Some frequently asked questions from people affected by GI cancer
1.Why is cancer so hard to treat?
2.What are GI cancers?
Oesophageal cancer is a form of cancer that develops in the swallowing tube that passes from the mouth/throat to the stomach. Some risk factors for cancer of the oesophagus are long-term exposure to smoking, heavy alcohol intake and Barrett’s oesophagitis.
Gallbladder cancer affects the digestive organ that stores bile (produced in the liver). The gallbladder digests and absorbs fats in the intestines. One risk factor for cancer of the gallbladder is gallstones.
Pancreatic cancer is a malignant tumour that develops in the small glandular organ, approximately six inches long, located in the upper abdomen. The pancreas is connected to the small intestine and secretes enzymes and hormones such as insulin and glucagon. It’s often called a “silent disease” because during the early stages of the disease there are very few, if any symptoms.
Stomach cancer is commonly referred to as gastric cancer and can develop in any part of this organ. The symptoms of stomach cancer are not well defined – however, loss of appetite and weight loss are sometimes indicators. Stomach ulcers are not necessarily risk factors for the development of stomach cancer.
Liver cancers generally originate from other areas, such as the colon, breast or lung, and then spread to the liver. The liver is the largest glandular organ of the body and performs an important range of functions in the digestive system including detoxification and the storage of vitamins and minerals. Cancers originating in the liver do exist, and are more common in people of Asiatic origin.
Small intestine cancer affects the hose-like portions of the digestive system that winds back and forth within the abdominal cavity (approximately 6.7 meters). The small intestine’s primary function is to absorb nutrients.
Bowel (colorectal) cancer:
Colon (large intestine) cancer is a malignant tumour that develops from within the inner wall of the large intestine. The colon is the lower part of the hose-like portion of the digestive system, extending from the lower end of the stomach to the rectum. Risk factor for cancer of the colon include heredity, colon polyps, and long standing ulcerative colitis.
Rectal cancer develops as a malignant tumour arising from the inner wall of the end (rectum) of the large intestine. This type of cancer is commonly known as rectal or colo-rectal cancer.
3.What treatments are available?
In some cases hormone therapy or a biological therapy may be used. The type of treatment recommended will depend on a range of factors including the location and type of cancer, the grade and stage of the disease and the patient’s age and general health. In some cases a combination of treatment methods may be used.
Surgery to remove the primary tumour and surrounding tissue is necessary in the treatment of most tumours. The aim of surgery is to remove as much of the tumour as possible. Any remaining cells can be treated using radiation and/or chemotherapy. How much surgery is done depends on how far the cancer has spread and on the patient’s general health.
Radiation therapy is treatment with high level radiation to eliminate any remaining cancer cells. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in or near the tumour (internal radiation or brachytherapy).
Both tumour cells and healthy cells may be affected by radiation. The radiation injures the cancer cells so they can no longer continue to divide or multiply. With each treatment, more of the cells die and the tumour shrinks. The dead cells are broken down, carried away by the blood and excreted by the body. Most of the healthy cells are able to recover from this injury.
The dose of radiation is determined by the size, extent, type and grade of tumour along with its response to radiation therapy. Often, the treatment is given over several different angles in order to deliver the maximum amount of radiation to the tumour and the minimum amount to normal tissues.
Chemotherapy refers to the use of chemicals (natural or synthetic) to destroy infective organisms or cancer cells. Chemotherapy with cytotoxic drugs is the main method of treatment for only a few cancers but it is increasingly used as an adjunct to surgery or radiation.
Cancer care often involves a collaboration of specialists – including medical oncologists (specialising in cancer treatment), surgical oncologists (surgeons specialising in surgically removing cancers), and radiation oncologists (specialising in radiation therapy).
4.What are these treatment side-effects?
Most side-effects of cancer treatment vary depending on the type of treatment and the extent of the cancer. However, it is important to remember that not everyone experiences the same side-effects; nor are they necessarily severe.
Surgery side-effects in general depend on the part of the body being treated, the type of surgical procedure, the patient’s general health, and a range of other factors. Just like any operation, patients will be uncomfortable during the first few days after surgery. In most cases post-surgical pain can be controlled with medicine.
Radiation therapy side-effects are determined by the actual dose of radiation and where the tumour is located. Tiredness, skin reactions, loss of appetite, and a decrease in the number of white blood cells are typical side-effects of radiation. Most of these side-effects will only last for a short period of time and can be treated.
Chemotherapy side-effects are dependent upon the type of medication and the dose administered. Chemotherapy affects blood cells, which may in turn, result in side-effects. Blood cells play an important role in fighting infection, helping the blood to clot, and carrying oxygen to different parts of the body. Without a constant and healthy supply of blood cells patients are more likely to develop infections, to bruise or bleed easily, and will often have less energy. Other side-effects of chemotherapy include a loss of appetite, nausea and vomiting, hair loss, mouth sores and sometimes impacts on fertility. In most cases medicine can help with side-effects and the majority of symptoms will cease once the treatment is discontinued.
