Thyroid Cancer

Thyroid cancer is a malignant (cancerous) growth found in the thyroid gland. The gland sits in the throat below the voice box (larynx) and makes thyroid hormone and the hormone calcitonin. Thyroid cancer is highly treatable if caught early, because of its location. In addition to other head and neck specialists, our thyroid cancer team includes endocrinologists, doctors who specialize in the endocrine system and hormone production.

Risk Factors

Often, no one knows why cells grow out of control and form thyroid cancers. But there are several risk factors:

  • Family history of thyroid disease or cancer, including certain genetic conditions; in the case of a rare cancer called medullary, a defect in the gene RET can get passed on from parents.
  • Radiation therapy to the head or neck as a child
  • Gender (women are more likely to develop thyroid cancer)
  • Age (higher risk between 25 and 65)
  • History of enlarged thyroid (goiter)
  • Ethnicity (Asians face a higher risk)

Are You at Risk for Thyroid Disease?

Approximately 12 million Americans are affected by thyroid disease. Thyroid diseases occur at least five times more frequently in women than in men.

  • As many as ten percent of women over age 65 have an underactive thyroid.
  • Thyroid dysfunction complicates between 5 percent and 9 percent of all pregnancies.
  • Thyroid nodules are common, but only between 5 and 10 percent of these are cancerous.

Symptoms

Symptoms of thyroid cancer may include:

  • A lump, or nodule, in the front of the neck near the Adam's apple (for men)
  • Hoarseness
  • Swollen lymph nodes, especially in the neck
  • Difficulty swallowing or breathing
  • Pain in the throat or neck

Other condition can also cause these symptoms, so it’s important to see a doctor right away.

Thyroid Cancer and Nodules

Thyroid nodules are growths, or collections of cells, that form on the thyroid. In most cases, thyroid nodules are benign, meaning they are not cancerous. They usually do not grow or spread and do not cause pain or other symptoms. In some cases, though, thyroid nodules are malignant, or cancerous. Cancerous thyroid growths can affect the functioning of the thyroid and cause other symptoms, including difficulty swallowing and swelling in the neck.

Diagnosis

To make a diagnosis, our doctors:

  • Take a full medical history
  • Perform a complete head and neck exam
  • Possibly remove a small amount of the tumor during a biopsy, for further study
  • Potentially run lab and imaging tests, including:
    • Laryngoscopy: examination of the larynx (voice box) with a laryngoscope
    • Blood Tests: look for abnormal levels of calcium and hormones, including the thyroid-stimulating hormone (TSH) that controls how fast thyroid cells grow
    • Ultrasound
    • CT (CAT) scan
    • X-ray

These exams and tests help the doctor determine:

  • The type of cancer and its stage
  • How aggressive it is
  • Whether it has spread
  • How best to treat it

The MedStar Georgetown Cancer Institute has thyroid cancer specialists who can offer you individualized treatment based on your needs. Thyroid cancer occurs in tissues of the endocrine system which consists of your body’s hormone-secreting glands including the thyroid, parathyroid, adrenal, pancreas, and pituitary glands. These glands are located in different areas of the body and produce hormones that regulate many bodily functions. 

Endocrine cancers are the fastest growing cancer in women and affect women three times more often than men. At the time of diagnosis, most women are usually between the ages 40 and 50. Men who develop endocrine cancer are usually diagnosed in later years, between the ages 60 and 70.  The most common type of endocrine cancer is thyroid cancer. Your thyroid is a small, butterfly-shaped gland at the base of your throat. It has two main sections, a left lobe and a right lobe. The middle of the thyroid gland, where the lobes meet, is called the isthmus. Your thyroid makes the hormone thyroxine which helps control metabolism, blood pressure, heart rate, body temperature, and weight.

Most thyroid cancers are very treatable and usually can be cured with surgery and appropriate therapy. 

Kidney Cancer

The kidney is a bean-shaped organ that is situated in the back, just below the ribcage, on both sides of the body. Their job is to clean the blood from any impurities. This extra waste is sent to the bladder, where it is stored until urination. Approximately 30,000 cases of kidney cancer will be diagnosed in the United States yearly, according to the American Cancer Society.

