Upper Gastro-Intestinal Cancer Treatment

Cancer of the upper gastro-intestinal (UGI) tract (oesophagus and stomach) affects about 3500 Australians every year. These cancers occur when cells growing in the lining of the oesophagus and stomach grow rapidly and out of control forming a tumour. The cancerous cell can invade through the wall of these organs into surrounding tissues and also spread to neighbouring lymph gland and distant organs such as the liver, lungs, abdominal cavity and bones. These secondary tumours are called metastases.

The UGI tract starts in the neck and goes through the chest into the upper abdomen and thus is a long organ. Consequently tumours arising at different sites can cause different problems depending on if they occur at the start, middle, or end of the UGI tract. They also require and respond to different treatments.

UGI cancer in the neck or chest can present early with symptoms but some stomach cancers can present very late. UGI cancers that have spread to many lymph glands or others organs are seldom curable and have a grave prognosis.

• • What Are the Causes of UGI Cancer?

    The exact cause is not known, however just getting older increases your risk of developing UGI cancer. There are lifestyle factors such as cigarette smoking, alcohol consumption, high fat and low fibre diet and a lack of exercise that are thought to increase the incidence of UGI cancer. People who have longstanding regurgitation and reflux are prone to develop cancer of the lower oesophagus.

  • What are the symptoms of UGI Cancer?

    The most common symptoms of UGI cancer is dysphagia or difficulty in swallowing. This may be accompanied by weight loss, regurgitation and heartburn. Vomiting blood can occur with advanced disease. Other symptoms are chest pain, cough, abdominal pain or swelling.

• • • • • What are the treatments for UGI Cancer?

          The available treatments for UGI cancer depend on the stage at which the cancer has been diagnosed, as well as the general health of the individual. If the cancer is diagnosed very early then surgery may be all that is required.

          If however the cancer is more advanced, initial chemotherapy (drug treatment) and sometimes radiation therapy may be required in addition to surgery. Chemotherapy also has the ability to delay or prevent the spread of cancer to other organs. of the cancer.

          Radiation therapy is used very commonly in combination with chemotherapy as definitive treatment for oesophageal cancer when surgery is both difficult and morbid. Combined chemotherapy and radiation therapy can be used for cancers in the middle and lower oesophagus before surgery is performed to improve the chance of the tumour being completely removed by the surgeon.

          Radiation therapy is also the treatment of choice for incurable patients who have difficulty with swallowing. If the radiation therapy fails to relieve the swallowing problem, insertion of a stent or a wire tube may be required. Radiation therapy in also useful in advanced UGI cancers where bleeding is a problem.

        • What are the side effects of Radiation Therapy?

          Radiation therapy to the chest may be associated with significant side effects, depending on the dose of radiation used and the specific area of the chest receiving radiation dose. Side effects may include, but are not limited to:

          Early side effects (usually occur in the second half of treatment, persisting for a few weeks)

          Oesophagus: Also known as the “gullet”, this tube carries food from your mouth to your stomach. If this area receives radiation it can result in heartburn-type symptoms and pain when swallowing. This is usually managed with local anaesthetic liquids, soluble paracetamol or even liquid morphine. Rarely, patients have difficulty eating or drinking enough to meet their requirements and a fine nasogastric tube is inserted down the nose so that nutrition can be passed directly into the stomach, bypassing the sore area. This tube may be removed a few weeks after treatment.

          Skin: Most patients experience at least some skin redness, usually on the back. Skin ulceration or breakdown is uncommon.

          Heart/Lung: Inflammation of the heart (pericarditis) or lining of the lung (pleurisy) is rare but can result in sharp pain, worse when taking a deep breath. It is not dangerous and settles by itself.

          If treatment includes the abdomen, nausea and vomiting can occur. This side effect can be prevented with anti-emetic drugs given before therapy. Almost all patients having radiation therapy complain of fatigue of some degree which can last for several months after therapy.

          Patients should be encouraged to exercise within moderate limits but also rest where necessary during therapy.

          Late or long-term side effects (side effects well after treatment)

          Late side effects may occur a few months to years after treatment. Depending on the problem it may occur once and then go or may be more persistent over the long term or may come and go over time. The likelihood of developing late side effects from radiation treatment depends on the amount of radiation and the relationship of the tumour to important structures located nearby. Your Radiation Oncologist will explain the potential late side effects of your treatment and how to manage potential side effects in more detail.

          Likely late side effects

          Oesophagus: Narrowing due to scarring, which may cause difficulty swallowing. Dilatation of the oesophagus may be necessary.

          Skin: There may be sustained discolouration of the skin where radiation was given. This can be permanent, though this is usually faint.

          Thyroid: If your upper chest is being treated, this may result in your thyroid gland becoming underactive in the future. This can be detected on blood tests and addressed with hormone tablets if necessary.

          Less likely late side effects

          Lung: Inflammation of the lung (pneumonitis) is uncommon. It can cause a dry cough and usually settles by Itself. There may be permanent scarring (fibrosis) in the lungs which may reduce your ability to exercise.

          Rare late side effects

          Spinal cord: Spinal cord damage is very rare. It can cause tingling. Paralysis is almost never seen since utmost care is taken to keep the dose to the spinal cord low.

          Second cancers: Any exposure to radiation increases the risk of a second cancer developing in that area, usually decades later. This risk is not entirely attributable to radiation received as part of your treatment. All X-rays and scans received over your lifetime contribute to this risk, as does unavoidable exposure to environmental radiation. The risk of a cancer being caused by radiation therapy is in the order of 0.5 – 1% at 10 years.

          Females: Radiation can seriously harm an unborn baby. You must not commence treatment if there is a chance you are pregnant, and you must also take precautions to avoid falling pregnant during treatment. If there is a chance you may be pregnant, you must inform your doctor immediately.