text
"
>What is prevention?
>General Information About Anal Cancer
>Anal Cancer Prevention
>About This PDQ Summary"
"
Cancer prevention is action taken to lower the chance of getting cancer."
"By preventing cancer, the number of new cases of cancer in a group or population is lowered."
"Hopefully, this will lower the number of deaths caused by cancer.
"
"To prevent new cancers from starting, scientists look at risk factors and protective factors ."
"Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.
"
"Some risk factors for cancer can be avoided, but many cannot."
"For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided."
Regular exercise and a healthy diet may be protective factors for some types of cancer.
"Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer.
"
"Different ways to prevent cancer are being studied, including:
>Changing lifestyle or eating habits.
"
">Avoiding things known to cause cancer.
"
">Taking
          medicines
          to treat a
          precancerous
          condition
          or to 
         keep cancer from starting."
"
>Anal cancer is a disease in which malignant (cancer) cells 
         form in the tissues of the anus.
"
">Squamous cell carcinoma is the most common type of anal cancer.
"
">In the United States, the number of new cases of anal cancer has increased in recent years."
"
The anus is the end of the large intestine , below the rectum , through which stool (solid waste) leaves the body."
The anus is formed partly from the outer skin layers of the body and partly from the intestine .
"Two ring-like muscles, called sphincter muscles, open and close the anal opening and let stool pass out of the body."
"The anal canal, the part of the anus between the rectum and the anal opening, is about 1-1½ inches long.
"
The skin around the outside of the anus is called the perianal area.
"Tumors in this area are skin tumors, not anal cancer .
"
"See the following PDQ summary for more information about anal cancer:
>Anal Cancer Treatment"
"
In the United States, the most common type of anal cancer is squamous cell carcinoma ."
"Studies show that human papillomavirus (HPV) infection is the main cause of this type of anal cancer.
"
"Another type of anal cancer, called anal adenocarcinoma , is very rare and is not discussed in this summary."
"
From 2007 to 2016, new cases of anal cancer and deaths from anal cancer increased each year."
"
>Avoiding risk factors and increasing protective factors may 
         help prevent cancer.
"
">The following are
           risk
           factors   for anal cancer:Anal HPV infectionCertain medical conditionsHistory of cervical, vaginal, or vulvar  cancerHIV infection/AIDSImmunosuppressionCertain sexual practicesCigarette smoking
>Anal HPV infection
>Certain medical conditionsHistory of cervical, vaginal, or vulvar  cancerHIV infection/AIDSImmunosuppression
>History of cervical, vaginal, or vulvar  cancer
>HIV infection/AIDS
>Immunosuppression
>Certain sexual practices
>Cigarette smoking
>"
"The following
           protective
           factor decreases the risk of anal cancer:HPV vaccine
>HPV vaccine
>It is not clear if the following protective factor decreases the risk of  anal cancer:Condom use
>Condom use
>Cancer prevention clinical trials are used to study ways 
    to prevent cancer.
"
">New ways to prevent anal cancer are being studied in clinical 
     trials."
"
Avoiding cancer risk factors may help prevent certain cancers."
"Risk factors include smoking, being overweight , and not getting enough exercise."
Increasing protective factors such as quitting smoking and exercising may also help prevent some cancers.
Talk to your doctor or other health care professional about how you might lower your risk of cancer.
"
"
Being infected with human papillomavirus (HPV) is the main risk factor for anal cancer .
"Being infected with HPV can lead to squamous cell carcinoma of the anus , the most common type of anal cancer."
"About nine out of every ten cases of anal cancer are found in patients with anal HPV infection .
"
Patients with healthy immune systems are usually able to fight HPV infections.
Patients with weakened immune systems who are infected with HPV have a higher risk of anal cancer.
"
Cervical cancer , vaginal cancer , and vulvar cancer are related to HPV infection."
"Women who have had cervical, vaginal, or vulvar cancer have a higher risk of anal cancer.
"
Being infected with human immunodeficiency virus (HIV) is a strong risk factor for anal cancer.
HIV is the cause of acquired immunodeficiency syndrome (AIDS).
HIV weakens the body's immune system and its ability to fight infection.
"HPV infection of the anus is common among patients who are HIV-positive .
"
The risk of anal cancer is higher in men who are HIV-positive and have sex with men compared with men who are HIV-negative and have sex with men.
"Women who are HIV-positive also have an increased risk of anal cancer compared with women who are HIV-negative.
"
"Studies show that intravenous drug use or cigarette smoking may further increase the risk of anal cancer in patients who are HIV-positive.
"
Immunosuppression is a condition that weakens the body's immune system and its ability to fight infections and other diseases.
"Chronic (long-term) immunosuppression may increase the risk of anal cancer because it lowers the body's ability to fight HPV infection.
"
"Patients who have an organ transplant and receive immunosuppressive medicine to prevent organ rejection have an increased risk of anal cancer.
