Gastrointestinal oncology is a unique discipline that focuses on the management of gastrointestinal cancers. Esophageal cancer, stomach cancer, liver cancer, and colorectal cancer are the common GI cancers reported in India.

Across the HCG Network, we have a strong team of oncologists who specialise in gastrointestinal oncology and are well-versed in accurately diagnosing, treating, and managing gastrointestinal cancers using modern technologies and new-age treatment approaches.

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What is Gastrointestinal Oncology?

Gastrointestinal oncology is the branch of medicine that deals with the diagnosis and treatment of cancers of the digestive system. Gastrointestinal (GI) cancer is a collective term that refers to cancers that originate in the organs of the GI tract. These cancers can cause a variety of symptoms, such as abdominal pain, bloating, changes in bowel habits, weight loss, and fatigue.

Gastrointestinal cancers, in most cases, may not show any symptoms in the early stages, and if they do, they will be similar to those of many other, less severe GI problems. Therefore, it is important not to ignore any GI symptom that lasts for more than 2 weeks and seek appropriate medical attention as and when necessary.

Types of Gastrointestinal Cancers

Gastrointestinal cancer is a collective term given to all cancers that arise along the gastrointestinal tract. Below are the different types of gastrointestinal cancers:

Esophageal Cancer: Esophageal cancer refers to cancer that arises in the esophagus, which is the tube that connects the throat with the stomach.

Stomach Cancer: Stomach cancer happens when the cells present in the lining of the stomach start dividing abnormally and form a mass.

Small Intestine Cancer: Small intestine cancer refers to tumour formation in the small intestine. This is a rare type of GI cancer.

Colorectal Cancer: Colorectal cancer is a collective term given to the cancers that form in the colon (large intestine) and rectum.

Liver Cancer: When the liver cells start dividing abnormally and form a mass, it is referred to as liver cancer.

Gallbladder Cancer: Gallbladder cancer occurs when the cells present in the gallbladder start dividing abnormally and form a tumour.

Bile Duct Cancer: Bile duct cancer happens when the cells present in the bile duct start dividing uncontrollably, and a tumour is formed.

Management of Gastrointestinal Cancers

The management of gastrointestinal cancers often demands a multidisciplinary approach, wherein specialists from multiple disciplines gather to study the case information, go through the diagnostic reports thoroughly, and come up with a treatment plan, that is specially devised to meet the needs of each individual patient.

At HCG Cancer Hospital, we have a multidisciplinary tumour board, which comprises surgical oncologists, radiation oncologists, medical oncologists, nuclear medicine specialists, radiologists, pain management specialists, rehabilitation specialists, and general physicians. This tumour board reviews each case carefully before recommending a treatment plan that works towards improving survival chances and enhancing the quality of life for the patient.

Diagnosis of Gastrointestinal Cancers

Oncologists recommend a wide array of tests for the diagnosis of gastrointestinal cancers. Also, a complete physical examination and medical history assessment will be done in order to get a better understanding of symptoms and the possible causes of these symptoms. Following are the tests commonly recommended by oncologists for the diagnosis of gastrointestinal cancers.

Lab Tests: Certain lab tests may be recommended to look for specific biomarkers that indicate the presence of gastrointestinal cancers.

Endoscopy: To properly assess the growth of the abnormal masses, the specialists will recommend endoscopy, which involves the insertion of a flexible tube fitted with a camera through the mouth or anus to examine the upper GI tract or lower GI tract for anomalies. This procedure is sometimes used to collect biopsy samples.

Biopsy: A biopsy involves the removal of a small portion of tissue from the suspected area. This tissue is later carefully examined for the presence of cancer cells under a microscope. In most cases, a biopsy helps in arriving at a conclusive diagnosis.

Imaging Tests: Imaging tests, namely MRI scans, PET/CT scans, etc., are recommended to gain more information about the tumour. The exact location, size, stage, and grade, which are some of the crucial parameters required for treatment planning, are obtained through imaging tests. Apart from staging and treatment planning, imaging tests are also helpful in studying the treatment response, restaging, and relapse evaluation.

Treatment of Gastrointestinal Cancers

The treatment plan for gastrointestinal cancers is made after considering various factors, namely the type of cancer, its origin, its stage, its size and shape, the exact location of the tumour, the patient’s age, the patient’s overall health status, and the patient’s preferences. Following are the different treatment options available for gastrointestinal cancers:

Surgery

Surgery is the main line of treatment for gastrointestinal cancers. Surgery aims at the removal of cancerous tissues, and this approach is found to be extremely effective in the management of early-stage GI cancers that are localised. The specialists may recommend open surgery or minimally invasive surgery (laparoscopic and robotic), depending on the factors mentioned earlier. Following are some of the important surgical procedures recommended for GI cancers.

Endoscopic mucosal resection (EMR): This procedure removes the early-stage tumours formed in the lining of the gastrointestinal tract. This is a minimally invasive procedure that can be done through endoscopy.

Endoscopic submucosal dissection (ESD): ESD refers to the minimally invasive surgery that removes the larger tumours formed in the gastrointestinal tract.

Laparoscopic Surgery: Laparoscopic surgery is minimally invasive and is recommended for early-stage GI cancers. During this procedure, smaller incisions are made, and the tumours are removed with the help of specialised tools.

Esophagectomy: This procedure involves the partial or complete removal of the esophagus.

Polypectomy: This procedure removes the polyps formed in the large intestine (colon). The presence of polyps can increase the risk of colon cancer.

Gastrectomy: This surgical procedure removes all or part of the stomach.

Cholecystectomy: This procedure involves the removal of the gallbladder.

Whipple procedure: This is a complex surgery that removes the head of the pancreas, part of the small intestine, the gallbladder, and part of the stomach. This procedure is recommended for the management of pancreatic cancer.

Hepatectomy: The surgical procedure removes the entire or part of the liver.

Colectomy: Colectomy removes the entire or part of the large intestine (colon).

Proctectomy: Proctectomy removes the entire or part of the rectum.

Radiation Therapy

Radiation therapy is one of the most common treatments recommended for gastrointestinal cancers. Radiation therapy can either be administered internally or externally. In order to enhance the overall effectiveness of the treatment, radiation therapy is often administered along with chemotherapy and surgery. Radiation therapy may also be recommended to manage pain in those patients with advanced-stage GI cancers.

Systemic Therapies

Systemic therapies refer to those treatments that find and kill cancer cells throughout the body. Systemic therapies are helpful in ensuring that there are no residual cancer cells left after the treatment and in managing cancers that have spread to other organs. Following are the different systemic therapies available for gastrointestinal cancers:

Chemotherapy: Chemotherapy uses strong drugs to destroy cancer cells. During the treatment of gastrointestinal cancers, chemotherapy may be recommended before or after the surgery to shrink the tumour or destroy the residual cancer cells, respectively.

Immunotherapy: Immunotherapy involves stimulating the patient’s immune system to identify and attack cancer cells. Immunotherapy is often administered along with other treatments for better treatment response.

Targeted Therapy: Targeted therapy works by targeting the specific proteins or other biomolecules that are responsible for the formation and growth of cancer cells. Targeted therapy drugs work by blocking the molecules or pathways that are responsible for cancer growth. As the name implies, targeted therapy specifically targets cancer cells and reduces damage to healthy tissues.