Focus — GI and Colorectal Cancer

GBMC’s Gastrointestinal and Colorectal Cancer Services: Offering Patients the Latest in Screening Technology, Surgical Techniques and Customized Care

Gastrointestinal & Colorectal Cancer Treatment at GBMC Patient-Centered Care from Screening to Surgery

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olorectal cancer is one of the leading causes of death in the United States and the third most diagnosed cancer in both men and women. Technology and treatments have come a long way, allowing patients to live longer while maintaining their quality of life. At GBMC, advances in screening technology help with early detection and diagnosis, while minimally invasive surgical techniques provide better outcomes, decreased pain, less risk and a quicker recovery.

Dr. Niraj Jani and Liz Hornack, MSRN, demonstrate an endoscopic ultrasound procedure, which aids in providing more accurate diagnostic and staging information for gastrointestinal and lung cancers.

Customized chemotherapy and radiation treatments, along with the availability of clinical trials, round out the comprehensive services offered.

Early Detection is Half the Battle

N

iraj Jani, MD, GBMC’s Division Head of Gastroenterology

Sigmoidoscopies are similar to colonoscopies, but examine

and Gastrointestinal (GI) Oncology, and the physicians

only the rectum and left colon where a majority of colorectal

who support him, are passionate about early detection of GI

cancers are found. They do not visualize the whole colon and

and colorectal cancers because the sooner cancer is found,

therefore are paired with FOBT to screen for colon cancer.

the more treatable it may be. “All of our team members

Virtual colonoscopies, which produce detailed images of the

are advocates for screenings with regular follow-ups as

colon and rectum using a CT scan, may be used in place of

recommended,” says Dr. Jani. Thanks to improved technology,

a colonoscopy for patients who have problems tolerating

physicians can now offer several options for screening that

sedation or have had multiple surgeries, making it difficult to

vary in invasiveness, cost, accuracy and accessibility. “Having

navigate a scope through the colon. “The disadvantage to this

such a range of testing procedures available allows us to

procedure is that it may not detect smaller polyps and if an

better tailor the exam to each patient, increasing the odds for

abnormality is found, the patient will require a colonoscopy,”

success,” he explains.

Dr. Jani notes.

“Having such a range of testing procedures available allows us to better tailor the exam to each patient, increasing the odds for success.”

—Niraj Jani, MD In addition to the traditional colonoscopy, several other tests can be performed to screen for colorectal cancer. A fecal occult blood test (FOBT) is a noninvasive way to look for blood in the patient’s fecal matter. This test, recommended annually for patients over the age of 50, has been proven by a study in the Journal of Medical Screening to reduce deaths from colon cancer by 15 to 33 percent.

To learn more, visit www.gbmc.org

An image taken during an endoscopic ultrasound procedure reveals a tumor (circled) in the patient’s rectum.

Screening has become the most powerful weapon in

For diagnosing and staging a variety of gastrointestinal

preventing and detecting colorectal cancers. “Screenings

cancers, Dr. Jani often utilizes endoscopic ultrasound. This

allow us to not only look for cancer, but also spot polyps that

procedure is performed by inserting an echoendoscope, a

may eventually become cancerous,” says Dr. Jani. “Because

scope with an ultrasound transducer mounted on top of an

we’re able to find and remove polyps early, the patient has

endoscope, into the upper or lower GI tract via the mouth or

less of a risk for developing colon cancer down the line.”

rectum. “Endoscopic ultrasound allows us to uncover lesions

Some colorectal cancer screenings double as diagnostic and

as small as 3 mm and can produce much better images than

therapeutic tests. Polyps and abnormal tissue can be removed

CT or MRI for specific organs. It also delivers detailed images

and biopsied during both a sigmoidoscopy and colonoscopy.

of adjacent structures in the GI tract. It’s essential for accurate staging of rectal cancer,” explains Dr. Jani.

Discovering the Best Treatment Options

Alicia Bowers, Sparks! Web/Media/Marketing

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fter cancer is diagnosed and staged, physicians are faced with the decision of the best course of treatment.

