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Cancer is a disease caused by the uncontrolled division and survival of abnormal cells in a particular part of the body.When this type of abnormal cell growth occurs within the Gastrointestinal (GI) tract, it is classified as GI cancer. There are 5 major types of Gastrointestinal Cancer:

Colorectal Cancer starts in the colon and/or rectum. They are grouped together as they share many similar features. Most colorectal cancers begin as noncancerous, or benign, polyps on the inner lining of the colon or rectum.2 Individuals diagnosed with a chronic inflammatory bowel disease (IBD) are at approximately twice the risk of developing Colorectal Cancer, as compared to people in the general population.3

Liver Cancer starts within the cells of the liver. While other cancers may affect the liver, only cancers that begin in the liver are classified as liver cancer, also known as Primary Liver Cancer. The most common type of liver cancer is Hepatocellular Carcinoma.2

Gastric Cancer starts in the stomach. While Gastric Cancer, also known as stomach cancer, can develop anywhere within the organ, most stomach cancers typically develop in the mucus producing cells in the stomach’s inner lining, known as Adenocarcinoma.2 

Pancreatic Cancer starts in the tissue in the pancreas. The pancreas sits directly behind the stomach and is responsible for the production of enzymes for digestion and hormones to regualte blood sugar levels. There are two types of cells present in the pancreas, exocrine and endocrine, both of which form different types of tumors.2

Esophageal Cancer occurs in the esophagus. The esophagus is a hollow, muscular tube, directly behind the trachea (windpipe), that helps move food from the back of the throat to the stomach.2

Other types of GI cancers include: Anal Cancer, Small Intestine Cancer, Gastrointestinal Stromal Tumors (GIST), Gallbladder Cancer, and Biliary Tract Cancer.2 A small percentage of gastrointestinal cancers are genetically inherited. 

Gastrointestinal cancers are more likely to develop in men, and that risk increases with age. Studies have linked these cancers to cigarette smoking, alcohol consumption, and unhealthy diets.

Specific underlying conditions may result in tumor growth, like gastroesophageal reflux disease (GERD), Helicobacter pylori infection, diabetes, inflammatory bowel disease, hepatitis B or C virus infection, or hepatic cirrhosis.4

Signs and Symptoms of Cancer

The most common symptoms of Colorectal cancer are: 5

  • Weight loss                           
  • Abdominal pain         
  • Abdominal cramping         
  • Diarrhea                               
  • Constipation
  • Narrowing of the stool
  • Anemia   
  • Fatigue                                 
  • Rectal Bleeding 
  • Blood in the stool (appearing black or dark brown)
  • Weakness

The most common symptoms of Liver cancer are: 5

  • Weight loss 
  • Loss of appetite
  • Feeling very full after a small meal
  • Nausea
  • Vomiting
  • An enlarged liver or feeling fullness under the ribs on the right side
  • An enlarged spleen or feeling fullness under the ribs on the left side
  • Pain in the abdomen
  • Pain near the right shoulder blade
  • Abdominal swelling
  • Itching
  • Jaundice

The most common symptoms of Gastric cancer, also known as stomach cancer, are: 5

  • Poor appetite
  • Weight loss
  • Abdominal pain
  • Discomfort in the abdomen, usually above the navel
  • A sense of fullness in the upper abdomen after eating a small meal
  • Heartburn
  • Indigestion
  • Nausea
  • Vomiting, with or without blood
  • Abdonimal swelling 
  • Blood in the stool
  • Anemia

Often, early pancreatic cancer does not cause any signs or symptoms. By the time symptoms arise, pancreatic cancer has typically already spread outside the pancreas. 

However, some symptoms may appear, such as: 5

  • Jaundice
  • Back pain
  • Abdominal pain
  • Weight loss
  • Poor appetite 
  • Nausea
  • Vomitting
  • Gall bladder or liver enlargement
  • Blood clots
  • Diabetes

The most common symptoms of esophageal cancer are: 5

  • Trouble swallowing
  • Chest pain
  • Weight loss
  • Loss of voice
  • Chronic cough
  • Vomiting
  • Bone pain (if cancer has spread to the bone)
  • Esophageal bleeding (blood then passes through the digestive tract, which may turn the stool black)
  • Anemia
  • Fatigue

Symptoms may vary depending on the location and severity of the disease.

Treatments for Cancer

Cancer is often treated with surgery, chemotherapy, radiation therapy, or targeted therapy or a combination of them. When the tumor is easy to reach, surgery may be all that’s necessary. When it’s harder to reach or its removal would significantly affect gastrointestinal function, then chemotherapy, radiation therapy or targeted therapy may be tried first.

Surgery involves complete removal of the tumor, along with some surrounding tissue. Often a procedure called anastomosis, to restore function of the esophagus or stomach,  may be performed to connect the remaining healthy portions of the organ. In some cases, liver cancer patients could be eligible for organ transplants.

For some with severe cases of gastrointestinal cancers that can’t be effectively treated, doctors may aim to alleviate symptoms rather than cure the disease.4

Treatment for colorectal cancer may vary depending upon location, symptoms, severity, comorbidities, and reaction to previous medications or therapies.  

Always consult a doctor prior to beginning or receiving any treatment. 

