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Cancer (Oncology)

Gastrointestinal Cancer

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NewYork-Presbyterian Cancer Centers are committed to excellence in research and clinical care of patients with gastrointestinal, hepatobiliary, and pancreatic cancer. Patients benefit from the programs and resources offered at both the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital/Columbia University Medical Center and the Weill Cornell Cancer Center at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, including the most advanced diagnostic tools and state-of-the-art treatments. The Cancer Centers' gastroenterologists and surgeons have a wealth of experience in all aspects of digestive disease cancer care and apply the latest advances in the field to screening and prevention, diagnosis, medical and surgical treatment, and rehabilitation.

Diagnostic Innovations

Cancers that affect the digestive tract and related organs are often complex, requiring a diagnostic approach that includes a thorough medical history, physical examination, laboratory tests, and sometimes a more extensive evaluation involving imaging studies and/or endoscopic procedures. The technology of endoscopy provides a window into the GI tract, facilitating the detection of pre-malignant disorders and early-stage cancers.

Endoscopy

Endoscopy has become an increasingly sophisticated tool, offering options for the diagnosis and treatment of digestive disease cancers never before possible. At NewYork-Presbyterian Cancer Centers, physicians have acquired vast experience with advanced endoscopic procedures, often pioneering or refining the techniques that are widely used today. These include:

• Endoscopic retrograde cholangiopancreatography (ERCP) -- a test used to diagnose abdominal pain and to evaluate the ducts of the gallbladder, pancreas, and liver. This technology can even be used as an interventional technology to treat biliary obstructions and tumors of the bile duct, or to treat pain related to pancreatic cancer.
• Endoscopic ultrasonography (EUS) -- a technique using miniaturized ultrasound probes inserted into the bile duct or the upper and lower gastrointestinal tract to provide detailed images that aid in the diagnosis of biliary conditions as well as the staging of patients with esophageal, gastric, and rectal cancers.
• Laproscopy -- a technique for direct examination of the liver, gallbladder and spleen, which is valuable in the diagnosis and staging of pancreatic, gastric, esophageal, and colorectal cancer.
• Endoscopic services also increase the Centers' colorectal screening effort and ability to evaluate patients for Barrett's esophagus -- a precursor for esophageal cancer. These services are provided in new, dedicated, state-of-the-art facilities at both NewYork-Presbyterian/Columbia and NewYork-Presbyterian/Weill Cornell.

Therapeutic Excellence

Digestive disease cancers generally require a multidisciplinary approach involving a combination of medical management, interventional procedures, and surgical treatment, depending on diagnosis and extent of disease. Our oncology programs include expertise in the full range of digestive diseases. Physicians here have developed a surgical protocol in conjunction with continuous heated chemotherapy for treating cancer that has spread to the stomach to minimize the tumor and attack any residual disease. NewYork-Presbyterian Cancer Centers are involved in major collaborative clinical trials of novel treatments for uncommon malignancies such as GI stromal tumors, and targeted therapies for a range of GI tumors.

The following are some of the other innovative treatments that are available to patients who come to NewYork-Presbyterian Cancer Centers for care.

Radiation Oncology

Radiation therapy is a major component of the Centers' multimodal approach to gastrointestinal tumors and has a particularly significant impact on the treatment of esophageal, rectal, stomach, bile duct, and pancreatic cancer. The Hospital is an affiliate of the Radiation Therapy Oncology Group (RTOG), a collaborative group sponsored by the National Cancer Institute, which includes most major hospitals throughout the country and conducts cutting-edge clinical research in radiation oncology. The RTOG has a number of GI cancer protocols, including those for the stomach, colon, esophagus, and pancreas.

Advances in technology enable physicians to deliver higher doses of radiation while decreasing risk of complication. This has the potential to increase the probability of local control or cure of a particular disease and to reduce side effects, making treatments more easily tolerated by patients.

Intensity Modulated Radiation Therapy (IMRT)

NewYork-Presbyterian Cancer Centers' radiation oncologists use sophisticated computer-controlled linear accelerators for routine procedures with the added ability to perform three-dimensional conformal radiation or intensity modulated radiation therapy (IMRT). These refinements maximize the therapeutic effect by targeting the radiation dose on the diseased tissue while reducing the exposure of normal tissues to radiation and minimizing toxicity.

Brachytherapy

The Cancer Centers' radiation oncologists also offer a brachytherapy program for patients with esophageal cancer or tumors of the bile ducts. Very small catheters are threaded to the site of the tumor to deliver a high dose of radiation. In the treatment of esophageal cancer, radiation therapy may be used for curative intent or patients may be candidates for treatment to relieve symptoms of their disease, such as an inability to swallow solid foods. Brachytherapy is also frequently used to supplement external radiation for the treatment of metastases.

Interventional Radiology

Interventional radiologists at NewYork-Presbyterian are pursuing innovative and effective treatments for primary liver cancer and tumors that have spread to the liver from other sites in the body. Using non-surgical, catheter-directed interventional radiological techniques, they are prolonging and improving the quality of patients' lives. With these techniques, tiny needles are directed into the cancerous tissue under the guidance of computed tomography (CT), ultrasound, or fluoroscopic imaging; radiofrequency ablation (thermal energy) is then used to kill the tumor. Alternatively, physicians inject specific alcohol solutions or highly concentrated acetic acid to destroy tumors. The combination of therapies has enhanced the ability to control and eradicate tumors without the need for surgery.

