Cancer

DIGESTIVE TRACT CANCERS
The NO. 1 Clinical Medical College

of Three Gorges University
Xiong Zhang-e
Epidemiology of digestive tract
cancers in India
 The incidence rates of most digestive cancers in India
are moderate or low.
 The highest rates are recorded in the urban population
of Mumbai and the lowest in the rural population of
Barshi in Maharashtra state.
 The rates will rise as the life expectancy of Indians
increases along with urbanization and, within the next
few decades, may reach those recorded in Indians
living abroad.
cancers in India
 Based on available population data, we
estimate that in the year 2001 there will be
approximately 145,000 new cases of digestive
cancers in India.
cancers in India
145,000 new cases in men
gall bladder 5%
pancreas 7%
esophagus esophagus 30%

stomach colon 9%
rectum
liver
colon liver 10%
pancreas
gall bladder
rectum 12%
stomach 27%
cancers in India
145,000 new cases in women
gall
bladder
13% esophagus
esophagus pancreas
stomach 6% 32%
rectum colon
liver 10%
colon
liver
pancreas 7%
gall bladder stomach
rectum 20%
12%
esophageal cancer
 The risk for esophageal cancer was 3.5 times higher
with alcohol consumption, 2.5 times higher for
tobacco users, and 2.8 times higher each for betel nut
chewers and smokers. The calculated odds ratio for
the social habits and diet factors was significant
amongst cases of cancer esophagus.
 CONCLUSION: Alcoholism, smoking, and chewing
of tobacco are factors predisposing to esophageal
cancer in India
WHAT IS ESOPHAGEAL CANCER?
 The esophagus is a muscular tube that extends

from the neck to the abdomen and connects the
mouth to the stomach.
 Cancer, or a malignant tumor, is the result of

uncontrolled growth of cells located in a
particular region of the body.
 The lining of the esophagus is the most
common region for cancers of the esophagus
to begin.
 Most of the length of the esophageal is lined with

squamous cells, which, if they degenerate into a
malignant tumor, give rise to squamous cell cancer.
 The very bottom portion of the esophagus and the
region where the esophagus and stomach join are
lined with columnar cells that can give rise to
malignant tumors called adenocarcinomas.
 Other rare forms of esophageal cancer include
sarcoma and small cell cancer.
HOW COMMON IS ESOPHAGEAL
CANCER?
 Esophageal cancer is not nearly as common as
cancers of the breast, lung, prostate, or colon.
 In the U.S. we expect an annual incidence of
esophageal cancer of between 12,000 and
18,000 new cases.
HOW COMMON IS ESOPHAGEAL
CANCER?
 It's difficult to state a more exact number because
there is some controversy about whether cancers of
the small region where the esophagus and stomach
join should be considered esophageal cancer or
stomach cancer.
 Interestingly, it's this region which gives rise to
cancers that are increasing in frequency faster than
any other type of cancer in the U.S.
WHAT CAUSES ESOPHAGEAL CANCER?
 The causes for esophageal cancer in the U.S.

differ depending in what type of cancer is
being considered.
 The risk factors for squamous cell cancer
include smoking tobacco and heavy use of
alcohol.
 People who are infected with human papilloma
virus are also at increased risk.
WHAT CAUSES ESOPHAGEAL
CANCER?
 Those who suffer from achalasia (a benign
esophageal disease), chronic scarring of the
esophagus due to prior injury, or tylosis (a rare
genetic disorder) are also at increased risk.
 The risk factors for adenocarcinoma are less well
understood. People who have Barrett's esophagus, an
abnormal lining of the bottom part of the esophagus
that is related to acid reflux problems, are at increased
risk, as are people who have longstanding acid reflux
problems alone.
WHO GETS ESOPHAGEAL CANCER?
 Most people who develop esophageal cancer

are in their 50's to 70's.
 In the U.S. squamous cell cancers develop
more often in men than they do in women, and
are more common among African-Americans
than among Caucasians.
WHO GETS ESOPHAGEAL CANCER?
 This is likely due to the higher incidence of

specific risk factors in this population than to
any increased risk based on race.
 Adenocarcinomas are more common among
men than women and are much more likely to
occur in Caucasions than in minorities.
WHAT ARE THE SYMPTOMS OF
ESOPHAGEAL CANCER?
 The most common symptom of esophageal