The MedStar Georgetown Cancer Institute specialists provide comprehensive care for kidney cancer including:

  • Laparoscopic radical nephrectomy
  • Open radical nephrectomy for large tumors
  • Partial nephrectomy for preservation of the kidney. This procedure can be done through traditional open surgery, laparoscopically or through robotic surgery.
  • Small molecule targeted therapy for late stage treatment
  • Palliative services

Symptoms of Kidney Cancer

Symptoms of kidney cancer may include:

  • Blood in the urine
  • Pain during urination
  • Pain in the pelvis
  • A feeling of generalized pressure in the pelvis. This may be caused by the tumor pressing on other organs near the kidneys.

Diagnosis of Kidney Cancer

Your doctor will ask for a complete medical history and will perform a thorough physical examination. Diagnostic tests may include:

  • Analysis of urine under a microscope to check for blood
  • Radiological imaging of the entire urologic system, including ultrasound
  • CT scan
  • MRI
  • Bone scan, to check for spread of cancer
  • PET scan

Hereditary Risk

genetric counseling

Is Genetic Counseling Right for You?

  • Does cancer run in your family? 
  • Were you diagnosed with cancer at a young age? 
  • When you heard about Angelina Jolie’s experience with BRCA1 genetic testing and her decision to have her breasts and ovaries removed to reduce her risk, did you wonder whether you or someone in your family should get tested? 

If you answered yes to any of these questions, genetic counseling – and possibly genetic testing – can help you and your family. 

Although many people have a family history of cancer, only 5-10 percent of cancers are due to an inherited susceptibility.  Genetic counseling can help you learn more about hereditary risks for cancer, and how genetic testing may provide important information for you and your family. 

Genetic Counseling at MedStar Georgetown Cancer Institute

Our program provides a full range of services to help you and your family when inherited, cancer-related mutations are suspected. We offer:

  • Expertise: We are the most experienced hereditary cancer team in the D.C. metro area—our doctors and researchers are nationally recognized, and our genetic counselors are certified by the American Board of Genetic Counseling. Such expertise is important, because:
    • Hereditary cancer is a complex, rapidly evolving field—studies show that doctors who don’t specialize in the subject often order the wrong tests or don’t interpret them correctly.
    • Most at-home genetic testing kits (direct-to-consumer, or DTC) don’t look for clinically important genes, and none come with the counseling that can ease anxiety, provide meaning and help guide care, including preventive steps.
  • Research and Clinical Trials: We are leaders in local, national, and international research efforts to understand cancer risks associated with gene mutations and cancer family histories; evaluate genetic counseling approaches; help people make decisions about management after genetic testing; identify additional inherited mutations that can cause cancer; and to find better ways to detect, treat and prevent hereditary cancers.
    • Through Georgetown Lombardi’s Fisher Center for Hereditary Cancer and Clinical Genomics Research, the Lombardi Research Participant Registry, and the MedStar Georgetown Cancer Institute, we are able to provide you with information about many research opportunities. You may benefit by:
      • Getting access to local and national clinical trials that test new approaches to genetic counseling, cancer screening and cancer risk management
      • Helping the next generation of your family
  • Seamless Care: We work closely with MedStar Georgetown Cancer Institute cancer specialists covering all types of cancer. While those doctors know when to send us patients, we also encourage you to contact us. We work with doctors outside the network, too, sharing results and collaborating on management plans.
  • Insurance Coverage for Genetic Testing and Counseling: Most insurance companies cover all or part of genetic counseling. For testing, we work with your insurer to get approval beforehand (pre-authorization).

Should I Get Genetic Counseling for Hereditary Cancer Risk?

Please contact us with any questions — we’d rather be in a position to determine you might not be a good candidate rather than miss the opportunity to provide help.