The Hospital's interventional radiologists have also developed extensive expertise in combination therapies, including chemoembolization and direct tumor ablations. Chemoembolization is an interventional radiological technique in which the blood supply to the tumor is blocked and high doses of chemotherapy are delivered using a tiny catheter advanced to the tumor site under fluoroscopic guidance. This deprives the tumor of its nutrient blood supply and allows concentrated solutions of chemotherapeutic agents to remain within it. In one study, use of these techniques for appropriately selected colon cancer patients achieved twice the survival rate reported with conventional intravenous chemotherapy alone.

Surgical Advances

The availability of laparoscopic technology, video imaging capabilities, and new energy sources for cutting and coagulation has made minimally invasive surgery an increasingly preferred option for the treatment of abdominal cancer. These procedures can be performed with one or more small incisions instead of a large incision. This results in less pain, shorter hospital stays and quicker recoveries for patients, and minimizes the effect on pulmonary and immune system function.

Research

Research efforts taking place at NewYork-Presbyterian Cancer Centers are helping to identify the etiology of digestive disease cancers at the molecular level, advance potential therapeutics, and foster prevention strategies.

Clinical Trials

Institutional and multicenter clinical trials are helping to establish new and better medical and surgical approaches to treating patients with digestive disease cancers. NewYork-Presbyterian maintains databases for clinical investigation in Barrett's esophagus, familial adenoma polyposis and hereditary nonpolyposis colorectal cancer, pancreatic cancer, and hepatobiliary cancers. The clinical trials network, a combined resource of the Hospital and Medical Colleges, make possible extraordinary contributions to the understanding of digestive disease cancers, helping to advance measures for prevention and treatment. Patients who come to the Hospital for care have access to some of the most important and advanced clinical trials in the country. For more information on active clinical trials at NewYork-Presbyterian, visit the following sites:

Clinical Trials at NewYork-Presbyterian/Weill Cornell.

Clinical Trials at Herbert Irving Comprehensive Cancer Center.

Surgical Outcomes

Improving surgical outcomes for the treatment of cancer is a major focus of NewYork-Presbyterian Hospital surgeons, who are studying:

• The effect of surgery on the immune system and preserving immune function through laparoscopic techniques;
• Development of tumor vaccines to stimulate immune system function prior to surgery to lower the risk of tumor recurrence;
• The use of new technologies, including robotics, for performing surgery;
• Physiologic, oncologic, and immunologic consequences of abdominal surgery;
• Methods for prevention of post-operative immunosuppression and tumor growth.

Specialized Support

• Nurses who guide patients through the diagnostic and treatment process, administer enterostomal therapy, and provide important health information;
• Nutritionists who prepare dietary recommendations that are often key in the prevention or treatment of digestive disorders and facilitate recovery following therapeutic procedures;
• Genetic counselors who help patients and families understand their risk factors for digestive disease cancer;
• Social workers who offer support programs for patients and families, as well as guidance on resources to aid in recovery;
• Cancer prevention programs that provide specific expertise in colon cancer genetics, screening, prevention, and early detection, and offer recommendations for genetic counseling and testing when appropriate.

The Jay Monahan Center for Gastrointestinal Health

In early 2004, the new Jay Monahan Center for Gastrointestinal Health opened at NewYork-Presbyterian/Weill Cornell. The Center is named in honor of Jay Monahan, the late husband of NBC Today show co-anchor Katie Couric, who died of colon cancer at age 42 in 1998. This unique interdisciplinary resource will address digestive disease cancers on many different levels. Using a humanistic approach, Monahan Center physicians will provide comprehensive services for digestive disease care in one location, offering the newest therapies as well as alternative and holistic treatment options. The Center will promote public and patient education and will be the first program of its kind to provide a universal referral service for information on clinical outcomes, research protocols, prevention, and treatment. To learn more, visit www.monahancenter.org.

Prevention Advances

The development of new clinical approaches and strategies for prevention are the focus of concerted research efforts among NewYork-Presbyterian Cancer Centers, Columbia University College of Physicians & Surgeons, and Weill Cornell Medical College. In the area of cancer screening and control, scientific endeavors are guided by world-renowned researchers in the field of Cox-2 inhibitors in GI cancer, and leading authorities on cancer genetics, early detection, and screening protocols.

Selective Cox-2 inhibitors are the focus of two major chemoprevention trials conducted at the Hospital's two academic medical centers. One trial seeks to prevent esophageal cancer by reducing existing benign lesions in patients with Barrett's esophagus. A second trial looks at preventing the recurrence of polyps, a widely recognized precursor of colorectal cancer, in patients who have had a colorectal adenoma removed. In addition, research is exploring natural substances, including derivatives and extracts from green tea, that may play a role in chemoprevention; nutro-genomics – understanding how nutrients can interact with the human genome to alter the expression of genes implicated in disease using Cox-2 as a prototype; and identification of novel therapeutic targets of non-steroidal anti-inflammatory drugs in the prevention of tumors.