cancer is difficulty swallowing, or the sticking
of food before it gets into the stomach.
 This is usually a progressive problem which
begins initially when large pieces of poorly
chewed food are swallowed, but can worsen to
the point that thin liquids won't go down easily.
WHAT ARE THE SYMPTOMS OF
ESOPHAGEAL CANCER?
 Esophageal cancer may also cause weight loss,
pain with swallowing, regurgitation of
undigested food, and bleeding manifested by
vomiting blood or passing old blood with
bowel movements.
HOW DO I KNOW IF I HAVE
ESOPHAGEAL CANCER?
 The main symptoms of esophageal cancer,

including difficulty swallowing and weight
loss, should prompt a visit to your physician.
 There is no simple way to determine whether
you have esophageal cancer.
HOW DO I KNOW IF I HAVE
ESOPHAGEAL CANCER?
 Tests are usually necessary to determine
whether there is a growth (or tumor) in the
esophagus that is creating problems with
swallowing.
 If such a problem is identified, a biopsy is
necessary to confirm the diagnosis.
WHAT EVALUATION IS APPROPRIATE
TO DIAGNOSE ESOPHAGEAL CANCER?
 In someone who is suspected of having esophageal

cancer, several tests are appropriate.
 An endoscopy is usually the first step in evaluation.
 This is an outpatient test performed under sedation in
which a flexible telescope is passed through your
mouth and down your esophagus into your stomach.
 The telescope permits the physician

performing the test to look at the lining of the
esophagus and take a small bite of tissue, or
biopsy, of any areas that look suspicious.
 The tissue is looked at under a microscope to
determine whether there is cancer present.
 Other common tests include an x-ray of the

esophagus and stomach performed while swallowing
a liquid that shows up on x-rays, giving your
physician a picture of the lining of your esophagus.
 Most patients will also undergo computed
tomography, or a CT scan, of the chest and abdomen
to get a picture of the lungs, liver, and other organs
surrounding the esophagus.
HOW IS STAGING OF ESOPHAGEAL
CANCER PERFORMED?
 If an esophageal cancer is diagnosed, staging

is the process that physicians use to determine
how advanced the cancer is and whether the
cancer has spread.
 Depending on the type of cancer, specific
staging tests are performed aimed at
investigating the most common areas for that
cancer to spread.
CANCER PERFORMED?
 For esophageal cancer, the common areas of
spread are the lymph glands (or lymph nodes),
lungs, liver, adrenal glands, kidneys, bones,
and lining of the chest and abdomen.
CANCER PERFORMED?
 The CT scan of the chest and abdomen is
useful to evaluate the lungs, liver, and adrenal
glands for spread from an esophageal cancer,
but is not much good for looking at lymph
nodes for potential cancer spread.
 The main tumor and adjacent lymph nodes are
sometimes evaluated using endoscopic
ultrasonography, or EUS.
CANCER PERFORMED?
 This is an endoscopic test that utilizes a special
telescope which emits ultrasound waves that
can produce a picture of the tumor and
surrounding lymph nodes.
 A bone scan is sometimes performed to
determine whether the cancer has spread to the
bones.
CANCER PERFORMED?
 An experimental staging test is PET scanning,
which currently is being assessed for its
usefulness in evaluating esophageal cancer.
HOW IS ESOPHAGEAL CANCER
TREATED?
 The treatment of any cancer depends in part on

the stage of cancer at the time it is diagnosed.
 Other considerations include the overall
condition of the patient and specific symptoms
the patient is having.
TREATED?
 Most cancers of the esophagus are diagnosed
at a relatively late stage because symptoms of
swallowing difficulty don't begin until many
months after the cancer begins to grow.
TREATED?
 For patients in whom the cancer has not spread to
other organs, and thus is potentially curable, surgery
to remove the majority of the esophagus is the main
form of therapy.
 Many patients also receive chemotherapy
(intravenous drug therapy) and radiotherapy (x-ray
treatments) after surgery although there is little
information to prove that these additional treatments
are useful.
TREATED?
 Many cancers centers are investigating the
usefulness of giving chemotherapy and
radiotherapy prior to surgery for patients who
are potentially curable.
TREATED?
 For patients who are found to have cancer
spread to other organs or who, for some other
reason, can't have surgery, combined
chemotherapy and radiotherapy is the most
common treatment.
TREATED?
 Since swallowing difficulties are not always
immediately relieved by this combined therapy, other
means to improve swallowing are available.
 These include stretching the esophagus, burning or
melting the tumor away using laser treatment, or
placement of a flexible tube (or stent) inside the
esophagus to maintain the swallowing passage.
WHAT IS THE PROGNOSIS FOR
ESOPHAGEAL CANCER?
 The likelihood of being cured of cancer