Generally speaking, these are the signs that cancer might run in your family:

Please keep in mind that:

  • If you have not had cancer and nobody in your family with cancer has undergone genetic testing, we may suggest that a relative who has one of the cancers above be tested first. This process may greatly help us understand the basis of cancer in your family.
  • Even if a cancer risk gene mutation runs in your family, you may not have it yourself.
  • Even if you have a cancer risk gene mutation, you won’t necessarily get cancer.
  • Confirmed history of a harmful alteration (mutation) in a cancer risk gene
  • One or more individuals with cancer diagnosed before age 50, such as:
    • Breast cancer in women: Triple negative breast cancer diagnosed before age 60 (these are breast cancers that are negative for estrogen and progesterone receptors and   HER2/neu)
    • Colon cancer
    • Uterine or endometrial cancer
    • Gastric cancer, especially diffuse type
    • Pancreatic cancer
    • Renal cancer
    • Sarcoma of bone or muscle
  • One or more individuals who have had any of these cancers:
    • Ovarian, fallopian tube, or peritoneal cancer
    • Male breast cancer
    • Medullary thyroid cancer
    • Sebaceous carcinoma
    • Adrenocortical cancer
    • Choroid plexus cancer
  • More than one cancer in the same person, especially if the first one was diagnosed before age 50, such as:
    • Breast and ovarian cancer
    • Breast and thyroid cancer
    • Colon and uterine cancer
    • Melanomas
  • One or more individuals with multiple colon polyps (adenomatous, hamartomatous or juvenile)
  • Individuals with the same or related cancers on the same side of the family, such as:
    • Breast, ovarian, prostate, and/or pancreatic cancers
    • Colon, uterine, ovarian, and/or stomach cancers
  • Abnormal testing results from colon or uterine tumors
    • These tests are called microsatellite instability, or MSI, and immunohistochemistry, or IHC
    • Abnormal results may indicate an increased hereditary risk
  • Jewish ancestry, especially with a personal or family history of breast, ovarian, or pancreatic cancer

What Does Genetic Counseling for Hereditary Cancer Risk Involve?

Genetic counseling provides a full range of support for individuals concerned about potential hereditary risks of cancer.  During your session, your certified genetic counselor will:

  • Take a complete personal and family medical history — particularly for brothers, sisters, parents, children, grandparents, aunts, uncles, nieces, nephews and first cousins-focusing on cancer diagnoses in the family and the age when family members were diagnosed.  
  • Explain how harmful gene changes (mutations) may be passed down in families and contribute to cancer risk, along with other factors
  • Discuss options for genetic testing, including the potential benefits, risks, and limitations of testing
  • Assess the chance that cancer will develop at some point in your life, or your chance of developing a second (primary) cancer
  • Create a personalized plan for cancer screening and risk reduction based on national guidelines and current research
  • Review the likelihood that relatives may have an inherited cancer risk mutation
  • Refer you to research and clinical trial opportunities
  • Provide emotional support and referrals to support groups
  • Review previous cancer genetic test results and identify possible new options for testing

Cancer and Genetic Testing

Testing for inherited mutations that are associated with increased cancer risks  is a powerful tool, one that continues to improve all the time. We can now test for mutations in over 20 different genes with just one blood or saliva sample.

If you choose to have genetic testing, in most cases, you can provide a sample immediately following your initial genetic counseling session. 

Some people who get counseling choose not to get testing. That is okay. We help you weigh the decision and encourage careful consideration — while you can get tested during your initial visit, you can also come back to do so.

Cancer and Genetic Testing: Things to Consider

We help you consider several factors when deciding whether to undergo genetic testing for cancer risk:

  • Impact: Most people who get genetic testing cope very well with the results. You may be relieved and feel good about taking action to protect your health and become more informed.  But sometimes coping with genetic test results can be challenging.  We provide information and support resources to help meet your individual needs. 
  • Family: Obtaining information for family members is often a key reason for choosing to have genetic testing. But sometimes relationships can be strained by prospects of testing and by the results — not everyone wants to know this type of information.
  • Uncertainty: Sometimes genetic testing fails to provide a definitive answer about cancer risk.
    • This can happen when extensive testing is pursued and no mutation is found.  This type of test result does not always rule out hereditary risks for cancer.
    • Sometimes a gene change is found and the cancer risks that are associated with it are very unclear. 
  • Timing: The length of time to receive results varies depending on the type of test and the lab used. Sometimes results take several weeks to obtain.
  • Cost: The cost of genetic testing varies widely depending on what tests are ordered, what lab is used, and whether you have insurance. 
  • Genetic Discrimination: The federal Affordable Care Act and the Genetic Information Nondiscrimination Act (GINA) as well as some state laws provide many protections against employers and health insurers treating people differently based on genetic information. 