"
Having an autoimmune disorder such as Crohn disease or psoriasis may increase the risk of anal cancer.
"It is not clear if the increased risk is due to the autoimmune condition, the treatment for the condition, or a combination of both."
"
The following sexual practices increase the risk of anal cancer because they increase the chance of being infected with HPV:
>Having receptive anal intercourse (anal sex).
"
">Having many sexual partners.
"
">Sex between men.
"
Men and women who have a history of anal warts or other sexually transmitted diseases also have an increased risk of anal cancer.
"
Studies show that cigarette smoking increases the risk of anal cancer."
Studies also show that current smokers have a higher risk of anal cancer than smokers who have quit or people who have never smoked.
"
The human papillomavirus (HPV) vaccine is used to prevent anal cancer, cervical cancer, vulvar cancer, and vaginal cancer caused by HPV."
"It is also used to prevent lesions caused by HPV that may become cancer in the future.
"
Studies show that being vaccinated against HPV lowers the risk of anal cancer.
The vaccine may work best when it is given before a person is exposed to HPV.
"
It is not known if the use of condoms protects against anal HPV infection."
This is because not enough studies have been done to prove this.
"
Cancer prevention clinical trials are used to study ways to lower the risk of developing certain types of cancer."
Some cancer prevention trials are conducted with healthy people who have not had cancer but who have an increased risk for cancer.
Other prevention trials are conducted with people who have had cancer and are trying to prevent another cancer of the same type or to lower their chance of developing a new type of cancer.
"Other trials are done with healthy volunteers who are not known to have any risk factors for cancer.
"
The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer.
"These may include eating fruits and vegetables, exercising, quitting smoking, or taking certain medicines, vitamins , minerals , or food supplements ."
"
Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage."
Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
"
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database."
"The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine."
Most summaries come in two versions.
The health professional versions have detailed information written in technical language.
"The patient versions are written in easy-to-understand, nontechnical language."
"Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish .
"
PDQ is a service of the NCI.
The NCI is part of the National Institutes of Health (NIH).
NIH is the federal government’s center of biomedical research.
The PDQ summaries are based on an independent review of the medical literature.
They are not policy statements of the NCI or the NIH.
"
This PDQ cancer information summary has current information about anal cancer prevention."
"It is meant to inform and help patients, families, and caregivers."
It does not give formal guidelines or recommendations for making decisions about health care.
"
Editorial Boards write the PDQ cancer information summaries and keep them up to date."
These Boards are made up of experts in cancer treatment and other specialties related to cancer.
The summaries are reviewed regularly and changes are made when there is new information.
"The date on each summary (""Updated"") is the date of the most recent change.
"
"The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Screening and Prevention Editorial Board ."
"
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another."
Trials are based on past studies and what has been learned in the laboratory.
Each trial answers certain scientific questions in order to find new and better ways to help cancer patients.
"During treatment clinical trials, information is collected about the effects of a new treatment and how well it works."
"If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become ""standard."""
Patients may want to think about taking part in a clinical trial.
"Some clinical trials are open only to patients who have not started treatment.
"
Clinical trials can be found online at NCI's website .
"For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237)."
"
PDQ is a registered trademark."
The content of PDQ documents can be used freely as text.
It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly.
"However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
"
"The best way to cite this PDQ summary is:
PDQ® Screening and Prevention Editorial Board."
PDQ Anal Cancer Prevention.
"Bethesda, MD: National Cancer Institute."
Updated <MM/DD/YYYY>.
Available at: https://www.cancer.gov/types/anal/patient/anal-prevention-pdq .
Accessed <MM/DD/YYYY>.
"[PMID: 26389512]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only."
"If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner."
It cannot be given by the National Cancer Institute.
"Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online ."
"Visuals Online is a collection of more than 3,000 scientific images."
"
The information in these summaries should not be used to make decisions about insurance reimbursement."
More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
"
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page."
"Questions can also be submitted to Cancer.gov through the website’s E-mail Us .
"
">Updated:April 2, 2020
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Anal Cancer Prevention (PDQ®)–Patient Version was originally published by the National Cancer Institute.”
"
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"
>General Information About Anal Cancer
>Stages of Anal Cancer
>Treatment Option Overview
>Treatment of Stage 0"
"(Carcinoma in Situ)
>Treatment of Stages I, II, and III Anal Cancer
>Treatment of Stage IV Anal Cancer
>Treatment of HIV and Anal Cancer
>Treatment of Recurrent Anal Cancer
>To Learn More About Anal Cancer
>About This PDQ Summary"
"
>Anal cancer is a disease in which malignant (cancer) cells form in
		  the tissues of the anus.
"
">Most anal cancers are related to human papillomavirus (HPV) infection.
"
">Signs of anal cancer include bleeding from the anus or rectum or a lump near the anus.