depends in large part on the stage of the cancer
at the time it is diagnosed.
 From 80% to 90% of patients with the earliest
stage of esophageal cancer can expect to be
alive and cancer free 5 years after treatment.
WHAT IS THE PROGNOSIS FOR
ESOPHAGEAL CANCER?
 However, since the typical esophageal cancer
is discovered at a relatively advanced stage,
the overall success rate in curing esophageal
cancer is disappointing.
stomach cancer
 The stomach is part of
the digestive system. It
is located in the upper
abdomen, under the ribs.
The upper part of the
stomach connects to the
esophagus, and the
lower part leads into the
small intestine.
What is stomach cancer?
 Stomach cancer is the result of cell changes in the
lining of the stomach. In Western Europe, stomach
cancer is only about one third as common as it was 50
years ago.
 The location of the tumours within the stomach has
also changed. It used to be that most of the tumours
were located near where the stomach joins the small
bowel, now the commonest site is close to the
junction with the oesophagus (gullet).
 Stomach cancer is very common in Japan and the
Japanese have developed an intensive and effective
approach to screening for stomach cancer.
What causes stomach cancer?
 The causes of stomach cancer continue to be debated.
A combination of heredity (the genes inherited from
your parents) and environment (diet, smoking, etc)
are all thought to play a part.
 Milk, fresh vegetables, vitamin C and frozen food all
appear to reduce the risk of stomach cancer. Any kind
of food that has been smoked, pickled or salted
appears to increase the risk.
What causes stomach cancer?
 Other risk factors that have been suggested

include being blood group A, and having the
bacteria Helicobacter pylori in the stomach.
 Stomach cancer is more common in men than
women, and has its peak age range between 40
and 60 years old.
What are the symptoms of stomach
cancer?
 Stomach cancer can grow slowly and
imperceptibly. Sometimes symptoms will only
develop once the disease has spread beyond
the stomach, for example to involve the liver.
In this case, the symptoms would be those of
cancer involving the liver.
cancer?
 There may be internal bleeding appearing as
blood in the vomit, or black, tar-like, faeces, or
the bleeding may be so slight as to pass
undetected, and the patient goes to the doctor
with iron-deficiency anaemia.
 Or there may be vomiting due to the
obstruction of the food passage by the tumour,
which is the first sign that something is wrong.
cancer?
 Excessive belching can be an early, and
embarrassing, symptom.
 This can progress to a sensation of vague
discomfort followed by pain if the tumour
grows through the stomach wall.
cancer?
 As with cancer of the esophagus, it may take a
long time, often many months, from the time
that symptoms first appear to the patient
seeking medical advice.
 This delay may allow time for the tumour to
spread and to progress from being potentially
curable to being inoperable.
How is stomach cancer diagnosed?
 Investigations for cancer of the stomach include:
 X-ray examination, in this case a barium meal. This
involves swallowing a white, chalky liquid and
having a series of X-ray pictures taken of the stomach
area.
 the most important test is a gastroscopy. During a
gastroscopy, the doctor examines the inside of the
stomach using a camera attached to a flexible tube
and is able to take a sample from the tumour for
biopsy and microscopy.
 In Japan, where stomach cancers are detected

much earlier in the course of the disease,
survival rates are higher. This shows the
importance of early diagnosis.
 Unfortunately, in the UK, many patients do not

realise the significance of their symptoms until
the later stages of the disease and this
significantly reduces the chances of cure.
 Chemotherapy has recently been shown to be

highly effective against some forms of
stomach cancer and may help convert an
inoperable tumour into an operable one.
 The regime used is toxic and complicated and,
unfortunately, only a minority of patients are
fit enough to be treated in this way.
How is stomach cancer treated?
 The most effective treatment is surgery and the

sooner the disease is discovered, the better the
chances of a complete recovery. The cure rate
after surgery is about 30 per cent.
 In Japan, where stomach cancers are detected
much earlier in the course of the disease,
survival rates are higher. This shows the
importance of early diagnosis.
 Unfortunately, in the UK, many patients do not