For colorectal cancer that is still in the early stages, surgery

is often the most common and effective treatment. In some cases, surgeons are able to reconnect healthy parts of the colon, allowing the patient to resume normal function. For patients with extensive rectal involvement, a colostomy is usually necessary. Depending on the severity of the patient’s case, the colostomy may be reversible or permanent. However, with advances in surgical techniques and technology, GBMC physicians are now able to perform more rectal-sparing surgeries, helping patients avoid permanent colostomies.

Minimally invasive options such as laparoscopic and

Drs. Lisa Savoie and George Apostolides

robotic surgery have become the preferred method for both physicians and patients. “Robotic-assisted surgery gives us three-dimensional visualization of the surgical site, as well as better tactile information while operating,” says George Y. Apostolides, MD, FACS, FASCRS, GBMC’s Chief of Colorectal

Surgery and Director of the Colorectal Surgery Residency Program. “The instruments are more responsive and we have the ability to work from 360 degrees, not just up, down, right and left.”

Along with Dr. Apostolides, Lisa M. Savoie, MD, FACS, FASCRS, Assistant Director of the Colorectal Residency Program at GBMC, also uses the latest da Vinci® SI Robotic Surgical System to perform many of her operations.

“Better visualization of the pelvic nerves and precise instrument control improves accuracy in preservation of bladder control and sexual function,” says Dr. Savoie. Patients who undergo robotic surgery usually experience fewer complications, have less pain and have an overall faster recovery.

When Surgery Isn’t Enough

T

hough surgery is sometimes the only treatment necessary to remove cancer, there are circumstances where patients may require chemotherapy, radiation therapy or a

combination of both. Patients in need of a multidisciplinary approach to fighting colorectal cancers can find all the treatment they need under one roof at GBMC.

“Our goals for these patients are to decrease the risk for cancer recurring for those with early stage disease and, for those with advanced disease, to slow the growth of the cancer,” says Robert Donegan, MD, Medical Oncologist at GBMC. “Over the last eight years, newer and more powerful drugs have nearly doubled the average length of survival rate for late stage Robert Donegan, MD

colorectal cancer. For those patients with stage III colon cancer, and some with high-risk stage III, chemotherapy has been shown to substantially improve the chance of cure.

Radiation therapy may also be recommended, particularly for those with stage II and stage III rectal cancer.”

To learn more, visit www.gbmc.org

Patients receive chemotherapy treatment in GBMC’s newly renovated Infusion Therapy Center.

Radiation therapy for colorectal cancer patients is available

on healthy tissue. This method is most frequently used for

on the RapidArc Linear Accelerator, which delivers precise

patients with rectal cancer.

beams of radiation to the tumor site, while minimizing damage to surrounding healthy tissue.

“The future of cancer care is always changing” says Dr. Donegan. “Right now, we’re looking at ways to make

Some cases may call for treatment with brachytherapy

treatment even more personalized by delving into the

radiation. In this method, small seeds of radioactive material

unique biology of a patient’s cancer cells. Understanding at a

are placed next to or right into the cancer during surgery.

molecular level what drives these cells to grow will hopefully

The radiation travels only a short distance, limiting effects

allow us to tailor effective treatments for each patient.”

Community Hospital with an Academic Feel

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BMC has an active research program in the field of colorectal cancer. Clinical staff is dedicated to research and testing ways to prevent, detect, diagnose and treat

cancer. Patients who qualify to participate in clinical trials receive state-of-the-art care from cancer experts and receive drugs and treatments that may have otherwise been

unavailable to them.

Patients enrolled in clinical trials are closely monitored by a dedicated team of research nurses. Due to the sometimes complex and sensitive nature of the trials, patients must meet precise standards and have specific qualifications for participation.

These patients tend to receive more clinical, nursing and psychological support due to the sensitive nature of the trials.

Currently, GBMC has more than 55 clinical trials available for a variety of cancer cases, with three specific to colorectal cancer. Physicians make an attempt to find trials for many of the patients who are interested. It’s because of this dedication to cancer research that GBMC often has the feel of an academic hospital, in a community setting.

To learn more about GBMC’s GI and Colorectal Cancer services, visit www.gbmc.org/GI or www.gbmc.org/colorectal.

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