"
">Tests that examine the rectum and anus are used to diagnose anal  cancer.
"
>Certain factors affect the prognosis (chance of recovery) and treatment options.
"
The anus is the end of the large intestine , below the rectum , through which stool (solid waste) leaves the body."
The anus is formed partly from the outer skin layers of the body and partly from the intestine.
"Two ring-like muscles, called sphincter muscles, open and close the anal opening and let stool pass out of the body."
"The anal canal, the part of the anus between the rectum and the anal opening, is about 1-1½ inches long.
"
The skin around the outside of the anus is called the perianal area.
"Tumors of the perianal skin that do not involve the anal sphincter are usually treated the same as anal cancers , although local therapy (treatment directed to a limited area of skin) may be used for some."
"
Risk factors for anal cancer include the following:
>Being
           infected
           with
           human papillomavirus
           (HPV).
"
">Having a
           condition
           or disease that causes a weakened
           immune system
           , such as
           human immunodeficiency virus
           (HIV) or an
           organ
           transplant
           .
"
">Having a
           personal history
           of
           vulvar
           ,
           vaginal
           , or
           cervical cancers
           .
"
">Having many
           sexual
           partners.
"
">Having receptive anal intercourse (anal sex).
"
">Smoking
           cigarettes
           ."
"
These and other signs and symptoms may be caused by anal cancer or by other conditions."
"Check with your doctor if you have any of the following:
>Bleeding from the anus or rectum.
"
">A lump near the anus.
"
">Pain or pressure in the area around the anus.
"
">Itching or
           discharge
           from the anus.
"
">A change in
           bowel
           habits."
"
The following tests and procedures may be used:
>Physical exam and health history
           :  "
"An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual."
"A history of the patient’s health habits and past illnesses and treatments will also be taken.
"
">Digital rectal examination (DRE)
           : An exam of the anus and rectum."
"The doctor or
           nurse
           inserts a
           lubricated
           , gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual.
"
">Anoscopy
           : An exam of the anus and lower rectum using a short, lighted tube called an anoscope.
"
">Proctoscopy
           : A procedure to look inside the rectum and anus to check for
           abnormal
           areas, using a
           proctoscope
           ."
"A proctoscope is a thin, tube-like instrument with a light and a
           lens
           for viewing the inside of the rectum and anus."
"It may also have a tool to remove
           tissue
           samples, which are checked under a
           microscope
           for signs of
           cancer
           .
"
">Endo-anal or endorectal ultrasound
           : A procedure in which an
           ultrasound transducer
           (probe) is inserted into the anus or rectum and used to bounce high-energy sound waves (
           ultrasound
           ) off internal tissues or
           organs
           and make echoes."
"The echoes form a picture of body tissues called a
           sonogram
           .
"
">Biopsy
           : The removal of
           cells
           or tissues so they can be viewed under a microscope by a
           pathologist
           to check for signs of cancer."
"If an abnormal area is seen during the anoscopy, a biopsy may be done at that time."
"
The prognosis depends on the following:
>The size of the tumor.
>"
"Whether the cancer has spread to the
           lymph nodes
           .
"
"The treatment options depend on the following:
>The
           stage
           of the cancer.
"
">Where the tumor  is in the anus.
"
">Whether the patient has human immunodeficiency virus (HIV).
"
">Whether cancer remains  after initial treatment or has
           recurred
           ."
"
>After anal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the anus or to other parts of the body.
"
">There are three ways that cancer spreads in the body.
"
">Cancer may spread from where it began to other parts of the body.
"
">The following stages are used for anal cancer:Stage 0Stage IStage IIStage IIIStage IV
>Stage 0
>Stage I
>Stage II
>Stage III
>Stage IV
>Anal cancer can recur (come back) after it has been treated."
"
The process used to find out if cancer has spread within the anus or to other parts of the body is called staging ."
The information gathered from this staging process determines the stage of the disease.
It is important to know the stage in order to plan treatment.
"The following tests may be used in the staging process:
>CT scan (CAT scan)
           :  "
"A procedure that makes a series of detailed pictures of areas inside the body, such as the
           abdomen
           ,
           pelvis
           , or chest, taken from different angles.  "
"The pictures are made by a computer linked to an
           x-ray
           machine."
"A
           dye
           may be
           injected
           into a
           vein
           or swallowed to help the
           organs
           or
           tissues
           show up more clearly.  "
"This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
"
">Chest x-ray
           : An x-ray of the organs and bones inside the chest.  "
"An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
"
">MRI (magnetic resonance imaging)
           : A procedure that uses a magnet,
           radio waves
           , and a computer to make a series of detailed pictures of areas inside the body."
"This procedure is also called nuclear magnetic resonance imaging (NMRI).
