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Digestive Cancer 

Digestive or gastrointestinal cancers affect the digestive system and are among the most common forms of cancer. They also can be among the most deadly. Colon cancer, for example, is the third most common cancer in men and women and the second leading cause of cancer death in the United States.

Although gastrointestinal cancer can be serious, screening and early diagnosis can play a large role in improving treatment outcomes.

Colorectal Cancer: StatisticsCáncer Colorrectal

Colorectal Cancer: Statistics

What are statistics?

Some people use numbers called statistics to figure out their chances of getting cancer. Or they use them to try to figure out their chances of dying from cancer. Because no 2 people are alike, statistics can’t be used to predict what will happen to one person. The statistics below describe large groups of people. They do not take into account a person's own risk factors, such as family history, behaviors, or cancer screenings. If you have questions, talk with your healthcare provider.

What are the statistics for colorectal cancer?

Here are some statistics about colorectal cancer:

  • Colorectal cancer is the third most common type of cancer (excluding skin cancer) in both men and women.

  • About 143,000 people were diagnosed with colorectal cancer in 2015. This includes about 93,000 people diagnosed with colon cancer and about 40,000 people diagnosed with rectal cancer.

  • For the average person, the lifetime risk of developing colorectal cancer is about 1 in 20 (5%). But this risk can be higher for people with certain risk factors.

  • Colorectal cancer is the third leading cause of cancer death in both men and women.

  • About 50,000 people were expected to die from colorectal cancer in 2015.

Source: American Cancer Society (ACS)

Colon Cancer

Colon cancer is cancer that starts in the large intestine (colon) or the rectum (end of the colon). This type is also referred to as "colorectal cancer".

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Esophageal Cancer Cáncer Esofágico

Esophageal Cancer

What is esophageal cancer?

Esophageal cancer is cancer that develops in the esophagus, the muscular tube that connects the throat to the stomach. The esophagus, located just behind the trachea, is about 10 to 13 inches in length and allows food to enter the stomach for digestion. The wall of the esophagus is made up of several layers and cancers generally start from the inner layer and grow out.

The American Cancer Society estimates that about 17,990 Americans will be newly diagnosed with esophageal cancer during 2013, and about 15,210 deaths are expected.

What causes esophageal cancer?

No one knows exactly what causes esophageal cancer. At the top of the esophagus is a muscle, called a sphincter, that releases to let food or liquid go through. The lower part of the esophagus is connected to the stomach. Another sphincter muscle is located at this connection that opens to allow the food to enter the stomach. This muscle also works to keep food and juices in the stomach from backing into the esophagus. When these juices do back up, reflux, commonly known as heartburn, occurs.

Long-term reflux can change the cells in the lower end of the esophagus. This condition is known as Barrett's esophagus. If these cells are not treated, they are at much higher risk of developing into cancer cells.

What are the different types of esophageal cancer?

There are 2 main types of esophageal cancer. The most common type, known as adenocarcinoma, develops in the glandular tissue in the lower part of the esophagus, near the opening of the stomach. It occurs in just over half of the cases.

The other type, called squamous cell carcinoma, grows in the cells that form the top layer of the inner lining of the esophagus, known as squamous cells. This type of cancer can grow anywhere along the esophagus.

Treatment for both types of esophageal cancer is similar.

What are the symptoms of esophageal cancer?

Often, there are no symptoms in the early stages of esophageal cancer. Symptoms do not appear until the disease is more advanced. The following are the most common symptoms of esophageal cancer. However, each individual may experience symptoms differently. Symptoms may include:

  • Difficult or painful swallowing. A condition known as dysphagia is the most common symptom of esophageal cancer. This gives a sensation of having food lodged in the chest, and people with dysphagia often switch to softer foods to help with swallowing.

  • Pain in the throat or back, behind the breastbone or between the shoulder blades

  • Severe weight loss. Many people with esophageal cancer lose weight unintentionally because they are not getting enough food.

  • Hoarseness or chronic cough that does not go away within two weeks

  • Vomiting

  • Blood in stool or black-looking stools

  • Heartburn

The symptoms of esophageal cancer may resemble other medical conditions or problems. Always consult your health care provider for a diagnosis.

