Lesson 1, Topic 1
In Progress

Gastrointestinal System Cancers

April 11, 2024

Learning Objective: Examine the cancers of the gastrointestinal system, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      Cancer can affect any part of the GI system. The cause of cancer is a mutation of the cells, which leads to a tumor. To diagnose cancer, the provider will do a physical exam, endoscopy procedures, imaging tests, blood work, and a biopsy. Treatment consists of surgery, radiation therapy, and chemotherapy. Targeted therapy, which uses medications that attack only the cancer cells, can be used for some types of GI system cancers.
      The risk factors, signs, and symptoms can vary for the different types of cancer. These are discussed in the following sections.

Oral Cavity, Pharyngeal, and Laryngeal Cancers
Learning Objective: Describe pancreatitis, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
     Oral cavity, pharyngeal, and laryngeal cancers can form in any of the tissues in the mouth and throat. Males are more likely than females to have oral cavity or pharyngeal cancer.
      Using alcohol and tobacco products (e.g., cigarettes, betel quid, and gutka) can increase the risk of these cancers. A personal history of oral or throat cancer, human papillomavirus (HPV) infection, or Epstein-Barr virus can also increase the risk. The signs and symptoms depend on the type of cancer:
              • Oral cancer: White or red patches, bleeding, or a continuous sore in the mouth, loose teeth, pain with swallowing, earache, and a lump in the neck
              • Throat cancer (pharyngeal and laryngeal cancers): Continuous sore throat, lump in the neck, ear pain, ringing in the ear, and problems swallowing
Besides a history and physical exam, the provider may order a biopsy of the mouth lesion. A UGI endoscopy and imaging tests, such as CT scans, are used for throat cancer. Treatment consists of the following:
              • Surgical removal of the tumor, a laryngectomy, or a pharyngectomy
              • Targeted therapy, which uses medications that attack only the cancer cells
              • Radiation therapy and chemotherapy

Stomach Cancer
Learning Objective: Describe stomach cancer, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      About 65% of stomach cancer cases occur in adults over age 65. Diagnosing stomach cancer in its early stages can be difficult because the symptoms (e.g., indigestion and stomach discomfort) can be caused by many other conditions.
      Males have a greater risk of stomach cancer. A personal history of H. pylori infection or stomach inflammation is also a risk factor, along with a family history of stomach cancer. The risk of stomach cancer increases with cigarette smoking and often consuming smoked, pickled, or salted foods. Besides indigestion and stomach discomfort, other signs and symptoms include bloody stools, vomiting, weight loss, jaundice, and difficulty swallowing.
      Besides a history and physical exam, the provider will order UGI endoscopy and imaging tests (e.g., CT scan and UGI series). Treatment consists of the following:
              • Surgical removal of the tumor, subtotal gastrectomy (with an anastomosis), or total gastrectomy (FIGURE 19.15)
              • Radiation therapy, chemotherapy, and targeted drug therapies

Pancreatic Cancer
Learning Objective: Discuss stomach cancer, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      Pancreatic cancer is difficult to diagnose in its early stages because the symptoms are vague and may go unnoticed. This type of cancer spreads quickly, and because the condition usually is diagnosed in the later stages of the disease, it can be difficult to treat.
      Risk factors for pancreatic cancer include smoking, long-term diabetes mellitus, chronic pancreatitis, and certain hereditary disorders. Signs and symptoms include jaundice, abdominal and back pain, weight loss, and fatigue.
      Besides a history and physical exam, the provider will order an endoscopic ultrasound and imaging tests (e.g., CT scan, MRI, positron emission tomography [PET]). Blood tests and biopsies may also be done. Treatment consists of the surgical removal of the tumor, a partial or total pancreatectomy, radiation therapy, and chemotherapy.

Liver Cancer
Learning Objective: Discuss liver cancer, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      Liver cancer can either be primary (the initial site) or metastatic (spread to the liver from the initial site elsewhere in the body). Primary liver cancer may be difficult to treat if it is diagnosed in an advanced stage.
      Risk factors for primary liver cancer include a personal history of hepatitis B or C, cirrhosis, obesity, diabetes, hemochromatosis, and heavy alcohol use. Signs and symptoms include jaundice, right abdominal pain, and a lump in the right abdomen. The symptoms may not appear until the cancer is in an advanced stage.

FIGURE 19.15  Anastomosis. Part of the stomach has been cut out, and the duodenum has been anastomosed to the remaining stomach. From Frank ED, Long BW, Smith BJ: Merrill’s atlas of radiographic positions and radiologic procedures, ed 12, St. Louis, 2012, Mosby.

      Besides a history and physical exam, the provider will order blood tests, imaging tests (e.g., CT scan, MRI, and US), and a biopsy. Treatment consists of the following:
              • Surgical removal of the tumor or liver transplantation
              • Localized treatments, including heating or freezing cancer cells, injecting alcohol or chemotherapy into the tumor or placing radiation beads into the liver
              • Radiation therapy, chemotherapy, targeted drug therapies, and immunotherapy


Small Intestinal Cancer
Learning Objective: Describe small intestinal cancer, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      Small intestinal or small bowel cancer can also be called duodenal, ileal, and jejunal cancer. Adenocarcinoma is the most common form of small intestine cancer.
      Risk factors for small intestine cancer include eating a high-fat diet or having a personal history of Crohn disease, colonic polyps, or celiac disease. Signs and symptoms include abdominal pain, weight loss, bloody stools, and a lump in the abdomen.
      Besides a history and physical exam, the provider will order blood tests, imaging tests (e.g., CT scan, MRI, PET, LGI series, and US), and endoscopic procedures (e.g., upper endoscopy and capsule endoscopy). Treatment consists of surgery, chemotherapy, targeted drug therapies, and immunotherapy.


Colorectal Cancer
Learning Objective: Describe colorectal cancer, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
     Colorectal cancer is also called colon cancer and rectal cancer. It affects both males and females. Screening is recommended to start at age 45 for those with an average risk.
      Risk factors for colorectal cancer include being over 50 years of age, smoking tobacco, and eating a high-fat diet. A family history of colorectal cancer, ulcerative colitis, or Crohn disease also increases the risk. A person with colorectal cancer may experience diarrhea, constipation, bloody stools, cramps, bloating, flatus (gas), nausea, vomiting, fatigue, or weight loss.
      Besides a history and physical exam, the provider will order a colonoscopy and biopsy. A carcinoembryonic antigen (CEA) blood test may also be done. CEA is sometimes produced by colon cancers. Treatment consists of the following:
              • Surgical removal of the tumor or polyp (polypectomy) or colectomy
              • Radiation therapy, chemotherapy, targeted drug therapies, and immunotherapy