People who have chronic (long-standing) inflammation of the bile ducts have an increased risk of developing bile duct cancer. Smaller stones that form in the bile ducts (bile duct stones) or pass into them from the gallbladder (gallstones) can lead to this type of chronic inflammation. Other inflammatory conditions can increase the risk of developing bile duct cancer: Ulcerative Colitis Ulcerative colitis is an inflammation of the large intestine. It is often associated with inflammation of the bile ducts, which is called primary sclerosing cholangitis. Ulcerative colitis can progress to cancer, particularly in people exposed to carcinogens, such as cigarette smoke. Biliary Parasites Although rarely seen in the United States, food- or water-borne parasites that live in the bile ducts are common in Asia and raise the risk of developing bile duct cancer. Congenital Bile Duct Cysts (Choledochal Cysts) These bile-filled sacs are connected to the common bile duct. Congenital bile duct cysts are typically diagnosed in childhood. The lining of these sacs often contains precancerous cells that increase the risk of developing cancer later in life. Chronic Hepatitis C This inflammatory disease is a risk factor for cancer of the intrahepatic bile ducts. Chronic (long-standing) hepatitis C is also the most common risk factor for liver cancer. Read more about liver cancer risk factors here. Smoking Studies have suggested that intrahepatic bile duct cancer is more common among heavy smokers. Age Bile duct cancer occurs most often in older people. The average age of diagnosis in the United States is 72. Diabetes Diabetes can slightly raise the risk for intrahepatic bile duct cancer. Bile Duct Cancer (Cholangiocarcinoma) Signs & Symptoms Bile duct cancer usually causes few symptoms until it reaches an advanced stage and has spread to other organs and tissues. However, people with this disease may experience the following symptoms or signs, often because a tumor is blocking a bile duct. The following signs and symptoms may be caused by bile duct cancer or another condition. Check with your doctor if you experience any of them. Jaundice Jaundice is a condition is which the skin and the whites of the eyes become yellow, urine darkens, and the color of stool is lighter than normal. This can occur because a bile duct tumor has grown large enough to block the bile duct. Very Itchy Skin Intense itching can be caused by a buildup of bile salts and bilirubin that collects in the skin. Loss of Appetite Bile duct cancer may make it uncomfortable to eat or make you feel like you don’t want to eat at all. Weight Loss The loss of a significant amount of weight without trying can be a sign of many cancers, including bile duct cancer. Fever An increase in body temperature without any explanation can be an early sign of cancer, including bile duct cancer. Belly Pain or Bloating The pain or bloating typically occurs in the upper right part of the belly. Fatigue Fatigue is a common symptom of many types of cancer, including bile duct cancer.

Bile duct cancer is also called cholangiocarcinoma. Most bile duct cancer is adenocarcinoma. This growth begins in the mucus glands that line the insides of the bile ducts. Bile duct tumors can occur in the main bile ducts outside the liver (extrahepatic) or within the liver (intrahepatic). Extrahepatic Bile Duct Cancer Most bile duct cancers — about 90 percent — develop in a bile duct outside the liver (extrahepatic). They can form in two regions: Hilar Bile Duct Cancer Hilar bile duct cancer is also called a Klatskin tumor or perihilar cholangiocarcinoma. It is found just outside the liver where the two main bile ducts meet as they leave the liver. About two-thirds of extrahepatic tumors are hilar bile duct cancer. Distal Bile Duct Cancer These tumors are found in the bile duct nearest the small intestine. Intrahepatic Bile Duct Cancer About 10 percent of bile duct cancer develops in the small duct branches within the liver. Intrahepatic bile duct tumors are often confused with primary liver cancer (hepatocellular carcinoma), a type of cancer that begins in the liver.