There is no routine screening examination for esophageal cancer; however, people with Barrett's esophagus should be examined often because they are at greater risk for developing the disease.

What are the risk factors for esophageal cancer?

The following factors can put an individual at greater risk for developing esophageal cancer:

  • Age. The risk increases with age. In the U.S., most people are diagnosed at 55 years of age or older.

  • Gender. Men have more than a 3 times greater risk of developing esophageal cancer than women.

  • Tobacco use. Using any form of tobacco, but especially smoking, raises the risk of esophageal cancer. The longer tobacco is used, the greater the risk, with the greatest risk among persons who have indulged in long-term drinking with tobacco use. Scientists believe that these substances increase each other's harmful effects, making people who do both especially susceptible to developing the disease.

  • Alcohol use. Chronic or long-term heavy drinking is another major risk factor for esophageal cancer.

  • Acid reflux. Abnormal backward flow of stomach acid into the esophagus increases esophageal cancer risk. 

  • Barrett's esophagus. Long-term irritation from reflux, commonly known as heartburn, changes the cells at the lower end of the esophagus. This is a precancerous condition, which raises the risk of developing adenocarcinoma of the esophagus.

  • Obesity. Being very overweight increases the risk of esophageal cancer. This might be because being overweight puts you at higher risk for reflux. 

  • Diet. Diets low in fruits and vegetables and certain vitamins and minerals can increase risk for this disease.

  • Other irritants. Swallowing caustic irritants such as lye and other substances can burn and destroy cells in the esophagus. The scarring and damage done to the esophagus can put a person at greater risk for developing cancer many years after ingesting the substance.

  • Medical history. Certain diseases, such as achalasia, a disease in which the bottom of the esophagus does not open to release food into the stomach, and tylosis, a rare, inherited disease, increase the risk of esophageal cancer. In addition, anyone who has had other head and neck cancers has an increased chance of developing a second cancer in this area, which includes esophageal cancer.

How is esophageal cancer diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for esophageal cancer may include the following:

  • Chest X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

  • Upper GI (gastrointestinal) series (also called barium swallow). A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.

  • Esophagogastroduodenoscopy (also called EGD or upper endoscopy). A procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube with a tiny video camera on the end, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).

  • Computed tomography scan (CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. If further imaging is needed, your doctor may order a MRI or PET scan.

  • Endoscopic ultrasound. This imaging technique uses sound waves to create a computer image of the wall of the esophagus, stomach, and nearby lymph nodes. The endoscope is guided into the mouth and throat, then into the esophagus and the stomach. As in standard endoscopy, this allows the doctor to view the inside of this area of the body, as well as insert instruments to remove a sample of tissue (biopsy).

  • Thoracoscopy and laparoscopy. These methods allow the doctor to examine the lymph nodes and other structures inside the chest or abdomen with a hollow, lighted tube inserted through a small cut in the skin, and remove suspicious areas for further testing.

  • PET scan. A test that uses a radioactive glucose (sugar) dye to highlight cancer cells and create pictures of the inside of the body. The test is done much like a CT scan. First, the doctor or nurse injects a small amount of radioactive dye into your vein. Then a scanner is moved around your body and takes many pictures of your neck, chest, and abdomen. A computer puts these pictures together to show where the cancer cells are located.

Treatment for esophageal cancer

Specific treatment options for esophageal cancer will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent and location of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of this disease

  • Your opinion or preference

Treatment may include:

  • Surgery. Two types of surgery are commonly performed for esophageal cancer. In one type of surgery, part of the esophagus and nearby lymph nodes are removed, and the remaining portion of the esophagus is reconnected to the stomach. In the other surgery, part of the esophagus, nearby lymph nodes, and the top of the stomach are removed. The remaining portion of the esophagus is then reconnected to the stomach.

  • Chemotherapy. Chemotherapy uses anticancer drugs to kill cancer cells throughout the entire body.