realise the significance of their symptoms until
the later stages of the disease and this
significantly reduces the chances of cure.
 Chemotherapy has recently been shown to be

highly effective against some forms of
stomach cancer and may help convert an
inoperable tumour into an operable one.
 The regime used is toxic and complicated and,
unfortunately, only a minority of patients are
fit enough to be treated in this way.
What is Rectal Cancer?
 The colon and rectum are parts of the body's digestive

system. It removes nutrients from food and stores
waste until it passes out of the body.
 Together, the colon and rectum form a long, muscular
tube called the large intestine (also called the large
bowel).
 The colon is the first 6 feet of the large intestine, and
the rectum is the last 8 to 10 inches.
 Cancer that begins in the colon is called

colon cancer, and cancer that begins in the
rectum is called rectal cancer.
 Cancers affecting either of these two
digestive system organs may also be
referred to as colorectal cancer.
 When colorectal cancer spreads outside the

colon or rectum, cancer cells are often found in
nearby lymph nodes.
 If cancer cells have reached these nodes, they
may also have spread to other lymph nodes,
the liver, or other organs.
Causes & Risk Factors
 The exact causes of rectal cancer are not

known. However, studies show that the
following risk factors of rectal cancer increase
a person's chances of developing this disease:
Rectal Cancer Causes: Who's at Risk?
 Age. Colorectal cancer is more likely to occur

as people get older. More than 90 percent of
people with this disease are diagnosed after
age 50. The average age at diagnosis is in the
mid-60s.
 Diet. Studies suggest that diets high in fat

(especially animal fat) and low in calcium,
folate, and fiber may increase the risk of
colorectal cancer. Also, some studies suggest
that people who eat a diet very low in fruits
and vegetables may have a higher risk of
colorectal cancer. More research is needed to
better understand how diet affects the risk of
colorectal cancer.
 Polyps. Polyps are benign growths on the

inner wall of the colon and rectum. They are
fairly common in people over age 50. Some
types of polyps increase a person's risk of
developing colorectal cancer.
 Personal medical history. Research shows

that women with a history of cancer of the
ovary, uterus, or breast have a somewhat
increased chance of developing colorectal
cancer. Also, a person who has already had
rectal cancer may develop this disease a
second time.
 Family medical history. First-degree relatives

(parents, siblings, children) of a person who
has had colorectal cancer are somewhat more
likely to develop this type of cancer
themselves, especially if the relative had the
cancer at a young age. If many family
members have had colorectal cancer, the
chances increase even more.
 Genetic alterations: Changes in certain genes

increase the risk of colorectal cancer.
 Ulcerative colitis or Crohn's disease. A

person who has had a condition that causes
inflammation of the colon (such as ulcerative
colitis or Crohn's disease) for many years is at
increased risk of developing colorectal cancer.
 Cigarette smoking. A person who smokes

cigarettes may be at increased risk of
developing polyps and colorectal cancer
Recognizing Rectal Cancer
Symptoms
 Common signs and symptoms of colorectal cancer include:
 A change in bowel habits
 Diarrhea, constipation, or feeling that the bowel does not
empty completely
 Blood (either bright red or very dark) in the stool
 Stools that are narrower than usual
 General abdominal discomfort (frequent gas pains, bloating,
fullness, and/or cramps)
 Weight loss with no known reason
 Constant tiredness
 Vomiting
Recognizing Rectal Cancer
Symptoms
 Most often, these symptoms are not due to
rectal cancer. Other health problems can cause
the same symptoms. Anyone with these
potential rectal cancer symptoms should see a
doctor so that any problem can be diagnosed
and treated as early as possible.
Diagnosing Rectal Cancer
 X-rays of the large intestine, such as the
DCBE(double contrast barium enema), can reveal
polyps or other changes.
 A sigmoidoscopy lets the doctor see inside the rectum
and the lower colon and remove polyps or other
abnormal tissue for examination under a microscope.
Diagnosing Rectal Cancer
 A colonoscopy lets the doctor see inside the
rectum and the entire colon and remove polyps
or other abnormal tissue for examination under
a microscope.
 A polypectomy is the removal of a polyp
during a sigmoidoscopy or colonoscopy.
 A biopsy is the removal of a tissue sample for
examination under a microscope by a
pathologist to make a diagnosis
Stages of Rectal Cancer
 Stage 0. The cancer is very early. It is found only in

