Treating GI cancer in young adults: a surgical oncologist’s perspective
Cancer in young people: Part of a series on diagnosing and treating young adults
Expert takeaways from: William F. Morano, MD, surgical oncologist
Many of the young people I see have been diagnosed with advanced gastrointestinal (GI) cancers and require a multidisciplinary treatment approach. A young patient and their primary care clinician are not usually thinking cancer could be causing their symptoms, so it often goes undiagnosed until symptoms have persisted and it has progressed into an advanced stage.
GI cancer treatment
It's understandable — a 35-year-old wouldn't expect to have cancer. It’s important to know that whether the cancer is localized or advanced, we have options for treatment. We can often be more aggressive with younger patients who can better tolerate high-risk procedures than older patients with chronic medical issues. But every case is different and depends on your overall health.
Personalized treatment options
Main Line Health uses a multidisciplinary team approach that includes the collaboration of many specialties and clinicians, including: surgical oncologists, medical oncologists, GI doctors, radiologists, radiation oncologists, pathologists, genetic specialists and nurse navigators.
This integrated approach allows us to tailor your individual treatment based on your:
- Unique medical conditions and needs
- Quality of life requests
- Family history
Treatment based on how the cancer has spread
Early-stage GI cancers can sometimes be removed endoscopically through a minimally invasive procedure, but most are found at stage two or later, requiring more invasive surgery, chemotherapy, radiation or a combination. Treatment sequencing options vary based on the type of cancer and whether the cancer has metastasized or spread.
Treating cancer that hasn't spread
GI cancers that are in the earlier stages and haven't metastasized are often contained in one organ. This type of cancer may use the following treatment options:
- Surgery to remove the cancer tumor
- Radiation therapy to target and kill cancer cells
- Chemotherapy or systemic medication to kill cancer cells
- Targeted therapy or certain medications that target a cancer cell’s specific gene mutations
- Immunotherapy or medications that help the immune system find and attack cancer cells
Treating cancer that has spread
GI cancers that have metastasized beyond their origin, such as to the liver, can be treated with the same methods as cancers that have not spread, but the sequence in which they’re used may vary:
- Chemotherapy will typically be used first if cancer has spread
- Minimally invasive and robotic surgery — even when cancer has spread, we can use smaller incisions to perform surgery (e.g., in the liver, robotic-assisted surgery may allow for removal of small pieces or entire lobes)
- Microwave ablation which uses heat to target and destroy cancer cells in the liver
- Percutaneous liver directed therapy when our interventional radiologists deliver treatment directed at areas of the body, often the liver, by accessing through a needle in one of the blood vessels
Advanced GI cancers (colon, rectum, appendix, stomach) that have spread to the lining of the abdomen, known as the peritoneum, may sometimes be candidates for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC removes of all visible cancer cells within the abdomen and delivers heated chemotherapy directly to the abdomen.
We can often be more aggressive with younger patients who can better tolerate high-risk procedures than older patients with chronic medical issues. Quality of life is a major factor as we create an approach tailored to each patient.
Colon cancer genetic testing
Genetic counseling is recommended for all young people with a cancer diagnosis, or family history of cancer at a young age, because many cancers are genetically connected. Genetic testing helps:
- You know if you are likely to develop other genetically linked cancers
- Your family members know what cancers they should talk to their clinicians about
Family history of linked cancers may warrant your relatives starting screenings like a colonoscopy earlier.
Ongoing support
Our cancer nurse navigators and social workers can connect patients with trustworthy services, resources and support groups. Hearing from others who have gone through treatment can be reassuring and offer practical advice.
Young people aren't supposed to get cancer, but unfortunately, it's becoming more common. Typically, the symptoms are just reflux or a hemorrhoid, but if your symptoms aren't going away, talk with your primary care clinician. Sometimes you have to be your own strongest advocate.
Understanding cancer in young people
Main Line Health's clinicians and care team have additional insights on their approaches to diagnosing, treating and supporting young people with cancer.
Next steps
Learn more about William Morano, MD
Learn more about cancer care at Main Line Health
Learn more about the Genetics and Risk Assessment Program
Related posts
Know the signs: Early diagnosis of GI cancers can save lives
Main Line Health first in U.S. to use minimally invasive tool that mimics open colorectal surgery
Content you want, delivered to your inbox
Want to get the latest health and wellness articles delivered right to your inbox?
Subscribe to the Well Ahead Newsletter.
