Gastrointestinal Cancer

  • Gastrointestinal cancer refers to malignant conditions of the gastrointestinal tract including, but not limited to, the esophagus, stomach, liver, pancreas, colon, rectum and anus.
  • Symptoms and treatment options are specific to each site and are covered below.

Esophagus:

Esophageal cancer is a malignancy of the esophagus that is usually diagnosed by biopsy. There are various subtypes, but are mainly classified as squamous cell carcinoma or adenocarcinoma. It is estimated that 16,470 men and women (12,970 men and 3,500 women) will be diagnosed with and 14,280 men and women will die of cancer of the esophagus in 2008.

Dysphagia (difficulty swallowing) is the first symptom in most patients. Odynophagia (painful swallowing) may be present. Fluids and soft foods are usually tolerated, while hard or bulky substances cause much more difficulty. Substantial weight loss is characteristic as a result of poor nutrition and the active cancer. Pain, often of a burning nature, may be severe and worsened by swallowing. An early sign may be an unusually husky or raspy voice. Nausea and vomiting may also be present as well as coughing and hematemesis (vomiting up blood may also be present. If the disease has spread elsewhere, this may lead to symptoms related to this: liver metastasis could cause jaundice and ascites. Lung metastasis could cause shortness of breath, pleural effusions, etc.

Small and localized tumors are usually treated surgically with curative intent. Larger tumors tend not to be operable and hence are more difficult to cure. These larger tumors are usually treated with a combination of chemotherapy and radiation therapy. In some cases chemo- and radiotherapy can render these larger tumors operable. Prognosis depends on the extent of the disease and other medical problems, but is fairly poor.

The stage distribution based on historic stage shows that 24% of esophagus cancer cases are diagnosed while the cancer is still confined to the primary site (localized stage); 30% are diagnosed after the cancer has spread to regional lymph nodes or directly beyond the primary site; 30% are diagnosed after the cancer has already metastasized (distant stage) and for the remaining 16% the staging information was unknown. The corresponding 5-year relative survival rates were: 34.4% for localized; 17.1% for regional; 2.8% for distant; and 11.6% for unstaged.