Crozer-Chester Medical Center offers screening services for the following types of gastrointestinal cancers:

Colorectal Cancer

Esophageal Cancer

Gastric Cancer

Pancreatic Cancer

Bile Duct and Gallbladder Cancer

Liver Cancer

Colorectal Cancer

Colorectal cancer is the second leading cause of cancer deaths in the United States. Six percent of Americans will be diagnosed with colon cancer in their lifetime.

Fortunately, screening for cancer and their precursors, adenomatous polyps, can nearly eliminate the risk of cancer in most people. In general, colon polyp screening is recommended for all persons at or over the age of 50, although symptoms of rectal bleeding or a family history of colon cancer often warrants earlier testing.

Screening tests currently available include fecal-occult blood testing, sigmoidoscopy, colonoscopy, barium enema and virtual colonoscopy (using a CT scan or, rarely, MRI).

• At this time, the most reliable test is colonoscopy, which offers both a complete survey of the entire colon, as well as the means to remove polyps in the same session. Colonoscopy does usually require sedation, but this allows for the vast majority of patients to have a well-tolerated examination.
• Barium enema is less accurate than colonoscopy, although an acceptable alternative for screening.
• Virtual colonoscopy is an exciting new option for colon cancer screening. Like colonoscopy or barium enema, it requires a bowel preparation, but uses CT scans to visualize the colon. Medium-to-large sized polyps are readily seen and the test allows for some patients without polyps to avoid the need for colonoscopy. However, if polyps are found during a virtual colonoscopy, standard colonoscopy is required to remove them. Your gastroenterologist should explain all options for colon cancer screening.

Cancer of the Esophagus

Esophageal cancer has increased in incidence over the past couple of decades. Most of this increase is attributed to cancers of the lower esophagus and gastroesophageal junction.

These tumors are usually related to prolonged gastroesophageal acid reflux and often can be detected in a premalignant condition called “Barrett’s esophagus,” which is a permanent change in the lining of the esophagus.

Screening for esophageal cancers in persons without any symptoms is only recommended in cases of certain rare medical disorders.  However, people with longstanding gastroesophageal reflux should be screened for Barrett’s esophagus, which can, although uncommonly, develop into esophageal cancer over time. Such patients are entered into surveillance programs for interval assessments for potential progression of their Barrett’s esophagus.

Tumors of the upper and mid esophagus do not have as-well-defined precursor states, although they are more common in long-time tobacco and alcohol consumers. Any patient with a sensation of pain or food sticking during swallowing or new heartburn symptoms after the age of 50 should have an esophageal evaluation.

Gastric Cancer

Although very common in some parts of the world, gastric cancer is less common in the U.S. There are some risk factors, but routine screening is not currently recommended. Infection with a bacteria called Helicobacter pylori is associated with the development of gastric cancers.

Some symptoms, such as upper abdominal pain, fullness after small meals, intestinal blood loss, or unexplained nausea, especially in older adults, should prompt some investigation for possible gastric cancer. Upper endoscopy is always the most accurate way to diagnose cancer in the stomach.

Cancer of the Pancreas

Pancreatic cancer is the fifth leading cause of cancer deaths in the United States. Even small pancreatic cancers often require complicated and extensive surgeries with no guarantee of cure, and chemotherapy provides limited longevity. These factors make pancreatic cancer one of the most dreaded malignancies. Risk for pancreatic cancer is increased in patients with chronic pancreatitis and certain familial cancer syndromes, in whom routine screening may be appropriate.

The possibility of pancreatic cancer also should be considered in patients with unexplained abdominal pain, weight loss, jaundice or acute pancreatitis without an obvious cause. Pancreatic cancer can be investigated with X-ray tests such as CT scans and MRIs, or with endoscopic tests such as ERCP (endoscopic retrograde cholagiopancreatography) or EUS (endoscopic ultrasound), both of which also allow for potential tissue sampling. Small tumors can be missed with CT or MRI and are most accurately identified using EUS.

Cancer of the Bile Duct and of the Gallbladder 

Cancers of the bile ducts and/or gallbladder, called cholangiocarcinomas, are less common than the cancers mentioned above. But like pancreatic cancers, these cancers can rarely be cured surgically and often do not respond well to other therapies. Patients predisposed to cholangiocarcinoma may have certain conditions, such as primary sclerosing cholangitis, ulcerative colitis, choledochal cysts and Caroli’s disease. Most patients develop jaundice when the tumor blocks proper bile flow. Investigation usually involves CT or MRI, as well as ERCP and/or EUS.

Liver Cancer

Liver cancers, or hepatocellular carcinoma, most frequently afflict persons with chronic liver diseases. Most liver cancers are found in patients who already have cirrhosis, i.e. scarring of the liver from a chronic condition, but can even be found before cirrhosis develops in patient with chronic hepatitis B, C or hereditary hemochromatosis. All patients with cirrhosis should be enrolled in liver cancer screening programs whereby ultrasound, CT or MRI as well as a certain tumor marker (alpha-fetoprotein) are checked every six months. In this way, liver cancers might be caught earlier, when curative surgery or even liver transplantation might still be possible.

At Crozer-Chester Medical Center, we specialize in evaluating patients with known, suspected or potential GI cancers of all types. In addition to providing state-of-the-art facilities for all modalities of testing, patients have access to specialists in every area of cancer care, including radiologists, surgeons, oncologists, radiation oncologists, family/genetic counseling, nutritionists, and hospice services.