If you do choose to get tested, we will help you to thoroughly understand the results, their meaning and their implications for you and your family.

  • We will give you a detailed written report summarizing your genetic counseling session, the interpretation of any genetic testing results, the recommendations for your medical management and implications for your relatives.
  • We will also make specific referrals for medical and other follow-up if needed.

Hereditary Cancer and Cancer Prevention 

There are several steps you and your family can take to lower the risk of cancer. We craft an individualized set of recommendations based on your family history, risk level, and if pursued, genetic testing results. We also help you weigh the options, which might include:

  • Earlier and more frequent cancer screening than people at average risk, sometimes with specific tests
  • Use of medications (for example, tamoxifen) to prevent cancer (called chemoprevention)
  • Preventative surgery (risk-reducing or prophylactic procedures) to remove the breast(s), the colon or the ovaries and fallopian tubes
  • If appropriate, lifestyle changes such as changing your diet, limiting alcohol consumption, getting more exercise or giving up smoking

If you have been newly diagnosed with cancer, genetic testing may provide information for your treatment planning, such as helping you make decisions about surgery. 

Insurance Coverage for Genetic Testing and Counseling

Many insurance companies cover all or part of genetic counseling. For testing, we submit the necessary paperwork to the laboratory who will then work with your insurer to obtain approval beforehand (pre-authorization). We can tell you what your out of pocket costs for testing will be before you get tested.  Of note, genetic testing may not be approved by certain Medicaid plans.

If you do not have any health insurance, you may be eligible to receive genetic testing at no charge, or at a reduced rate, provided you meet certain criteria.

Small Bowel Cancer

Small bowel cancer is a rare disease in which malignant (cancer) cells form in the tissues of the small intestine.

The small intestine is part of the body’s digestive system, which also includes the esophagus, stomach, and large intestine. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The small intestine is a long tube that connects the stomach to the large intestine. It folds many times to fit inside the abdomen.

There are five types of small intestine cancer.

The types of cancer found in the small intestine are:

  • Adenocarcinoma
  • Sarcoma
  • Carcinoid tumors
  • Gastrointestinal stromal tumor
  • Lymphoma, including adenocarcinoma and leiomyosarcoma.
    • Adenocarcinoma starts in glandular cells in the lining of the small intestine and is the most common type of small intestine cancer. Most of these tumors occur in the part of the small intestine near the stomach. They may grow and block the intestine.
    • Leiomyosarcoma starts in the smooth muscle cells of the small intestine. Most of these tumors occur in the part of the small intestine near the large intestine.

Symptoms of Small Bowel Cancer

Possible signs of small bowel cancer include abdominal pain and unexplained weight loss.

These and other symptoms may be caused by small intestine cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

  • Pain or cramps in the middle of the abdomen.
  • Weight loss with no known reason.
  • A lump in the abdomen.
  • Blood in the stool.

Diet and health history can affect the risk of developing small intestine cancer.

Risk Factors

Risk factors for small bowel cancer include the following:

  • Eating a high-fat diet.
  • Having Crohn disease.
  • Having celiac disease.
  • Having familial adenomatous polyposis (FAP).

Stages of Small Bowel Cancer

Staging is used to find out how far the cancer has spread, but treatment decisions are not based on stage. See the General Information section for a description of tests and procedures used to detect, diagnose, and stage small intestine cancer.

There are three ways that cancer spreads in the body.

  • Through tissue. Cancer invades the surrounding normal tissue.
  • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
  • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

Small bowel cancer is grouped according to whether or not the tumor can be completely removed by surgery.