If you have symptoms that suggest you may have bile duct cancer, it’s vital that your doctor has a clear and complete understanding of what’s causing them. When making a diagnosis, our experts take the time to learn about your medical history and understand your overall health. We conduct a thorough physical examination. You may have some of the following tests. Blood Tests Diagnosing bile duct cancer may begin with a test to measure the amount of bilirubin in the blood. Bilirubin is a chemical that comes from the breakdown of red blood cells and gives bile its yellow color. A high bilirubin level can lead to jaundice (a yellowing of the skin and the whites of the eyes) and mean that the liver or bile ducts are not functioning properly. Other blood tests measure levels of liver enzymes (such as alkaline phosphatase, AST, ALT, and GGT) and can identify abnormal amounts of other substances (such as CEA and CA 19-9). Finding any of these substances in the blood can indicate the presence of bile duct cancer. Imaging we use the latest imaging techniques to pinpoint the exact size and location of newly diagnosed bile duct tumors. These details help us determine whether a tumor can be removed by surgery. They also help predict a tumor’s response to other treatments. Imaging helps guide our surgeons and interventional radiologists during many kinds of procedures. The imaging techniques we use include:

• CT Scans

CT scans take cross-sectional pictures of the body, helping doctors determine if the cancer cells are only in the bile duct or if they have spread to other areas. We use triphasic CT scans. These take images of the bile ducts, liver, and nearby lymph nodes during three phases of blood flow through the liver.

• Ultrasound

Ultrasound is useful for detecting the location and number of tumors and whether the tumor involves the main blood vessels. Ultrasound can distinguish whether a mass is cancer or a benign (noncancerous) gallstone disease. Unlike CT, ultrasound does not use radiation.

• Magnetic Resonance Cholangiopancreatography

This technique uses MRI to show how much a tumor has grown within the bile duct. It helps doctors determine if the tumor can be removed by surgery. More detailed MRI may be needed to see if the tumor has spread to the liver or other organs.

• Positron Emission Tomography

PET scans can detect whether cancer has spread from the bile duct to other tissues or organs. PET and CT scans are sometimes used together (PET-CT) to pinpoint the exact location of tumors.               Other Diagnostic Techniques We may do other tests to learn more about the extent of the tumor and the types of cells involved. These are often performed in an outpatient setting.  

• Biopsy

During a biopsy, a doctor removes a small amount of tissue from the area where the cancer is suspected. We use an image-guided technique called fine needle aspiration to get the sample of bile duct cancer. This procedure is usually performed by an interventional radiologist (a doctor who specializes in minimally invasive techniques).

• Endoscopy

This technique involves inserting an endoscope (a long, narrow tube attached to a camera and light) through the mouth and down the throat to examine the interior lining of the bile ducts.

• Laparoscopy

In this procedure, a doctor inserts a laparoscope (a thin lighted tube with a camera on its tip) through a small incision (cut) in the abdominal wall to look at the organs in the belly or pelvis. The doctor can then see the size of the cancer and if it has spread to other organs and lymph nodes. This evaluation is also called staging. Tissue samples may be removed for a biopsy during a laparoscopy as well.

• Surgery Sometimes a bile duct tumor is too small to do a biopsy. If cancer is suspected, surgery to remove the tumor may be necessary to confirm the diagnosis.

Bile duct cancer is classified according to the type and stage, from the earliest to the most advanced. The stages of bile duct cancer are based on the location and size of the tumor and how far it has spread. Cancers at similar stages tend to have a similar outlook and are often treated in much the same way. When we know the stage of the cancer, our doctors can prepare a treatment plan that’s customized specifically to each person’s needs. The TNM classification system groups bile duct cancer into one of four stages. Here is a description of the stages: Bile Duct Cancer Stages  

• Local Local bile duct cancer has not spread outside of the bile duct and can be removed by surgery.
• Locally Advanced Locally advanced bile duct cancer is located in the bile duct, and it has spread to nearby organs, arteries, or veins but not to distant parts of the body.
• Metastatic Metastatic bile duct cancer has spread to distant parts of the body and probably requires a treatment other than surgery.
• Recurrent Recurrent bile duct cancer has come back after treatment. It may need to be staged again (called restaging) using the TNM classification system.

Bile Duct Cancer Treatment Groups The stages of bile cancer are also generally grouped by how the cancer may be treated. There are two treatment groups:  

• Localized (Resectable) Bile Duct CancerThe cancer is in an area, such as the lower part of the common bile duct or hilar area (just outside the liver), where it can be removed completely by surgery.