"
">PET scan (positron emission tomography scan)
           : A procedure to find
           malignant
           tumor
           cells
           in the body.  "
"A small amount of
           radioactive
           glucose
           (sugar) is injected into a vein.  "
"The PET
           scanner
           rotates around the body and makes a picture of where glucose is being used in the body.  "
"Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
"
">Pelvic exam
           : An exam of the
           vagina
           ,
           cervix
           ,
           uterus
           ,
           fallopian tubes
           ,
           ovaries
           , and
           rectum
           .    "
"A
           speculum
           is inserted into the vagina and the doctor or
           nurse
           looks at the vagina and cervix for
           signs
           of disease.  "
"A
           Pap test
           of the cervix is usually done.  "
"The doctor or nurse also inserts one or two
           lubricated
           , gloved fingers of one hand into the vagina and places the other hand over the lower
           abdomen
           to feel the size, shape, and position of the uterus and ovaries."
"The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or
           abnormal
           areas."
"
Cancer can spread through tissue , the lymph system , and the blood :
>Tissue."
"The cancer spreads from where it began by growing into nearby areas.
"
>Lymph system.
The cancer spreads from where it began by getting into the lymph system.
"The cancer travels through the
           lymph vessels
           to other parts of the body.
"
>Blood.
The cancer spreads from where it began by getting into the blood.
"The cancer travels through the
           blood vessels
           to other parts of the body."
"
"
"When cancer spreads to another part of the body, it is called metastasis ."
"Cancer cells break away from where they began (the primary tumor ) and travel through the lymph system or blood.
"
>Lymph system.
"The cancer gets into the lymph system, travels through the lymph vessels, and forms a
           tumor
           (
           metastatic
           tumor) in another part of the body.
"
>Blood.
"The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
"
The metastatic tumor is the same type of cancer as the primary tumor.
"For example, if anal cancer spreads to the lung , the cancer cells in the lung are actually anal cancer cells."
"The disease is metastatic anal cancer, not lung cancer ."
"
In stage 0 , abnormal cells are found in the mucosa (innermost layer) of the anus ."
These abnormal cells may become cancer and spread into nearby normal tissue .
Stage 0 is also called high-grade intraepithelial lesion (HSIL).
"
In stage I , cancer has formed and the tumor is 2 centimeters or smaller."
"
Stage II anal cancer is divided into stages IIA and IIB.
"
">In stage IIA, the
            tumor
            is larger than 2
            centimeters
            but not larger than 5 centimeters.
"
">In stage IIB, the tumor is larger than 5 centimeters."
"
Stage III anal cancer is divided into stages IIIA, IIIB, and IIIC.
"
">In stage IIIA, the
            tumor
            is 5
            centimeters
            or smaller and has spread to
            lymph nodes
            near the
            anus
            or
            groin
            .
"
">In stage IIIB, the tumor is any size and has spread to nearby
            organs
            , such as the
            vagina
            ,
            urethra
            , or
            bladder
            .
            "
"Cancer
            has not spread to lymph nodes.
"
">In stage IIIC, the tumor is any size and may have spread to nearby organs."
Cancer has spread to lymph nodes near the anus or groin.
"
In stage IV , the tumor is any size."
"Cancer may have spread to lymph nodes or nearby organs and has spread to other parts of the body, such as the liver or lungs ."
"
The cancer may come back in the anus or other parts of the body, such as the liver or lungs."
"
>There are different types of treatment for  patients with anal cancer.
"
">The following types of treatment are used:SurgeryRadiation therapyChemotherapy
>Surgery
>Radiation therapy
>Chemotherapy
>New types of treatment are being tested in clinical trials."
"RadiosensitizersImmunotherapy
>Radiosensitizers
>Immunotherapy
>Treatment for anal cancer may cause side effects.
"
">Patients may want to think about taking part in a clinical trial.
"
">Patients can enter clinical trials before, during, or after starting their cancer treatment.
"
>Follow-up tests may be needed.
"
Different types of treatments are available for patients with anal cancer ."
"Some treatments are standard (the currently used treatment), and some are being tested in clinical trials ."
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer .
"When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment."
Patients may want to think about taking part in a clinical trial.
Some clinical trials are open only to patients who have not started treatment.
"
>Local
            resection
            :   A
            surgical
            procedure in which the
            tumor
            is cut from the
            anus
            along with some of the healthy
            tissue
            around it."
Local resection may be used if the cancer is small and has not spread.
"This procedure may save the
            sphincter
            muscles so the patient can still control
            bowel
            movements."
"Tumors that form in the lower part of the anus can often be removed with local resection.
"
">Abdominoperineal resection
            : A surgical procedure in which the anus, the
            rectum
            , and part of the
            sigmoid colon
            are removed through an
            incision
            made in the
            abdomen
            ."
"The doctor sews the end of the
            intestine
            to an opening, called a
            stoma
            , made in the surface of the abdomen so body waste can be collected in a disposable bag outside of the body."
