotherapy (HIPEC) in appropriate cases. HIPEC is a new form of chemotherapy where high dose, heated chemotherapy is used for tumors local to the abdominal cavity. It has the advantage of being highly concentrated with a minimum of side effects.

The esophagus is the “food tube” that connects the throat to the stomach. While cancer of the esophagus is rarer than other GI cancers, Sheba Medical Center has experienced experts on staff to provide world class medicine to esophageal cancer patients.

There are multiple risk factors for esophageal cancer. These include excessive alcohol use, smoking, male gender, and the presence of other medical conditions, such as Barrett’s esophagitis result from gastric reflux.

Symptoms of this cancer include a sore throat, frequent coughing, and difficulty swallowing. Pain around the center of the chest and unexplained weight loss may also be indications of esophageal cancer.

Esophageal cancer is divided into two main classifications – squamous cell carcinoma and adenocarcinoma. The majority of cases in Western nations are of the adenocarcinoma type. The type of esophageal cancer, as well as the patient’s individual characteristics, determines the course of treatment in our philosophy of tailor made medicine.

Treatments may include surgical removal of local cancers, radiation therapy, and chemotherapy. Chemotherapy is often used in conjunction with radiotherapy and/or surgery. At Sheba Medical Center, gastric oncology specialists, radiation oncologists, surgeons, and pathologists all work together for the best outcome for our patients

Like many organs, the stomach is composed of multiple layers. Gastric cancer typically originates in the innermost layer and may then spread to outer layers. Types range from stage 0, or carcinoma in situ, which is the presence of abnormal cells in the stomach, to stage 5, where the cancer has spread to distant organs.

Risk factors include a poor diet of fatty and processed foods, frequent stomach inflammation, infection of the stomach with H. pylori bacteria, smoking, and excessive alcohol intake.

Among the symptoms of stomach cancer are blood in the stool, stomach pain, excessive weight loss, fatigue, loss of appetite, nausea, and vomiting.

The usual treatment for stomach cancer is surgery in combination with chemotherapy, although every patient is unique and radiation therapy is sometimes used. The surgeons, radiation oncologists, GI oncologists, pathologists, and support staff consult on each case to come up with the best treatment plan.

Along with the kidneys, the liver is responsible for blood filtration and breaking down toxic substances in the blood stream. This organ also stores sugar reserves and produces enzymes that aid digestion.

Obesity, diabetes, large amounts of alcohol consumption, and hepatitis all put one at risk for liver cancer. The stages of liver cancer vary from stage 1, the presence of a single, local tumor, to stage 4, in which metastasis to other organs is present.

The symptoms of liver cancer are multiple and include nausea, vomiting, weight loss, bloating in the abdomen, and jaundice.

Sheba Medical Center offer advanced treatment of liver cancer in the form of radiotherapy, chemotherapy, and specialized techniques like hepatic artery embolization. Liver transplantation may also be an option.

The pancreas is a gland in the digestive system responsible for the production of several important enzymes and hormones. Traditionally, pancreatic cancer has been poorly understood and difficult to treat, but Sheba Medical Center is making great strides.

Risk factors for pancreatic cancer may include smoking and diabetes, but family history certainly plays a strong role. Pancreatitis, or inflammation of the pancreas, may also contribute to an increased risk of pancreatic cancer.

The vast majority of pancreatic tumors are adenocarcinomas. The disease ranges from small local tumors that are easily removed to complete metastasis to other organs.

Symptoms of pancreatic cancer include nausea, very high blood sugars, diarrhea, jaundice, and weight loss.

Surgery is used to treat pancreatic cancer when the tumor is small and not adjacent to vital blood vessels. Chemotherapy may be utilized in conjunction with surgery to reduce the tumor size and alleviate symptoms.