Gastrointestinal Cancer Treatment

Surgery

Surgery for gastrointestinal cancers is indicated for stages 0, I, II and III cancers and surgical removal is often considered the primary treatment for cancer. It involves the complete removal of the primary tumour along with a margin of healthy tissue to ensure that there are no residual cancer cells. The surgical procedure depends to a large degree on the spread of cancer through the tract wall, to other organs or to the lymph nodes. If infected, lymph nodes and adjoining organs are removed along with the gastrointestinal cancer. In some cases, surgery is combined with radiotherapy or chemotherapy.

Procedure

Gastrointestinal cancer surgeries are performed under general anaesthesia. Some of the common surgeries are mentioned below.

Oesophagectomy

Oesophageal cancer surgery aims at treating cancer by surgically removing the whole (total oesophagectomy) or part of the oesophagus (oesophagectomy) and the surrounding tissue that is affected. The remaining oesophagus is then reattached to the stomach. Surgery for oesophageal cancer can be performed by either an open approach or minimal invasively using laparoscopy.

Gastrectomy

Gastrectomy is the removal of the stomach to treat gastric cancer. It can be subtotal gastrectomy, where only a part of the stomach is removed, or total or radical gastrectomy, where the whole stomach is freed from the surrounding tissue, cut and carefully removed. The remaining part of the stomach is joined to the bowel.

Pancreatectomy

Pancreatectomy is the removal of the entire or part of the pancreas. There are many types of pancreatectomy. Also known as pancreaticoduodenectomy, the Whipple procedure involves the removal of the head (wide part) of the pancreas along with parts of the gallbladder, small intestine, bile duct, and sometimes a part of the stomach. The remaining structures are reconnected so that enzymes and bile can flow normally into the intestine. Distal pancreatectomy is usually performed when cancer is found in the middle or tapering end of the pancreas. Total pancreatectomy or complete resection is opted when the tumor extends across the pancreas.

Cholecystectomy

Cholecystectomy is surgery to treat cancers of the gallbladder. The procedure may also involve the removal of parts of other neighbouring organs such as the liver, common bile duct, pancreas, small intestine and/or lymph nodes.

Hepatectomy

Hepatectomy is surgery to remove the liver along with some of the healthy tissue around it. It may involve the excision of only a part or the whole liver, in which case a healthy liver is transplanted to replace the diseased one.

Endoscopic mucosal resection (EMR)

The endoscopic mucosal resection (EMR) procedure is indicated to treat gastrointestinal cancer that has spread to the lining of the tract. Your surgeon inserts an gastroscope (a thin long tube with a light source and camera) through the mouth to the cancerous growth present in the oesophagus, stomach or upper small intestine. Cancers in the colon are reached by a colonoscope inserted through the anus. Surgical tools are passed through the scope to perform EMR to remove the cancerous tissue. The surgery is non-invasive as it does not involve any cuts on the body.

Palliative surgeries

Palliative surgeries are performed to provide relief from symptoms, prevent or help control cancer. Some examples of palliative surgeries include the placement of a stent to open up a blocked duct or bypassing a tumour so food or other substances can flow freely.

Post–operative information

After the surgery, you will be shifted to the recovery room until the sedative effect has worn off. Avoid driving for at least few days after surgery. The post-operative guidelines differ for different cancer surgeries. For gastrectomy you may be recommended vitamin B12 injections as absorption of vitamin B12 occurs through the upper part of the stomach. Inform your doctor immediately if you experience fever, chills, vomiting, black or bright red bowel, fainting and shortness of breath after surgery.

Benefits of this approach

The biggest benefit of gastrointestinal cancer surgery is the ability to completely remove the cancer. For extensive cancers, surgery is indicated to remove cancer cells to a maximum extent making it easier to be treated with other therapies such as chemo or radiation therapy. Surgery can also be used to treat symptoms of cancer and in many cases prevent/control its growth.

Preparation

You may be instructed not to eat or drink or smoke anything before the procedure. If the procedure is performed in the colon your surgeon will prescribe a solution for you the day before surgery to cleanse your bowel. Your surgeon will review your daily medications and may instruct you on the medications that you need to avoid.

Outcome

Surgery may be the only reliable option for a curative treatment. However, as with any procedure, gastrointestinal cancer surgery may involve certain risks and complications which include bleeding, infection, leakage from the newly connected region after excision, formation of blood clots, damage to nearby organs, frequent heartburn and vitamin deficiencies.

Post-op stages of recovery and care plan

After the procedure you will be given specific instructions with regard to your diet. You are advised not to lift heavy objects for some time after the surgery. The care plan varies depending upon the type of surgery and location of cancer.

For gastrectomy your doctor may refer you to a nutritionist to plan your diet and you need to eat more often with small meals as the size of the new stomach is smaller.

Down-time - lifestyle or off work duration

You can gradually resume your daily activities after the surgery.

Costs

Any costs involved will be discussed with you prior to your surgery.

Research

Extensive research is being done to find better treatment options for gastrointestinal cancer. Some of the recent studies have found that:

• Treatment of resectable gastric cancer. Therap Adv Gastroenterol. 2012 Jan; 5(1): 49–69doi:10.1177/1756283X11410771.¹
• Improving the outcomes in gastric cancer surgery. World J Gastroenterol. 2014 Oct 14; 20(38): 13692–13704doi:10.3748/wjg.v20.i38.13692;Published online 2014 Oct 14. ²
• Stem cells in gastrointestinal cancers: The road less travelled. World J Stem Cells. 2014 Nov 26; 6(5): 606–613 doi:10.4252/wjsc.v6.i5.606;Published online 2014. ³
• Tumor markers in colorectal cancer, gastric cancer and gastrointestinal stromal cancers: European group on tumor markers 2014 guidelines update. Int J Cancer. 2014 Jun 1; 134(11): 2513–2522 doi:10.1002/ijc.28384; Published online 2013 Aug 27. ⁴