  • Radiation therapy. Radiation therapy uses high-energy rays to kill or shrink cancer cells.

  • Photodynamic therapy (PDT) or other laser therapies. In these treatments, an endoscope with a laser on the end is used to destroy cancer cells on or near the inner lining of the esophagus. 

Sometimes, several of these treatments may be combined to treat esophageal cancer.

Esophageal Cancer

Esophageal cancer is a malignant (cancerous) tumor of the esophagus, the muscular tube that moves food from the mouth to the stomach.

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Liver TumorsTumores del Hígado

Liver Tumors

What is a tumor?

Tumors are abnormal masses of tissue that form when cells begin to reproduce at an increased rate. Both noncancerous (benign) and cancerous (malignant) tumors can develop in the liver.

What are benign liver tumors?

Benign (noncancerous ) liver tumors are quite common and usually do not produce symptoms. Often, they are not diagnosed until an ultrasound, computed tomography scan, or magnetic resonance imaging scan is performed. There are several types of benign liver tumors, including the following:

  • Hepatocellular adenoma. This benign tumor is linked to the use of certain drugs. Most of these tumors remain undetected. Sometimes, an adenoma will rupture and bleed into the abdominal cavity, requiring surgery. Adenomas rarely become cancer.

  • Hemangioma. This type of benign tumor is a mass of abnormal blood vessels. Treatment is usually not required. Sometimes, infants with large liver hemangiomas require surgery to prevent clotting and heart failure.

  • Focal nodular hyperplasia. This benign tumor is made up of many different types of cells. It is often difficult to tell them apart from real liver cancer. 

  • Nodular regenerative hyperplasia. This benign tumor typically results from the chronic use of certain medications. 

What are malignant liver tumors?

A malignant (cancerous) liver tumor that originates in the liver is called primary liver cancer. 

What is hepatocellular carcinoma (hepatoma)?

Hepatocellular carcinoma, also called hepatoma, is the most common form of primary liver cancer. Chronic infection with hepatitis B and C increases the risk of developing this type of cancer, especially in the setting of cirrhosis. Other causes include certain chemicals, iron, alpha-1 anti-trypsin, and alcoholic liver disease. 

What are the symptoms of hepatocellular carcinoma?

The following are the most common symptoms of a liver hepatoma. However, each individual may experience symptoms differently. Symptoms may include:

  • Abdominal pain

  • Weight loss

  • Nausea

  • Vomiting

  • Large mass can be felt in upper, right part of abdomen

  • Fever

  • Jaundice. Yellowing of the skin and eyes.

  • Persistent itching

The symptoms of a liver hepatoma may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is hepatocellular carcinoma diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for a liver hepatoma may include the following:

  • Liver enzymes and liver function tests. A series of special blood tests that can determine if the liver is functioning properly.

  • Abdominal ultrasound (also called sonography). A diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen, such as the liver, spleen, and kidneys and to assess blood flow through various vessels.

  • Computed tomography scan (CT or CAT scan). A diagnostic imaging procedure using a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. They are sometimes able to differentiate between benign and malignant liver tumors as well as tell if the cancer has metastasized to other parts of the body. 

  • Hepatic angiography. X-rays taken after a substance in injected into the hepatic arteries.

  • Liver biopsy. A procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.

Treatment for liver hepatoma

Specific treatment for liver hepatoma will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance of specific medicines, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment may include:

  • Surgery. In some cases, a partial hepatectomy (removal of part of the liver) can be done if the cancer is confined to a small area of the liver. 

  • Tumor ablation. A small needle is inserted into the tumor through the skin. Several methods of ablation are used to destroy the tumor and include: radiofrequency ablation, ethanol ablation, microwave thermotherapy, and cryotherapy. 

  • Embolization therapy. A substance is injected into one of the arteries in the liver that supplies blood to the tumor. Once this is done, the cancer cells die off. Embolization therapy includes: arterial embolization, chemoembolization, and radioembolization. 

  • Radiation therapy. Radiation therapy uses high-energy rays to kill or shrink cancer cells. 

