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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 is malignant cells found in the colon or rectum. The colon and the rectum are parts of the large intestine, which is part of the digestive system. Because colon cancer and rectal cancers have many features in common, they are sometimes referred to together as colorectal cancer. Cancerous tumors found in the colon or rectum also may spread to other parts of the body.
Excluding skin cancers, colorectal cancer is the third most common cancer in both men and women. The American Cancer Society estimates that about 140,000 colorectal cancer cases and about 50,000 deaths from colorectal cancer occur each year. The number of deaths due to colorectal cancer has decreased, which is attributed to increased screening and polyp removal and to improvements in cancer treatment.
A type of cancer called adenocarcinoma accounts for more than 95 percent of cancers in the colon and rectum and is usually what is meant by the term colorectal cancer. It is the type we focus on in this section. There are other types of cancer that can be found in the colon and rectum, but they are rare.
Here is an overview of the types of cancer in the colon and rectum:
Adenocarcinoma. Adenocarcinomas are tumors that start in the lining of internal organs. Adeno means gland. These tumors start in cells with glandular properties, or cells that secrete. They can form in many different organs, such as the lung or the breast. In colorectal cancer, early tumors start as small adenomatous polyps that continue to grow and can then turn into malignant tumors. The vast majority of colorectal cancers are adenocarcinomas.
Gastrointestinal stromal tumors (GIST). These are tumors that start in specialized cells in the wall of the digestive tract called the interstitial cells of Cajal. These tumors may be found anywhere in the digestive tract, although they rarely appear in the colon. They can be benign (noncancerous) at first, but many do turn into cancer. When this happens, they are called sarcomas. Surgery is the usual treatment if the tumor has not spread.
Lymphoma. A lymphoma is a cancer that typically starts in a lymph node, which is part of the immune system. However, it can also start in the colon, rectum, or other organs.
Carcinoids. Carcinoids are tumors that start in special hormone-producing cells in the intestine. Often they cause no symptoms at first. Surgery is the usual treatment.
Sarcoma. Tumors that start in blood vessels, muscle, or connective tissue in the the colon and rectum wall.
The following are the most common symptoms of colorectal cancer. However, each individual may experience symptoms differently.
People who have any of the following symptoms should check with their doctors, especially if they are over 50 years old or have a personal or family history of the disease:
A change in bowel habits such as diarrhea, constipation, or narrowing of the stool that lasts for more than a few days
Rectal bleeding, dark stools, or blood in the stool
Cramping or gnawing stomach pain
Unintended weight loss
Weakness and fatigue
A feeling that you need to have a bowel movement that is not relieved by doing so
The symptoms of colorectal cancer may resemble other conditions, such as infections, hemorrhoids, and inflammatory bowel disease. It is also possible to have colon cancer and not have any symptoms. Always consult your health care provider for a diagnosis.
Risk factors may include:
Age. Most people who have colorectal cancer are over age 50; however, it can occur at any age.
Race and ethnicity. African-Americans have the highest risk for colorectal cancer of all racial groups in the U.S. Jews of Eastern European descent (Ashkenazi Jews) have the highest colorectal cancer risk of any ethnic group in the world.
Diet. Colorectal cancer is often associated with a diet high in red and processed meats.
Personal history of colorectal polyps. Benign growths on the wall of the colon or rectum are common in people over age 50, and may lead to colorectal cancer.
Personal history of colorectal cancer. People who have had colorectal cancer have an increased risk for another colorectal cancer.
Family history. People with a strong family history of colorectal cancer or polyps in a first-degree relative (especially in a parent or sibling before the age of 45 or in two first-degree relatives of any age) have an increased risk for colorectal cancer.
Ulcerative colitis or Crohn's disease. People who have an inflamed lining of the colon have an increased risk for colorectal cancer.
Inherited syndromes, such as familial adenomatous polyposis or hereditary nonpolyposis colon cancer, also known as Lynch syndrome
Heavy alcohol consumption
Type 2 diabetes
The exact cause of most colorectal cancer is unknown, but the known risk factors listed above are the most likely causes. A small percentage of colorectal cancers are caused by inherited gene mutations. People with a family history of colorectal cancer may wish to consider genetic testing. The American Cancer Society suggests that anyone undergoing such tests have access to a doctor or geneticist qualified to explain the significance of these test results.
