Areas of Expertise
Gastrointestinal Cancers
Gastrointestinal cancers involve the esophagus, stomach, colon and rectum, pancreas, liver and bile ducts. Some give no symptoms in the early stages, so knowing the risk factors and using screening programs matters. Diagnosis is made by a physician and a multidisciplinary team; this page is for general information only.
01
Esophageal cancer
It is a cancer that develops from the inner lining of the esophagus and may present with difficulty swallowing.
Esophageal cancer develops from cells lining the inside of the esophagus. Smoking and alcohol use are established risk factors. Long-standing reflux and the related Barrett’s esophagus, as well as obesity, may also raise the risk. Regularly drinking very hot beverages is also recognized as a risk factor. Having a risk factor does not mean cancer will develop; most people never develop it.
Symptoms
- Often no symptoms in the early stages
- Food sticking, progressively worsening difficulty swallowing
- Weight loss without a clear cause
- Persistent chest or back pain or burning
- Long-lasting hoarseness or cough
- Black stools or anemia
When to see a doctor
- If difficulty swallowing is new or getting worse, without delay
- If swallowing difficulty comes with weight loss
- If you have had reflux symptoms for many years
- If you notice blood in vomit or black stools
How is it diagnosed?
Diagnosis is made by the physician and the multidisciplinary team. An upper gastrointestinal endoscopy is usually performed and a biopsy is taken from the suspicious area. Imaging such as computed tomography may be used to assess spread.
Treatment and lifestyle
- Quitting smoking and avoiding alcohol are among the key preventive steps
- Long-standing reflux should be reported to a physician and evaluated
- If Barrett’s esophagus is present, the endoscopic follow-up plan is set with your physician
- Maintaining a healthy weight helps lower the risk
- It is advised not to drink beverages while they are very hot; let them cool a little
- Treatment options are planned together in a multidisciplinary tumor board
LifestyleA plant-forward Mediterranean-style diet rich in vegetables, fruit and whole grains, avoiding smoking and alcohol, and regular physical activity are beneficial.
02
Stomach cancer
Stomach cancer develops from the inner lining of the stomach and can be linked to long-term gastritis.
Stomach cancer develops from cells in the stomach wall. Helicobacter pylori infection is an established risk factor. Very salty, smoked and pickled foods and smoking may also raise the risk. A family history of stomach cancer is important. A diet low in vegetables and fruit is also linked to risk. Having a risk factor does not mean you will develop cancer.
Symptoms
- Often no symptoms in the early stages
- Persistent indigestion or discomfort in the upper abdomen
- Feeling full after eating very little, reduced appetite
- Weight loss without a clear cause
- Nausea or repeated vomiting
- Black stools or anemia
When to see a doctor
- If indigestion does not go away despite treatment
- If weight loss or loss of appetite is present
- If you notice black stools or blood in vomit
- If stomach cancer runs in your family
How is it diagnosed?
Diagnosis is made by the physician and the multidisciplinary team. Stomach endoscopy shows the suspicious area and a biopsy is taken. H. pylori can also be looked for in the biopsy sample. Imaging may be needed to assess spread.
Treatment and lifestyle
- Testing for H. pylori and treating it when needed is a physician’s decision
- Limiting salty, smoked and pickled foods is advised
- Quitting smoking helps lower the risk
- With a family history of stomach cancer, the follow-up plan is set with your physician
- Persistent stomach complaints should not be ignored
- Treatment options are planned together in a multidisciplinary tumor board
LifestyleA diet rich in fresh vegetables and fruit, reducing salt intake and avoiding smoking contribute to prevention.
03
Colon and rectal cancer
Colon and rectal cancer usually develops over years from small growths called polyps, and screening can lower the risk or catch it at an early stage.
Most colorectal cancers develop from polyps that form in the bowel over years. Advancing age, a family history of colorectal cancer or polyps, and inflammatory bowel disease are risk factors. Red and processed meat, alcohol, smoking, excess weight and inactivity may also raise the risk. Having a risk factor does not mean cancer will develop.
Symptoms
- Often no symptoms in the early stages
- Blood in the stool or black stools
- A persistent change in bowel habits
- Abdominal pain or bloating
- Weight loss without a clear cause
- Fatigue due to anemia
When to see a doctor
- When you notice blood in the stool, without assuming a simple cause
- If a change in bowel habits lasts longer than a few weeks
- If there is anemia with no identified cause
- If colorectal cancer or polyps run in your family
How is it diagnosed?
Diagnosis is made by the physician and the multidisciplinary team. Colonoscopy allows the inside of the bowel to be seen, and biopsies are taken from polyps and suspicious areas. Imaging may be needed to assess spread. People with a positive screening test are usually advised to have a colonoscopy for further evaluation.
Treatment and lifestyle
- People aged 50 to 70 can use the fecal occult blood test in the national program
- Those with a positive test are referred for colonoscopy
- Removing polyps during colonoscopy helps prevent cancer
- With a family history, screening may start earlier and follow a separate plan
- If a hereditary syndrome is suspected, genetic counseling is considered with the physician
- Treatment options are planned together in a multidisciplinary tumor board
LifestyleA fiber- and vegetable-rich diet, limiting red and processed meat, avoiding alcohol and smoking, a healthy weight and regular activity contribute to prevention.