  • Chemotherapy. Chemotherapy uses anticancer drugs to kill cancer cells. Chemotherapy is almost never used to treat liver cancers. 

  • Liver transplantation

What are other types of primary liver cancers?

Other, less common primary liver cancers include the following:

  • Cholangiocarcinoma. A cancer that originates in the lining of the bile channels in the liver or in the bile ducts.

  • Hepatoblastoma. A cancer in infants and children, sometimes causing the release of hormones that result in early puberty.

  • Angiosarcoma. A rare cancer that originates in the blood vessels of the liver.

  • Mixed hepatocellular cholangiocarcinoma. A rare cancer that has characteristics of both hepatocellular carcinoma and cholangiocarcinoma. 

What are the stages of liver cancer?

When a doctor diagnoses liver cancer, the next step is to determine how far the cancer cells have spread (a process called staging). The National Cancer Institute defines the following stages for primary liver cancer:

Localized resectable

Cancer is in the liver only, has not spread, and can be removed completely with surgery.

Localized unresectable

Cancer is in the liver only, has not spread, but cannot be totally removed, usually due to its location near major blood vessels.

Advanced

Cancer has spread throughout the liver or to other parts of the body.

Recurrent

Cancer has come back after it was treated.

What is secondary liver cancer?

Cancer that starts in another part of the body and spreads to the liver is called secondary liver cancer. Cancer that has spread to the liver usually originates in the lung, breast, colon, pancreas, or stomach. Leukemia and other blood cancers sometimes also spread to the liver.

Liver Cancer

Many types of tumors can form in the liver, both benign (noncancerous)and malignant (cancerous). The most common type of malignant liver cancer is hepatocellular carcinoma.

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Pancreatic CancerCáncer Pancreático

Pancreatic Cancer

What is pancreatic cancer?

Pancreatic cancer is the fourth most common cause of cancer death in the U.S. Pancreatic cancer occurs when a cell in the pancreas is damaged and this malignant (cancer) cell starts to grow out of control.

There are several types of pancreatic cancers, including the following:

  • Adenocarcinoma of the pancreas. The most common pancreatic cancer, which occurs in the lining of the pancreatic duct.

  • Adenosquamous carcinoma. A rare pancreatic cancer.

  • Squamous cell carcinoma. A rare pancreatic cancer.

What are the risk factors for pancreatic cancer?

Risk factors for pancreatic cancer include:

  • Age. Most pancreatic cancer occurs in people over the age of 55.

  • Smoking. Heavy cigarette smokers are 2 or 3 times more likely than nonsmokers to develop pancreatic cancer.

  • Obesity and physical inactivity. Pancreatic cancer is more common in people who are very overweight and in people who don't get much physical activity.

  • Diabetes. Pancreatic cancer occurs more often in people who have type 2 diabetes than in those who do not.

  • Gender. More men than women are diagnosed with pancreatic cancer.

  • Race. African-Americans are more likely than Asians, Hispanics, or whites to be diagnosed with pancreatic cancer.

  • Family history. The risk for developing pancreatic cancer is higher if a person's mother, father, or a sibling had the disease.

  • Cirrhosis of the liver. People with cirrhosis have a higher risk of pancreatic cancer.

  • Workplace exposures. Exposure to certain occupational pesticides, dyes, and chemicals used in the metal industry may increase the risk of pancreatic cancer.

  • Some genetic syndromes. Certain inherited gene mutations, such as in the BRCA2 gene, increase the risk of pancreatic cancer.

  • Chronic pancreatitis. Long-term inflammation of the pancreas has been linked with increased risk for pancreatic cancer.

What are the symptoms of pancreatic cancer?

The following are the other most common symptoms of pancreatic cancer. However, each person may experience symptoms differently. Symptoms may include:

  • Pain in the upper abdomen (belly) or upper back

  • Loss of appetite

  • Weight loss

  • Jaundice (yellow skin and eyes, and dark urine)

  • Indigestion

  • Nausea

  • Vomiting

  • Extreme tiredness (fatigue)

  • An enlarged abdomen from a swollen gallbladder 

  • Pale, greasy stools that float in the toilet 

The symptoms of pancreatic cancer may be a lot like those of other conditions or medical problems. Always consult your doctor for a diagnosis.

