The following describes the symptoms, diagnosis and treatment of upper gastrointestinal cancers. For specific information regarding your health and treatment options, please contact your Hurley physician or medical professional.

What are upper gastrointestinal (GI) cancers?

Upper GI cancers include cancers that affect the upper areas of the digestive system, including the esophagus and stomach. The esophagus is the muscular tube that connects the throat to the stomach. The wall of the esophagus is made of several layers of tissue; cancers of the esophagus typically start in the inner layer of tissue and grow toward the outer (surface) lining. The stomach is the primary organ of digestion; cancers that occur in this organ may present different symptoms and require different treatments from cancers found in other areas of the digestive system. Approximately 40,000 people each year are diagnosed with these types of upper GI cancer; both types of cancer are very serious, and around 25,000 people die each year of these diseases.

What causes upper GI cancers?

The exact causes of upper GI cancers, as with most cancers, are unknown. Men are generally at greater risk of developing upper GI cancer than women, and people over the age of 50 of both sexes are more likely to contract the disease than younger individuals. For esophageal cancer, African-Americans are at elevated risk as compared to Caucasions, as are people from Iran, India, northern China and southern Africa.

People with untreated esophageal reflux, in which the stomach acids back up into the esophagus (causing heartburn), may experience changes in the cells at the lower end of the esophagus. This condition is known as Barrett’s esophagus, and people with this condition are more likely to get esophageal cancer. Other risk factors for esophageal cancer include smoking and alcohol use, diets low in fruits and vegetables, damage caused by swallowing irritants such as lye, and certain diseases that affect the movement and digestion of food.

Risk factors for stomach cancer include diets heavy with smoked or salted foods, nitrates and pickled vegetables, and are low in fiber. Other risk factors for stomach cancer include tobacco abuse, alcohol abuse, a history of stomach polyps and previous stomach surgery, some types of anemia, exposure to certain toxins in the workplace, and a family or personal history of stomach cancer.

What are the symptoms of upper GI cancers?

Since some of the symptoms of upper GI cancers vary across individuals and may appear similar to symptoms of other illnesses and disorders, you should always speak to your Hurley physician about any symptoms you are experiencing.

For stomach cancer, symptoms may include:

• Heartburn or indigestion
• Abdominal pain or discomfort, or bloating after meals
• Nausea and loss of appetite
• Vomiting (including blood in the vomit)
• Diarrhea, constipation and/or blood in the stool
• Unexplained weight loss
• Weakness and fatigue

For esophageal cancer, symptoms may include:

• Hoarseness or chronic cough (including coughing up blood)
• Extreme weight loss (due to not eating enough food because of discomfort)
• Pain in the throat, chest or upper back
• Vomiting (including blood in the vomit)

How are upper GI cancers diagnosed?

During your appointment, your Hurley physician will ask you questions about your medical history and conduct a complete physical examination. A fecal occult blood test can identify the presence of blood in the stool, which may be related to cancer in the upper GI. Your physician may use an endoscope, alone or in conjunction with ultrasound, to visually inspect the esophagus and stomach. An endoscope is a long, thin tube with a device at the end that allows the physician to see the inside of the body and take tissue samples. These tissue samples (biopsies) are examined by one of Hurley’s board-certified pathologists for the presence of abnormal or cancer cells.

Imaging techniques such as CT scans and MRIs, along with laparoscopic techniques (which use a thin tube and a viewing device, similar to an endoscope, to view internal structures of the body), may also be used to determine the location and size of tumors.

How are upper GI cancers treated?

Part of the diagnostic testing process involves grading and “staging” of upper GI cancers. In this step, your oncologist will determine the type of cancerous cells or tumors present, the rate of tumor growth, and the degree to which the cancer has spread to other organs and systems of the body. Your oncologist will then recommend a course of treatment that takes this information into account, as well as your age, overall health, and personal and family circumstances, and your unique needs and objectives for treatment.

Surgery may be required to remove the tumor or tumors, the affected areas of the esophagus or stomach, and, in some cases, nearby lymph nodes. In particularly severe cases, the entire stomach may need to be removed and alternative feeding procedures are established. In partial removals of tissue and organs, the remaining portions of the esophagus and stomach are reattached to allow food to pass through the digestive system.

Chemotherapy and internal or external radiation therapy may also be used alone, in combination with each other, or in addition to surgical techniques. Esophageal cancer may respond to a form of laser therapy called photodynamic therapy (PDT) that targets cancer cells that have been injected with certain types of chemicals that respond to the light in a chemical reaction that destroys the cancer cells.

There are a number of new drugs and innovative therapies that have been developed recently to target and treat upper GI cancers. Research on upper GI cancers is ongoing; you may wish to speak with your Hurley physician about clinical trials that are testing new, emerging treatment options.