 

• Unresectable, Metastatic, or Recurrent Bile Duct Cancer Unresectable cancer cannot be removed completely by surgery. Most people with bile duct tumors have unresectable cancer. Metastatic bile duct cancer may have spread to the liver, other parts of the belly, or distant parts of the body. Recurrent bile duct cancer is cancer that has come back after treatment. The cancer may return in the bile ducts, liver, or gallbladder. Less often, it may come back in distant parts of the body

Surgery, chemotherapy, targeted therapy, radiation, or a combination of these may be used to treat bile duct cancer. Depending on the stage of the disease. We will determine the most appropriate treatment plan for you. Surgery Surgery is the preferred treatment for bile duct cancer and offers the best chance for a cure. The most effective approach for tumors that have not spread is surgery to remove the bile duct and the nearby lymph nodes. A more extensive surgery may be necessary if the cancer has spread. Surgery is the preferred treatment for bile duct cancer and offers the best chance for a cure. The location and sensitivity of the bile ducts make surgery challenging. These procedures require a high level of expertise. For tumors that have not spread, the most effective approach is using a traditional open technique. Minimally invasive surgery is generally not used for bile duct surgery. Partial Hepatectomy This procedure is often used to treat large bile duct tumors inside the liver (intrahepatic tumors). It involves removing a piece of normal liver tissue, an entire lobe, or a larger part of the liver surrounding the cancer. The remaining section of the liver takes over all of the organ’s functions. Sometimes the liver grows back to its normal size within a few weeks. Before a partial hepatectomy, doctors may use a technique called portal vein embolization to redirect the blood supply to the healthy portion of the liver. This stimulates cell growth in the healthy part of the liver, allowing some people to have a partial hepatectomy who otherwise might have been ineligible for the surgery. Whipple Procedure (Pancreatoduodenectomy) The Whipple procedure is commonly used to treat extrahepatic bile duct tumors that are near the pancreas. It is also known as a pancreatoduodenectomy. The Whipple procedure involves removing part of the bile duct, part of the stomach, part of the small intestine, and the head (the rightmost section) of the pancreas. The remaining portions of the stomach, bile duct, and pancreas are then joined to the remaining small intestine so that digestive enzymes can mix with food. This ensures that the pancreatic fluids and bile will flow into the small intestine. Although this procedure is complex, it is safe and effective for many people. The Whipple procedure is also used to treat pancreatic cancer.   Symptom Relief for Bile Duct Cancer                 (Cholangiocarcinoma) Many people are not candidates for surgery by the time bile duct cancer is diagnosed. However, minimally invasive, image-guided procedures can help improve their quality of life by allowing bile to flow through or drain out of a bile duct that is blocked by a tumor. Our surgeons and experts in interventional radiology use tools, such as catheters and needles, to relieve such symptoms as jaundice (yellowing of the skin and the whites of the eyes), itching, nausea, vomiting, and infection. Biliary Bypass A biliary bypass connects the bile duct or gallbladder directly to the small intestine. This creates a new way for bile to get around a tumor that is blocking the flow from the bile duct. Our doctors can often perform a biliary bypass using a laparoscope (a thin lighted tube with a camera on its tip) inserted through a small incision (cut) in the belly. Stent Placement A stent is a small tube that can relieve a blocked bile duct so bile can flow across a blockage to the small intestine. When possible, the stent is placed using an endoscope (a small tubelike instrument) inserted through the mouth. When that method is not possible, a stent can be placed with a needle inserted through the liver. Imaging is used to identify the blockage and place a stent (or a drainage catheter, a small flexible tube) through the blockage. Some people may need to have a catheter for a while after getting a stent. Neurolytic Celiac Plexus Block People with advanced bile duct cancer often have pain. The pain may be caused by cancer cells that have invaded a cluster of nerves near the liver known as the celiac plexus. People who don’t get enough pain relief with conventional drugs may benefit from a procedure called neurolytic celiac plexus block (NCPB). This involves injecting a local anesthetic into the celiac plexus to disrupt the body’s pain signals. NCPB has been shown to reduce pain significantly and improve mood and life expectancy for people with advanced bile duct cancer. NCPB can be performed with a laparoscope while examining the bile duct to diagnose and stage the cancer. Many other cancer centers perform percutaneous NCPB (through the skin) with a needle. This method is associated with side effects, such as muscle and limb weakness. Laparoscopic NCPB may provide similar or better pain relief than percutaneous NCPB with fewer potential side effects. NCPB also can be performed using an endoscopic ultrasound. This involves inserting a small probe through the mouth and into the stomach to get a detailed view of the celiac plexus. As with laparoscopic NCPB, endoscopic NCPB may be at least as effective as the percutaneous approach, with fewer potential side effects. Ablation Ablation destroys cancer cells by delivering heat or cold through a needle placed into a bile duct tumor. It requires no incisions (cuts) and is effective for some people with isolated tumors who are not candidates for bile duct surgery. Embolization In this technique, microscopic beads are injected into blood vessels that feed the bile duct tumor to cut off its blood supply. This can kill the tumor.

