Colorectal cancer is a type of cancer that forms in the digestive system of the body. One of the main organs used in digestion is the large intestine. The first 6 feet of the large intestine make up the colon and the last few inches are the rectum. Colon and rectal cancers together are the fourth most common cancers in the United States.

 There are several different types of colon cancer that can develop, but most are adenocarcinomas (or cancers from glandlike tissue). Adenocarcinomas are produced when polyps, or growths, on the inner lining of the colon or rectum change to cancer over a period of years. Not all polyps become cancer but removing these growths during a colonoscopy can help reduce the risk of developing colon cancer. Screening tools, such as colonoscopies, enable doctors to diagnose colorectal cancer in its earliest stages when it is most treatable.

Other types of intestinal cancer include:

• Carcinoid tumors (small intestine)
• Small cell carcinomas
• Gastrointestinal stromal tumors (GIST)

The liver is a large, two-lobe organ situated in the upper right side of the abdomen. It has three main functions:

• To filter the blood for harmful substances, which are then passed out of the body as waste products
• To make bile that helps digest the fat in food
• To store sugar for the body to use as energy
• To make some of the proteins critical for clotting, and other regulatory transitions.

Adult liver cancer that originates in the liver is called primary liver cancer. There are two types: hepatocellular carcinoma (HCC) and cholangiocarcinoma (bile duct cancer). HCC is the most common type of liver cancer and most often develops in patients with chronic liver diseases, such as cirrhosis caused by Hepatitis B, Hepatitis C or excessive alcohol consumption. Cholangiocarcinoma is a rare cancer in the bile ducts, which are tubes that move the bile fluid from the liver to the small intestine.

Secondary liver cancer starts in another part of the body and spreads to the liver. Such metastatic cancer is named after the organ where it developed. Secondary liver cancer is more common than primary liver cancer.

Located behind the lower part of the stomach, the pancreas produces enzymes for digestion and hormones to regulate blood sugar. When cells in the pancreas develop abnormalities in their DNA, they grow unchecked and live for extended periods of time. These mutated cells then band together and form a malignant tumor.

There are many types of pancreatic cancer. Among them:

• Pancreatic adenocarcinomas are by far the most common type of pancreatic cancer and usually develop in the ducts of the pancreas. Adenocarcinomas make up 95 percent of exocrine pancreas cancers.
• Acinar cell carcinomas are formed from the cells that make the digestive enzymes in the pancreas.
• Islet cell carcinoma involves cells that secrete a variety of hormones. These tumors can be functional and produce abnormally high amounts of hormones, or nonfunctional and not produce any hormones. Most endocrine tumors or neuroendocrine tumors (NET) are malignant, including gastrinomas, glucagonomas, somatostatinomas, VIPomas and PPomas. Some are benign, such as insulin-producing islet cell tumors.
• Isolated sarcomas and lymphomas can occur in the pancreas, but these are exceedingly rare. Some of those include adenosquamous carcinomas, squamous cell carcinomas, signet ring cell carcinomas, undifferentiated carcinomas and undifferentiated carcinomas with giant cells.
• Pseudopapillary neoplasms are uncommon, slow-growing tumors that occur mostly in women in their teens and twenties.

Pancreatic cancers are difficult to detect in their early stages because symptoms often don’t develop until the disease has progressed.

Stomach, or gastric, cancer starts in the lining of the main body of the organ. Incidence rates for this type of cancer have been falling steadily in the United States since the 1930s. Meanwhile, the 5-year relative survival rate for stomach cancer has increased over the last 40 years.

Gastroesophageal cancer, which occurs at the junction where the top of the stomach meets the bottom of the esophagus swallowing tube, has been on the rise, however. This type of cancer is associated with gastrointestinal reflux disease (GERD) and other factors that habitually irritate the esophagus.

On a related note, a small percentage of patients with GERD develop Barrett's esophagus, which is associated with an increased risk of developing esophageal cancer. A patient with GERD has a relaxed or leaky valve between the stomach and esophagus, allowing stomach acid to travel back into esophagus. When this happens, it can damage esophagus tissue, and when the esophagus tries to heal itself, the cells can develop into cancer.

For most patients with colon cancer, surgery to remove the tumor is a key element of treatment. Doctors at Orlando Health are leaders in robotic colorectal surgery. As a recognized epicenter for da Vinci® robotic colorectal surgery, Orlando Health is visited by doctors from across the country to receive training from our skilled surgeons in robotic colon and rectal surgery.

Your surgeon may perform one of these procedures:

• Local excision: If your cancer is in an early stage, your doctor may be able to avoid cutting through the abdominal wall and instead insert a tube into the rectum up to the colon to cut out the cancer.

• Robotic Colectomy: The colon, or large intestine, is the lower part of the intestines. A colectomy, also called a colon resection, is performed to treat colon cancer. In a partial colectomy, only part of the colon is removed. In a total colectomy, all of the colon is removed. When a colectomy is required to treat a cancerous tumor, the surgeon must remove both the tumor and the vascular and lymph structures connected to that portion of the colon. Depending on the stage of the cancer, this operation can be curative.  