Surgery for Early-Stage
If the cancer is small and contained, surgeons may be able to remove polyps during a colonscopy, also known as a polypectomy. A surgeon can also remove pieces of the inner mucosal lining of the colon, known as a endoscopic mucosal resection, with special tools. For polyps that can’t be removed during a colonoscopy, a surgeon may recommend laproscopic surgery to remove the cancerous polyps. Laproscopic surgery is a minimally invasive surgery where the surgeon performs the operation through several small incisions in the abdominal wall, inserting instruments with attached cameras, while watching on video monitor. 9

Surgery for Advanced-stage 
If the cancer is very advanced, not responding to other treatments, or creating blockages within the intestine, asurgeon may recommend an operation to relieve that blockage of the colon, remove sections affected by cancer, or other conditions in order to improve symptoms. A surgeon can perform many different types of surgeries to remove the affected piece colon and or rectum.9 They can elect to perform one of the following surgeries: 8

  • Heliocolectomy – removal of the ascending  (right) or descending (left) portion of the colon
  • Proctocolectomy – removal of both the colon and rectum
  • Partial Colectomy – often called a subtotal colectomy or bowel resection, it involves removal of part of the colon 
  • Total Colectomy – removal of the entire colon 

Sometimes, following a partial colectomy, the bowel tissue may need some additional time to heal before reattachment, so a temporary ostomy is needed. During a proctolectomy, total colectomy, or heliocolectomy, where large portions of the colon are removed, the ostomy will be permanent.15

To perform ostomy surgery, the surgeon makes an opening through the skin of the abdomen and connects the bowel to that opening, called a stoma. Stool passes out of the body through the opening into a disposable bag, called an ostomy pouch. This is attached with a skin safe adhesive over the stoma to collect the stool.15

Chemotherapy
Administered orally or intravenously, chemotherapy drugs seek to destroy tumor cells that may have broken away from original tumor and could begin to grow again elsewhere in the body as they travel through the bloodstream. Chemotherapy may be used at different times during treatment for colorectal cancer after surgery (adjuvant) and before surgery (neoadjuvant), sometimes with radiation.  Chemotherapy may also be delivered into the body in different means, either through systemic or regional chemotherapy.7  

  • Systemic chemotherapy – medications are administered into the blood through a vein or taken by mouth. The medications enter the bloodstream and reach almost all areas of the body.
  • Regional chemotherapy – medications are administered into an artery that leads to the part of the body with the cancer. This focuses the chemo on the cancer cells in that area, reducing side effects by limiting the amount of drug reaching the rest of your body. 

Chemotherapy medications that are given through intravenous injection can be administered over minutes or as an infusion over a longer period of time. This can be done in a doctor’s office, infusion center, or a hospital.7

Radiation Therapy
Using powerful energy sources, such as X-rays, radiation therapy seeks to kill cancer cells. It is sometimes used to shrink large polyps before surgery so that they may be removed more easily. When surgery isn’t an option, radiation therapy may be used to relieve symptoms. Radiation may, sometimes, be used in combination with chemotherapy, a treatment called chemoradiation.9

Different types of radiation therapy can be used to treat colorectal cancer:10

  • External-beam radiation therapy (EBRT) – used most often for people with colorectal cancer, radiation is focused on the cancer from a machine outside the body, similar to an x-ray but with more intense radiation. 
  • Brachytherapy (Internal radiation therapy) – a radioactive source is placed inside the rectum into or near the tumor, allowing the radiation to reach the rectum without passing through the skin and other tissues. Two common forms of brachytherapy are endocavitary radiation therapy and interstitial brachytherapy.
  • Radioembolization – done by injecting miscrospheres, tiny beads coated with an radioactive isotope, into the body near the site of the cancer, the beads lodge in the blood vessels nearby where they administer small amounts of radiation to the site for several days.11

Treatments for primary liver cancer depend on the severity of the disease as well as age, overall health, comorbidities, and reaction to previous medications or therapies.

Always consult a doctor prior to beginning or receiving any treatment. 

Early-stage Treatments
Typically used when the cancer is found in early stages, these treatments are surgery, ablation, and some radiation therapies.

Surgery
There are two types of surgery used to treat liver cancer, partial hepatectomy or transplantation. 

    • Partial hepatectomy – removal of part of the liver affected by the cancer. Only people with good liver function, who are healthy enough for surgery, and a single tumor that has not grown into blood vessels can have this operation.
    • Transplantation – removal of the liver and replacing it with a healthy liver from a deceased donor or a portion of a healthy liver from a living donor.

Most patients with liver cancer in the United States also have cirrhosis, or fibrosis (scarring) of the liver.16 With severe cirrhosis, removing even a small amount of the patient’s liver tissue might not leave enough to perform important functions. To avoid this, doctors may assess liver function by assigning a Child-Pugh score before proceeding with the liver transplant. It is a measure of cirrhosis based on labs and symptoms, placing patients into classifications of A (most likely), B (less likely), or C (not an option). There are three primary limitations to the use of Child-Pugh:17

    • Grading requires a subjective assessment
    • It does not account for renal function
    • There are only ten different scores available.  

This last limitation is significant because patients are not able to be adequately differentiated based on the severity of the disease, and therefore wait time for transplants had a considerable impact on prioritization.17 Therefore, a new prognostic score, the HCC-model for end-stage liver disease (HCC-MELD), was developed to improve risk stratification of dropout in patients with hepatocellular carcinoma. HCC-MELD makes a numerical calculation based on the following information:18

    • How effectively liver excretes bile
    • How well the liver can produce blood clotting factors 
    • The current function of the kidney 
    • Amount of sodium present
    • Amount of alpha-fetoprotein present19
    • Tumor size 19

Ablative Treatments
Ablation is a treatment that destroys the cancerous tumor rather than removing it. When surgery is not an option, these procedures may be used in patients with few small tumors. There are four major types of ablation used in the treatment of liver cancer. 21

    • Percutaneous ethanol injection – also known as ethanol ablation, ethanol is injected directly into the liver to destroy the cancer cells. Generally safe, if the alcohol escapes from the liver, however, a person may experience brief but severe pain. This option may take multiple injections but is rarely used and has been largely replaced by RFA.
    • Radiofrequency ablation – or RFA, is performed by a doctor inserting a thin, needle-like probe into the tumor through the skin. A high-frequency current is then passed through the needle, which heats the tumor and destroys the cancer cells.
    • Microwave ablation – uses electromagnetic waves to heat and destroy the tumor using a probe.
    • Cryoablation – or cryotherapy, a probe is guided into the tumor where very cold gasses are passed through the probe to freeze the tumor causing the cancer cells to die.