Chemotherapy is a drug or a combination of drugs that kills cancer cells wherever they are in the body. You may receive chemotherapy before surgery to shrink a bile duct tumor. This is called neoadjuvant therapy. If you receive chemotherapy after surgery to destroy and cancer cells that may remain, it is called adjuvant therapy. The standard chemotherapy drugs for bile duct cancer are gemcitabine (Gemzar^®) and cisplatin. Other drugs sometimes used include fluorouracil (also called 5-FU), oxaliplatin (Eloxatin^®), and capecitabine (Xeloda^®). We will carefully tailor your treatment to make sure that it’s as effective as possible while helping maintain your quality of life. If you have bile duct cancer that has spread, you may receive chemotherapy as the main treatment if surgery is not an option. Research has suggested that the combination of gemcitabine and cisplatin can lengthen the lives of people with bile duct cancer that cannot be removed by surgery. Chemotherapy is also occasionally given to relieve symptoms due to bile duct cancer, such as a tumor that is pressing on a nerve and causing pain. Chemotherapy with Hepatic Arterial Infusion we are evaluating the potential of a new chemotherapy technique called hepatic arterial infusion (HAI) in the treatment of bile duct cancer. HAI involves delivering a high dose of chemotherapy drugs directly to the liver through a tiny pump implanted under the skin in the lower belly. The chemotherapy passes from the liver into the bile ducts. HAI therapy may be used to shrink tumors before surgery. Targeted Therapies for Bile Duct Cancer Targeted therapies block specific changes in cancer cells that help them grow and survive or disrupt their blood supply. We are currently investigating several targeted therapies for bile duct cancer. Ivosidenib blocks an abnormal form of a protein called IDH1. Abnormal IDH1 causes too much of a substance called 2-HG to be produced. Scientists believe that too much 2-HG can fuel the growth of bile duct cancer. Two other targeted therapies, pemigatinib (INCB054828) and infigratinib (BGJ398) help reduce the production of the abnormal form of a protein called FGFR2 in cancer cells. Radiation Therapy for Bile Duct Cancer (Cholangiocarcinoma)   Radiation therapy uses precisely focused high-energy beams to kill cancer cells. To treat bile duct cancer, our doctors may give radiation alone or in combination with chemotherapy or other treatments. The kind of radiation we recommend depends on the type of bile duct cancer, the location of the tumor, and whether it has spread. External-beam radiation therapy is the most common type of radiation therapy used to treat bile duct cancer. The radiation may be given alone or in combination with a radiosensitizer. This is a drug that makes the body more sensitive to radiation. You may have heard of CyberKnife. This is a brand name for a type of radiation therapy called stereotactic body radiation therapy. KIMS uses a similar technology that employs a system called TrueBeam, which incorporates CT imaging into the same device that delivers the radiation. This method destroys tumors with very intense doses of radiation in fewer sessions than standard radiation therapy. Minimizing Radiation Side Effects Our doctors use highly sophisticated computer software and 3-D computer images from CT scans to develop individualized plans for each person we care for. This makes it possible to deliver high doses of radiation to a bile duct tumor while sparing surrounding organs and reducing the risk to healthy tissue. Our doctors use radiation therapy to treat bile duct cancer in several ways: Before or After Surgery Radiation is occasionally given before surgery to shrink a tumor so it is possible to remove it. After a bile duct tumor has been removed, radiation may be given to the area where the tumor once was or in the nearby lymph nodes. This is done to destroy any cancer cells that may remain following surgery. As the Main Cancer Treatment Radiation therapy may be used as the main treatment in people with bile duct cancer that has spread throughout the body and cannot be removed by surgery. The radiation will not cure the cancer, but it may help people with advanced bile duct cancer live longer. As Palliative Therapy Radiation is sometimes given to people with advanced bile duct cancer to shrink a tumor that is causing discomfort by blocking blood vessels or bile ducts or pressing on nerves.            Living Beyond Bile Duct Cancer                  (Cholangiocarcinoma) we know that even after you’ve finished bile duct cancer treatments, you may still need our help. We’re committed to supporting you in every way we can — physically, emotionally, spiritually, and otherwise — for as long as you need us. We’ve built a program designed for cancer survivors and their families. Our Survivorship Center has many services for you and your loved ones, including support groups, follow-up programs, educational resources, and more.   Stomach (Gastric) Cancer [expander_maker id="1" more="Read more" less="Read less"] Usually stomach (gastric) cancer starts in the lining of the stomach, growing slowly over the course of several years and causing few if any symptoms. Types of Stomach Cancer Most people (up to 95 percent) develop a stomach cancer called adenocarcinoma, which starts in the tissues that make up the stomach lining.   There are three types of adenocarcinoma:   Noncardia (Distal) Stomach Cancer This type of stomach cancer may be related to long periods of inflammation and irritation in the lower part of the stomach. It’s often associated with chronic infection of bacteria called Helicobacter pylori and is more common in developing countries than in other parts of the world.   Proximal Stomach Cancer This type of stomach cancer starts in the first (proximal) part of the stomach and may extend into the gastroesophageal junction (where the esophagus joins the stomach). This cancer is more common in the United States than in other parts of the world, and tends to start in people who are obese or have gastro-esophageal reflux disease.   Diffuse Stomach Cancer This aggressive cancer grows rapidly in the cells of the stomach wall. It doesn’t form a mass or a tumor, so it can be challenging to diagnose. It tends to start in younger people with a family history of the disease or a related genetic syndrome.   Less common types of gastric cancer include gastrointestinal stromal tumors, which start in stomach muscle or connective tissue; carcinoid tumors, which start in the stomach’s hormone-producing cells, and  lymphoma, which starts in the stomach’s immune cells.   Stomach (Gastric) Cancer Symptoms The early stages of stomach cancer can be easy to miss. The symptoms, which can include an upset stomach and general stomach discomfort, are quite common and usually aren’t related to anything serious. For example, an upset stomach can be mistaken for indigestion or a stomach virus. For these reasons, diagnosing stomach cancer in its earliest stages can be challenging.   Some symptoms that could be caused by stomach cancer when it’s in the early stages include:  

