The mission of The University of Arizona Clinical Gastrointestinal Cancer Program is to provide state-of-the-art preventive, diagnostic and treatment services for patients at risk for, or those suffering from, gastrointestinal cancers. The American Cancer Society estimates that more than 170,000 US citizens will develop cancer of the digestive tract this year; 100,000 will die of it. Led by cancers of the colon, esophagus and pancreas, GI cancers account for more than 17 percent of US cancer deaths.
The Cancer Center's Clinical Gastrointestinal Cancer Program is a multidisciplinary program that draws on special expertise in gastrointestinal cancer pathology (Dept. of Pathology), cancer genetics, diagnosis and prevention (Gastroenterology Section and Cancer Control), surgical oncology, interventional radiology, radiation oncology, pain management, nutrition and psychosocial services. Gastrointestinal cancers include malignant tumors of esophagus, pancreas, biliary tract and liver, colon and rectum, and anal cancers.
Learn more - download the Gastrointestinal Cancer Program Fast Facts.
Risk assessment includes the taking of a careful family history of any cancer and a past medical history for conditions known to predispose to particular cancers. Behavioral factors, such as tobacco smoking, excessive alcohol consumption, physical inactivity and certain dietary habits, play a crucial role in causation of the common cancers, including those of the gastrointestinal tract. We have embarked on a major initiative, involving behavioral scientists, epidemiologists, primary care physicians and other experts, to develop research and education prevention programs targeting gastrointestinal and other cancers.
In carefully selected individuals, generally those already known to be at increased risk for a particular cancer such as colorectal or pancreatic, genetic testing may be indicated. An absolute requirement is that genetic testing should only be carried out in consultation with a fully qualified genetic counselor.
Screening and Diagnosis of Precancerous and Cancerous Lesions:
The premise of screening is that treatment is more likely to be successful if a condition is diagnosed before symptoms arise. Colorectal cancer exemplifies this premise; more than 90 percent of colorectal cancers are cured permanently by surgery, if diagnosed at the earliest stage of invasion into the bowel wall. However, the great majority of colorectal cancers at this earliest stage cause no symptoms and, therefore, can be diagnosed only through screening. Colorectal cancer screening is now recommended from age 50 for those at average risk for the disease, which means everyone not at increased risk, for whom screening protocols are individualized.
Colonoscopy is an example of an endoscopic procedure used to diagnose precancerous and cancerous lesions of the large intestine (colon and rectum). Upper endoscopy is endoscopic procedure used to examine upper gastrointestinal tract (esophagus, stomach and duodenum). These procedures are performed by experienced gastroenterology specialists. The technology includes a powerful light source and a videochip at the instrument tip, allowing the inside of the gut ahead to be projected in real time on a television monitor in front of the operator. Endoscope allow for passage of forceps and other instruments, which can be used to take small tissue specimens (biopsies), remove and retrieve adenomas and carry out other manipulations.
Prevention efforts include interventions to modify risky behaviors, such as tobacco smoking, unhealthy diet and physical inactivity, and programs to enhance adherence to recommendations for screening for colorectal and other cancers. It is estimated that approximately two-thirds of the population are not being screened for colorectal cancer according to current guidelines. In conjunction with the Arizona Department of Health Services and the American Cancer Society, we are developing a comprehensive program to boost the proportion of Arizonans in compliance with colorectal cancer screening recommendations to more than 50 percent by the year 2010.
Treatment for gastrointestinal cancers often involves different approaches, most commonly surgery, radiation therapy and chemotherapy or other forms of anti-cancer therapy. Many patients will be cured with surgery, frequently combined with chemotherapy or chemotherapy/radiation. Colorectal surgery focuses on both cure and quality of life. For rectal cancer our faculty have been leaders in developing ”total mesorectal excision (TME), autonomic nerve preservation (sexual function), and ultra-low reconstructions frequently utilizing the colonic J-Pouch technique."
About a third of patients with colorectal cancer and a large majority of patients with esophageal, stomach and pancreatic cancer present with advanced, incurable disease. The goal of the effective treatment for those patients is to prolong the life, eliminate suffering caused by cancer, and hopefully be able to cure some patients with advanced gastrointestinal cancers. Surgical extirpation of liver, bile duct and pancreatic tumors is an area of expertise in the surgical faculty. Cancers that cannot be removed may be “ablated”; a technique that uses radio-frequency to fatally heat the cancer cells. Heated abdominal chemotherapy (HIPEC) may be used to treat some abdominal cancers; an approach unique in the Southwest to The University of Arizona Cancer Center in recent years we have learned a great deal about genes and proteins that make cancer cells behave aggressively and survive various treatments. These genes and proteins are considered to be important targets for the so-called targeted therapies. Recent examples of successful targeted therapies include designed antibodies, such as Avastin and Erbitux for colorectal cancer, and Gleevec for GI stromal tumors. Similar approaches are being actively investigated by cancer researchers at the Arizona Cancer Center. Researchers and clinicians from The University of Arizona Cancer Center have been awarded major research grants to study and develop new strategies to detect, prevent and cure gastrointestinal cancers. Examples are the prestigious GI Cancer SPORE Grant and Pancreatic Cancer P 01 Grant (in collaboration with Tgen) awarded to The University of Arizona Cancer Center researchers.GI Team
Evan Ong, MD, MS, Surgical Oncologist - liver, pancreas and upper GI
Emad Elquza, MD, GI Medical Oncologist
Baldassarre Stea, MD, PhD, Radiation Oncologist
Rainer Gruessner, MD, Surgery - liver and pancreatic cancer
John F. Renz, MD, PhD, Surgery - liver and pancreas
Nam Nguyen, MD, Radiation Oncologist
Amanda Baker, PharmD, PhD, Translational Research
Christopher Campen, PharmD, BCPS, Clinical Pharmacist
Sandy Kurtin, ANP
Jill Winter, MSW, Social Worker
Michelle Bratton, Clinical Nutritionist
Bhaskar Banerjee, MD
Thomas Boyer, MD
John Cunningham, MD
Ronnie Fass, MD
Steve Goldschmid, MD
Peter Lance, MD
Raymond Moldow, MD
Abdul Nadir, MD
Rafael Fleury Perini, MD
Kristen Ray, NP
Richard Sampliner, MD
Achyt Bhattacahrriya, MD
Rob Klein, MD
Steven Smythe, MD
Lisa Gushwa, MD
Erika Albani, MD
Maya Porrino, MD
Phaythoune Chothmounethinh, MD
Emil Annabi, MD