Radiation Therapy
Radiation therapy uses high-energy rays to kill cancer cells. It may not be a good option for some patients with severely damaged livers by conditions such as hepatitis or cirrhosis. 20

    • External-beam radiation therapy (EBRT) – radiation is focused on the cancer from a machine outside the body, similar to an x-ray but with more intense radiation. 
    • Stereotactic body radiation therapy (SBRT) – uses precisely focused beams of high-dose radiation aimed at the tumor from many different angles, allowing treatment to be completed in a short-time compared to EBRT.

Advanced-stage Treatment

Chemoembolization
There are two types of chemoembolization that are typically utilized during the treatment of liver cancer: 22

    • Trans-arterial chemoembolization – or TACE,  is used when liver cancer cannot be treated with surgery or ablation by combininig embolization with chemotherapy, medications are administered through the catheter directly into the artery. The artery is then blocked up to ensure the medication stays close to the tumor.
    • Drug-eluting bead chemoembolization – or DEB-TACE, is essentially the same as TACE except that the artery is blocked after drug-eluting beads, tiny beads that contain a chemotherapy drug, are injected. 

Radioembolization

Radioembolization is performed by injecting miscrospheres, tiny beads coated with a radioactive isotope, into the body near the site of the cancer, the beads lodge in the blood vessels nearby where they administer small amounts of radiation to the site for several days. 22

Treatment for gastric cancer, also known as stomach cancer,  may vary depending upon location, symptoms, severity, comorbidities, and reaction to previous medications or therapies.  

Always consult a doctor prior to beginning or receiving any treatment. 

Surgery
Surgery is a treatment option for many stages of gastric cancer (0-3), depending upon the patients overall health. The type of operation usually depends on what part of the stomach the cancer is in, how much cancer is in the surrounding tissue, and stage of the cancer. There are 5 types of surgery that can be used to treat stomach cancer: 30

  • Endoscopic resection – performed by a surgeon passing an endoscope down the throat and into the stomach. Surgical tools are then passed through the endoscope to remove the tumor and part of the normal stomach wall around it. There are two types of endoscopic rescection:
    • Endoscopic mucosal resection
    • Endoscopic submucosal resection
  • Subtotal gastrectomy – or partial gastrectomy,part of the stomach is removed. Part of the esophagus or the duodenum may be removed as well. 
  • Total gastrectomy – removal of the entire stomach, nearby lymph nodes, and omentum. The spleen, parts of the esophagus, intestines, pancreas, or other nearby organs may be removed as well. The end of the esophagus is then attached to part of the small intestine.
  • Lymphadenectomy – removal of lymph nodes. This is often performed during total and subtotal gastrectomies. In the USA, it is recommended that at least 15 lymph nodes are removed, also known as a D1 lymphadenectomy. However, in Japan, surgeons have had very high success by removing even more lymph nodes near the cancer, referred to as a D2 lymphadenectomy.
  • Placement of a feeding tube – a jejunostomy tube, or a J tube, is a tube that is placed into the intestine at the time of gastrectomy through the skin of the abdomen. Liquid nutrition is put directly into the intestine, via the tube, to help prevent and treat malnutrition. 

Chemotherapy
Treatment will depend on the type of stomach (gastric) cancer, its stage, and the patients overall health. Administered by mouth or intravenously, patients may recieve one or more medications during treatment. Chemotherapy may also be used at different times during treatment, after surgery (adjuvant) and before surgery (neoadjuvant). 31

Radiation Therapy
Using powerful energy sources, such as X-rays, radiation therapy seeks to kill cancer cells. It is sometimes used to shrink cancer before surgery so that they may be removed more easily. When surgery isn’t an option, radiation therapy may be used to relieve symptoms. Radiation may, sometimes, be used in combination with chemotherapy, a treatment called chemoradiation. 32

  • External-beam radiation therapy (EBRT) – radiation is focused on the cancer from a machine outside the body, similar to an x-ray but with more intense radiation. Specific types of EBRT are often used to treat gastric cancer, such as: 33
    • Three-dimensional conformal radiation therapy (3D-CRT) 
    • Intensity modulated radiation therapy (IMRT)

Treatment for pancreatic cancer may vary depending upon location, symptoms, severity, comorbidities, and reaction to previous medications or therapies.  

Always consult a doctor prior to beginning or receiving any treatment. 