• constant stomach pain, indigestion, or discomfort
• heartburn
• bloating, especially after eating
• mild nausea
• loss of appetite
• fatigue

As stomach cancer becomes more advanced, the symptoms become more prominent and noticeable. They can include:  

• unexplained or unintentional weight loss
• vomiting after meals
• stomach pain, especially after meals
• trouble swallowing
• weakness
• belching (burping)
• fluid buildup around the stomach (called ascites)

the development of a yellow tint to the skin or the whites of the eyes (called jaundice) blood tests that show anemia a persistent stomach ulcer These symptoms may be related to a different condition unrelated to stomach cancer. However, if you experience any of them or are concerned, speak with your doctor to see if you should undergo diagnostic testing. Stomach Cancer Risk Factors & Prevention Stomach cancer has several known risk factors. Some you can control, others you can’t.   Your diet and lifestyle choices can play a role in the risk for developing this cancer, for example. Using tobacco and drinking a lot of alcohol can increase your risk, as can a diet high in salted, smoked, or pickled foods.   Some studies also indicate that a diet low in a mineral called selenium, which is present in various nuts, fish, and meats, can increase your risk for the disease.   Risk Factors You Can’t Control Illnesses that lower the level of acid in your stomach can increase your risk of developing gastric cancer. These include the autoimmune disorder pernicious anemia and a rare illness called Ménétrier disease that causes the growth of large folds in the stomach.   Infection with the bacterium Helicobacter pylori, which can cause chronic inflammation in the inner layer of your stomach, can also lead to the development of precancerous tissue and gastric lymphoma in some cases.   You may also be at increased risk for gastric cancer if you have close relatives with the illness, or if you are of Asian, Eastern European, or South American heritage. For reasons that are still unclear, people with type A blood are also at higher risk.  

