Gastrointestinal (Digestive Tract) Cancers

Introduction

Digestive tract tumors include cancers that occur in the esophagus, stomach, liver, pancreas, gallbladder, colon, rectum, and anus.

Causes

There are a wide variety of causes for cancers of the digestive tract. Chronic acid reflux and smoking may increase the risk of esophageal cancer. Anal cancer is typically are squamous cell carcinomas caused by human papilloma virus (HPV) and also more likely occur in individuals who smoke.

Colon and rectal cancers tend to be sporadic with no identifiable cause. In rare cases, patients with colon cancer have a genetic syndrome which predisposes them to colon polyps and subsequently colon cancer.

Clinical Manifestations and Diagnosis

Currently, there is no widely recommended screening test for esophageal cancer, liver cancer, or pancreatic cancer for the general population. Individuals who have cirrhosis may benefit from screening for hepatocellular carcinoma.

Colon and rectal cancers are most often identified on colonoscopy, a routine screening test which is recommended for the general population based on age and pre-existing risk factors. Some individuals may have their colon or rectal cancer identified because of difficulty having a bowel movement or after passing blood in her stool.

Cancers of the anal canal may be identified by patient's who noticed a masslike sensation when moving their bowels. These tumors may also be identified at the time of routine colonoscopy.

Treatment Strategies

Gastrointestinal tract tumors are diverse, and specific treatment recommendations will be tailored to a patient's unique clinical characteristics. Broadly, esophageal cancers are often treated with chemotherapy and radiation together followed by a surgical resection. Colon cancers are often resected first with chemotherapy afterwards, if needed.

Rectal cancers, like esophageal cancers, are often treated with chemotherapy and radiation first followed by surgical resection. Cancers of the anal canal are often treated with chemotherapy and radiation alone; surgery is reserved for cases of disease recurrence after chemotherapy and radiation.

For more information concerning specific cases, please consult your oncology team.

Prognosis and prognostic factors

Each patient has a unique cancer type and stage with different underlying risk factors. During a oncology consultation visit, ask your doctor about expected outcomes.

As with most cancers, the size of the primary tumor, lymph node spread, and distant metastatic spread are all important factors for patient prognosis. Tumor response to initial chemotherapy and radiation treatments may also predict outcomes.

Treatment Side Effects

Radiation treatment side effects tend to affect the tissues that are close to the tumor where the radiation is directed. Some side effects can be more pronounced during and shortly after radiation treatment (acute side effects). While other side effects may occur many months or years after treatment (chronic or late side effects).

For patients receiving radiation therapy to the esophagus, side effects tend to include pain and difficulty swallowing. Most patients will require a feeding tube inserted through their skin and into their digestive tract for nourishment. They will also be radiation given to lungs which may cause scarring or radiation pneumonitis. Depending on where the esophageal cancer is, patients may have increased risk of cardiovascular disease.

For patients receiving radiation therapy to the rectum anus, side effects typically include increased stool frequency and urgency, loose or watery stools, skin irritation and redness and peeling around the treatment site. The side effects tend to be short-term during and shortly after radiation therapy. However, they may persist longer-term in some patients. Patients may also experience increased urinary frequency and urgency. Fatigue is also common.