04
Pancreatic cancer
Pancreatic cancer often causes symptoms late, which is why knowing the risk factors matters.
The pancreas is an organ behind the stomach that produces digestive enzymes and insulin. In pancreatic cancer, smoking is the best-known risk factor. Long-standing chronic pancreatitis, a family history of pancreatic cancer and certain inherited conditions may also raise the risk. Excess weight and long-standing diabetes are also linked to risk.
Symptoms
- Often no symptoms in the early stages
- Yellowing of the eyes and skin, dark urine, itching
- Pain in the upper abdomen or spreading to the back
- Weight loss without a clear cause, reduced appetite
- Pale, greasy-looking stools
- New-onset diabetes at an older age together with weight loss (most diabetes is not related to pancreatic cancer)
When to see a doctor
- When you notice jaundice, without delay
- If abdominal pain spreading to the back does not go away
- If there is weight loss without a clear cause
- If pancreatic cancer runs in your family
How is it diagnosed?
Diagnosis is made by the physician and the multidisciplinary team. Blood tests, ultrasound, computed tomography, magnetic resonance imaging or endoscopic ultrasound (EUS) may be used. Confirmation with a tissue sample is often needed.
Treatment and lifestyle
- Quitting smoking is one of the key preventive steps
- Routine pancreatic cancer screening is not advised for the general population
- For people at high familial risk, follow-up is planned at a specialist center
- Regular physician checkups matter for people with chronic pancreatitis
- A healthy weight and good diabetes control are helpful
- Treatment options are planned together in a multidisciplinary tumor board
LifestyleAvoiding smoking and alcohol, a plant-forward diet and a healthy weight contribute to prevention.
05
Liver cancer (HCC)
Liver cancer mostly develops in the setting of chronic liver disease and can be caught early with regular surveillance in at-risk people.
The most common type of liver cancer is hepatocellular carcinoma (HCC). It mostly develops in the setting of chronic hepatitis B or C, cirrhosis, alcohol-related liver disease and fatty liver. Obesity and diabetes may also raise the risk. The risk is higher in people with cirrhosis and in some with chronic hepatitis B; regular surveillance for them is an established recommendation.
Symptoms
- Often no symptoms in the early stages
- Pain or fullness in the upper right abdomen
- Weight loss without a clear cause, reduced appetite
- Swelling of the abdomen, swollen ankles
- Yellowing of the eyes and skin
- Marked fatigue
When to see a doctor
- If you have cirrhosis, or chronic hepatitis with a high risk of liver cancer, for regular surveillance
- If you have persistent pain in the upper right abdomen
- If you notice jaundice or abdominal swelling
- If weight loss and loss of appetite occur together
How is it diagnosed?
Diagnosis is made by the physician and the multidisciplinary team. Blood tests, liver ultrasound, computed tomography or magnetic resonance imaging may be used. A tissue sample may be needed in some cases.
Treatment and lifestyle
- In cirrhosis and high-risk chronic hepatitis B, regular surveillance (ultrasound ± blood test) is recommended
- Surveillance is usually an ultrasound about every 6 months (sometimes with a blood test); the individual plan is set by the physician
- Hepatitis B vaccination and diagnosis and treatment of hepatitis B and C are important
- If you have chronic liver disease, avoiding alcohol and keeping a healthy weight help protect the liver
- Fatty liver and diabetes should be followed under physician supervision
- Treatment options are planned together in a multidisciplinary tumor board
LifestyleAvoiding alcohol, a healthy weight, a Mediterranean-style diet and regular activity help protect liver health.
06
Bile duct and gallbladder cancers
Bile duct and gallbladder cancers are uncommon and are often noticed through symptoms such as jaundice.
The bile ducts carry bile made in the liver to the intestine; the gallbladder stores this bile. Cancer in these structures is uncommon. Gallstones and gallbladder polyps are very common and most do not lead to cancer; still, long-standing gallstones, large or growing polyps, primary sclerosing cholangitis and bile duct cysts are counted among the risk factors. Smoking and obesity may also be linked to risk. Most people with a risk factor do not develop cancer.
Symptoms
- Often no symptoms in the early stages
- Yellowing of the eyes and skin, itching
- Dark urine, pale stools
- Pain in the upper right abdomen
- Weight loss without a clear cause
- Jaundice together with fever or chills
When to see a doctor
- When you notice jaundice, without delay
- If fever or chills accompany jaundice, urgently
- If upper right abdominal pain keeps recurring
- If you have a gallbladder polyp or primary sclerosing cholangitis
How is it diagnosed?
Diagnosis is made by the physician and the multidisciplinary team. Blood tests, ultrasound, computed tomography, magnetic resonance cholangiography or endoscopic methods may be used. A tissue sample is taken when needed.
Treatment and lifestyle
- Gallstones and gallbladder polyps should be followed as your physician advises
- For people with primary sclerosing cholangitis, regular follow-up is planned with the physician
- Routine screening tests are not advised for the general population
- Quitting smoking and keeping a healthy weight are helpful
- It is important to see a physician without delay for warning signs such as jaundice
- Treatment options are planned together in a multidisciplinary tumor board
LifestyleAvoiding smoking, a healthy weight, a plant-forward diet and regular activity contribute to prevention.