Treatment depends on whether the tumor can be removed by surgery and if the cancer is being treated as a primary tumor or is metastatic cancer.

Recurrent Small Intestine Cancer

Recurrent small intestine cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the small intestine or in other parts of the body.

Diagnosis

Tests that examine the small intestine are used to detect, diagnose, and stage small intestine cancer.

Procedures that create pictures of the small intestine and the area around it help diagnose small intestine cancer and show how far the cancer has spread. The process used to find out if cancer cells have spread within and around the small intestine is called staging.

In order to plan treatment, it is important to know the type of small intestine cancer and whether the tumor can be removed by surgery. Tests and procedures to detect, diagnose, and stage small intestine cancer are usually done at the same time. The following tests and procedures may be used:

  • Physical exam and history. An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.
  • Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver disease that may be caused by small intestine cancer.
  • Abdominal x-ray: An x-ray of the organs in the abdomen. An x-ray is a type of energy beam that can go through the body onto film, making a picture of areas inside the body.
  • Barium enema: A series of x-rays of the lower gastrointestinal (GI) tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.
  • Fecal occult blood test: A test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.
  • Upper endoscopy: A procedure to look at the inside of the esophagus, stomach, and duodenum (first part of the small intestine, near the stomach). An endoscope (a thin, lighted tube) is inserted through the mouth and into the esophagus, stomach, and duodenum. Tissue samples may be taken for biopsy.
  • Upper GI series with small bowel follow-through: A series of x-rays of the esophagus, stomach, and small bowel. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus, stomach, and small bowel. X-rays are taken at different times as the barium travels through the upper GI tract and small bowel.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. This may be done during the endoscopy. The sample is checked by a pathologist to see if it contains cancer cells.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.
  • Laparotomy: A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken for biopsy.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The type of small intestine cancer.
  • Whether the cancer has spread to other places in the body.
  • Whether the cancer can be completely removed by surgery.
  • Whether the cancer is newly diagnosed or has recurred.

Esophageal Cancer Risk Factors and Screening

Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus.

Esophageal cancer is found more often in men: Men are about three times more likely than women to have esophageal cancer. There are more new cases of esophageal adenocarcinoma each year and fewer new cases of squamous cell carcinoma. Squamous cell carcinoma of the esophagus is found more often in blacks than in whites. The chance of developing esophageal cancer increases with age.

Smoking, heavy alcohol use, and Barrett esophagus can affect the risk of developing esophageal cancer.

Anything that increases the chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor.

Risk factors for squamous cell esophageal cancer include the following:

  • Using tobacco.
  • Drinking a lot of alcohol.
  • Being malnourished (lacking nutrients and/or calories).
  • Being infected with human papillomavirus (HPV).
  • Having tylosis.
  • Having achalasia.
  • Having swallowed lye (a chemical found in some cleaning fluids).
  • Drinking very hot liquids on a regular basis.

Risk factors for esophageal adenocarcinoma include the following:

  • Having gastroesophageal reflux disease (GERD).
  • Having Barrett esophagus.
  • Having a history of using drugs that relax the lower esophageal sphincter (the ring of muscle that opens and closes the opening between the esophagus and the stomach).
  • Being overweight.

Esophageal Cancer Screening

There is no standard or routine screening test for esophageal cancer.

Screening for esophageal cancer is under study with screening clinical trials taking place in many parts of the country. 

Tests that may detect (find) esophageal cancer are being studied:

  • Esophagoscopy: A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope is inserted through the mouth or nose and down the throat into the esophagus. An esophagoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
    A thin, lighted tube is inserted through the mouth and into the esophagus to look for abnormal areas.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. Taking biopsy samples from several different areas in the lining of the lower part of the esophagus may detect early Barrett esophagus. This procedure may be used for patients who have risk factors for Barrett esophagus.
  • Brush cytology: A procedure in which cells are brushed from the lining of the esophagus and viewed under a microscope to see if they are abnormal. This may be done during an esophagoscopy.
  • Balloon cytology: A procedure in which cells are collected from the lining of the esophagus using a deflated balloon that is swallowed by the patient. The balloon is then inflated and pulled out of the esophagus. Esophageal cells on the balloon are viewed under a microscope to see if they are abnormal.
  • Chromoendoscopy: A procedure in which a dye is sprayed onto the lining of the esophagus during esophagoscopy. Increased staining of certain areas of the lining may be a sign of early Barrett esophagus.
  • Fluorescence spectroscopy: A procedure that uses a special light to view tissue in the lining of the esophagus. The light probe is passed through an endoscope and shines on the lining of the esophagus. The light given off by the cells lining the esophagus is then measured. Malignant tissue gives off less light than normal tissue.

Esophageal Cancer

Esophageal Cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus.

The esophagus is the hollow, muscular tube that moves food and liquid from the throat to the stomach. The wall of the esophagus is made up of several layers of tissue, including mucous membrane, muscle, and connective tissue. Esophageal cancer starts at the inside lining of the esophagus and spreads outward through the other layers as it grows.

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The stomach and esophagus are part of the upper digestive system.

The two most common forms of esophageal cancer are named for the type of cells that become malignant (cancerous):

  • Squamous cell carcinoma: Cancer that forms in squamous cells, the thin, flat cells lining the esophagus. This cancer is most often found in the upper and middle part of the esophagus, but can occur anywhere along the esophagus. This is also called epidermoid carcinoma.
  • Adenocarcinoma: Cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the esophagus produce and release fluids such as mucus. Adenocarcinomas usually form in the lower part of the esophagus, near the stomach.

Symptoms of Esophageal Cancer

The most common signs of esophageal cancer are painful or difficult swallowing and weight loss.

These and other symptoms may be caused by esophageal cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

  • Painful or difficult swallowing.
  • Weight loss.
  • Pain behind the breastbone.
  • Hoarseness and cough.
  • Indigestion and heartburn.

Diagnosis

Tests that examine the esophagus are used to detect (find) and diagnose esophageal cancer.

  • The following tests and procedures may be used:
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.
  • Barium swallow. The patient swallows barium liquid and it flows through the esophagus and into the stomach. X-rays are taken to look for abnormal areas.
  • Esophagoscopy: A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope, a thin, lighted tube, is inserted through the mouth or nose and down the throat into the esophagus. An esophagoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy is usually done during an esophagoscopy. Sometimes a biopsy shows changes in the esophagus that are not cancer but may lead to cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The stage of the cancer (whether it affects part of the esophagus, involves the whole esophagus, or has spread to other places in the body).
  • The size of the tumor.
  • The patient's general health.

When esophageal cancer is found very early, there is a better chance of recovery. Esophageal cancer is often in an advanced stage when it is diagnosed. At later stages, esophageal cancer can be treated but rarely can be cured.

Taking part in one of the clinical trials being done to improve treatment should be considered. Learn more about our clinical trials.

Treating Esophageal Cancer

There are different types of treatment for patients with esophageal cancer.

Different types of treatment are available for patients with esophageal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Patients have special nutritional needs during treatment for esophageal cancer.

Many people with esophageal cancer find it hard to eat because they have trouble swallowing. The esophagus may be narrowed by the tumor or as a side effect of treatment. Some patients may receive nutrients directly into a vein. Others may need a feeding tube (a flexible plastic tube that is passed through the nose or mouth into the stomach) until they are able to eat on their own.

Five types of standard treatment are used:

  • Surgery: Surgery is the most common treatment for cancer of the esophagus. Part of the esophagus may be removed in an operation called an esophagectomy. 
    • Esophagectomy: A portion of the esophagus is removed and the stomach is pulled up and joined to the remaining esophagus.The doctor will connect the remaining healthy part of the esophagus to the stomach so the patient can still swallow. A plastic tube or part of the intestine may be used to make the connection. Lymph nodes near the esophagus may also be removed and viewed under a microscope to see if they contain cancer. If the esophagus is partly blocked by the tumor, an expandable metal stent (tube) may be placed inside the esophagus to help keep it open.
    • Esophageal stent: A device (stent) is placed in the esophagus to keep it open to allow food and liquids to pass through into the stomach.
  • Radiation therapy: A plastic tube may be inserted into the esophagus to keep it open during radiation therapy. This is called intraluminal intubation and dilation.
  • Chemotherapy: Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
  • Laser therapy: Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.
  • Electrocoagulation: Electrocoagulation is the use of an electric current to kill cancer cells.