Surgery
Depending on the stage, size, and location of the tumor, patients may have one of the following types of surgery: 44

  • Pancreaticoduodenectomy – also called the Whipple procedure, it removes the head of the pancreas along with lymph nodes surrounding it, the duodenum, gallbladder, part of the bile duct, and the pylorus. This operation is typicall done through a large incision down the middle of the abdomen, however, it can be performed laparoscopically.
  • Pylorus-preserving pancreaticoduodenectomy – also called the modified Whipple procedure, it removes the head of the pancreas and surrounding lymph nodes, however the pylorus is not removed. 
  • Distal pancreatectomy – removal of the tail of the pancreas. Occasionally, some of the body of the pancreas, along with the spleen, may be removed.  
  • Total pancreatectomy – removal of the entire pancreas along with surrounding lymph nodes, the pylorus, part of the bile duct, duodenum, and gall bladder. The spleen may also be removed.
  • Bypass surgery – surgery to reroute the flow of bile from the bile duct directly into the small intestine, bypassing the pancreas and, often, the duodenum. Bypass surgery won’t remove the pancreatic cancer, but it may help relieve the symptoms.45

Ablative Treatments
Ablation is a treatment that destroys the cancerous tumor rather than removing it. When surgery is not an option, these procedures may be used in patients with few small tumors. There are four major types of ablation used in the treatment of pancreatic cancer: 47

    • Percutaneous ethanol injection – also known as ethanol ablation, ethanol is injected directly into the tumor to destroy the cancer cells. 
    • Radiofrequency ablation – or RFA, is performed by a doctor inserting a thin, needle-like probe into the tumor through the skin. A high-frequency current is then passed through the needle, which heats the tumor and destroys the cancer cells.
    • Microwave ablation – uses electromagnetic waves to heat and destroy the tumor using a probe.
    • Cryoablation – or cryotherapy, a probe is guided into the tumor where very cold gasses are passed through the probe to freeze the tumor causing the cancer cells to die.

Chemotherapy
Treatment will depend on the stage of pancreatic cancer and the patients overall health. Administered by mouth or intravenously, patients may recieve one or more medications during treatment. Chemotherapy may also be used at different times during treatment, after surgery (adjuvant) and before surgery (neoadjuvant). 46

Radiation Therapy
Using powerful energy sources, such as X-rays, radiation therapy seeks to kill cancer cells. It is sometimes used to shrink cancer before surgery so that they may be removed more easily. When surgery isn’t an option, radiation therapy may be used to relieve symptoms. Radiation may, sometimes, be used in combination with chemotherapy, a treatment called chemoradiation.48  The most commonly used radiation therapy is: 

  • External-beam radiation therapy (EBRT) – radiation is focused on the cancer from a machine outside the body, similar to an x-ray but with more intense radiation. A specific type of EBRT may be used to treat pancreatic cancer, known as: 49
    • Stereotactic body radiation therapy (SBRT)

Treatment for esophageal cancer may vary depending upon location, symptoms, severity, comorbidities, and reaction to previous medications or therapies.  

Always consult a doctor prior to beginning or receiving any treatment. 

Surgery
For esophageal cancer in early stages, surgery can be used to try to remove the cancer and some of the normal surrounding tissue. It may also be combined with other treatments. There are four major types of surgery that may be used in the treatment of esophageal cancer: 36

  • Endoscopic mucosal resection – some of the inner lining of the esophagus is removed with instruments passed through an endoscope. Following this procedure, proton pump may be prescibed inhibitors to suppress acid production in the stomach. 
  • Esophagectomy – removal of a portion of the esophagus. Esophagectomy can be performed in different ways, depending upon location of the disease:
    • Open esophagectomy – the surgeon operates through one or more large incisions in the neck, chest, or abdomen. There are two primary types of open esophagectomy:
      • Transhiatal esophagectomy – incisions made in the neck and abdomen.
      • Transthoracic esophagectomy – incisions made in the chest and abdomen.
    • Laparoscopic esophagectomy – a minimally invasive procedure, the esophagus is removed through several small incisions instead of large incisions aided by the use of a laparoscope, a thin, tube-like instrument with a light and lens for viewing.
  • Esophagogastrectomy – removal of part of the esophagus and the upper portion of your stomach
  • Lymphadenectomy – removal of lymph nodes. Often performed alongside esophagectomy and esophagogastrectomy operations. Typically, at least 15 lymph nodes are removed during surgery. 

Photodynamic Therapy
Porfimer sodium (Photofrin), a photosensitizing agent, is injected into a vein. Over a period of days, the drug collects in the cancer cells. Using an endoscope, a special wavelength of light is then focused on the cancer. This light activates the drug, producing a form of oxygen, that kills the cancer cells. The dead cells may then be removed a few days later during an upper endoscopy. 42 43

Ablative Treatments
Ablation is a treatment that destroys the cancerous tumor rather than removing it. When surgery is not an option, these procedures may be used in patients with few small tumors. There are four major types of ablation used in the treatment of esophageal cancer: 42

  • Radiofrequency ablation – or RFA, is performed by a doctor inserting a thin, needle-like probe into the tumor through the skin. A high-frequency current is then passed through the needle, which heats the tumor and destroys the cancer cells.
  • Laser ablation – a neodymium: yttrium-aluminum-garnet (Nd:YAG) laser is aimed at the cancer through the tip of an endoscope to destroy the cancer. This treatment may need to be repeated, as the cancer often grows back. 
  • Electrocoagulation – uses a probe passed through the end of an endoscope to burn the affected with an electric current.   
  • Argon plasma coagulation – or APC, uses a probe, equipped with ionized argon gas and a high-voltage spark, passed through the end of an endoscope to evenly treat the affected area. 