the innermost lining of the rectum.
 Stage I. The cancer involves more of the inner wall
of the rectum.
 Stage II. The cancer has spread outside the rectum to
nearby tissue, but not to the lymph nodes. (Lymph
nodes are small, bean-shaped structures that are part
of the body's immune system.)
Stages of Rectal Cancer
 Stage III. The cancer has spread to nearby lymph

nodes, but not to other parts of the body.
 Stage IV. The cancer has spread to other parts of the
body. Rectal cancer tends to spread to the liver and/or
lungs.
 Recurrent. Recurrent cancer means the cancer has
come back after treatment. The disease may recur in
the colon or rectum or in another part of the body.
Treatment
 Preparing for Rectal Cancer Treatment

 The doctor develops a rectal cancer treatment
plan to fit each person's needs. Treatment for
rectal cancer depends mainly on the location of
the tumor in the rectum and the stage of the
disease. The doctor can describe the treatment
options and the expected results.
Methods of Rectal Cancer Treatment
 Rectal cancer treatment may involve surgery,

radiation therapy, or chemotherapy. Some
people have a combination of treatments.
 Colon cancer sometimes is treated differently
from rectal cancer.
Methods of Rectal Cancer Treatment
 At any stage of rectal cancer, treatments are

available to control pain and other symptoms,
and to relieve the side effects of therapy.
 This kind of treatment is called supportive care,
symptom management, or palliative care.
What is Gallbladder Cancer?
 Gallbladder cancer is a rare disease in which

malignant (cancer) cells are found in the
tissues of the gallbladder.
 The gallbladder is a pear-shaped organ that
lies just under the liver in the upper abdomen.
 The gallbladder stores bile, a fluid made by the

liver to digest fat. When food is being broken
down in the stomach and intestines, bile is
released from the gallbladder through a tube
called the common bile duct, which connects
the gallbladder and liver to the first part of the
small intestine.
The wall of the gallbladder has 3 main layers of

tissue:
 Mucosal (innermost) layer
 Muscularis (middle, muscle) layer
 Serosal (outer) layer

 Between these layers is supporting connective

tissue. Primary gallbladder cancer starts in the
innermost layer and spreads through the outer
layers as it grows.
Symptoms
 These and other gallbladder cancer symptoms

may be caused by gallbladder cancer or by
other conditions. Only a medical professional
can tell for sure if these symptoms are the
result of gallbladder cancer, so a doctor should
be consulted if any of the following problems
occur:
Symptoms
 Jaundice (yellowing of the skin and whites of

the eyes)
 Pain above the stomach
 Fever
 Nausea and vomiting
 Bloating
 Lumps in the abdomen
Treatment
 Different types of treatments are available for

patients with gallbladder cancer. Some
gallbladder cancer treatments are standard (the
currently used treatment), and some are being
tested in clinical trials. Before starting
gallbladder cancer treatment, patients may
want to think about taking part in a clinical
trial.
Treatment
 A treatment clinical trial is a research study

meant to help improve current treatments or
obtain information on new treatments for
patients with cancer. When clinical trials show
that a new treatment is better than the
"standard" treatment, the new treatment may
become the standard treatment.
Treatment
Three types of standard treatment are used:

 Gallbladder Surgery
 Radiation Therapy
 Chemotherapy
Gallbladder Surgery
 One method of treating gallbladder cancer is

with surgery. Gallbladder cancer may be
treated with a cholecystectomy, surgery to
remove the gallbladder and some of the tissues
around it. Nearby lymph nodes may be
removed.
Gallbladder Surgery
 A laparoscope is sometimes used to guide

gallbladder surgery. The laparoscope is
attached to a video camera and inserted
through an incision (port) in the abdomen.
Gallbladder Surgery
 Surgical instruments are inserted through other

ports to perform the surgery. Because there is a
risk that gallbladder cancer cells may spread to
these ports, tissue surrounding the port sites
may also be removed.
Radiation Therapy for Gallbladder Cancer
 Radiation therapy is a cancer treatment that