How is pancreatic cancer diagnosed?

Technician preparing patient for CT scan

In addition to a complete medical history and physical examination, diagnostic procedures for pancreatic cancer may include the following:

  • Ultrasound. A diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver, pancreas, spleen, and kidneys and to assess blood flow through various vessels. The ultrasound may be done using an external or internal device:

    • Transabdominal ultrasound. The technician places an ultrasound device on the abdomen to create the image of the pancreas.

    • Endoscopic ultrasound (EUS). The doctor inserts an endoscope, a small, flexible tube with an ultrasound device at the tip, through the mouth and stomach, and into the small intestine. As the doctor slowly withdraws the endoscope, images of the pancreas and other organs are made. 

  • Computed tomography scan (CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

  • Endoscopic retrograde cholangiopancreatography (ERCP). A procedure that allows the doctor to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines X-ray and the use of an endoscope, a long, flexible, lighted tube. The scope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum (first part of the small intestine). The doctor can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected that will allow the bile and pancreatic ducts to be seen on an X-ray.

  • Percutaneous transhepatic cholangiography (PTC). A needle is put through the skin and into the liver where the dye (contrast) is injected so that the bile duct structures can be seen by X-ray. This test is generally only done if an ERCP cannot be done. 

  • Pancreas biopsy. A procedure in which a sample of pancreatic tissue is removed (with a needle or during surgery) for examination under a microscope.

  • Special blood tests

  • Positron emission tomography (PET). A type of nuclear medicine procedure. For this test, a radioactive substance, usually bound to a type of sugar, is injected through a vein before the body is scanned. The radioactive sugar collects in cancer cells, which will show up on images. This test is not as specific as CT scanning, and is not used alone to diagnose pancreatic cancer. A PET scan is often done in combination with a CT scan.

Treatment for pancreatic cancer

Specific treatment for pancreatic cancer will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Location and extent of the disease

  • Type of cancer

  • Your tolerance of specific medicines, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Depending on the type and stage, pancreatic cancer may be treated with the following:

  • Surgery. This treatment may be necessary to remove the tumor, a section, or the entire pancreas and often parts of other organs. The type of surgery depends on the stage of the cancer, the location and size of the tumor, and the person's health. Types of surgery for pancreatic cancer include the following:

    • Whipple procedure. This procedure involves removal of the head of the pancreas, part of the small intestine, the gallbladder and part of the common bile duct, part of the stomach, and lymph nodes near the head of the pancreas. Most pancreatic tumors occur in the head of the pancreas, so the Whipple procedure is the most commonly performed surgical procedure for pancreatic cancer.

    • Distal pancreatectomy. If the tumor is located in the body and tail of the pancreas, both of these sections of the pancreas will be removed, along with the spleen.

    • Total pancreatectomy. The entire pancreas, part of the small intestine and stomach, the common bile duct, the spleen, the gallbladder, and some lymph nodes will be removed. This type of operation is not done often.

    • Palliative surgery. For more advanced cancers, surgery may be done not to try to cure the cancer, but to relieve problems such as a blocked bile duct.

  • External radiation (external beam therapy). A treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes. Radiation therapy may be given alone, or in combination with surgery and/or chemotherapy.

  • Chemotherapy. The use of anticancer drugs to kill cancer cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual. Chemotherapy may be given alone, or in combination with surgery and radiation therapy.

  • Medication (to relieve or reduce pain)

Long-term prognosis for individuals with pancreatic cancer depends on the size and type of the tumor, lymph node involvement, and degree of metastases (spreading) at the time of diagnosis.

Pancreatic Cancer

There are two types of pancreatic tumors - endocrine and exocrine. Exocrine tumors are more common and are more likely to be malignant or cancerous. Endocrine tumors are also known as islet cell tumors and are usually benign.

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Stomach Cancer

The most common type of stomach cancer is called adenocarcinoma, which starts from cell types found in the lining of the stomach.

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