Radiation Therapy for Upper GI Cancers

Written by: Dr. Thakkar

Upper gastrointestinal cancers include tumors of the esophagus and stomach. The esophagus is the muscular tube that connects the throat to the stomach. Cancers can arise anywhere along this track and often cause trouble swallowing, weight loss, and pain. Staging of these tumors involves looking at how deep the tumor extends through the wall and the whether the cancer has spread to nearby areas. Treatment for both esophageal and stomach cancer often involves radiation, chemotherapy & surgery and it is important to have a team approach.

Radiation treatment for these cancers requires careful field design and attention to detail. SERO doctors are skilled in the use of conformal treatment planning which allow radiation to be delivered to the areas at high risk for cancer while shielding normal tissues such as the lungs, spinal cord, kidneys, and liver. In addition to radiation planning and delivery, many sites have access to nutrition support and other important services to help patients through treatment.

With 32 highly qualified, experienced, board certified radiation oncologists in the Piedmont region, SERO doctors work closely with members of the medical team to design the best treatment plan for patients with cancers of the esophagus or stomach.

Upper GI cancers include cancers of the esophagus and stomach.

In 2013, more than 13,000 men and 8,000 women will be diagnosed with stomach cancer in the United States. Most will be over 70 years old.

Men are nearly three times more likely than women to develop esophageal cancer.

In 2013, about 18,000 Americans will be diagnosed with esophageal cancer.

The most common cancers of the esophagus include squamous cell cancers and adenocarcinomas, whereas most stomach cancers are adenocarcinomas.

General Risk Factors for Upper GI Cancers

The use of tobacco and alcohol greatly increases your chances of developing upper GI cancer. Risk factors include:

  • Smoking or use of smokeless tobacco, such as chew or dip
  • Alcohol consumption
  • Gastroesophageal reflux disease (GERD) and Barrett’s esophagus increase esophageal cancer risk due to the chronic irritation of the mucosal lining.
  • Plummer-Vinson syndrome (disorder from nutritional deficiencies)
  • Exposure to viruses, including the human papillomavirus (HPV) and Epstein-Barr

Signs of Upper GI Cancers

Although there are sometimes no symptoms of Upper GI cancer, common complaints include:

  • Trouble swallowing
  • Chronic pain when swallowing
  • Frequently choking on food
  • Pressure or burning in your chest
  • Indigestion or heartburn
  • Unexplained weight loss
  • Pain behind your breastbone or in your throat

Diagnosing Upper GI Cancers

To look for cancer, your doctor will perform a physical examination to test the areas around your abdomen, chest, and throat.

A barium swallow, or upper GI series, is often used to create images of the esophagus and stomach. During the procedure, the patient will be asked to eat or drink a substance that contains a compound called barium. The barium coats the stomach and esophagus, allowing x-rays to be taken of the entire area.

Your doctor may also use a flexible endoscope, a thin, lighted tube that is passed through the mouth, to obtain images of the esophagus.

CT, MR and PET scans are often needed to show the location and extent of the cancer.

To confirm if you have cancer, some tissue will be removed and analyzed. This test is called a biopsy.

Treating Upper GI Cancer

Treatment for Upper GI Cancers depends on several factors, including the type of cancer, the size and stage, its location, and your overall health.

  • Surgery, radiation therapy and chemotherapy are the mainstays of treating Upper GI Cacner.
  • For many Upper GI cancers, combining two or three types of treatments may be most effective. That’s why it is important to talk with several cancer specialists about your care, including a surgeon, a radiation oncologist and a medical oncologist.

Understanding Radiation Therapy

Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat cancer.

  • Cancer doctors called radiation oncologists use radiation therapy to try to cure cancer, to control cancer growth or to relieve symptoms, such as pain.
  • Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
  • Healthy cells are also affected by radiation, but they are able to repair themselves in a way cancer cells cannot.
  • After a diagnosis of stomach or esophageal cancer has been established, it’s important to talk about your treatment options with a radiation oncologist.

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the cancer.

  • Painless radiation therapy treatments are delivered in a series of daily sessions. Radiation treatments take only a few minutes, but each session takes about half an hour to get checked in, change clothes, get into position and receive the radiation. For some conditions, radiation is given twice a day, with a four to six hour gap between treatments.
  • Treatments are usually scheduled Monday through Friday, for five to eight weeks. However, your radiation oncologist may schedule your treatments more or less often depending on your cancer.
  • 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the affected area. Tailoring each of the radiation beams to accurately focus on the patient’s tumor allows coverage of the cancer while at the same time keeping radiation away from nearby healthy tissue.
  • Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of each radiation beam. This technique allows a precise adjustment of radiation doses to the tissue within the target area. IMRT may allow doctors to direct a higher radiation dose to the affected area and keep more radiation away from nearby healthy tissue.
  • To help you keep still during treatment, your doctor may use a plastic head or shoulder mask. These devices are specially fitted for you and are painless to use.

Internal Radiation Therapy

Also called brachytherapy, internal radiation therapy involves surgically implanting radioactive material into a tumor or surrounding tissue. For some types of Upper GI cancers brachytherapy is often used in conjunction with external beam radiation therapy, but may be used alone.

  • During low-dose-rate brachytherapy, your radiation oncologist implants thin, hollow, plastic tubes in and around a tumor.
  • These tubes are loaded with tiny radioactive seeds that remain in place for one or several days to kill the cancer. The seeds and the tubes are then removed. Sometimes, tiny radioactive seeds are implanted directly into the tumor and remain permanently.
  • For high-dose-rate brachytherapy, your doctor implants hollow tubes in and around the tumor site.
  • After these tubes are implanted, they are then connected to a special brachytherapy machine that houses a high activity radioactive source. According to your doctor’s specifications, the seed is automatically delivered from the machine and into the tubes, delivering localized radiation over several minutes to kill the cancer.

