Ask the Doctor at Saint John’s: Saint John’s Physician Reports on Newest Treatments for Gastrointestinal Cancer

Q. What is gastrointestinal cancer and what are the newest treatments for it?

A: By Melani Shaum, M.D., Medical Oncologist, Gastrointestinal Oncologist and Hematologist, The Angeles Clinic and Research Institute at Saint John’s Health Center.

Gastrointestinal cancer refers to cancers of the gastrointestinal or GI tract. That includes the esophagus and stomach, the liver, the bile ducts, the gall bladder and pancreas, and the colon and rectum.

If detected early, GI cancers are highly curable. We encourage all Americans over 50 to be screened regularly for colon cancer with a colonoscopy. If you have a family history of colon cancer or colon polyps, you should start screening at age 40 or perhaps in your 30s. Polyps have the potential to turn into cancer, so they should be attended to.

If we screen everyone regularly, we can cut down on the number of colon cancers that occur by at least 90 percent. We try to do more colonoscopies than sigmoidoscopies because sigmoidoscopies only view the bottom two feet of colon, whereas colonoscopies show us the entire colon, which is five or six feet.

If cancer is detected through routine screening, often patients will have surgical treatment, then they might see a medical oncologist if they need additional drug treatment to improve their chances of success and survival.

The recent news is that chronic heartburn is a very important symptom and people who have it habitually, two or three times a week, should see a gastroenterologist and have an upper endoscopy to be screened for cancers of the esophagus and stomach. Chronic heartburn may be a symptom of chronic acid reflux, which can lead to a higher risk for these cancers.

Until about 2000, we had only one effective drug for treating GI cancers, but now we have five or six. There’s been an explosion of drugs, particularly in treating colon and rectal cancer. A couple of the drugs are classical chemotherapy agents. The important drug in that area is Oxaliplatin, which is highly effective against colon and rectal cancers with fewer side effects than some previous chemotherapy drugs.

We also have some exciting targeted-therapy drugs. These include monoclonal antibodies that are also useful in treating colon and rectal cancers. One is an antibody called Erbitux that keeps cancer cells from being able to respond to external growth factors. The other one, Avastin, is an antibody which keeps cancer cells from being able to generate a blood supply.

I see patients at the Angeles Clinic, where we have a number of clinical research protocols for patients with a variety of disease types. This is an outstanding feature we’re able to offer because if we treat someone who has cancer and we have exhausted what we can do with standard drugs and treatments, we’re able to sometimes move them into investigational drugs in a setting that they’re already accustomed to. They can see the same staff doctors and nurses.

Melani Shaum, M.D., is a specialist in Medical Oncology at Saint John’s Health Center. For more information about Dr. Shaum or other Saint John’s services, please call (310) 829-8990 or visit the website at www.stjohns.org. For a physician referral or a second opinion, please call 1-888-ASK-SJHC.

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