"This is called a
            colostomy
            .
            "
"Lymph nodes
            that contain cancer may also be removed during this operation."
"This procedure   is used only  for cancer that remains or comes back after treatment with
            radiation therapy
            and
            chemotherapy
            ."
"
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing."
"There are two types of radiation therapy:
>External radiation therapy
            uses a machine outside the body to send radiation toward the area of the body with cancer.
"
">Internal radiation therapy
            uses a
            radioactive
            substance sealed in needles,
            seeds
            , wires, or
            catheters
            that are placed directly into or near the cancer.
"
The way the radiation therapy is given depends on the type and stage of the cancer being treated.
External and internal radiation therapy are used to treat anal cancer.
"
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing."
"When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body ( systemic chemotherapy )."
"
This summary section describes treatments that are being studied in clinical trials."
It may not mention every new treatment being studied.
Information about clinical trials is available from the NCI website .
"
Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy."
Combining radiation therapy with radiosensitizers may kill more tumor cells.
"
Immunotherapy is a treatment that uses the patient's immune system to fight cancer."
"Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer."
"This cancer treatment is a type of biologic therapy .
"
"Immune checkpoint inhibitor therapy is a type of immunotherapy.
"
">PD-1
            and
            PD-L1
            inhibitor therapy: PD-1 is a
            protein
            on the surface of
            T cells
            that helps keep the body’s
            immune responses
            in check."
PD-L1 is a protein found on some types of cancer cells.
"When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell."
PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other.
"This allows the T cells to kill cancer cells.
            "
"Pembrolizumab
            and
            nivolumab
            are  types of PD-1 inhibitors."
"
For information about side effects caused by treatment for cancer, see our Side Effects page."
"
For some patients, taking part in a clinical trial may be the best treatment choice."
Clinical trials are part of the cancer research process.
"Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment .
"
Many of today's standard treatments for cancer are based on earlier clinical trials.
"Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
"
Patients who take part in clinical trials also help improve the way cancer will be treated in the future.
"Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward."
"
Some clinical trials only include patients who have not yet received treatment."
Other trials test treatments for patients whose cancer has not gotten better.
"There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
"
Clinical trials are taking place in many parts of the country.
Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage.
Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
"
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated."
Some tests will be repeated in order to see how well the treatment is working.
"Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
"
Some of the tests will continue to be done from time to time after treatment has ended.
The results of these tests can show if your condition has changed or if the cancer has recurred (come back).
These tests are sometimes called follow-up tests or check-ups.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of stage 0 is usually local resection .
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of stage I , stage II , and stage III anal cancer may include the following:
>Local
          resection
          for
          tumors
          of the skin around the outside of the
          anus
          and tumors inside the
          anal
          opening that do not involve the anal
          sphincter
          .
>External-beam radiation therapy
          with
          chemotherapy
          .
>Radiation therapy
          alone.
"
">Abdominoperineal resection
          , if
          cancer
          remains or comes back after treatment with radiation therapy and chemotherapy."
"Other options may include treatment  with additional
          chemoradiation
          therapy, chemotherapy alone, or
          immunotherapy
          .
"
"Patients who have had treatment that saves the sphincter muscles may receive follow-up exams every 3 months for the first 2 years, including rectal exams with endoscopy and biopsy , as needed to check for recurrence .
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of stage IV anal cancer may include the following:
>Palliative
          surgery
          to relieve
          symptoms
          and improve the
          quality of life
          .
>Palliative
          radiation therapy
          .
"
">Palliative
          chemotherapy
          with or without radiation therapy.
"
">A
          clinical trial
          of
          immune  checkpoint inhibitors
          .
"
">A
          clinical trial
          of new treatment options.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
In general, treatment for patients who have anal cancer and the human immunodeficiency virus (HIV) is similar to treatment for other patients, and these patients have similar outcomes."
"However, this treatment can further damage the weakened immune systems of patients who have HIV."
Treatment in patients with a history of AIDS -related complications may require lower doses of anticancer drugs and radiation therapy than doses used for patients who do not have HIV.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of recurrent anal cancer may include the following:
>Radiation therapy
          and
          chemotherapy
          , for
          recurrence
          after
          surgery
          .
"
">Surgery, for recurrence after radiation therapy and/or chemotherapy.
"
">A
          clinical trial
          of radiation therapy with chemotherapy and
          radiosensitizers
          .
"
">A clinical trial of  chemotherapy options.
"
">A clinical trial of
          immune checkpoint inhibitors
          .
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients."
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For more information from the National Cancer Institute about anal cancer , see the following:
>Anal Cancer Home Page
>Tobacco
          (includes help with quitting)
>Human Papillomaviruses and Cancer
>Immunotherapy to Treat Cancer
For general cancer information and other resources from the National Cancer Institute, see the following:
>About Cancer
>Staging
>Chemotherapy and You: Support for People With Cancer
>Radiation Therapy and You: Support for People With Cancer
>Coping with Cancer
>Questions to Ask Your Doctor about Cancer
>For Survivors and Caregivers"
"
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database."