Possible Side Effects

Side effects of radiation therapy are limited to the area that is receiving treatment.

External radiation therapy aimed at the chest may cause a sore throat, cough, or shortness of breath. You may feel a lump in your throat or burning in your chest or throat when you swallow. After several weeks of treatment, it may be painful to swallow. Your health care team can suggest ways to manage these problems. The problems usually go away when treatment ends.

Upper GI cancers include cancers of the esophagus and stomach.

In 2013, more than 13,000 men and 8,000 women will be diagnosed with stomach cancer in the United States. Most will be over 70 years old.

Men are nearly three times more likely than women to develop esophageal cancer.

In 2013, about 18,000 Americans will be diagnosed with esophageal cancer.

The most common cancers of the esophagus include squamous cell cancers and adenocarcinomas, whereas most stomach cancers are adenocarcinomas.

General Risk Factors for Upper GI Cancers

The use of tobacco and alcohol greatly increases your chances of developing upper GI cancer. Risk factors include:

  • Smoking or use of smokeless tobacco, such as chew or dip
  • Alcohol consumption
  • Gastroesophageal reflux disease (GERD) and Barrett’s esophagus increase esophageal cancer risk due to the chronic irritation of the mucosal lining.
  • Plummer-Vinson syndrome (disorder from nutritional deficiencies)
  • Exposure to viruses, including the human papillomavirus (HPV) and Epstein-Barr

Signs of Upper GI Cancers

Although there are sometimes no symptoms of Upper GI cancer, common complaints include:

  • Trouble swallowing
  • Chronic pain when swallowing
  • Frequently choking on food
  • Pressure or burning in your chest
  • Indigestion or heartburn
  • Unexplained weight loss
  • Pain behind your breastbone or in your throat

Diagnosing Upper GI Cancers

To look for cancer, your doctor will perform a physical examination to test the areas around your abdomen, chest, and throat.

A barium swallow, or upper GI series, is often used to create images of the esophagus and stomach. During the procedure, the patient will be asked to eat or drink a substance that contains a compound called barium. The barium coats the stomach and esophagus, allowing x-rays to be taken of the entire area.

Your doctor may also use a flexible endoscope, a thin, lighted tube that is passed through the mouth, to obtain images of the esophagus.

CT, MR and PET scans are often needed to show the location and extent of the cancer.

To confirm if you have cancer, some tissue will be removed and analyzed. This test is called a biopsy.

Treating Upper GI Cancer

Treatment for Upper GI Cancers depends on several factors, including the type of cancer, the size and stage, its location, and your overall health.

  • Surgery, radiation therapy and chemotherapy are the mainstays of treating Upper GI Cacner.
  • For many Upper GI cancers, combining two or three types of treatments may be most effective. That’s why it is important to talk with several cancer specialists about your care, including a surgeon, a radiation oncologist and a medical oncologist.

Understanding Radiation Therapy

Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat cancer.

  • Cancer doctors called radiation oncologists use radiation therapy to try to cure cancer, to control cancer growth or to relieve symptoms, such as pain.
  • Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
  • Healthy cells are also affected by radiation, but they are able to repair themselves in a way cancer cells cannot.
  • After a diagnosis of stomach or esophageal cancer has been established, it’s important to talk about your treatment options with a radiation oncologist.

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the cancer.

  • Painless radiation therapy treatments are delivered in a series of daily sessions. Radiation treatments take only a few minutes, but each session takes about half an hour to get checked in, change clothes, get into position and receive the radiation. For some conditions, radiation is given twice a day, with a four to six hour gap between treatments.
  • Treatments are usually scheduled Monday through Friday, for five to eight weeks. However, your radiation oncologist may schedule your treatments more or less often depending on your cancer.
  • 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the affected area. Tailoring each of the radiation beams to accurately focus on the patient’s tumor allows coverage of the cancer while at the same time keeping radiation away from nearby healthy tissue.
  • Intensity modulated radiation therapy (IMRT) is a form of 3D-CRT that further modifies the radiation by varying the intensity of each radiation beam. This technique allows a precise adjustment of radiation doses to the tissue within the target area. IMRT may allow doctors to direct a higher radiation dose to the affected area and keep more radiation away from nearby healthy tissue.
  • To help you keep still during treatment, your doctor may use a plastic head or shoulder mask. These devices are specially fitted for you and are painless to use.

Internal Radiation Therapy

Also called brachytherapy, internal radiation therapy involves surgically implanting radioactive material into a tumor or surrounding tissue. For some types of Upper GI cancers brachytherapy is often used in conjunction with external beam radiation therapy, but may be used alone.

  • During low-dose-rate brachytherapy, your radiation oncologist implants thin, hollow, plastic tubes in and around a tumor.
  • These tubes are loaded with tiny radioactive seeds that remain in place for one or several days to kill the cancer. The seeds and the tubes are then removed. Sometimes, tiny radioactive seeds are implanted directly into the tumor and remain permanently.
  • For high-dose-rate brachytherapy, your doctor implants hollow tubes in and around the tumor site.
  • After these tubes are implanted, they are then connected to a special brachytherapy machine that houses a high activity radioactive source. According to your doctor’s specifications, the seed is automatically delivered from the machine and into the tubes, delivering localized radiation over several minutes to kill the cancer.

Possible Side Effects

Side effects of radiation therapy are limited to the area that is receiving treatment.

External radiation therapy aimed at the chest may cause a sore throat, cough, or shortness of breath. You may feel a lump in your throat or burning in your chest or throat when you swallow. After several weeks of treatment, it may be painful to swallow. Your health care team can suggest ways to manage these problems. The problems usually go away when treatment ends.