Advanced Treatments & Procedures
The treatment of gastrointestinal cancer depends on several factors, including the area of the tumor, the size of the tumor and the patient's age and health. Treatments include:
Surgical removal of solid gastrointestinal tumors: Surgery offers the best chance for a cure for solid gastrointestinal tumors and may be combined with other treatments including radiation and chemotherapy.
Photodynamic Therapy (PDT) is a procedure that treats or relieves the symptoms of esophageal cancer with a photosensitizing drug and a special laser light. PDT appears to shrink or destroy tumors by damaging blood vessels in the tumor, preventing the cancer from receiving necessary nutrients. PDT also may activate the immune system to attack the tumor cells.
The Whipple Procedure, also called pancreaticduodenectomy, is a surgical procedure for pancreatic cancer that generally offers the best chance for a cure. The procedure involves the removal of the gallbladder, common bile duct, part of the duodenum (a part of the small intestine), head of the pancreas and associated lymph nodes. In some cases, a portion of the stomach and the entire duodenum may be removed.
Colonic stenting is performed to open an obstruction in the colon from a tumor. This procedure allows for a full evaluation of the patient and preparation of the colon, which may prevent the need for colostomies in certain situations. The procedure also is performed to improve the quality of life for those who are not candidates for surgery.
Laparoscopic surgery is available to selected colon cancer, pancreas cancer patients; it diminishes recovery time without reducing the cure rate for colon and rectal cancers.
Laparoscopic liver resections may benefit patients with localized tumors. Tumors can originate in the liver itself or can present as metastatic disease.
Total mesenteric excisional surgery is the state-of-the-art treatment for rectal cancer. Mesenteric excision, with or without radiation therapy, allow the patient to have optional rectal function while maximizing the cure rate and dramatically reducing pelvic recurrences of rectal cancer.
Radiofrequency ablation/Microwave ablation is a treatment where a probe is placed into a liver tumor during surgery and microwaves heat the tumor to kill it. This procedure has the advantage of killing the tumor cells while limiting injury to the normal liver tissue.
Hepatic pumps allow for chemotherapy to be given directly to the liver through the hepatic artery. This requires the placement of a catheter into the main artery of the liver.
Chemotherapy is used to treat some gastrointestinal cancers after surgery. Occasionally, chemotherapy may be given before surgery. Chemotherapy drugs are most often given orally or through a needle in a vein and travel through the bloodstream to kill cancer cells throughout the body. Newer delivery methods target the tumor and include:
Intraperitoneal Hyperthermic Chemotherapy (IPHC) is an abdominal cancer treatment that combines heat and chemotherapy administered during surgery. The treatment may be used for select patients whose cancer has spread to the abdominal cavity from primary colon, appendix, gastric and ovarian tumors.
Radiation Therapy is used before or after surgery for certain gastrointestinal cancers. Radiation also may be used to control the disease and relieve the pain and discomfort of cancer that has spread or re-grown.
Sir-Spheres (selected internal radiation therapy) may be appropriate for patients with primary colorectal cancer that has spread to the liver and has failed to respond to chemotherapy. SIR-Spheres are microscopic, radioactive beads that help destroy tumors and are inserted directly into the liver artery that supplies the tumor using X-ray guidance.
Image-guided radiation therapy (IGRT) makes the tracking and targeting of tumors with radiation more accurate, as it addresses the problem of the patient's internal movement of critical structures and disease. IGRT is a robotically controlled “arm” that allows the radiation oncologist to counteract the patient's internal body movements and pinpoint the tumor site on a daily basis. This results in better outcomes as less healthy tissue is exposed to radiation and higher doses of radiation can be given to the tumor.
Interventional Radiology procedures include:
- Chemoembolization allows for chemotherapy to be injected directly into the liver and the blood supply of the tumor. This often helps control the disabling symptoms that the tumor may be causing.
- Alcohol injections are performed by a radiologist and can be used to kill cells in tumors that are inoperable.
- TheraSphere is an FDA-approved outpatient treatment for inoperable liver cancer; it uses radioactive microscopic glass beads inserted directly into the liver's blood supply. The beads lodge inside the liver tumor and deliver high doses of radiation.