• Resection of the colon with colostomy: If after removing the cancer the surgeon cannot reconnect the two pieces of the colon, an opening is made outside the body for waste to pass through.

In cases where the cancer has spread from the colon and rectum to other parts of the body, our highly trained team of surgeons, radiation oncologists and radiologist will determine if they can pursue other local measures. If so, they can use any of the many procedures designed to remove or kill these masses including:

• Radiofrequency ablation: a probe with tiny electrodes, placed into the tumor
• Microwave ablation: microwaves are created from a needle, placed in the tumor
• Surgical resection: a procedure to remove a tumor and normal tissue around it
• Cryosurgery: an instrument that freezes the cancer cells

After surgery, your team of physicians will discuss with you whether radiation or chemotherapy is needed to eliminate any remaining cancer cells. Radiation uses high-energy X-rays to kill or stop the growth of cancer cells. Radiation therapy can be performed with an external machine or internally with a radioactive substance sealed in needles, seeds, wires or catheters targeting the cancer. Chemotherapy uses medicines to kill the dividing cancer cells and may be injected directly into the blood supply of these metastases liver lesions.

If your cancer already has spread within the abdominal cavity, you may be a candidate for Cytroreductive Surgery and Hyperthermic Interperitoneal Chemotherapy (HIPEC). This two-step procedure involves surgery to remove all visible tumor followed by heated chemotherapy drugs that are placed in the abdomen. The patient lies on a cooling blanket to keep body temperature at a safe level, and surgeons rock the patient during the procedure. Afterward, the chemotherapy is removed from the body.

HIPEC has several advantages over traditional chemotherapy:

• Direct placement of the agent means the drug is better able to access cancer cells at this concentration.

• Depending on tumor type, the patient may only need a single dose that is administered in the operating room.

• Because most of the drug stays in the abdomen, typically chemotherapy side effects can be avoided.

We offer many treatments for liver cancer, and your team of doctors will recommend a combination of therapies that best suit your diagnosis and personal preferences.

Surgery, called hepatectomy, to remove the tumor(s) can be an option for patients with early-stage cancer who have otherwise healthy livers. This option is more viable when the tumors are small and do not affect nearby blood vessels. Patients with early-stage cancer whose livers are not healthy may be candidates for liver transplant surgery.

When a liver tumor cannot be removed safely by surgery but the cancer has not spread to other parts of the body, treatment options usually focus on reducing symptoms and extending life expectancy, rather than curing the disease.

• Intraarterial chemotherapy is the use of strong medicines to kill the dividing cancer cells.

• Radiation therapy can be done externally with a machine targeting the cancer cells with high-energy X-rays to kill them, or internally with a radioactive substance sealed in needles, seeds, wires or catheters to target the cancer.

• Ablation uses a probe with tiny electrodes to target the tumors.

• Embolization is a procedure that injects substances to stop blood flow to cancer cells in the liver.

• Targeted therapy uses chemotherapy drugs designed to work in different ways than traditional chemotherapy while still covering the whole body.

• Immunotherapy is the use of medicines that help a patient’s own immune system identify and destroy cancer cells.

Secondary liver cancer is far more common than primary liver cancer. That means the cancer is the result of metastasis of cancer from another part of the body to the liver. When that happens, the Gastrointestinal Cancer Center at Orlando Health uses highly specialized therapies to fight the disease. Among them:

• Staged liver surgery for bilobar disease involves performing surgery on tumors in both lobes of the liver during separate operations.

• Yttrium 90 Spheres are a type of Selective Internal Radiation Therapy (SIRT) that is administered through a catheter in the artery that supplies blood to the tumor. These beads contain radiation and travel through the bloodstream to the liver where they become lodged in the tumor and kill the cancer cells. This therapy delivers a dose of internal radiation up to 40 times higher than traditional external therapy and protects healthy tissues.

• Chemoembolization is a procedure that delivers a highly concentrated dose of chemotherapy medicine through a catheter in the blood vessel at the location of the tumor. A blood vessel occluding agent also is used to starve the tumor’s blood supply. This two-pronged approach is often successful in stopping tumor growth or even shrinking a tumor.

• Clinical trials explore the most innovative therapies, giving patients new options for treatment.

New technology available at Orlando Health allows for more precise treatment of cancer tumors through real-time magnetic resonance imaging (MRI) during radiation therapy.

Called MRIdian®, the system enables physicians to target tumors in real time instead of relying on static images taken minutes or even days before a patient’s radiation session. Real-time visualization offers physicians the advantage of more accurate treatment as the location of a tumor inside the body may shift during subtle natural movements, such as when a patient breathes or digests food.

For more information on MRIdian®, MRI-guided radiation therapy, click here.

Difficult to detect in its early stages because symptoms often don’t develop until the disease has progressed, treating pancreatic cancer depends on a combination of surgery, chemotherapy and radiation therapy. Treatments are named according to surgical involvement:

• Resectable: Surgery is the main treatment, although chemotherapy and radiation could be used before or after.

• Borderline resectable: Chemotherapy and radiation are used first and then possibly followed by surgery.

• Unresectable: Chemotherapy and possibly radiation are done without surgery.

• Metastatic: Chemotherapy is the primary treatment.