Chemotherapy
Treatment will depend on the type of esophageal cancer, its stage, and the patients overall health. Administered by mouth or intravenously, patients may recieve one or more medications during treatment. Chemotherapy may also be used at different times during treatment, after surgery (adjuvant) and before surgery (neoadjuvant). 37

Radiation Therapy
Using powerful energy sources, such as X-rays, radiation therapy seeks to kill cancer cells. It is sometimes used to shrink cancer before surgery so that they may be removed more easily. When surgery isn’t an option, radiation therapy may be used to relieve symptoms. Radiation may, sometimes, be used in combination with chemotherapy, a treatment called chemoradiation. Some commonly used radiation therapies are: 38

  • External-beam radiation therapy (EBRT) – radiation is focused on the cancer from a machine outside the body, similar to an x-ray but with more intense radiation.
  • Brachytherapy (Internal radiation therapy) – a radioactive source is placed inside the esophagus into or near the tumor, allowing the radiation to reach the rectum without passing through the skin and other tissues

Medicines

Medicines used to treat GI cancer varies, depending on the type of cancer. Some therapies are designed to kill cancer cells; others aim to stop the cancer cells from growing, attack their abnormalities, or decrease the chance of them returning.

Always consult a doctor prior to beginning or receiving any medications.

Chemotherapy
A chemotherapy schedule, or regimen, usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or a combination of different drugs given at the same time. Some of the most common chemotherapy medications used are: 12

  • Capecitabine (Xeloda)
  • Fluorouracil (5-FU)
  • Irinotecan (Camptosar)
  • Oxaliplatin (Eloxatin)
  • Trifluridine/tipiracil (Lonsurf)

Targeted therapy
Targeted therapy targets the specific genes, proteins, or the tissue environment that contributes to the cancer’s growth and survival. This treatment seeks to stop the growth and spread of cancer cells while limiting damage to healthy cells. There are three common types of targeted therapy: 12

  • Anti-angiogenesis therapy – focused on stopping angiogenesis, or the process of making new blood vessels. Some commonly prescribed anti-angiogenesis therapies are:
      • Bevacizumab (Avastin)
      • Regorafenib (Stivarga)
      • Ziv-aflibercept (Zaltrap)
      • Ramucirumab (Cyramza)
  • Epidermal growth factor receptor (EGFR) inhibitors – block the activity of proteins called epidermal growth factor receptors.13 Some commonly prescribed EGFR inhibitiors are:12
      • Cetuximab (Erbitux)
      • Panitumumab (Vectibix)
  • Tumor-agnostic treatment – focuses on the cancer’s genetic and molecular features without regard to the cancer type or where the cancer started in the body.14 A commonly prescribed tumor-agnostic treatment is:12
      • Larotrectinib (Vitrakvi)

Immunotherapy
Also known as biologic therapy, immunotherapy is designed to boost the body’s natural defenses to fight the cancer, using biologic materials to improve, target, or restore immune system function. Some commonly prescribed immunotherapies are:12

  • Pembrolizumab (Keytruda)
  • Nivolumab (Opdivo)
  • Ipilimumab (Yervoy)

Chemotherapy
A chemotherapy schedule, or regimen, usually consists of a specific number of cycles given over a set period of time. However, most chemotherapy medications do not have a significant effect on liver cancer. A patient may receive one drug at a time or a combination of different drugs given at the same time. Recent advances have shown that a combination of drugs may be more helpful, yet even those combintations shrink a small number of tumors and response is often short. Some of the most commonly prescribed chemotherapy medications are: 23

    • Gemcitabine (Gemzar)
    • Oxaliplatin (Eloxatin)
    • Cisplatin
    • Doxorubicin (pegylated liposomal doxorubicin)
    • 5-fluorouracil (5-FU)
    • Capecitabine (Xeloda)
    • Mitoxantrone (Novantrone)

Chemotherapy can be delivered in a few different ways to treat liver cancer: systemic chemotherapy, regional chemotherapy, and hepatic artery infusion. 23

  • Systemic chemotherapy – drugs are administered through intravenous injection or taken by mouth
  • Regional chemotherapy – medications are injected into an artery that leads to the part of the body with the tumor.
  • Hepatic artery infusion – surgery is needed to put an infusion pump under the skin of the abdomen, attached to a catheter that connects to the hepatic artery. Medication is injected through the skin into the pumps reservoir and released slowly into the hepatic artery.

Targeted therapy
Targeted therapy targets the specific genes, proteins, or the tissue environment that contributes to the cancer’s growth and survival. This treatment seeks to stop the growth and spread of cancer cells while limiting damage to healthy cells. There are two primary types of targeted therapies used to combat liver cancer: 24

  • Kinase inhibitors – a substance that blocks a type of enzyme called a kinase. Human cells have many different kinases, and they help control important functions, such as cell signaling, metabolism, division, and survival. Blocking them may help keep the cancer cells from growing, and may also block the growth of new blood vessels that tumors need to grow.25  Some commonly prescribed kinase inhibitors are: 24
    • Sorafenib (Nexavar)
    • Lenvatinib (Lenvima)
    • Regorafenib (Stivarga)
    • Cabozantinib (Cabometyx)
  • Anti-angiogenesis therapy – focused on stopping angiogenesis, or the process of making new blood vessels. Some commonly prescribed anti-angiogenesis therapies are: 24
    • Bevacizumab (Avastin)
    • Ramucirumab (Cyramza) 

Immunotherapy
Also known as biologic therapy, immunotherapy is designed to boost the body’s natural defenses to fight the cancer, using biologic materials to improve, target, or restore immune system function. 20

  • PD-1 inhibitors – target the PD-1 protein, a protein found on T cells that helps keep the body’s immune responses in check.26 When PD-1 is bound to another protein called PD-L1, it helps keep T cells from killing other cells, including cancer cells. Blocking this protein can help boost the immune response against cancer cells. Some commonly prescribed PD-1 inhibitor is:29
    • Pembrolizumab (Keytruda)
    • Nivolumab (Opdivo)
  • PD-L1 inhibitors – target the PD-L1 protein, a protein that acts like a “brake” to keep the body’s immune responses under control.27 Blocking this protein can help boost the immune response against cancer cells. A commonly prescribed PD-L1 inhibitor is: 29
    • Atezolizumab (Tecentriq)
  • CTLA-4 inhibitors – target CTLA-4, a protein found on T cells that helps keep the body’s immune responses in check. When CTLA-4 is attached to another protein called B7, it helps keep T cells from killing other cells, including cancer cells. 28 A commonly prescribed CTLA-4 inhibitor is: 29
    • Ipilimumab (Yervoy)

