Diagnostic and Treatment Options for Upper GI Cancers

The Lifespan Cancer Institute is an active clinical trials site, committed to providing patients with the latest protocols. Our patients have access to groundbreaking new immunotherapies and other new and emerging cancer treatments at various stages of diagnosis and across many cancer types. Cancer treatments include the latest chemotherapy, biologic agents, radiation oncology, surgery, and image-guided procedures—many of which are not available elsewhere in New England. Our physicians actively participate in the Brown University Oncology Group, a unique regional clinical trials network that provides highly innovative approaches to cancer care.

The Upper Gastrointestinal Multidisciplinary Clinic teams are trained in traditional surgical treatments as well as options that employ the most current technology. We will help the patient understand the diagnosis and choose the best treatment, which may or may not involve surgery. 

• Laparoscopic surgery: Many liver and pancreatic surgeries can now be conducted laparoscopically, employing small "key hole" incisions and the use of a laparoscope, a long fiber-optic cable system, which allows a surgeon to view the affected area.
   

• Benefits: When performed laparoscopically, liver and pancreatic surgery may result in less pain, as well as less scarring, less blood loss, a shorter hospital stay and faster recovery. The surgeon will discuss whether the patient is a candidate for this or the other surgeries.

Tumor ablation destroys a tumor using heat. If a tumor is not able to be surgically removed, the patient may be a candidate to have it eliminated through the use of tumor ablation, which heats it by using either radiofrequency ablation (RFA) or microwave ablation.

Cryoablation can eliminate or shrink tumors by freezing them. Together, they are known as image-guided tumor ablation, or IGTA. With IGTA, a doctor inserts a thin, needle electrode through a tiny puncture in the skin with guidance from CT scan or ultrasound. The energy is then delivered to the tumor. A vast majority of these procedures can be performed with intravenous sedation on an outpatient basis.

Benefits: Tumor ablation causes less trauma to adjacent tissues. There are lower risks of infection and blood loss than with conventional surgery. In the months following tumor ablation, the dead tumor cells are eliminated through the body’s natural healing process. Depending on the patient’s medical situation, tumor ablation may be used in combination with conventional cancer therapies, such as surgery, chemotherapy, and/or radiation therapy, or as sole treatment. Because of its safety, IGTA can be an excellent option for those too frail to tolerate surgery or chemotherapy, and is useful in shrinking tumors to alleviate pain and improve quality of life. Depending on the nature of the cancer, IGTA can be curative or palliative.

Chemoembolization is a minimally invasive treatment for liver cancer that can be used when there is too much tumor to treat with ablation, when the tumor is in a location that cannot be treated with ablation, or in combination with ablation or other treatments.

Radioembolization is very similar to chemoembolization but with the use of radioactive microspheres. This therapy is used to treat both primary and metastatic liver tumors.

Benefits: Catheter-directed therapies use the body's natural "highway" system, the blood vessels, to allow interventional radiologists to access the tumor's actual blood supply. Tiny tubes (catheters) are passed through openings in the skin the size of pencil-points and accurately steered to the tumor, usually within the liver, using X-ray imaging. The active tumor killing agent is then delivered very near or within the tumor, minimizing side-effects. These are usually done as outpatient procedures.