Symptoms, Conditions, Causes and Risk Factors for Upper GI Cancers

Our clinic provides care ranging from basic screening to the most innovative treatments, including state-of-the-art radiation oncology, advanced surgical techniques, advanced technological vascular interventional radiology, and access to investigational therapies.

We provide care for patients who have or are at risk for the following types of cancer:

Esophageal Cancer

The esophagus is the tube that connects the mouth to the stomach. A cancer may form anywhere along the length of the esophagus.

The first sign of esophageal cancer is usually pain with swallowing or a sensation that food is sticking when trying to swallow. First, it becomes difficult to swallow solid foods and then later it may also be difficult to swallow liquids. Trouble swallowing may cause weight loss.

Esophageal cancer is usually diagnosed by a test called an upper endoscopy, which uses a scope to look at the inside of the esophagus. If a tumor is seen in the esophagus, a biopsy is taken. The biopsy tells us if the tumor is cancerous and confirms the diagnosis of esophageal cancer.

After a diagnosis of esophageal cancer, more testing is often needed before starting treatment. Tests may include another endoscopy with ultrasound, a CT scan, or a PET scan. These tests are used to determine the stage of the cancer. The treatment for esophageal cancer depends on tumor stage. Treatment may involve surgery, chemotherapy, radiation therapy, or some combination of those treatments.

Stomach Cancer

Stomach cancer, also called gastric cancer, is a cancer that starts in the stomach. Most stomach cancers develop slowly over many years and therefore symptoms often go undetected.

The cells that form the tumor determine the type of stomach or gastric cancer one has. Most gastric cancers begin in the glandular cells of the stomach and are called adenocarcinoma, the most common form of gastric cancer. Other types of gastric cancer include: Lymphoma, which begins in the immune system, carcinoid cancer, which begins in the hormone-producing cells, and gastrointestinal stromal tumor (GIST), which begins in the tissues of the nervous system. There are other, more rare types of gastric cancer as well.

Common signs and symptoms of stomach cancer may include: fatigue, unintentional weight loss, feeling very bloated or full after eating small amounts of food, severe and persistent heartburn and/or indigestion, persistent nausea and vomiting, and stomach pain.

Tests and procedures used to diagnose gastric cancer may include an upper endoscopy, imaging tests such as a CT scan, and a special X-ray called a Barium Swallow test. Sometimes, exploratory surgery is needed to fully understand the stage and extent of gastric cancer, which helps to determine the best course of treatment. Treatment for gastric cancer may include further surgery, radiation therapy, and chemotherapy.

The goal of surgery is to remove all the gastric cancer and a margin of healthy tissue, if possible. There are several different kinds of surgery for gastric cancer, depending on the stage at which the cancer is found. Removing a portion of the stomach is called a subtotal gastrectomy. Removing the entire stomach is called a total gastrectomy. Lymph nodes may also be removed during surgery so they can be tested for cancer cells. Surgery can also be performed to relieve signs and symptoms of advanced gastric cancer. Part of the stomach can be removed to “bypass” a growing tumor. This particular surgery is considered palliative because it will provide relief of symptoms, but will not cure advanced gastric cancer.

Pancreatic Cancer

Pancreatic cancer affects an estimated 38,000 people each year in the United States. The best results with treatment are achieved when surgery is used for removal of the tumor. Unfortunately, only about 20% of people diagnosed with pancreatic cancer will be a candidate for surgical removal of their tumor at the time of diagnosis. Patients with pancreatic cancer may also be treated with chemotherapy, as well as radiation therapy. Our team reviews each case to design a unique multidisciplinary plan of care that is individualized to provide each patient with the best available treatment.

• Pancreatic neuroendocrine tumors (islet tumors) are more slow growing tumors of the pancreas that can be either benign or cancerous. Symptoms of neuroendocrine tumors may include diarrhea, flushing, light headedness, ulcers, skin rash, low blood sugar, pain or weight loss. Neuroendocrine tumors can be treated using a variety of techniques including surgery to remove the tumor, ablation, embolization, chemotherapy or radiation. Our team will help design a unique, individualized treatment plan that is best for you.
• Pancreatic cysts are fluid collections within the pancreas. These can be benign (e.g., pseudocysts, serous cyst adenoma) or pre-cancerous (e.g., mucinous cystic tumors and intraductal papillary mucinous neoplasms [IPMN]). Pancreatic cysts should be removed when they are large; cause symptoms including pain, inability to eat, or weight loss; or when they have a risk of becoming cancerous. Our team can help determine which type of cyst a patient has and whether or not the patient might benefit from having the cyst removed.

Liver Cancer

Tumors of the liver may be metastatic, meaning they started at a different site (e.g., colon, kidney, etc.) or they may be primary, meaning they arise from within the liver (e.g., hepatocellular carcinoma or cholangiocarcinoma). Liver tumors can be treated using a variety of techniques, including surgery to remove the tumor, ablation, embolization, chemotherapy, or radiation. Our team will help design a unique, individualized treatment plan that is best for the patient based on the type of tumor and the stage at which it is diagnosed.

Benign (non-cancerous) liver tumors include adenoma hemangioma and focal nodular hyperplasia (FSH). Benign tumors may require treatment if they are pre-cancerous or when they cause symptoms such as pain or difficulty eating.

Bile Duct/Gallbladder Cancer

The bile ducts are tubes that carry bile that is made in the liver into the intestine. The gallbladder is attached to the bile ducts and stores bile before it is passed into the intestine. The bile helps you absorb food and provides the brown color of your stool. Blockage of the bile ducts can lead to yellowing of the skin (jaundice), light-colored stools, dark urine, and itching.

Bile duct cancer, cholangiocarcinoma, is an uncommon tumor with only 2,000-3,000 new cases diagnosed each year in the United States. Our team of experts has extensive experience diagnosing and treating both bile duct cancer and gallbladder cancer.

Symptoms of yellowing of the skin, itching, light-colored stool and dark-colored urine, and unexplained weight loss may be the result of cholangiocarcinoma; however, other conditions may account for similar symptoms. If a patient has some or all of these symptoms, our team can arrange for a panel of tests that may include blood work, abdominal ultrasound, CT scan and/or MRI to help determine what is causing your symptoms. A special type of endoscopy called an ERCP (endoscopic retrograde cholangiopancreatography) can be useful in selected cases to help establish the diagnosis, as well as to place a stent to relieve the blockage caused by the tumor in efforts to alleviate symptoms.

Our team of experts has several different treatment options available, including surgery to remove the tumor, radiation, and chemotherapy. At the Multidisciplinary Upper GI Tumor Clinic at Rhode Island Hospital, we will develop a personalized, state-of-the-art plan of care tailored specifically the patient for the treatment of the tumor.

We also treat bile duct cysts (choledochoceles), which are a risk factor for bile duct cancer. The treatment includes surgical removal of the bile duct and a liver bypass. If the patient has been diagnosed with a bile duct cyst, our team of experts will be able to help determine if the cyst requires surgery and will help guide the patient through diagnosis and treatment in a safe and efficient manner.

More about the Upper Gastrointestinal Multidisciplinary Clinic