• Inherited Illnesses that May Increase Your Risk Include:
• familial adenomatous polyposis (FAP)
• hereditary diffuse gastric cancer (HDGC)
• Peutz-Jeghers syndrome (PJS)
• hereditary nonpolyposis colorectal cancer, also called Lynch syndrome
• mutations in certain genes such as BRCA1, BRCA2, or CDH1

  Stomach (Gastric) Cancer Diagnosis It’s important that we are able to accurately diagnose and stage your stomach cancer to determine the best treatment approach for you. Improvements in our ability to identify subtle but important differences among various types of stomach cancer have also influenced how effectively we are able to treat the disease.   In addition to understanding the condition of your overall health and any symptoms you may have, your KIMS treatment team will likely use one of the following tests to diagnose stomach cancer Endoscopy In an endoscopy, a doctor inserts a thin, lighted tube (an endoscope) into your mouth, down your esophagus, and into your stomach while you’re sedated or under anesthesia. The endoscope allows your doctor to look at the inner lining of the stomach wall. It can also be used to take a sample of any areas your doctor wants analyzed by a pathologist (a doctor who specializes in diagnosing disease). Barium X-Ray In this test, you drink a liquid solution containing barium, a silver-white metal that shows up on an x-ray and helps doctors see a clear image of any potential abnormalities. Once we establish a diagnosis, we’ll want to determine the stage of the cancer and build a customized plan of care for you. Stages of Stomach Cancer Once your treatment team confirms your diagnosis, we’ll use imaging tests to determine whether the cancer has spread beyond your stomach. This is known as the staging process, and it’s a critical step in customizing a plan of care that fits your unique needs.   Our gastric cancer experts use the TNM system to describe the stage of a cancer:   T stands for how deep the tumor is in the stomach wall N represents whether the tumor has spread to nearby lymph nodes M indicates whether cancer has metastasized — that is, spread — to other parts of the body. CT scan This scan can find the location and extent of the tumor. It provides your treatment team with 3-D images of your stomach. A CT scan can include a special dye that is designed to enhance the image. PET scan This scan involves the injection of a small amount of a radioactive substance that reveals any cancerous cells (cancer cells absorb the substance). Endoscopic ultrasound With this test, your doctor inserts an endoscope (a thin, lighted tube) into your mouth and then down into your stomach. An ultrasound probe at the tip of the endoscope bounces sound waves off your stomach’s walls to create a highly detailed picture of your abdominal area, including nearby lymph nodes and organs.   Laparoscopic staging During this minimally invasive surgical procedure, your doctor inserts a laparoscope (a thin, lighted tube with a camera on its tip) into your abdomen through a small incision in the skin. The image is projected on a large viewing screen. Your surgeon inspects the inside of the stomach and removes tissue samples using specially designed surgical instruments. The surgeon can also inspect the outside wall of the stomach, examine lymph nodes, and evaluate the surfaces of other nearby organs to determine if the cancer has spread to those areas.   Stomach Cancer Treatment Stomach cancer continues to become more treatable thanks to improvements in staging the disease, along with advances in surgical technology and expanding recognition of the different types of gastric cancer. And as doctors evaluate and treat more people with early-stage tumors, increasing numbers of people are surviving stomach cancer.   Surgery (gastrectomy) is the most common treatment approach, especially when the illness is at an early stage. For many people with gastric cancer, minimally invasive surgical techniques provide the best option since they tend to lead to fewer complications, shorter recovery times, less need for pain relief, and reduced risk that the cancer will return compared with open surgeries. Our surgeons are global leaders in this area, having performed more laparoscopic stomach procedures than any other cancer center in the country.   For more advanced stomach cancer, your care team may recommend treatments in addition to surgery, such as chemotherapy, radiation therapy, or a combination of these approaches. These therapies may help you live longer and experience fewer symptoms.   Developing a Care Plan for You In creating your care plan, we consider such factors as the location of the cancer, how deep it is in your stomach, whether it’s metastasized (spread) to other parts of the body, and previous treatments you may have received.   Our effectiveness in treating this cancer has also been enhanced by our improved ability to identify subtle but important differences among various types of stomach cancer and to pinpoint the stage of your condition.   