5. Who can I talk to who has had cancer?
There are many support groups, networks and information services within Australia. These groups provide various care options including home care, community-based programs and assisted living facilities. Below are some examples of potentially useful web sites.
The Cancer Council Australia
Country Cancer Support
Bowel Cancer Australia
ACT Cancer Council
NSW Cancer Council
VIC Cancer Council
SA Cancer Council
WA Cancer Council
TAS Cancer Council
NT Cancer Council
QLD Cancer Council
6.What is a clinical trial?
Under most circumstances, a clinical trial involves a comparison of a new drug or treatment against the current or standard therapy. The two (or more) regimens under investigation are monitored for both efficacy and safety.
Whilst there are certain risks involved in researching novel treatments, clinical trials represent the only true means of accurately measuring the benefits of new therapies. Patients who become involved in clinical trials make an important contribution to medical science and to the broader community.
7.What are “phases” of clinical trials?
Phase I trials determine the most appropriate way to give a new treatment. For example, should it be given by mouth, injected into the blood or injected into the muscle? These studies also evaluate what dose is safe and how often it should be used. A Phase I trial focuses on the safety of a treatment and generally involves only a small number of patients.
A Phase II trial determines how well a new treatment works. These trials test the safety of the treatment at a more advanced level than Phase I trials and evaluate the anti-cancer effect of the treatment.
Phase III trials are studies that compare a new treatment with current standard treatments. For example, a Phase III trial would evaluate whether a new drug is better than a drug that is currently being used to treat patients with the same condition. Similarly, a new surgical procedure may be investigated to determine whether it’s better than a surgical procedure that is the general standard of treatment. Phase III trials are only ever initiated if the results of Phase I and II trials show that the new treatment is safe and effective and likely to be as good as, or better than, the standard treatment. Phase III trials involve hundreds of patients, often from around the world.
Randomised control trials are where the treatment that a participant receives is chosen by random allocation (i.e. the decision about which treatment to give which patient is randomly selected, usually by computer). When a patient is ‘randomised’ it means that they have been randomly selected to receive either a particular treatment or intervention (i.e. a new drug) or placebo – a pill that contains no active ingredient.
8.Why should I get involved in a trial?
- Be treated by a leading specialist in the field of cancer research.
- Have the potential to access to new drugs and treatment methods that may not otherwise be available to you.
- Have access to a team of medical professionals that will monitor you.
- Be ensured that any treatment-related side-effects are monitored very closely.
- Be involved in making a valuable contribution to cancer research.
When you take part in a clinical trial, you receive cancer treatment much the same as you’d receive treatment in a hospital, cancer clinic or doctor’s office. The difference between general treatment and the treatment in a clinical trial is that as a participant of a trial, you may be required to have more tests and clinic visits than you would if you weren’t in the study. It’s also possible that trial staff may stay in contact with you for a longer period of time once the treatment is complete.
9.What are the risks of doing a trial?
These principles form part of an important scientific document referred to as a protocol. Every clinical trial must develop a protocol and this must be approved by a Human Research Ethics Committee (HREC). The committee ensures that participants’ rights are maintained throughout the study and that the protocol is being followed.
The major potential risk of participating in a clinical trial is that you’re becoming part of a study that’s asking a question to which the answer is unknown. New drugs and treatment methods may have side-effects. The efficacy of new therapies is also unpredictable – and in some cases, they may be less effective than standard treatments.
Participants’ rights are extremely important in a clinical trial and researchers are required to obtain informed consent from individuals prior to them becoming involved in the trial. The informed consent process requires that researchers inform patients about the key facts of the study, including the type of treatments, other treatment options, how many tests and what sort of tests are required, possible benefits of the study, possible risks and the known side-effects of therapy. All of this information must be provided before a patient decides whether or not to participate in a study. Signed informed consent must be given by every patient prior to commencing a clinical trial, and the rights of the patient continue for the duration of the study.
As a participant you have the right to change your mind and leave the study at any time. Signing a consent form does not mean you must stay in the study. You are free to stop participation at any point during the study, before the study has begun, once you have started or even during the follow-up period.
10. What trials are available?
11. If I meet the trial’s selection criteria what happens next?
Informed consent is a process in which you learn the key facts about a clinical trial before you decide whether or not to participate. You’ll learn new facts during the clinical trial to help you decide whether or not to continue to participate. Feel free to ask questions to the Research Staff at any time before, during, or after the clinical trial.
It’s important that you understand the clinical trial as fully as you can, including how the treatments and tests in the study are different from tests and treatments outside of the clinical trial. The Research Staff should explain the possible risks and benefits of participating in the study and how it will be determined which ‘treatment group’ you’ll be in.
The information about the clinical trial should be given to you verbally (explained aloud) and in writing. You should be given enough opportunities to ask questions and seek advice from people you trust. You are the person who must decide what is enough time to ask questions and get advice from people you trust.
You have the right to ask for this information to be provided to you in a language other than English, if this will help you understand it completely.
There’s also a consent form which will look something like this (click to download PDF): Example patient consent form