Although the exact cause of colorectal cancer is not known, it may be possible to lower your risk of colorectal cancer with the following:
Diet, weight, and exercise. It is important to manage the risk factors you can control, such as diet, body weight, and exercise. Eating more fruits, vegetables, and whole-grain foods, and limiting red and processed meats, plus exercising appropriately, even small amounts on a regular basis, can be helpful. Avoiding excess alcohol intake may also lower your risk.
Drug therapy. Some studies have shown that low doses of nonsteroidal anti-inflammatory drugs, such as aspirin, and hormone replacement therapy for postmenopausal women, may reduce the risk of colorectal cancer. But these drugs also have their own potentially serious risks, so it is important to discuss this with your health care provider.
Screenings. Perhaps most important to the prevention of colorectal cancer is having screening tests at appropriate ages. Screening may find some colorectal polyps that can be removed before they have a chance to become cancerous. Because some colorectal cancers cannot be prevented, finding them early is the best way to improve the chance of successful treatment, and reduce the number of deaths caused by colorectal cancer.
The following screening guidelines can lower the number of cases of the disease, and can also lower the death rate from colorectal cancer by detecting the disease at an earlier, more treatable stage.
Screening methods for colorectal cancer, for people who do not have any symptoms or strong risk factors, include the following:
Fecal occult blood test (FOBT). Checks for hidden (occult) blood in the stool. It involves placing a very small amount of stool on a special card, which is then sent to a laboratory.
Fecal immunochemical test (FIT). A test that is similar to a FOBT, but does not require any restrictions on diet or medications prior to the test.
Flexible sigmoidoscopy. A diagnostic procedure that allows the doctor to examine the inside of a portion of the large intestine. A short, flexible, lighted tube with a small video camera on the end, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.
Colonoscopy. A procedure that allows the doctor to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.
CT colonography (virtual colonoscopy). A procedure that uses computerized tomography (CT) scans to examine the colon for polyps or masses. The images are processed by a computer to make a three-dimensional (3-D) model of the colon. Virtual colonoscopy is noninvasive, although it requires a small tube to be inserted into the rectum to pump air into the colon. If something abnormal is seen with this test, a standard colonoscopy will be needed as follow up.
Barium enema with air contrast (also called a double contrast barium enema). 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 administered into the rectum to partially fill up the colon. Air is then pumped in to expand the colon and rectum. An X-ray of the abdomen is then taken and can show strictures (narrowed areas), obstructions (blockages), and other problems.
Screening guidelines for colorectal cancer
Colorectal cancer screening guidelines from the American Cancer Society for early detection include:
Beginning at age 50, both men and women should follow one of the examination schedules below:
Fecal occult blood test or fecal immunochemical test every year
Flexible sigmoidoscopy every five years
Double-contrast barium enema every five years
Colonoscopy every 10 years
CT colonography (virtual colonoscopy) every five years
People with any of the following colorectal cancer risk factors should begin screening procedures at an earlier age and/or be screened more often:
Strong family history of colorectal cancer or polyps in a first-degree relative, especially in a parent or sibling before the age of 45 or in two first-degree relatives of any age
Family with hereditary colorectal cancer syndromes, such as familial adenomatous polyposis and hereditary nonpolyposis colon cancer
Personal history of colorectal cancer or adenomatous polyps
Personal history of chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis)
If a person has symptoms that might be caused by colorectal cancer, the doctor will want to get a complete medical history and do a physical examination. The doctor may also do certain tests to look for cancer. Many of these tests are the same as those done to screen for colorectal cancer in people without symptoms.
Digital rectal examination. A doctor or other health care provider inserts a gloved and lubricated finger into the rectum to feel for anything unusual or abnormal. This test can detect some cancers of the rectum, but not the colon.
Fecal occult blood test. This test checks for hidden (occult) blood in the stool. It involves placing a very small amount of stool on a special card, which is then sent to a laboratory.
Colonoscopy. A procedure that allows the doctor to view the entire length of the large intestine. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.
Barium enema (also called double contrast barium enema). 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 administered into the rectum to partially fill up the colon. An X-ray of the abdomen is then taken that can show strictures (narrowed areas), obstructions (blockages), and other problems.
Biopsy. a procedure in which polyps or tissue samples are removed (during a colonoscopy or surgery) from the body for examination under a microscope to determine if cancer or other abnormal cells are present.
