GI Cancer Diagnosis & Treatment

Genetic counseling professionals can provide genetic testing services, including:

• Determining your eligibility for genetic testing
• Assessing your risk for certain types of cancer based on your personal and family medical histories
• Determining if other members of your family are eligible for genetic testing

Genetic testing may help you:

• Understand your and your family members’ risk for cancer
• Prevent cancer with appropriate screening and prevention methods if positive
• Make decision about treating and managing cancer

An esophagogastroduodenoscopy (EGD) or "upper GI" is an endoscopic procedure that allows gastroenterologists to view, take samples from, and treat disorders of the esophagus (food pipe), stomach and the duodenum (part of the small intestine that connects to your stomach). The instrument used to examine your upper GI tract is called an endoscope. An endoscope is a thin, flexible tube that holds microscopic instruments and a miniature camera that sends images to a video monitor.

A colonoscopy uses a flexible tube to look into the colon and rectum (your large intestine). The instrument used to examine your colon, called a colonoscope, has a miniature camera that allows your doctor to view the inside of your colon. A colonoscopy is routinely used for colorectal cancer screening and prevention, and it’s helpful for diagnosing other colorectal and intestinal disorders.

A small bowel capsule allows the physician to examine the lining of the small intestine. The patient swallows a capsule the size of a large vitamin that contains a mini-camera and a light source. The capsule passes naturally through the digestive system while the camera takes pictures of the intestine. These images are transmitted to small sensors, which are placed on the abdomen with a sticker. A receiver the size of a Walkman, which is worn around the waist, will store the images. Thirteen hours after ingesting the capsule, the test is finished and the receiver can be returned to the physician for processing.

Endoscopic retrograde cholangiopancreatography (ERCP) is a specialized endoscopic technique used to study the gallbladder, pancreas, and bile ducts, and has the added benefit of being a therapeutic tool. ERCP has been used for more than 30 years, and is considered the standard for diagnosing disorders of the biliary tract. During ERCP, an anesthetic is used to numb the throat along with a mild sedative. A gastroenterologist will then pass a flexible endoscope with a miniature TV camera inside through the mouth and into the stomach and small intestine. Then the gastroenterologist will pass a thin ultrasound probe through the ERCP. Endoscopic ultrasound uses ultrasound images in place of X-rays for better viewing of the bile and pancreatic ducts. Special preparations are required for this endoscopic procedure.

Endoscopic ultrasound (EUS) combines minimally invasive endoscopic technology with the imaging capabilities of ultrasound. An ultrasound probe within the endoscope (see EGD) produces sound waves that create high-resolution images of the area being studied. EUS is used to both diagnose and treat disorders of the upper and lower gastrointestinal tract, the biliary tract, pancreas, and liver.

Thyroid ultrasound is an imaging technique, which helps your care team see your thyroid better and determine whether there are features suggestive of or that increase your risk for thyroid cancer. 

Many hereditary cancer syndromes are associated with an increased risk for developing endometrial cancer. Screening modalities include clinical examinations by a health care provider as well as endometrial sampling. It is important to monitor for clinical symptoms. In addition, prophylactic surgery may be recommended based on your risk. The age to initiate screening, the frequency of screening and the modalities used are determined by your risk. 

Many hereditary cancer syndromes are associated with an increased risk for developing ovarian cancer. Screening modalities include clinical examinations by a health care provider, transvaginal ultrasounds, and blood tests. It is important to monitor for clinical symptoms. In addition, prophylactic surgery may be recommended based on your risk. The age to initiate screening, the frequency of screening and the modalities used are determined by your risk. 

Many hereditary cancer syndromes are associated with an increased risk of breast cancer. Screening modalities include a combination of self-examinations, imaging (e.g. mammograms, MRIs) and clinical examinations by a health care provider. The age to initiate screening, the frequency of screening and the modalities used are determined by your risk. 

Chemoprophylaxis refers to medications that can be used to slow progression of a disease. In the setting of hereditary cancer syndromes, the goal of chemoprophylaxis is to prevent cancer and the optimal time for use is before cancer develops.

If colorectal surgery is needed to treat colon cancer or remove polyps or infected areas of the colon, our care team will guide you every step of the way.

• Colorectal cancer treatment may include surgery, chemotherapy, radiation, and targeted therapies using antibodies to target specific molecules within cancer cells.
• Colon resection is when surgeons remove the affected/at-risk part of the colon laparoscopically or with open surgery, and join the remaining ends together, allowing for bowel movements.
• Colostomy is used in cases where there is too much inflammation to rejoin your colon and rectum. A surgeon may perform a colostomy—an opening in the abdominal wall connected to the colon for stool to pass into a bag. Once inflammation has improved, the surgeon can rejoin the ends of the colon and close the opening in the abdomen.

The hepatopancreaticobiliary surgery team at Virginia Mason Franciscan Health is renowned for the surgical treatment of pancreatic cancer. Because our team of experts performs hundreds of major pancreatic surgeries a year, we have demonstrated exemplary outcomes in pancreatic cancer treatment, specifically in pancreatic resections. Procedures include:

• Pancreas sparing duodectomy, in which surgeons remove part of the gastrointestinal tract while preserving the pancreas, often performed to reduce the risk of duodenal cancer in high-risk individuals (e.g. duodenal polyposis in FAP).
• The Whipple procedure, in which surgeons remove part of the pancreas, small intestine and stomach. Our team of surgeons performs more than 100 Whipple procedures per year. We also send patients home an average of seven days after the procedure—much faster than the national average of about two weeks.
• Irreversible electrophoresis, which uses ultrasound-guided needles to apply electric pulses to the tumor. This can kill cancer cells in people with locally advanced cancer.
• Other advanced procedures such as distal pancreatectomy, total pancreatectomy, major vascular resection and reconstruction for advanced tumors.