Managing Symptoms and Side Effects Our specially trained staff is available to help you manage side effects of stomach cancer treatment such as pain and nausea. For example, one way to avoid bothersome symptoms is to eat smaller, more frequent meals following surgery. Because the stomach plays an important role in vitamin absorption, we may also prescribe dietary vitamin supplements.   Our patients continue to see their doctor regularly for follow-up examinations and tests once treatment is over. People who experience any new symptoms should contact their doctor right away. Stomach Cancer Surgery Surgery is a common treatment for stomach cancer, especially when it’s in its early stages. Depending on your situation, we may incorporate minimally invasive surgical techniques when performing gastrectomy to help lessen the risk for complications, shorten your recovery time, and minimize pain.   Stomach cancers that are advanced or aggressive may require a partial or total gastrectomy.   Partial gastrectomy involves removing part of your stomach and the nearby lymph nodes (lymphadenectomy) to determine if they contain cancer cells. Depending on the tumor’s location, your surgeon may also remove parts of other tissues and organs. Total gastrectomy is an appropriate treatment if you have stomach cancer that’s advanced but hasn’t metastasized (spread) to other organs. Your surgeon removes your entire stomach and may also remove parts of other organs and tissues near the tumor. To enable you to continue eating and swallowing normally the surgeon then connects your esophagus to your small intestine. The Minimally Invasive Surgery Option Our gastric surgeons have been leaders in using minimally invasive surgical techniques to help treat stomach cancers. Your treatment team will meet with you to discuss your two primary options: laparoscopy or robot-assisted surgery. Both techniques can help shorten your recovery time and reduce your risk for complications.   Laparoscopy: With his approach, your surgeon inserts a laparoscope (a thin, lighted tube with a video camera at its tip) into your abdomen through a tiny incision in the skin. He or she can then operate through this small opening with special instruments. Robot-assisted surgery: With this approach, your surgeon uses a robotic surgical tool to perform the operation from a console that displays a magnified 3-D image of the inside of your abdomen, highlighted with a special fluorescent dye.   Chemotherapy   Depending on your situation and the stage of your cancer, chemotherapy and targeted therapies may help you live longer and experience fewer symptoms. Typically, we reserve these approaches for people with more advanced cancer.   Your treatment team may use chemotherapy in addition to surgery. Neoadjuvant therapy, which happens before surgery, can shrink tumors and make them easier to remove surgically. Adjuvant therapy, which happens after surgery, can eliminate any remaining cancer cells. If you have advanced cancer or surgery isn’t an option for you, your team may combine chemotherapy with radiation therapy.   Another drug treatment for gastric cancer is intraperitoneal (IP) chemotherapy. With this approach, your doctor places chemotherapy drugs directly into your internal abdominal area using a surgically implanted catheter (a thin tube). IP chemotherapy can be a more effective treatment for stomach cancer than chemotherapy drugs taken by mouth or through an IV. Radiation Therapy Radiation therapy uses high-energy rays or particles to kill cancer cells. At KIMS we often use this approach after stomach cancer surgery if we think it might help you. Your treatment team may recommend radiation therapy by itself or along with chemotherapy.   For example, if surgery isn’t an option for you, radiation therapy may help make you more comfortable by reducing your symptoms. We can use sophisticated technologies to deliver radiation directly to tumors in and around your stomach while limiting exposure to nearby healthy tissue.   Our radiation specialists monitor how you’re doing during as well as after treatment using advanced imaging and specialized techniques. We may also recommend a clinical trial that is studying a new combination of chemotherapy and radiation therapy. Image-Guided Radiation Therapy With image-guided radiation therapy (IGRT) we can treat tumors with even more accuracy by taking multiple images of the tumor during treatment. This helps us make sure we are aiming the beam of radiation to the correct area and not damaging any other tissue nearby. Respiratory Gating Because your stomach can shift when you breathe, our radiation therapists use respiratory gating to deliver radiation at specific points in your breathing cycle. Real-time CT scans are used during your treatment session to determine the best position of the tumor for giving radiation. Radiation Safety Keeping you as safe as possible during radiation therapy is as important to us as treating your cancer. Our medical physicists work closely with your radiation oncologist to carefully plan the radiation dosage before your treatment. Medical physicists will be there during your treatment to ensure that the radiation is delivered precisely where it’s needed. [/expander_maker]