Blood count. A test to check for anemia (that can be a result of bleeding from a tumor).
Imaging tests. Tests, such as a CT scan, PET scan, ultrasound, or MRI of the abdomen, may be done to look for tumors or other problems. These tests may also be done if colorectal cancer has already been diagnosed to help determine the extent (stage) of the cancer.
When colorectal cancer is diagnosed, tests will be performed to determine how much cancer is present, and if the cancer has spread from the colon or rectum to other parts of the body. This is called staging, and it is an important step toward planning a treatment program. The stages for colorectal cancer are as follows:
Stage 0 (Cancer in situ)
The cancer is found in the innermost lining of the colon or rectum.
Stage I (also called Dukes' A colon cancer)
The cancer has spread beyond the innermost lining of the colon or rectum to the second and third layers. The cancer has not spread to the outer wall or outside of the colon or rectum.
Stage II (also called Dukes' B colon cancer)
The cancer has spread through into the wall or outside the colon or rectum to nearby tissue. However, the lymph nodes are not involved.
Stage III (also called Dukes' C colon cancer)
The cancer has spread to nearby lymph nodes, but has not spread to other organs in the body.
Stage IV (also called Dukes' D colon cancer)
The cancer has spread to other parts of the body, such as the lungs.
Specific treatment for colorectal cancer will be determined by your doctor based on:
Your age, overall health, and medical history
Extent and location of the disease
Results of certain lab tests
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of this disease
Your opinion or preference
After the colorectal cancer is diagnosed and staged, your doctor will recommend a treatment plan. Treatment may include:
Colon surgery. Often, the primary treatment for colorectal cancer is an operation, in which the cancer and a length of normal tissue on either side of the cancer are removed, as well as the nearby lymph nodes.
Radiation therapy. Radiation therapy is the use of high-energy radiation to kill cancer cells and to shrink tumors. There are two ways to deliver radiation therapy, including the following:
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.
Internal radiation (brachytherapy, implant radiation). Radiation is given inside the body as close to the cancer as possible. Radioactive material is placed next to or directly into the cancer, which limits the effects of surrounding healthy tissues. Some of the radioactive implants are called seeds or capsules.Internal radiation involves giving a higher dose of radiation in a shorter time span than with external radiation. Some internal radiation treatments stay in the body temporarily. Other internal treatments stay in the body permanently, though the radioactive substance loses its radiation within a short period of time. In some cases, both internal and external radiation therapies are used.
Chemotherapy. Chemotherapy is the use of anticancer drugs to treat cancerous 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. Studies have shown that chemotherapy after surgery may increase the survival rate for patients with some stages of colon cancer. It can also be helpful before or after surgery for some stages of rectal cancer. Chemotherapy can also help slow the growth or relieve symptoms of advanced cancer.
Targeted therapy. Newer medications called targeted therapies may be used along with chemotherapy or sometimes by themselves. For example, some newer medications target proteins that are found more often on cancer cells than on normal cells. These medications have different (and often milder) side effects than standard chemotherapy medications and may help people some live longer.
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".
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.
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.
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.
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
Blood in stool or black-looking stools
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.
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.
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.
Specific treatment options for esophageal cancer will be determined by your doctor based on:
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 is a malignant (cancerous) tumor of the esophagus, the muscular tube that moves food from the mouth to the stomach.
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.
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.
A malignant (cancerous) liver tumor that originates in the liver is called primary liver cancer.
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.
The following are the most common symptoms of a liver hepatoma. However, each individual may experience symptoms differently. Symptoms may include:
Large mass can be felt in upper, right part of abdomen
Jaundice. Yellowing of the skin and eyes.
The symptoms of a liver hepatoma may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.
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.
Specific treatment for liver hepatoma will be determined by your doctor based on:
Extent of the disease
Your tolerance of specific medicines, procedures, or therapies
Expectations for the course of the disease
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.
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.
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:
Cancer is in the liver only, has not spread, and can be removed completely with surgery.
Cancer is in the liver only, has not spread, but cannot be totally removed, usually due to its location near major blood vessels.
Cancer has spread throughout the liver or to other parts of the body.
Cancer has come back after it was treated.
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.
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.
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.
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.
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
Jaundice (yellow skin and eyes, and dark urine)
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.
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.
Specific treatment for pancreatic cancer will be determined by your doctor based on:
Location and extent of the disease
Type of cancer
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.
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.
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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