Chemotherapy
A chemotherapy schedule, or regimen, usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or a combination of different drugs given at the same time. Some of the most common chemotherapy medications used are: 34

  • Cisplatin 
  • Oxaliplatin (Eloxatin)
  • Fluorouracil (5-FU, Efudex)
  • Capecitabine (Xeloda)
  • Docetaxel (Taxotere)
  • Epirubicin (Ellence)
  • Irinotecan (Camptosar)
  • Paclitaxel (Taxol)

Targeted therapy
Targeted therapy targets the specific genes, proteins, or the tissue environment that contributes to the cancer’s growth and survival. This treatment seeks to stop the growth and spread of cancer cells while limiting damage to healthy cells.35  There are two primary types of targeted therapies used to combat stomach cancer: 34

  • HER2-targeted therapy – targets a protein called human epidermal growth factor receptor 2 (HER2). This type of cancer is called HER2-positive cancer. The most commonly prescribed HER2 therapy is:
    • Trastuzumab (Herceptin)
  • Anti-angiogenesis therapy – focused on stopping angiogenesis, or the process of making new blood vessels. The most commonly prescribed anti-angiogenesis therapy is:
    • Ramucirumab (Cyramza)

Immunotherapy
Also known as biologic therapy, immunotherapy is designed to boost the body’s natural defenses to fight the cancer, using biologic materials to improve, target, or restore immune system function. Because immunotherapy works in a different way than traditional chemotherapy, it may be effective when chemotherapy does not work. A commonly prescribed immunotherapy is:

  • Pembrolizumab (Keytruda) – targets the PD-1 protein, a protein found on T cells that helps keep the body’s immune responses in check. When PD-1 is bound to another protein called PD-L1, it helps keep T cells from killing other cells, including cancer cells. Blocking this protein can help boost the immune response against cancer cells. 31

Chemotherapy
A chemotherapy schedule, or regimen, usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or a combination of different drugs given at the same time. Some of the most common chemotherapy medications used are: 46

  • Gemcitabine (Gemzar)
  • 5-fluorouracil (5-FU)
  • Oxaliplatin (Eloxatin)
  • Albumin-bound paclitaxel (Abraxane)
  • Capecitabine (Xeloda)
  • Cisplatin
  • Irinotecan (Camptosar)
  • Liposomal Irinotecan (Onivyde)
  • Paclitaxel (Taxol)
  • Docetaxel (Taxotere)

Targeted therapy
Targeted therapy targets the specific genes, proteins, or the tissue environment that contributes to the cancer’s growth and survival. This treatment seeks to stop the growth and spread of cancer cells while limiting damage to healthy cells. There are three primary types of targeted therapies used to combat pancreatic cancer: 50

  • NTRK inhibitors – targets abnormal NTRK gene fusion, a mutation that occurs when a piece of the chromosome, containing NTRK, breaks off and joins with a gene on another chromosome, leading to abnormal proteins called TRK fusion proteins, which may cause cancer cells to grow. The most commonly prescribed NTRK inhibitors are: 50
    • Entrectinib (Rozlytrek) 
    • Larotrectinib (Vitrakvi)
  • EGFR inhibitors – block the activity of a protein called epidermal growth factor receptor (EGFR).13  The most commonly prescribe EGFR inhibitor is: 50
    • Erlotinib (Tarceva)
  • PARP inhibitors – block an enzyme in cells called PARP, or poly (ADP-ribose) polymerase, which helps repair DNA when it becomes damaged. Blocking PARP may cause cancer cells to die by keeping them from repairing their damaged DNA.51 The most commonly prescribe PARP inhibitor is: 50
    • Olaparib (Lynparza)

Immunotherapy
Also known as biologic therapy, immunotherapy is designed to boost the body’s natural defenses to fight the cancer, using biologic materials to improve, target, or restore immune system function. PD-1 inhibitors are commonly used in the treatment of individuals with pancreatic cancer.

  • PD-1 inhibitors – target the PD-1 protein, a protein found on T cells that helps keep the body’s immune responses in check.26 When PD-1 is bound to another protein called PD-L1, it helps keep T cells from killing other cells, including cancer cells. Blocking this protein can help boost the immune response against cancer cells. A commonly prescribed PD-1 inhibitor is: 52
    • Pembrolizumab (Keytruda)

 

Chemotherapy
A chemotherapy schedule, or regimen, usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or a combination of different drugs given at the same time. Some of the most common chemotherapy medications used are: 37

  • Carboplatin 
  • Paclitaxel (Taxol)
  • Oxaliplatin
  • Capecitabine (Xeloda)
  • Cisplatin (Platinol AQ)
  • 5-fluorouracil (5-FU) 
  • Irinotecan (Camptosar)

Targeted therapy
Targeted therapy targets the specific genes, proteins, or the tissue environment that contributes to the cancer’s growth and survival. This treatment seeks to stop the growth and spread of cancer cells while limiting damage to healthy cells.  There are three primary types of targeted therapies used to combat esophageal cancer: 39