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Esophageal Cancer Risk Factors and Screening

 

Stomach Cancer

Stomach or gastric cancer develops when a tumor grows in the stomach. Stomach cancer can be serious and is a common cause of death worldwide. Fortunately, rates of stomach cancer in the United States are falling.

Stomach Cancer Care - Our Approach

We believe that a multidisciplinary approach is the best way to treat patients with stomach cancer. Our team includes experts from a wide range of fields including: 

  • Gastroenterologists
  • Fellowship trained surgical oncologists
  • Medical oncologists
  • Radiation therapists
  • Rathologists
  • Radiologists
  • Nurse navigators

Working as a true team, we meet regularly to discuss each of our patients in great detail so we can develop and mange the best treatment plans. As a patient, you benefit from the variety of experience and talent we bring together. 

Risk Factors

A risk factor increases your chances of developing a disease. The risk factors for stomach cancer include:

  • Presence of H. Pylori: These stomach-dwelling bacteria can be with antibiotics. While not everyone who develops stomach cancer has H. Pylori bacteria, those who do may be at increased risk.
  • Gender: Men are more likely than women to develop stomach cancer.
  • Pernicious anemia: A severe lack of red blood cells can lead to stomach cancer.
  • Absence of acid production: Lack of sufficient acid in the stomach can contribute to the development of stomach cancer.
  • Gastric polyps: Certain types of gastric polyps are more likely to develop into cancer.
  • Smoking: People who smoke increase their risk for developing stomach cancer. 
  • Alcohol consumption: People who drink heavily increase their risk for developing stomach cancer.
  • Certain inherited diseases: Diseases such as hereditary non-polyposis colon cancer (HPNCC) may be associated with stomach cancer.

Symptoms

  • Abdominal pain
  • Heartburn
  • Nausea
  • Vomiting
  • Weight loss
  • Feeling full after small meals

These symptoms are similar to those of acid reflux. If you experience any of these, consult with your primary care doctor.

Diagnosis

If you may have stomach cancer, your primary care physician will recommend that you meet with a gastroenterologist or surgical oncologist. Our team of gastroenterologists and surgical oncologists take great care to make accurate diagnosis for each patient and carefully evaluate any symptoms with the following diagnostic tools and procedures:

  • Medical history: We will ask you about your background, previous surgeries and any family history of stomach cancer. 
  • Physical examination: We will perform a detailed physical examination to determine whether you have a stomach tumor and if it has spread anywhere else in your body. This exam may include any of the following tests and procedures: 
    • Biopsy: This procedure allows your surgeon to carefully examine the cells of the tumor under a microscope to determine whether it is cancerous. 
    • Endoscopy: In this procedure, your gastroenterologist will place an endoscope, which is a thin camera with a special light, into your stomach. With the endoscope, your surgical oncologist can locate the tumor and remove cells from it for a biopsy. 
    • Endoscopic ultrasound: This is a specialized test gastroenterologists use to determine specific details about the tumor, including how thick it is and whether the cancer is spreading to nearby lymph nodes. 
    • CT Scan: These are tests your gastroenterologist uses to create a computerized picture of other organs, such as your liver and lungs, to determine if your stomach cancer is spreading. 
    • Laparoscopy: If your gastroenterologist determines that you have a stomach tumor, he or she will refer you to a surgical oncologist for further evaluation. The surgical oncologist will place a special camera in the abdomen to inspect the entire area for cancer through a surgical procedure called a laparoscopy. Laparoscopy determines whether the cancer is spreading and helps avoid additional surgical procedures. 

Treatment

Your physician team, which includes a medical oncologist, radiation therapist, and surgical oncologist, will carefully evaluate your condition and determine the most effective form of treatment for you.