"The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine."
Most summaries come in two versions.
The health professional versions have detailed information written in technical language.
"The patient versions are written in easy-to-understand, nontechnical language."
"Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish .
"
PDQ is a service of the NCI.
The NCI is part of the National Institutes of Health (NIH).
NIH is the federal government’s center of biomedical research.
The PDQ summaries are based on an independent review of the medical literature.
They are not policy statements of the NCI or the NIH.
"
This PDQ cancer information summary has current information about the treatment of anal cancer."
"It is meant to inform and help patients, families, and caregivers."
It does not give formal guidelines or recommendations for making decisions about health care.
"
Editorial Boards write the PDQ cancer information summaries and keep them up to date."
These Boards are made up of experts in cancer treatment and other specialties related to cancer.
The summaries are reviewed regularly and changes are made when there is new information.
"The date on each summary (""Updated"") is the date of the most recent change.
"
"The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board ."
"
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another."
Trials are based on past studies and what has been learned in the laboratory.
Each trial answers certain scientific questions in order to find new and better ways to help cancer patients.
"During treatment clinical trials, information is collected about the effects of a new treatment and how well it works."
"If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become ""standard."""
Patients may want to think about taking part in a clinical trial.
"Some clinical trials are open only to patients who have not started treatment.
"
Clinical trials can be found online at NCI's website .
"For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237)."
"
PDQ is a registered trademark."
The content of PDQ documents can be used freely as text.
It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly.
"However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
"
"The best way to cite this PDQ summary is:
PDQ® Adult Treatment Editorial Board."
PDQ Anal Cancer Treatment.
"Bethesda, MD: National Cancer Institute."
Updated <MM/DD/YYYY>.
Available at: https://www.cancer.gov/types/anal/patient/anal-treatment-pdq .
Accessed <MM/DD/YYYY>.
"[PMID: 26389368]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only."
"If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner."
It cannot be given by the National Cancer Institute.
"Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online ."
"Visuals Online is a collection of more than 3,000 scientific images."
"
The information in these summaries should not be used to make decisions about insurance reimbursement."
More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
"
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page."
"Questions can also be submitted to Cancer.gov through the website’s E-mail Us .
"
">Updated:December 16, 2022
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Anal Cancer Treatment (PDQ®)–Patient Version was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
Cancer is a disease in which cells in the body grow out of control."
"When cancer starts in the colon or rectum, it is called colorectal cancer."
"Sometimes it is called colon cancer, for short.
"
"Colorectal cancer is a leading cause of cancer death in the United States, but it doesn’t have to be."
Colorectal cancer screening saves lives.
Screening can find precancerous polyps—abnormal growths in the colon or rectum—that can be removed before they turn into cancer.
"Screening also helps find colorectal cancer at an early stage, when treatment works best."
"About nine out of every 10 people whose colorectal cancers are found early and treated appropriately are still alive five years later.
"
"If you are 45 years old or older, get screened now."
"If you think you may be at increased risk for colorectal cancer, speak with your doctor about when to begin screening, which test is right for you, and how often to get tested.
"
Colorectal cancer is cancer that occurs in the colon or rectum.
"Sometimes it is called colon cancer, for short.
"
"Your risk of getting colorectal cancer increases as you get older, and there are other risk factors.
"
"The most effective way to reduce your risk of colorectal cancer is by having regular colorectal cancer screening tests beginning at age 45.
"
"Colorectal cancer doesn’t always cause symptoms, especially at first."
"See a list of possible symptoms.
"
"Screening tests can find precancerous polyps, so that they can be removed before they turn into cancer."
"Screening tests can also find colorectal cancer early, when treatment works best.
"
Several screening tests can be used to find polyps or colorectal cancer.
Each test has advantages and disadvantages.
"Talk to your doctor about the pros and cons of each test, and how often to be tested.
"
Tell your doctor about any symptoms or risk factors you may have.
"Discuss with your doctor which test is best for you.
"
">Facebook
>Twitter
>LinkedIn
>Syndicate"
"
“I’ve been screened twice."
"I made everybody I love get screened,” says actress Meryl Streep in this video."
"“People that are screened early and find cancer and are treated early—they’re alive because of that early detection.”
"
"Overall, the most effective way to reduce your risk of colorectal cancer is to get screened for colorectal cancer routinely, beginning at age 45.
"
Almost all colorectal cancers begin as precancerous polyps (abnormal growths) in the colon or rectum.
Such polyps can be present in the colon for years before invasive cancer develops.
"They may not cause any symptoms, especially early on."
Colorectal cancer screening can find precancerous polyps so they can be removed before they turn into cancer.
"In this way, colorectal cancer is prevented."
