Taking the Fiction Our of Science Fiction
New Treatments for G"I Cancer
What if you could go to your primary care doctor’s office and receive a simple blood test capable of detecting a gastrointestinal cancer in its earliest stages, so you could immediately seek personalized cancer therapy? What sounds like science fiction is closer to reality and a beacon of hope for the 343,000 Americans diagnosed with cancers of the digestive tract every year.
The most common gastrointestinal cancers (GI) are colorectal cancer, esophageal cancer, gastric (stomach) cancer, liver cancer, and pancreatic cancer. Approximately 62,000 Americans are diagnosed with pancreatic
cancer annually, while more than 150,000 will face a diagnosis of colorectal cancer. While the incidence of colorectal cancer has dropped since the mid-1980s due to increased screening measures, it has been rising in recent years among people younger than 50. In response to this, in May 2021, the U.S. Preventive Services Task Force lowered the recommended colonoscopy screening age from 50 to 45.
“I don’t think it’s entirely clear why, but it is happening,” confirms Henry Tsai, MD, Board Certified in Internal Medicine, Hematology and Medical Oncology, and Director of Gastroenterology Oncology at Eisenhower Lucy Curci Cancer Center, noting that a more sedentary lifestyle, excessive alcohol use, smoking, and diet may play a role.
The incidence of gastroesophageal junction cancer has also increased in the past few decades. Gastroesophageal reflux disease (GERD) and Barrett’s esophagus, a precancerous disorder caused by frequent acid reflux and heartburn, are two contributing conditions.
Dr. Tsai notes that cancer epidemiology often changes over time, citing cancers of the liver and bile ducts. “In the 1960s and 1970s, excessive alcohol consumption was associated with an increased risk of liver cancer,” he explains. “Although alcohol remains a risk factor, it’s now more common to see viral hepatitis B and C infections and fatty liver disease linked to these types of cancer.”
The incidence of anal cancer has been steadily climbing for the last two decades. Identified risk factors include multiple sexual partners, conditions that compromise the immune system, and human papillomavirus (HPV) infection, the cause of most squamous cell anal cancers.
Symptoms to watch for
While chronic fever, night sweats, fatigue and unexplained weight loss apply to all GI cancers, changes in bowel habits may signal a colorectal cancer diagnosis. Difficulty swallowing food or liquids, known as dysphagia, can be a sign of cancer. Blood in the urine, jaundice or gray/pale colored stools often indicate some type of bile duct obstruction, which may point to liver cancer.
While colonoscopy remains the gold standard for colorectal cancer screening, patients with symptoms like dysphagia, acid reflux, heartburn, bleeding, and other problems may need to undergo an upper endoscopy to detect cancer and other disorders. Also known as esophagogastroduodenoscopy (EGD), this procedure uses a small endoscope to examine the lining of the esophagus and upper part of the small intestine called the duodenum.
“As far as cancer of the pancreas, it remains a difficult entity to master,” says Iyoob Ilyas, MD, Board Certified in General Surgery and Colon/Rectal Surgery. “We still don’t have an easy diagnostic or screening tool for pancreatic cancer, but there is extensive research underway,” he notes. “We are identifying more pancreatic lesions due the increased use of MRI and CT scans.”
Additionally, Eisenhower Health has an affiliation with UC San Diego Health Cancer Network. Their Pancreatic Screening and Prevention Clinic led by Surgical Oncologist Andrew Lowy, MD, provides Eisenhower patients access to their screening clinic.
GI cancer treatments
“There are a lot of new treatments and technologies available,” says Dr. Tsai. “Immunotherapy and targeted therapy are moving into GI tract cancer care, and they are making a big difference.”
He is particularly excited about Circulating Tumor DNA (ctDNA), a biomarker technology comprising fragmented DNA from dead cancer cells released into the blood stream. ctDNA has major implications for early-stage cancer detection, selecting and monitoring the best tumor-specific treatment, and the likelihood of recurrence. Dr. Tsai and his colleagues at Eisenhower have been at the forefront of liquid biopsy research with a clinical trial underway designed to increase chances for early cancer detection.
“After colorectal surgery, we can use ctDNA to assess minimal residual disease for stage 2 and 3 patients along with traditional pathology and staging information,” explains Dr. Tsai. “If any microscopic cancer is left behind, we can make the decision whether or not to include chemotherapy in the treatment plan. And if patients do undergo chemotherapy and we see that the DNA disappears, that’s how we can tell the treatment is working.”
Dr. Ilyas notes that surgical interventions for GI cancers vary depending on the type of cancer and how advanced it is. “We have a high success rate treating anal cancers with a combination of chemotherapy and radiation, so surgery is usually reserved for early stage or recurrence.”
He has seen a significant shift from standard open operations to laparoscopic procedures to robotic-assisted surgeries. “Between 95 to 99 percent of my abdominal procedures are minimally invasive,” he says, “which translates to less pain and complications, minimal blood loss, and faster recovery.”
Most colon cancers require some type of surgery. Patients who have early-stage rectal cancer or rectal polyps may be candidates for robotic transanal minimally invasive surgery (R-TAMIS), a technique allowing the surgeon to excise the tumor without making an incision in the abdomen.
“It’s virtually pain-free and, in many cases, patients can be discharged from the hospital within 24 hours,” Dr. Ilyas says.
Dr. Tsai and Dr. Ilyas both emphasize the importance of healthy living — and that includes listening to your body if something feels amiss.
“Patients need not travel far to receive outstanding gastrointestinal cancer care,” says Dr. Ilyas, noting that Eisenhower is deeply invested in new technologies and attracting top-notch talent in the medical field.
“With the availability of treatment options, we are starting to see better outcomes in GI cancers, even in stage 4,” says Dr. Tsai. “These new technologies are changing the way we detect cancer and changing the way we manage treatment.”
For more information or to contact Eisenhower Lucy Curci Cancer Center, call 760.674.3602 or visit EisenhowerHealth.org/Cancer.