  • Surgery: After diagnosing your stomach cancer, and determining that it has not spread to other organs, your surgical oncologist will likely recommend that you have surgery. The extent of the surgery will depend on where your tumor is located and whether it has spread to the surrounding lymph nodes. Surgery generally involves removing part or all of the stomach as well as affected lymph nodes.
  • Chemotherapy: Major studies suggest that chemotherapy either with or without radiation may add to the benefits of surgery. Chemotherapy, which is cancer medication that you receive through your veins, can attack tumor cells in the body that surgery and imaging cannot detect. Your physician team will carefully evaluate the most effective form of treatment for you. 
  • Post-surgical Care: Your team will monitor your progress every three months for the first two years following stomach cancer surgery. We will repeat your endoscopy and CT scan to make sure the cancer is not coming back. We also encourage patients to meet with our:

    • Nutritionist, who will help you understand any necessary changes in your diet following your treatment.
    • Social worker, who will help you manage any other needs and concerns before, during, and after your treatment.

Liver Cancer

Liver cancer is one of the most common malignancies worldwide, affecting nearly one million individuals. The most common cancer that begins in the liver is called hepatocellular carcinoma; this is associated with several chronic liver diseases, including alcoholic cirrhosis, chronic Hepatitis B, and Hepatitis C. Certain metabolic conditions are also associated with HCC, including hemochromatosis, autoimmune hepatitis, and PBC.

Symptoms

  • Abdominal pain
  • Abdominal mass
  • Jaundice
  • Nausea
  • Other indications of liver dysfunction

Physicians at MedStar Health may use a series of physical, laboratory, and imaging tests to uncover liver cancer, but the final diagnosis is often confirmed via needle biopsy, which is the removal and examination of a small piece of the suspected tumor.

Treatment

Liver tumors may be benign or malignant, but most require surgical removal.  MedStar Health physicians work closely with patients to develop the best treatment plan for their specific case, which may include the following

  • Surgery
  • Ablation: This procedure involves destroying the liver tumor and the cancer cells with high levels of heat aimed at the tumor. It has minimal side effects.
    • Radiofrequency ablation (RFA): This technique uses a heating probe to destroy tumors with an alternating radiofrequency electrical current. It can be performed during open surgery, laparoscopy, or through the skin using X-ray.
    • Microwave ablation: This technique is similar to radiofrequency ablation, but uses microwave energy to destroy the tumor instead.
  • Resection: Portions of the liver are surgically removed (the liver quickly regenerates, or grows back, to normal size, after this procedure). This can also be performed laparoscopically
  • Radiation therapy
  • Chemotherapy
  • Liver transplant

 

Gallbladder Cancer

Gallbladder cancer is rare. Your prognosis and treatment options depend on whether it is discovered early or at a late stage:

  • Early-stage gallbladder cancer: Surgical removal, or a cholecystectomy, is an option when the cancer has not spread to other areas of the body. In some cases, if the cancer has spread into the liver, your surgeon can remove affected portions of the liver and surrounding bile ducts during the cholecystectomy.
  • Late-stage gallbladder cancer: Surgery is not an option for cancer that has spread beyond the gall bladder to other parts of the body. Your doctor may prescribe radiation therapy, chemotherapy, or both to relieve your symptoms and make you as comfortable as possible.

Bile Duct Cancer

Bile duct cancer is rare. The tumors grow in and block the ducts that carry bile from the liver to the small intestine. They tend to grow slowly and do not spread quickly. Treatment options vary depending on the tumor's size and stage and include:

  • Surgery: If tumors are small and caught early, your doctor may be able to eliminate all of the cancer cells by removing part of the bile duct. If the cancer has advanced, your doctor may need to remove some liver tissue, as well. Bile duct cancer surgery may be performed in conjunction with radiation therapy, chemotherapy, or both.
  • Ablation: Ablation aims high levels of heat at the tumor to destroy its cancerous cells.

As with all of our treatment teams, our gastrointestinal surgical oncology team is dedicated to working closely with you and your family in healing and recovery.