"Screening can also find colorectal cancer early, when treatment works best."
"
Research is underway to find out if changes to your diet can reduce your colorectal cancer risk."
"Medical experts often recommend a diet low in animal fats and high in fruits, vegetables, and whole grains to reduce the risk of other chronic diseases, such as coronary artery disease and diabetes."
This diet also may reduce the risk of colorectal cancer.
"
Some studies suggest that people may reduce their risk of developing colorectal cancer by increasing physical activity, keeping a healthy weight, limiting alcohol consumption, and avoiding tobacco.
"
">Facebook
>Twitter
>LinkedIn
>Syndicate"
"
Your risk of getting colorectal cancer increases as you get older, but getting regular physical activity and keeping a healthy weight may help lower your risk.
"
"Other risk factors include having—
>Inflammatory bowel disease
         such as Crohn’s disease or ulcerative colitis.
"
">A personal or
         family history
         of colorectal cancer or colorectal polyps.
"
">A genetic syndrome such as
         familial adenomatous polyposis (FAP)
         or
         hereditary non-polyposis colorectal cancer (Lynch syndrome).
"
"Lifestyle factors that may contribute to an increased risk of colorectal cancer include—
>Lack of regular
         physical activity.
"
">A diet low in fruit and vegetables.
"
">A low-fiber and high-fat
         diet,
         or a diet high in processed meats.
"
">Overweight and obesity.
"
">Alcohol
         consumption.
"
">Tobacco use.
"
">Facebook
>Twitter
>LinkedIn
>Syndicate"
"
Screening tests can find precancerous polyps, so that they can be removed before they turn into cancer."
"Screening tests can also find colorectal cancer early, when treatment works best."
"
A screening test is used to look for a disease when a person doesn’t have symptoms."
"(When a person has symptoms, diagnostic tests are used to find out the cause of the symptoms.)
"
Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum.
"Screening tests can find precancerous polyps, so that they can be removed before they turn into cancer."
"Screening tests can also find colorectal cancer early, when treatment works best."
"
Regular screening, beginning at age 45, is the key to preventing colorectal cancer and finding it early."
The U.S. Preventive Services Task Force (Task Force) recommends that adults age 45 to 75 be screened for colorectal cancer.
"The Task Force recommends that adults age 76 to 85 talk to their doctor about screening.
"
"The Task Force recommends several colorectal cancer screening strategies, including stool tests, flexible sigmoidoscopy, colonoscopy, and CT colonography (virtual colonoscopy)."
Learn about these screening tests.
"
Most people should begin screening for colorectal cancer soon after turning 45, then continue getting screened at regular intervals."
"However, you may need to be tested earlier than 45, or more often than other people, if you have—
>Inflammatory bowel disease
         such as Crohn’s disease or ulcerative colitis.
"
">A personal or
         family history
         of colorectal cancer or colorectal polyps.
"
">A genetic syndrome such as
         familial adenomatous polyposis (FAP)
         or
         hereditary non-polyposis colorectal cancer (Lynch syndrome).
"
"If you think you are at increased risk for colorectal cancer, speak with your doctor about—
>When to begin screening.
"
">Which test is right for you.
"
>How often to get tested.
"
Colorectal cancer screening tests may be covered by your health insurance policy without a deductible or co-pay."
"For more information about Medicare coverage, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227)."
TTY users should call 1 (877) 486-2048.
"Check with your insurance plan to find out what benefits are covered for colorectal cancer screening.
"
">Facebook
>Twitter
>LinkedIn
>Syndicate"
"
Several screening tests can be used to find polyps or colorectal cancer."
The benefits and risks of these screening methods vary.
Discuss with your doctor which test is best for you.
"
The U.S. Preventive Services Task Force recommends that adults age 45 to 75 get screened for colorectal cancer."
The decision to get screened between ages 76 and 85 should be made on an individual basis.
"If you are older than 75, talk to your doctor about screening."
"People at an increased risk of developing colorectal cancer should talk to their doctors about when to begin screening, which test is right for them, and how often to get tested.
"
Several screening tests can be used to find polyps or colorectal cancer.
The benefits and risks of these screening methods vary.
"Discuss with your doctor which test is best for you, and check with your insurance provider to find out which tests are covered by your insurance plan, and how much you will have to pay."
Medicare helps pay for colorectal cancer screening.
"
"
"Do I need to get a screening test for colorectal cancer?
>"
What screening test(s) do you recommend for me?
"Why?
>How do I prepare?"
"Do I need to change my diet or my usual medication before taking the test?
"
>
What’s involved in the test?
"Will it be uncomfortable or painful?
"
">Is there any risk involved?
>"
"When and from whom will I get results?
"
"If you’re having a colonoscopy or sigmoidoscopy, you will want to know—
>"
"Who will do the exam?
"
>Will I need someone with me?