uses high-energy x-rays or other types of
radiation to kill cancer cells.
 There are two types of radiation therapy used
to treat gallbladder cancer.
Radiation Therapy for Gallbladder
Cancer
 External radiation therapy uses a machine
outside the body to send radiation toward the
cancer.
 Internal radiation therapy uses a radioactive
substance sealed in needles, seeds, wires, or
catheters that are placed directly into or near
the cancer.
Radiation Therapy for Gallbladder
Cancer
 The way the radiation therapy is given depends
on the type and stage of the gallbladder cancer
being treated.
Chemotherapy for Gallbladder Cancer
 Chemotherapy is a gallbladder cancer

treatment that uses drugs to stop the growth of
cancer cells, either by killing the cells or by
stopping the cells from dividing.
 When chemotherapy is taken by mouth or
injected into a vein or muscle, the drugs enter
the bloodstream and can reach cancer cells
throughout the body (systemic chemotherapy).
Chemotherapy for Gallbladder Cancer
 When chemotherapy is placed directly into the

spinal column, a body cavity such as the
abdomen, or an organ, the drugs mainly affect
cancer cells in those areas.
 The way the chemotherapy is given depends
on the type and stage of the gallbladder cancer
being treated.
What is a Liver Tumor?
 Tumors are abnormal masses of tissue that

form when cells begin to reproduce at an
increased rate. The liver can grow both
noncancerous (benign) and cancerous
(malignant) tumors. Malignant tumors of the
liver fall into two broad categories, those that
start in the liver (primary tumors) and those
that spread to the liver from other sites
(secondary or metastatic tumors).
 The most common primary tumor of the liver

is hepatocellular carcinoma, also known as
hepatoma. This tumor typically occurs in
patients with cirrhosis from chronic hepatitis
or long-term alcohol use.
 Metastatic tumors to the liver can originate

from many different types of cancer. Many of
these tumors are treated with systemic
chemotherapy, although there are cases where
resection of the tumor or other liver-directed
therapy can be curative. Two of the most
common metastatic liver tumors that can be
treated with liver-directed therapy include
colorectal and neuroendocrine neoplasms
What Causes Liver Cancer?
 Cancer develops when healthy liver cells

become abnormal and grow too quickly. The
abnormal cells form a mass called a tumor.
When a tumor has the ability to spread to other
parts of the body, it is called malignant.
Another word for a malignant tumor is cancer.
The exact cause of liver cancer is not known.
Risk factors for primary liver cancer (hepatocellular

carcinoma) include:
 Viral hepatitis B and C
 Alcohol
 Cirrhosis
 Exposure to toxins
 Intake of anabolic steroids
 Non-alcoholic cirrhosis (fatty liver)

 In many patients, liver tumors result from the

spread (metastasis) of another cancer to the
liver through the bloodstream. This spread of
metastatic disease represents the most common
form of cancer in the liver in the United States.
Most commonly, cancer occurring in the colon,
rectum, breast, or kidney may spread to the
liver.
What are the Symptoms of Liver Cancer?
Many patients do not experience symptoms;

the cancer is discovered during routine follow-up
tests for a previous cancer outside of the liver,
or during diagnostic testing for the presence of
cirrhosis or viral hepatitis B or C.
What are the Symptoms of Liver
Cancer?
Symptoms of liver cancer may include:
 Pain
 Fever
 Jaundice
 Indigestion, lack of appetite, nausea, and

weight loss
 Abdominal or leg swelling
Liver Cancer Diagnosis
 These are the tests which are used most

frequently to evaluate liver cancer:
 Blood tests: Some tumors produce measurable

amounts of chemicals known as tumor markers
in the blood. Blood tests to determine the
presence of these markers can be used to help
diagnose or monitor the disease process. Other
tests measure the functions of the liver and
other organs.
 CEA: CEA is a marker that has been found to

be elevated in some patients with colorectal
cancer. Not all patients have elevation in the
CEA, and thus this test is only useful in
patients with known elevation.
 AFP: alpha-feto protein is a marker used in

patients with hepatocellular cancer. Not all
hepatocellular cancers have an elevated AFP.
This marker is only useful in patients with
elevated AFP.
 X-rays: Many different types of x-rays can

been used in the diagnosis and
management of patients with liver cancer.
 Ultrasound (US): This test uses sound waves

to form a picture that can be seen on a small
television screen. The picture can show organs
in the abdomen and possibly the presence of a
tumor. Ultrasound is commonly performed by
placing a probe on the surface of the abdomen.
 Computed tomography (CT) scan: This test

