Diagnosis & Treatment
Screening & Diagnosis
Colorectal cancer is the third most common cancer in the United States but also one of the most treatable, especially when it is detected early. Our doctors are experienced in performing colonoscopy, endoscopy, and endoscopic ultrasound to screen for various digestive cancers in their earliest stages before they cause symptoms. Our physicians are skilled in various techniques for removing precancerous polyps before they progress to cancer. Tests we perform to diagnose digestive cancers include:
- Upper endoscopy (EGD) to see the upper part of the digestive tract using a scope
- Colonoscopy to view the inside of the rectum and colon with a scope
- Video capsule endoscopy, which uses a pill-sized camera to examine the inside of the small intestine for sites of bleeding or abnormal growths
- Advanced endoscopic techniques:
- Endoscopic ultrasound (EUS) utilizes the most advanced ultrasound equipment and a scope inserted in the digestive tract to sample, diagnose, and treat a variety of diseases—from precancerous disorders such as cysts to cancers throughout the gut
- Endoscopic retrograde cholangiopancreatography (ERCP) combines the use of x-rays with an endoscope to visualize abnormal tissue and obstructions in the digestive tract and hepatobiliary system (liver, pancreas, and bile duct) and to remove tissue to be analyzed for cancer cells
- Stent placement and dilation can relieve benign and cancerous blockages throughout the length of the digestive tract
- Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are minimally invasive, leading-edge methods to remove cancerous and precancerous tissue in the digestive tract
- Balloon-assisted enteroscopy utilizes a thin endoscope with an inflatable balloon over the tube to diagnose and treat otherwise unreachable sections of the small intestine
- Imaging exams such as ultrasound, CT, MRI/MRCP, and PET/CT scanning
- Blood and stool tests to look for markers that may suggest the presence of cancer
Treatments for Digestive Cancers
When planning your treatment, our physicians take into account the type, location, and stage of your cancer, as well as your age and physical health.
Minimally invasive surgery. We perform minimally invasive surgery for digestive cancers whenever appropriate — including laparoscopic and robotic colectomies (removal of the colon) and transanal endoscopic microsurgery (TEMS) for rectal cancer — resulting in less pain after surgery, smaller incisions, a shorter recovery, and a quicker return to your regular activities. Some patients with early-stage esophageal cancer can have video-assisted thoracoscopy (VATS); scopes placed through small incisions in the chest and abdomen are used to see, grasp, and remove diseased esophageal tissue and surrounding lymph nodes. If you need a more extensive procedure, such as certain liver and pancreatic surgeries, it may be performed at NewYork-Presbyterian/Columbia, with your presurgical and postoperative care at our hospital.
Preserving bowel function. Using laparoscopic and open surgical approaches, our highly experienced double board-certified colorectal surgeons are often able to maintain or restore bowel function and avoid the need for a permanent colostomy in patients with colorectal cancer. They perform complex procedures such as "intersphincteric proctectomy" (removal of the rectum) and colonic J-pouch and coloplasty (construction of a pouch to serve as a replacement for a surgically removed large intestine). Our goal is to remove your cancer effectively while leaving you with as much bowel function as possible.
Chemotherapy may be used before surgery to shrink your tumor and/or after surgery to kill any remaining cancer cells, and is sometimes given in combination with radiation therapy. Presurgical therapy increases the likelihood of complete removal of your tumor during surgery and improves your chance of a cure. Chemotherapy is the primary treatment for most patients with inoperable tumors. You can receive chemotherapy in our modern and comfortable Infusion Center.
Immunotherapy. Some patients with advanced digestive cancers may receive drugs that boost the power of the immune system to find and kill cancer cells. You can receive these medications in our Infusion Center.
Interventional endoscopic techniques. EUS and ERCP may be used alone or with other methods (described above) to unblock clogged bile ducts, insert a stent into narrowed or obstructed portions of the digestive tract or bile ducts, drain cysts, and/or destroy cancerous tissue in the upper digestive tract using intense heat (radiofrequency ablation) or freezing temperatures. These approaches can be therapeutic or curative—as well as palliative, to relieve discomfort due to pain, jaundice, and other symptoms.
Radiation therapy. We use intensity modulated radiation therapy (IMRT), which enables us to deliver precisely targeted radiation directly to the tumor while sparing nearby healthy tissue, as well as stereotactic body radiotherapy (SBRT) to deliver pencil-thin beams of radiation to target some digestive cancers.