Diagnosis and Evaluation
As dictated by their needs, patients will see a surgical, medical, radiation oncologist or a combination of these specialists during their first clinic visit. The primary physician managing the patient's care will develop the treatment plan with the patient. Patients may be offered the opportunity to participate in one of many clinical research trials. If surgery is required, a date will be set. Patients requiring chemotherapy will be instructed as to what to expect and how to manage care at home.
If, after being evaluated by a radiation oncologist radiation treatment is planned, the treatment, procedures and side effects will be explained. The patient may be scheduled for simulation. This process involves using x-ray images to plan radiation treatment so that the target treatment area is precisely located and marked. After simulation, a radiation therapist gives the patient the date and time when treatment will begin.
The results of the diagnostic tests and studies will be carefully reviewed by the managing physician. Complex cases requiring multi-specialty input will be reviewed at the weekly case review conference to make sure that the best treatment plan is developed. The managing physician will contact the patient to discuss the treatment plan developed by the GI team. Our program strives to provide continuity in the patient's care. Team members ensure that the patient's care is coordinated if s/he needs to see multiple cancer specialists and receive different types of treatment. Letters are sent to referring physicians updating them on their patient's current care and status. Patients are referred back to their local physician for continuing care when appropriate.
All good treatment plans are based on excellent diagnostic studies. Our team’s radiologists and gastroenterologists employ highly sensitive scanning and imaging technologies that are ahead of current medical standards. Along with our new hospital facilities we have established leading-edge MRI (magnetic resonance imaging), CT (computerized tomography) and PET/CT scanning facilities. These imaging technologies allow for in-depth, pre-treatment planning and for precise evaluation of the extent of a patient's cancer. They also allow us to distinguish benign from malignant tumors and assist us in determining the most appropriate therapy for each patient. The team’s gastroenterologists further extend our diagnostic capacity through use of endoscopic ultrasonography. This is another advanced imaging technique that is especially helpful in staging patients with esophageal, gastric, pancreatic and rectal carcinomas.
Ongoing active collaboration among medical oncologists, surgeons, and radiation oncologists allow our program to offer effective combined-modality treatment regimens for diseases such as esophageal, gastric, pancreatic, rectal and anal cancer. The team also has focused interest in treating primary liver tumors and cancer metastases to the liver.
Rectal Cancer or Rectal Cancer Recurrence
Our program specializes in sphincter-preserving management of rectal cancer patients. Combination chemotherapy, radiotherapy and surgical therapy permit us to avoid permanent colostomy in most patients with low rectal cancer.
UNC is one of the few centers in the US to have dedicated intraoperative radiation therapy. This permits us to effectively treat patients with difficult abdominal or pelvic tumors, and those with evidence of recurrence of their disease after primary treatment. Another technique we employ that is not used at many centers is Brachytherapy. This technique involves implanting radiation sources internally during a surgical procedure. This therapy limits toxicity to surrounding organs and allows for radiation therapy to be delivered to a localized area of concern immediately following surgery. Brachytherapy is very effective as an adjunct in treating rectal cancers.
Over the last decade we have evolved a leading-edge multidisciplinary approach for patients with liver malignancies including primary liver cancer (hepatoma) as well as metastatic colorectal cancers. We offer extensive expertise in the use of cryoablation, radio-frequency ablation (RFA) as well as surgery for liver tumors. Both cryoablation and radio frequency ablation permit the destruction of tumor deposits deep within the substance of the liver, which may not be amenable to surgery. Frequently, these procedures can be carried out without an operation, as the probes can be placed through the skin with CT or ultrasound guidance. Treatment of liver metastases is frequently supplemented with placement of a hepatic artery infusion pump. This pump allows delivery of high doses of chemotherapy directly to the liver while sparing the rest of the body.
Arrangements can be made for the patient to meet support service providers such as a social worker, a financial counselor, a chaplain or a patient counselor. Patients will have an opportunity to visit the Cancer Patient/Family Resource Center where they can obtain information about their diagnosis and learn about support groups and resources for individuals with cancer.
Genetic Counseling and Screening
Certain individuals are at high risk for developing GI tumors due to an inherited predisposition. As the data from the genome project are further developed we are constantly learning about more genes and their involvement with cancer development and treatment. The GI oncology program includes a genetics team that can guide patients through this very complex and changing aspect of cancer care. Their recommendations might include further testing and evaluation for other family members at high risk for developing GI cancer.
We have developed materials describing the multidisciplinary clinics, which are sent out at the time the appointment is made. Printed materials (in both Spanish and English) are handed out to the patient during the initial visit. We have also developed helpful videos available to patients. We maintain a listing of all our active and future clinical trials in GI cancer, which is available upon request for patients and referring physicians.
Patients who will receive radiation therapy are invited to watch the radiation therapy and radiation department videos. They are also given a packet that includes information on radiation therapy, nutrition, support groups, etc.