Gastrointestinal Cancer

Colorectal cancer is a leading cause of cancer-related deaths in the United States, yet it is curable when detected early. In this edition of Sound Health, Dr. Thomas McGarrity, chief of gastroenterology and hepatology at Penn State Milton S. Hershey Medical Center, talks about risk factors for colorectal cancer as well as screening techniques.

Specialists in the Division of Gastroenterology use the most advanced and innovative techniques of medicine and endoscopy to diagnose premalignant and malignant conditions of the gastrointestinal system.  Today, we remain the leader in central Pennsylvania for diagnostic and interventional endoscopy, which is important for managing patients with these conditions.  Our interventionists routinely can perform the most accurate diagnostic procedures and perform technically challenging therapeutic procedures that often allow patients to avoid major surgeries and to achieve the best possible outcomes.  When patients present with more than an early cancerous lesion which can be treated endoscopically, the Division of Gastroenterology and Hepatology enjoys a close working relationship with numerous multispecialty groups of the Penn State Cancer Institute and patients can be seamlessly transitioned to the appropriate group.  Care for patients with gastrointestinal premalignant lesions and malignancies typically require multidisciplinary approaches.  Comprehensive care is optimized at academic medical centers such as Penn State Hershey Medical Center where surgeons, medical and radiation oncologists, interventional endoscopists, pathologists and radiologists can collaborate and tailor personalized regimes for patients with esophageal, gastric, pancreatic, colorectal, liver, neuroendocrine and other GI cancers.  In contrast to early Tumor Boards which were retrospective in nature, the current weekly conferences, such as the Liver Pancreas and Foregut Group Conference, are prospective and give patients a distinct advantage.  In effect, patients are getting multiple physician opinions about their cases without having to travel to various offices resulting in time delays in diagnosis and treatment.  Cancers and precancers treated by our group include:

 

  1. Barrett's Esophagus with precancerous and cancerous changes which lead to esophageal cancer: GI specialists both diagnosis and treat premalignant diseases of the esophagus such as Barrett's esophagus, as well as the treatment of certain types of early esophageal cancers, which can avoid major surgery.  Endoscopic treatment of esophageal obstruction through endoscopically delivered stenting is also offered.  When required, an early and seamless transition to the Penn State Cancer Institute is facilitated.
  2. Pancreatic Cancer is the second most common gastrointestinal malignancy and the fourth leading cause of cancer related death in the United States.  Because the majority of patients are diagnosed late in the course of the disease, the prognosis of pancreatic cancer is dismal.  GI PSHMC specialists are committed to the early detection and proper staging of this disease.  We also offer palliative approaches to the disease, such as endolumenal stenting of duodenal and gastric outlet obstruction, and EUS-guided celiac plexus neurolysis.
  3. Colorectal cancer remains the third leading cause of cancer death in the United States, and its early detection and prevention is a major goal of the Division of Gastroenterology.  More advanced disease is managed in conjunction with the Division of Colorectal Surgery and the Penn State Cancer Institute.
  4. Submucosal tumors.  This broad spectrum of neoplasia ranges from the completely benign to the high risk. The accurate diagnosis and staging of these lesions can be challenging and requires the high level of training and technology that the PSHMC Divison of Gastroenterology provides such as specialized physicians expertly trained in EUS-FNA.
  5. Pancreatic cyst evaluation and surveillance clinic.  Pancreatic cysts are a common and complex finding which afflict many patients.  Those that require evaluation and/or surveillance require specialized expertise which is provided in this clinic, and those with complex or high-risk cases which may require treatment are discussed at the Liver Pancreas Foregut Group for a multispecialty approach.  We also provide one of the few clinical protocols which allows a minimally invasive treatment for pancreatic cysts, the Penn State CHARM trial for EUS-guided ablation for these lesions.

 

At the Penn State Hershey Medical Center, patients with gastrointestinal cancer are predominantly managed in a multidisciplinary approach where oncologists, cancer surgeons, gastroenterologists, pathologists, radiologists, and others work closely together to produce well planned and comprehensive care for our patients. GI cancer patients must deal with multiple medical issues which complicate or even supersede the cancer, both heart or lung disease or chronic GI conditions, which can lead to delays in treatment or surgery or a sudden need for inpatient hospital support.  PSHMC is well suited to managing complex cases of GI malignancy.  Managing complex cases is our strength, in part due to the close working relationship of our top clinicians and surgeons of PSHMC specialties such as Oncology, Colorectal Surgery, Surgical Oncology, Cardiology, Pulmonary Critical Care, and Infectious Disease and General Internal Medicine. 

Additionally, patients with familial polyposis or multiple family members with cancer may benefit from evaluation and education of cancer risk to themselves and family members. Such patients should be referred to Dr. Thomas McGarrity or to Maria Baker, Ph.D. (genetics counselor) for advice about genetic counseling.

Hospital to Hospital Transfers: Call MD Network at 717-531-5880 or 800-233-4082 

PSHMC GI Clinic Appointments:  717-531-1441 

PSHMC Interventional (Therapeutic) Endoscopy: Fax Endoscopy Request Form and summary records for disposition to 717-531-4598 or call Eileen at 717-531-1470

GI Doctor to Doctor Discussion Line: To discuss an urgent or high risk case, call 717-531-8521 to have the requested physician paged or hold the line. If requested physician is unavailable, have the GI or Hepatology Attending-on-Call paged.