Multidisciplinary Care Team Approach
After an initial diagnosis of gastrointestinal cancer, you’ll need to be seen by many specialists. Our Gastrointestinal Cancer Multidisciplinary Clinic brings the specialists to you by scheduling all of these appointments in one place over one to two days. This streamlined approach allows you to stay in one place during initial cancer treatment conversations.
This approach is convenient for you and allows all of our specialists to develop an individualized treatment plan in real time, thus creating a faster start to the treatment process. Our team will continue to discuss your progress and adjust the plan as needed throughout the treatment process.
Our multidisciplinary team includes gastrointestinal cancer experts in the following areas:
- Medical oncology
- Radiation oncology
- Surgery
- Genetics
- Nutrition/dietary services
- Social work
- Enterostomal therapy
- Others, as needed
You will find your way through cancer treatment with the help of our nurse navigator. A nurse navigator is a registered nurse that is your primary point of contact. You can contact the nurse navigator with questions or ask for help communicating with their care team.
Our nurse navigator assists patients by:
- Bridging the gap between cancer screening, diagnosis and treatment.
- Summarizing treatment plan and outlining next steps.
- Coordinating care appointments.
- Facilitating communication to the physician and surgeon.
- Answering questions about test results, side effects and treatment options.
- Providing individualized education.
- Guiding patients to medical and community resources, such as support groups.
- Following up with patients after appointments or after treatment is complete.
If you have been diagnosed with a form of GI cancer, you will be contacted by the Gastrointestinal Cancer Multidisciplinary Clinic nurse navigator to schedule appointments with our care team.
Gastrointestinal Cancer Treatment Options
At Carle Cancer Institute, the latest state-of-the-art treatments and technologies are available to our patients. It is important to remember that different types of cancers require different treatments based on a variety of factors. For this reason, your treatment plan will be designed to meet the needs and requirements of your specific type of cancer.
Colorectal cancer is a cancer that develops in the tissues of the colon and/or rectum. If your cancer began in the colon, which is the first four to five feet of the large intestine, it may be referred to as colon cancer. If the cancer began in the rectum, which is the last several inches of the large intestine leading to the anus, it is called rectal cancer.
Colorectal cancer starts in the inner lining of the colon and/or rectum, slowly growing through some or all of its layers. Typically it starts as a growth of tissue called a polyp. If that polyp develops into cancer it is referred to as an adenoma.
The stage of colorectal cancer is one of the most important factors in evaluating treatment options. Diagnostic tests determine the stage of the cancer, which may include endoscopic procedure, biopsy, MRI, ultrasound, CT, PET Scan and laboratory blood tests.
Your doctors will create an individualized cancer treatment plan for you that depends upon:
- Exact location of tumor
- Stage of cancer
- Patient's age
- General health of patient
Patients and doctors will confer to carefully consider cancer treatment options, while considering how the treatment might change a patient's appearance, speech ability, and eating and breathing. There is much to consider, and each step will be carefully analyzed for the best interest of the patient.
Different types of treatment are available for patients with colon cancer. Some treatments are standard (the currently used cancer treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new cancer treatments for patients.
Surgery
Gastrointestinal tumors treated with surgery approaches include: colon, rectal, esophagus, stomach, small intestine, pancreas, bile ducts, gallbladder and liver.
Cancer surgery is utilized for a variety of measures including: diagnosing cancer, relieving symptoms and removing tumors.
Surgery is the most common treatment for gastrointestinal tumors. During the procedure, the surgeon may remove part of or the entire tumor. The ultimate goal of surgery is to remove any visible cancer. At the same time, lymph nodes near the tumor are removed during surgery so that they can be checked for cancer cells.
Types of surgery for gastrointestinal tumors include:
- Endoscopic mucosal resection
- Local excision
- Partial gastrectomy
- Small bowel resection
- Pancreaticoduodenectomy (Whipple procedure)
- Segmental colon resection or hemicolectomy
Gastrointestinal surgical approaches include:
Minimally invasive surgery technique/laparoscopic surgery: This is the use of a viewing tube with a lens or camera inserted through a small incision in order to examine organs and remove tissue. When appropriate, minimally invasive techniques may be utilized. These include robotic and/or laparoscopic techniques which result in less scarring, discomfort and faster recovery time.
In some instances, chemotherapy or radiation therapy before surgery is used to help shrink the tumor. These treatments are often used after surgery as well to help kill residual tumor cells.
Doctors and researchers are looking at combinations of surgery, chemotherapy and radiation therapy to see what combination has the most beneficial effect.
Chemotherapy
Chemotherapy is the use of anti-cancer drugs designed to slow or stop the growth of rapidly dividing cancer cells in the body. Chemotherapy may be used as a primary treatment to destroy cells; before another treatment to shrink the tumor; after another treatment to destroy any remaining cancer cells; or to relieve symptoms of advanced cancer.
Chemotherapy can be delivered orally, intravenously, topically, injection, or direct placement (lumbar puncture).
Treatment options will depend on the stage and type of cancer, and may include: FOLFOX (oxaliplatin, leucovorin, 5FU); Irinotecan, oral capecitabine.
Monoclonal antibody therapy is a targeted drug therapy bioengineered proteins that help leverage the body’s natural immune response to recognize, attack, and destroy colorectal cancer cells. Monoclonal antibodies can be used alone or in combination with colorectal cancer chemotherapy. The following are monoclonal antibody therapy agents; Bevacizumab (Avastin) - aims to prevent the growth of new blood vessels to tumors. This agent will starve the tumor of the nutrients it needs to grow; Cetuximab (Erbitux) – this agent binds to a protein and blocks growth signals from reaching the colorectal cancer cells, stopping the growth and division of cancer cells; Panitumumab (Vectibix) – also binds to a protein and blocks growth signals from reaching the colorectal cancer cells, stopping the growth and division of cancer cells.
Other targeted drugs used to treat advanced colorectal cancer include ziv-aflibercept (Zaltrap) and regorafenib (Stivarga).
Managing chemotherapy side effects:
While chemotherapy targets cancer cells, it can also damage healthy cells and cause unpleasant side effects, such as nausea, vomiting, hair loss, fatigue and mouth sores. Our dedicated care team will provide a variety of integrative oncology services to help you prevent or manage side effects throughout your chemotherapy treatment.
Radiation Therapy
Radiation oncology aims to reduce tumors by creating chemical changes within cancer cells. Because it is highly localized, radiation therapy produces limited side effects and is one of the most precise treatment options available. Radiation therapy may be delivered in one of the following forms:
Intensity-modulated radiation therapy (IMRT)
A form of external beam therapy which breaks the radiation into thousands of thin beams to better target the cancer and minimize effects on surrounding tissue.
Image-guided radiation therapy (IGRT)
One of the most cutting edge innovations in fighting cancer, combining imaging and treatment capabilities on a single machine.
3-D conformal radiation therapy
Uses CT, MRI or PET technology to more precisely target cancerous tumors gauging width, height and depth; 4-D conformal radiation therapy includes respiratory gating, which monitors the patient's breathing and respiratory cycle to determine the exact moment to deliver the most effective radiation treatment.