  • HER2-targeted therapy – targets a protein called human epidermal growth factor receptor 2 (HER2). This type of cancer is called HER2-positive cancer. The most commonly prescribed HER2 therapy is:
    • Trastuzumab (Herceptin)
  • Anti-angiogenesis therapy – focused on stopping angiogenesis, or the process of making new blood vessels. The most commonly prescribed anti-angiogenesis therapy is:
    • Ramucirumab (Cyramza) 
  • NTRK inhibitors – targets abnormal NTRK gene fusion, a mutation that occurs when a piece of the chromosome, containing NTRK, breaks off and joins with a gene on another chromosome, leading to abnormal proteins called TRK fusion proteins, which may cause cancer cells to grow. The most commonly prescribed NTRK inhibitors are: 39
    • Entrectinib (Rozlytrek) 
    • Larotrectinib (Vitrakvi)

Immunotherapy
Also known as biologic therapy, immunotherapy is designed to boost the body’s natural defenses to fight the cancer, using biologic materials to improve, target, or restore immune system function. PD-1 inhibitors are commonly used in the treatment of individuals with esophageal cancer.

  • PD-1 inhibitors – target the PD-1 protein, a protein found on T cells that helps keep the body’s immune responses in check.26 When PD-1 is bound to another protein called PD-L1, it helps keep T cells from killing other cells, including cancer cells. Blocking this protein can help boost the immune response against cancer cells. Some commonly prescribed PD-1 inhibitors are: 41
    • Pembrolizumab (Keytruda)
    • Nivolumab (Opdivo)
  1. World Health Organization. 2020. Cancer. [online] Available at: <https://www.who.int/health-topics/cancer#tab=tab_1>.
  2. Compass Oncology. 2020. What Are Gastrointestinal (GI) Cancers? | Compass Oncology. [online] Available at: <https://compassoncology.com/disease-drug-info/types-of-cancer/gastrointestinal-gi-cancers/#:~:text=Gastrointestinal%20(GI)%20cancer%20is%20a,biliary%20system%2C%20and%20small%20intestine.>.
  3. American Cancer Society. “Colorectal Cancer Facts & Figures 2017-2019.” American Cancer Society, 2017, www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2017-2019.pdf.
  4. “Gastrointestinal Cancers: Symptoms, Diagnosis And Treatment”. Yale Medicine, 2020, https://www.yalemedicine.org/conditions/gastrointestinal-cancers/.
  5. “Find A Cancer Type”. Cancer.Org, 2020, https://www.cancer.org/cancer/all-cancer-types.html.
  6. Colon Cancer Treatment. 2020, https://www.hopkinsmedicine.org/health/conditions-and-diseases/colon-cancer/colon-cancer-treatment.
  7. “Colorectal Cancer Chemotherapy | Chemo For Colon & Rectal Cancer”. Cancer.Org, 2020, https://www.cancer.org/cancer/colon-rectal-cancer/treating/chemotherapy.html.
  8. “Colectomy – Mayo Clinic”. Mayoclinic.Org, 2020, https://www.mayoclinic.org/tests-procedures/colectomy/about/pac-20384631#:~:text=Total%20colectomy%20involves%20removing%20the,both%20the%20colon%20and%20rectum.
  9. “Colon Cancer – Diagnosis And Treatment – Mayo Clinic”. Mayoclinic.Org, 2020, https://www.mayoclinic.org/diseases-conditions/colon-cancer/diagnosis-treatment/drc-20353674.
  10. “Radiation Therapy For Colorectal Cancer | Radiation For Colorectal Cancer”. Cancer.Org, 2020, https://www.cancer.org/cancer/colon-rectal-cancer/treating/radiation-therapy.html.
  11. “Ablation And Embolization For Colorectal Cancer”. Cancer.Org, 2020, https://www.cancer.org/cancer/colon-rectal-cancer/treating/ablation-embolization.html.
  12. “Colorectal Cancer – Types Of Treatment”. Cancer.Net, 2020, https://www.cancer.net/cancer-types/colorectal-cancer/types-treatment.
  13. “NCI Dictionary Of Cancer Terms”. National Cancer Institute, 2020, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/egfr-inhibitor.
  14. “NCI Dictionary Of Cancer Terms”. National Cancer Institute, 2020, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/tumor-agnostic-therapy.
  15. “Colostomy For Colorectal Cancer | Michigan Medicine”. Uofmhealth.Org, 2020, https://www.uofmhealth.org/health-library/uh1593.
  16. “Cirrhosis – Symptoms And Causes”. Mayo Clinic, 2020, https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487#:~:text=Cirrhosis%20is%20a%20late%20stage,it%20tries%20to%20repair%20itself.
  17. Tsoris, Andrea, and Clinton Marlar. “Use Of The Child Pugh Score In Liver Disease”. Ncbi.Nlm.Nih.Gov, 2020, https://www.ncbi.nlm.nih.gov/books/NBK542308/.
  18. “Understanding The MELD Score | Penn Medicine”. Pennmedicine.Org, 2020, https://www.pennmedicine.org/updates/blogs/transplant-update/2020/may/understanding-the-meld-score.
  19. Guerrini, Gian Piero et al. “Value of HCC-MELD Score in Patients With Hepatocellular Carcinoma Undergoing Liver Transplantation.” Progress in transplantation (Aliso Viejo, Calif.) vol. 28,1 (2018): 63-69.
  20. “Liver Cancer – Types Of Treatment”. Cancer.Net, 2020, https://www.cancer.net/cancer-types/liver-cancer/types-treatment.