gives detailed pictures of the body and can
show how far the cancer has spread. The CT
scan is the primary test used to determine the
number and size of tumors in the liver and
whether the tumor can be surgically removed.
 Magnetic resonance imaging (MRI): This

test is obtained when further details of the liver
and tumor anatomy are required. Through the
use of a magnetic field, precise images of the
liver can be obtained.
 Paracentesis: With this procedure, a needle is

placed into the abdominal cavity (but not into
the liver) to remove excess abdominal fluid
(ascites). This fluid can be tested for cancer
cells or infection. Sometimes the fluid is
removed in large quantities (for example, 3 to
5 quarts) in order to provide symptomatic
relief.
 Laparoscopy: This test is done in the

operating room under general anesthesia. The
surgeon guides a small camera through a half-
inch incision in the abdomen. The organs in
the abdomen can then be examined directly.
This test is done to find out if the liver tumor
has spread to other parts of the liver or other
organs or structures inside the abdomen.
Liver Cancer Treatment Options
 The treatment of primary and malignant liver

tumors depends on the extent of the disease
within the liver as well as outside the liver, the
overall health of the liver, and the overall
health of the patient. The various options in the
treatment of focal liver masses are as follows:
Surgical options
 Resection (view types)
 Resection with radiofrequency ablation (Resection with RFA)
 Radiofrequency ablation alone (RFA alone)
 Microwave Ablation (MA)
 intra-operative Magnetic Resonance Imaging (iMRI)
 Unroofing and marsupialization
 Fenestration and resection
 Enucleation
 Transplantation
Non-surgical options
 Selective Internal Radiation Therapy (SIRT)
 Hepatic artery infusion (port or pump)
 Embolization and chemoembolization
 Alcohol ablation

Cancer

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Cancer

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DIGESTIVE TRACT CANCERS

The NO. 1 Clinical Medical College

145,000 new cases in men

esophagus esophagus 30%

 The esophagus is a muscular tube that extends

 Cancer, or a malignant tumor, is the result of

 Most of the length of the esophageal is lined with

 The causes for esophageal cancer in the U.S.

 Most people who develop esophageal cancer

 This is likely due to the higher incidence of

 The most common symptom of esophageal

 The main symptoms of esophageal cancer,

 In someone who is suspected of having esophageal

 The telescope permits the physician

 Other common tests include an x-ray of the

 If an esophageal cancer is diagnosed, staging

 The treatment of any cancer depends in part on

 The likelihood of being cured of cancer

 Other risk factors that have been suggested

 In Japan, where stomach cancers are detected

 Unfortunately, in the UK, many patients do not

 Chemotherapy has recently been shown to be

 The most effective treatment is surgery and the

 Unfortunately, in the UK, many patients do not

 Chemotherapy has recently been shown to be

 The colon and rectum are parts of the body's digestive

 Cancer that begins in the colon is called

 When colorectal cancer spreads outside the

 The exact causes of rectal cancer are not

 Age. Colorectal cancer is more likely to occur

 Diet. Studies suggest that diets high in fat

 Polyps. Polyps are benign growths on the

 Personal medical history. Research shows

 Family medical history. First-degree relatives

 Genetic alterations: Changes in certain genes

 Ulcerative colitis or Crohn's disease. A

 Cigarette smoking. A person who smokes

 Stage 0. The cancer is very early. It is found only in

 Stage III. The cancer has spread to nearby lymph

 Preparing for Rectal Cancer Treatment

 Rectal cancer treatment may involve surgery,

 At any stage of rectal cancer, treatments are

 Gallbladder cancer is a rare disease in which

 The gallbladder stores bile, a fluid made by the

The wall of the gallbladder has 3 main layers of

 Muscularis (middle, muscle) layer

 Serosal (outer) layer

 Between these layers is supporting connective

 These and other gallbladder cancer symptoms

 Jaundice (yellowing of the skin and whites of

 Different types of treatments are available for

 A treatment clinical trial is a research study

Three types of standard treatment are used:

 One method of treating gallbladder cancer is

 A laparoscope is sometimes used to guide

 Surgical instruments are inserted through other

 Radiation therapy is a cancer treatment that

 Chemotherapy is a gallbladder cancer

 When chemotherapy is placed directly into the

 Tumors are abnormal masses of tissue that

 The most common primary tumor of the liver

 Metastatic tumors to the liver can originate

 Cancer develops when healthy liver cells