At present, the treatment of cancer of the digestive apparatus should be considered from a multidisciplinary perspective, which involves different specialists (surgeons, oncologists, radiotherapists, radiologists, pathologists). Nowadays, there are a large number of diagnostic tests that allow an accurate diagnosis and the staging of gastrointestinal tumors, which is essential to decide the best treatment for each case.
The surgery for the digestive apparatus tumors is often complex and it requires to be performed by surgeons with experience and used to risk operations. Currently, a large proportion of these surgeries can be performed safely by laparoscopy (mini-invasive or minimal access surgery) so that the patient has a faster recovery and the postoperative period is less painful. This is very important with a view to begin future complementary treatments, such as chemotherapy, as soon as possible, after the appropriate surgery.
The digestive tumors are the most common ones: Colon and Rectum, Stomach, Pancreas, Liver (metastasis), esophagus and retroperitoneal tumors. The diagnosis of any of these tumors requires a thorough preliminary study of it and then, in most cases, radical surgery. The extirpation of a gastrointestinal tumor requires a deep knowledge of its anatomic connections and it should be performed with adequate safety margins to prevent it from regrow (recurrence). Nowadays, the improvement of complementary treatments such as chemotherapy and radiotherapy, has allowed us to recover some tumors that had previously been dismissed for an adequate surgical treatment.
Colon and Rectum
The colon and rectum cancer are the most prevalent digestive tumors in our environment. While the standard treatment for colon cancer is the surgical extirpation and the subsequent chemotherapy, the rectum cancer operation is usually performed first combining chemo-radiotherapy and then the surgically extirpation of the tumor. In almost 80% of cases, the surgical treatment for the colorectal cancer can be performed laparoscopically.
It is surely the most aggressive digestive tumor that exists and the one that requires most an aggressive and radical surgical, since other treatments such as chemotherapy and radiotherapy have not shown to be very effective. In cases of pancreas tumors is essential a precise preoperative diagnosis in order to distinguish what strain of tumor we face to, because the prognosis may be very different. This requires advanced technology such as multi-slice helicoidal CT, pancreatic MRI and Endoscopic Ultrasonography, with the possibility of perform biopsies. Pancreatic operations usually involve a long postoperative period with a high risk of complications and even death, that it is why these should be performed only by experienced surgeons.
The most frequent hepatic tumors are the metastases, usually derived from colon and rectum tumors. Metastases are disseminations (implants) in the liver of an initial digestive tumor (primary). Metastases from colorectal cancer can be treated by surgical extirpation in a high percentage of cases, so that it has been shown an increased survival. In addition to surgical extirpation, there are other new alternative treatments and/or complementary such as the radiofrequency. The radiofrequency is usually done within the surgery operation as a complementary treatment or in cases in which the metastases cannot be completely extirpated. All patients diagnosed with hepatic metastases should be evaluated by a surgeon with experience in hepatic surgery before being dismissed as a candidate for surgery.
The stomach cancer, very common in the past, has decreased significantly its prevalence in recent years. Thanks to the availability of digestive endoscopy, the diagnosis is now found earlier, so the surgical treatment is more effective and has a better chance of cure. After an adequate surgical extirpation, which in many cases can be performed laparoscopically, it is necessary to complete the treatment with chemotherapy in order to improve the long-term results.
While the incidence of esophageal squamous cell carcinoma (related to tobacco and alcohol) has decreased, the incidence of the esophagogastric junction adenocarcinoma has increased. The increase in the incidence of the esophagus adenocarcinoma is related to the high prevalence of the pathological gastro-esophageal reflux. The treatment of the esophageal cancer usually requires radiotherapy, sometimes as single therapy, and sometimes prior to surgical extirpation. In cases in which surgical extirpation is required, the laparoscopic approach is becoming established as an increasingly used option, since it improves the postoperative period and prevents significantly the appearance of some associated problems such as respiratory disorders.
The most common retroperitoneal tumors are the sarcomas. Among these, the liposarcoma is the most prevalent strain. The sarcomas are usually slow-growing tumors and can therefore reach a big size and include any digestive organ, so their treatment may require the extirpation of different associated organs (colon, kidney, pancreas, stomach, etc.). With these tumors, the only effective treatment is the complete surgical extirpation of the tumor within the adequate margins.
Most of the suprarenal tumors that are diagnosed are usually benign. From a certain size (it is generally accepted 4 cm in diameter), it is recommended its extirpation because of risk of malignization. The tumors located in the adrenal glands may produce different hormones and that is why they must be operated. Currently, the extirpation of the suprarenal gland tumors, especially when they are not a carcinoma, is performed in most of the cases by laparoscopy.