The development of cancer is very complex and different for each person. There are many elements that can contribute to the growth of cancerous cells and the ability of your body to defend against them. There is still much to discover about the causes of GI cancer, and whilst environmental factors such as diet, exercise and smoking can increase your risk of cancer, it is your genetics and family history that control how your body will be able to repair and defend against the damage caused.
The Pharmaceutical Benefits Scheme (PBS) is managed by the Department of Health and is available to all Australian residents who have a current Medicare card.
Under the PBS, the government subsidises the cost of medicine for most medical conditions.
A positron emission tomography (PET) scan is a safe type of imaging test when used appropriately. It uses a radioactive substance called a tracer to look for disease in the body.
A PET scan can detect cancers based on the different metabolic activity of cancer cells compared to normal cells.
PET scans are frequently used with CT scans to improve accuracy in diagnosis, using the structural information from the CT scan and the function information of the PET scan.
Gastro-Intestinal cancer is a broad term used to encompass all cancers of the Gastro-Intestinal tract (digestive system). This includes cancers of the oesophagus, stomach, liver, gallbladder, pancreas, bowel, rectal and anal. Following is a brief overview of each cancer:
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.
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).
Whilst the objective of cancer treatment is to work against cancer, often treatment will also damage healthy cells and tissues, the outcome of which can sometimes result in unpleasant 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.
Since September 2012, our Engage network of cancer survivors, patients and their family and friends have been sharing stories about cancer journeys and clinical trials information.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. See more here.
The Cancer Council Australia
Cancer Voices 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
Clinical Trials FAQs
No. Costs to participate in clinical trials are funded by the organisation conducting the clinical trial, usually with funding support received from government agencies such as the National Health and Medical Research Council (NHMRC) and Cancer Australia; or from untied sponsorship from the pharmaceutical industry; or from charitable funds raised by organisations such as the GI Cancer Institute and Cancer Council.
If after talking to your doctor you decide to participate in a clinical trial then the next step would be to provide your informed consent. Informed consent involves more than signing a form and will continue throughout the clinical trial. 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.
When you are discussing treatment with your doctor, they may suggest that you participate in a clinical trial or tell you about a trial for which you would be eligible. If they do not, you can ask your doctor if there is a trial for which you would be eligible. Alternatively, you can find trials on the Australian Cancer Trials website and discuss their suitability with your doctor.
However, in some cases there will not be a trial available that you and your type of cancer would be eligible for, as trials are usually very specific. In addition, if you have certain health conditions such as a susceptibility to particular side effects, or if you are taking other medications, you may be ineligible for some clinical trials.
If you are eligible for a suitable trial, take time to reflect on the information, discuss things with family and friends, weigh up the pros and cons, and have further discussions with your doctor before you come to a decision.
Clinical trials are classified into one of three phases, each phase representing a different step in the testing of a new clinical treatment. Each step allows researchers to ask and answer important questions about the type of treatment and its effectiveness for patients.
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.
If a trial involves more than one type of treatment, then a participant’s particular treatment is chosen for them randomly from the available trial treatments. This means that all patients on a trial are equally likely to receive the standard or the new treatment. If patients do not receive the new treatment they will receive the best standard available treatment; there will not be any control group that receives no treatment. Sometimes the participant will not know what particular treatment plan they are on and neither will their doctor. This is known as a double blind approach, in which any potential bias is minimised.
No cancer treatment is guaranteed to be successful and most treatments have a number of side effects, and the treatments given in clinical trials are no exception. However, clinical trials must conform to a number of safety rules before they are approved by an independent ethics committee. Researchers must ensure that clinical trials are scientifically sound, that they do not produce more harm than good, that they keep patients informed of developments and results, and that they meet internationally agreed standards about the right way to carry out research involving people.
Before joining a trial, participants must be given accurate information about the study that outlines the purpose, all foreseeable benefits and risks (including side effects), full details of what is required of patients, and patients’ rights. Once all information about the trial is understood, the patient will sign a patient information and consent form. Most importantly, participants are free to opt out of the trial at any time for whatever reason, without any compromise to their future medical care.
Clinical trials provide many benefits to participants. For example:
- Patients who participate in clinical trials often receive immediate access to the latest treatments before they are made widely available to cancer patients.
- The treatments offered on a clinical trial are either the best current standard therapy or therapy that is thought to be as good, or better, than the current standard therapy.
- Some patients worry that they will receive no treatment if they are allocated to a control group, however all clinical trials are required to ensure that all patients receive at least the same level of treatment that would have been prescribed for them if they did not participate in the trial.
- Patients involved in clinical trials receive an excellent standard of care, and are closely and regularly monitored by leading doctors, research nurses, and other medical experts.
- Research shows that patients treated in clinical trials usually have greater cure rates and a better quality of life than those who are not involved.
- Patients who take part in clinical trials play an active role in ensuring future cancer sufferers have access to the best medication.
Clinical trials are necessary to find out if new treatments are more effective than those currently accepted as the best available standard therapy. Trials are also essential for new, improved treatments to be adopted, as all treatments and procedures must be scientifically proven before they can be made widely accessible. Furthermore, because not all people or cancer tumours are the same, clinical trials are needed in order to test how effective different types and/or combinations of treatments are for different people and tumours.
Additionally, conducting clinical trials in Australia means patients are able to access new treatments three to five years earlier than if they were conducted overseas.
Clinical trials are run by teams of researchers at universities, hospitals and private institutions. The Australasian Gastro-Intestinal Trials Group (AGITG) coordinates most GI cancer trials in Australia and New Zealand. The AGITG has been conducting clinical trials for over 25 years and there are many doctors and research professionals who volunteer their time to conduct these trials. Each clinical trial has a Study Chair who is in charge of running the trial and a Principal Investigator (PI) from each institution taking part.
Clinical trials can fall into several different categories, such as:
- Prevention studies, which test how types of cancers can be prevented in people;
- Detection studies, which test ways in which types of cancer are diagnosed, with the aim of increasing the chance of early diagnosis;
- Treatment studies, which are conducted to find out which treatments are the most effective, and to test new treatments to see if they are more effective than existing standard treatments. Treatments tested can include drugs (chemotherapy) as well as radiotherapy, surgery, and complementary therapies;
- Quality-of-life studies, which look for ways of improving the overall comfort of patients with cancer, and;
- Cost-effectiveness studies, which compare new treatments with existing treatments in terms of costs, efficiency, and benefits.