  21. “Ablation For Liver Cancer”. Cancer.Org, 2020, https://www.cancer.org/cancer/liver-cancer/treating/tumor-ablation.html.
  22. “Embolization Therapy For Liver Cancer”. Cancer.Org, 2020, https://www.cancer.org/cancer/liver-cancer/treating/embolization-therapy.html.
  23. “Chemotherapy For Liver Cancer”. Cancer.Org, 2020, https://www.cancer.org/cancer/liver-cancer/treating/chemotherapy.html.
  24. “Targeted Drug Therapy For Liver Cancer”. Cancer.Org, 2020, https://www.cancer.org/cancer/liver-cancer/treating/targeted-therapy.html.
  25. “NCI Dictionary Of Cancer Terms”. National Cancer Institute, 2020, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/kinase-inhibitor.
  26. “NCI Dictionary Of Cancer Terms”. National Cancer Institute, 2020, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/pd-1.
  27. “NCI Dictionary Of Cancer Terms”. National Cancer Institute, 2020, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/pd-l1.
  28. “NCI Dictionary Of Cancer Terms”. National Cancer Institute, 2020, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/ctla-4.
  29. “Immunotherapy For Liver Cancer”. Cancer.Org, 2020, https://www.cancer.org/cancer/liver-cancer/treating/immunotherapy.html.
  30. “Stomach Cancer Surgery | Stomach Cancer Operation”. Cancer.Org, 2020, https://www.cancer.org/cancer/stomach-cancer/treating/types-of-surgery.html.
  31. Stomach Cancer Treatment. 2020, https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/stomach-cancer-treatment#chemotherapy.
  32. “Stomach Cancer – Diagnosis And Treatment – Mayo Clinic”. Mayoclinic.Org, 2020, https://www.mayoclinic.org/diseases-conditions/stomach-cancer/diagnosis-treatment/drc-20352443.
  33. “Radiation Therapy For Stomach Cancer | Gastric Cancer Radiation”. Cancer.Org, 2020, https://www.cancer.org/cancer/stomach-cancer/treating/radiation-therapy.html.
  34. “Stomach Cancer – Types Of Treatment”. Cancer.Net, 2020, https://www.cancer.net/cancer-types/stomach-cancer/types-treatment.
  35. “Targeted Therapy For Stomach Cancer – Canadian Cancer Society”. Www.Cancer.Ca, 2020, https://www.cancer.ca/en/cancer-information/cancer-type/stomach/treatment/targeted-therapy/?region=qc.
  36. “Surgery For Esophageal Cancer | Esophagus Cancer Surgery”. Cancer.Org, 2020, https://www.cancer.org/cancer/esophagus-cancer/treating/surgery.html.
  37. “Chemo For Esophageal Cancer | Esophagus Cancer Chemo”. Cancer.Org, 2020, https://www.cancer.org/cancer/esophagus-cancer/treating/chemotherapy.html.
  38. “Esophageal Cancer – Diagnosis And Treatment – Mayo Clinic”. Mayoclinic.Org, 2020, https://www.mayoclinic.org/diseases-conditions/esophageal-cancer/diagnosis-treatment/drc-20356090.
  39. “Targeted Therapy For Esophageal Cancer | Targeted Drugs”. Cancer.Org, 2020, https://www.cancer.org/cancer/esophagus-cancer/treating/targeted-therapy.html.
  40. “Esophageal Cancer – Diagnosis And Treatment – Mayo Clinic”. Mayoclinic.Org, 2020, https://www.mayoclinic.org/diseases-conditions/esophageal-cancer/diagnosis-treatment/drc-20356090.
  41. “Esophageal Cancer Immunotherapy | Esophagus Cancer Immunotherapy”. Cancer.Org, 2020, https://www.cancer.org/cancer/esophagus-cancer/treating/immunotherapy.html.
  42. “Esophageal Cancer Endoscopic Treatments | Endoscopic Treatment”. Cancer.Org, 2020, https://www.cancer.org/cancer/esophagus-cancer/treating/endoscopic-treatments.html.
  43. “Photodynamic Therapy For Cancer”. National Cancer Institute, 2020, https://www.cancer.gov/about-cancer/treatment/types/surgery/photodynamic-fact-sheet.
  44. “Treatments For Pancreatic Cancer – Canadian Cancer Society”. Www.Cancer.Ca, 2020, https://www.cancer.ca/en/cancer-information/cancer-type/pancreatic/treatment/?region=qc.
  45. “Surgery For Pancreatic Cancer”. Cancer.Org, 2020, https://www.cancer.org/cancer/pancreatic-cancer/treating/surgery.html.
  46. “Chemotherapy For Pancreatic Cancer”. Cancer.Org, 2020, https://www.cancer.org/cancer/pancreatic-cancer/treating/chemotherapy.html.
  47. “Ablation Or Embolization Treatments For Pancreatic Cancer”. Cancer.Org, 2020, https://www.cancer.org/cancer/pancreatic-cancer/treating/ablative-techniques.html.
  48. “Radiation Therapy For Pancreatic Cancer”. Cancer.Org, 2020, https://www.cancer.org/cancer/pancreatic-cancer/treating/radiation-therapy.html.
  49. “External Beam Radiation Therapy For Cancer”. National Cancer Institute, 2020, https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy/external-beam.
  50. “Targeted Therapy For Pancreatic Cancer”. Cancer.Org, 2020, https://www.cancer.org/cancer/pancreatic-cancer/treating/targeted-therapy.html.
  51. “NCI Dictionary Of Cancer Terms”. National Cancer Institute, 2020, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/parp-inhibitor.
  52. “Immunotherapy For Pancreatic Cancer”. Cancer.Org, 2020, https://www.cancer.org/cancer/pancreatic-cancer/treating/immunotherapy.html.