"
Some people are at increased risk because they have inflammatory bowel disease, a personal or family history of colorectal polyps or colorectal cancer, or genetic syndromes like familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (also known as Lynch syndrome)."
These people may need to start screening earlier than age 45.
"If you believe you are at increased risk, ask your doctor if you should begin screening earlier than age 45."
"
Tell your doctor if you have any of these symptoms—
>A change in bowel habits.
"
">Blood in or on your stool (bowel movement).
"
">Diarrhea, constipation, or feeling that the bowel does not empty all the way.
"
">Abdominal pain, aches, or cramps that do not go away.
"
">Weight loss and you don’t know why.
"
"These symptoms may be caused by something other than cancer, but the only way to know what is causing them is to speak with your doctor about them.
"
">Facebook
>Twitter
>LinkedIn
>Syndicate"
"
“I lost my mom to colorectal cancer, which may have been prevented,” says Joy.
"
“There is no better time than now to talk to your doctor and get screened.”
"Joy, Philadelphia, Pennsylvania
I lost my mom to colorectal cancer, which may have been prevented if my mom had gotten her routine colorectal cancer screenings."
My mom never got a colonoscopy done until it was too late.
"I will not let that same fate happen to my kids and loved ones.
"
"In honor of my mom, I am meeting with a gastroenterologist to talk about when I should start screening based on my age and family history of colorectal cancer."
"The recommended age for most people to begin screening, male or female, is now 45."
"Some people may need to be tested earlier than 45 if they have a family history, inflammatory bowel disease, or a genetic syndrome like Lynch syndrome."
These screenings can help find precancerous polyps before they become cancerous.
It makes me sad to know that I could have had more time with my mom had she taken these measures.
"But with this knowledge, I’m going to do everything I can to prevent colorectal cancer.
"
There is no better time than now to talk to your doctor and get screened.
Believe me when I say that your loved ones will appreciate it if you do.
I know I would have.
"
“Colorectal cancer often comes with no symptoms,” says Adrian.
"
“Did you know there is often no warning sign that you have colorectal cancer?”
"Adrian, Edenton, North Carolina
I made an appointment to get my first colonoscopy at 47."
"Because of the COVID-19 pandemic and delaying regular appointments and screenings, I missed the memo that the screening age for colorectal cancer now begins at 45 for both men and women."
"Colorectal cancer often comes with no symptoms, and it’s very preventable.
"
"If doctors find a precancerous polyp, they can get rid of it and, in many cases, prevent cancer from ever developing."
"And if they do find cancer, treatment works best when it’s detected early."
Don’t delay your screening.
"
“There are different screening options available, even some that can be done at home,” says Dr. Caudle.
"
“Many of my patients are fearful about getting screened for colorectal cancer.”
"Dr. Jen Caudle, Philadelphia, Pennsylvania
Colorectal cancer screening saves lives, but many of my patients are fearful about getting screened for colorectal cancer, so they put it off."
"If it’s helpful, I let my patients know that there are different screening options available, even some that can be done at home.
"
"I’ll be going for my colorectal cancer screening soon, so I tell my patients that we are in this together."
Screening is important because it helps find precancerous polyps before they turn into cancer.
"Screening also helps find colorectal cancer early, when treatment works best!
"
"I’ll be right there with you, and I’ll be talking to my doctor about my screening options."
"
“I got screened for colorectal cancer, and they found precancerous polyps, preventing me from developing colorectal cancer,” says Lorraine.
"
“Screening prevented me from developing colorectal cancer.”
"Lorraine, Sarasota, Florida
I got screened for colorectal cancer, and they found precancerous polyps, preventing me from developing colorectal cancer."
"By the age of 59, I had completed several screenings."
"I am slated for another screening next year because of my high risk and family history.
"
My father was diagnosed with colorectal cancer at 82.
"He had never had a screening, so I didn’t know I had a family history of colorectal cancer until he was diagnosed.
"
"At first, he had no symptoms, and that’s why screenings are so important."
"Colorectal cancer doesn’t always have symptoms, especially in the early stages."
"
“Fortunately, because the cancer was found early enough, the surgery was successful."
"But I never would have found it early if I hadn’t been screened,” says Robert.
"
“If I hadn’t been screened I wouldn’t have been able to see my son go off to college.”
"Robert
I’m a father of two, husband, and salesman who travels around the country for work."
I’ve had a full life.
"I watched my daughter graduate from college and graduate school, and my son graduate from high school."
"Now that both of our kids have left the house, my wife and I are beginning the next chapter of our life together.
"
"In 2016, I noticed I seemed to be getting more tired, from traveling I thought."
I decided to see my doctor for a checkup.
"I spoke with him about having a colonoscopy, even though I didn’t have any symptoms, aside from feeling tired."
I wanted to get screened because it had been 7 years since my last colonoscopy.
"Also, my father had colon cancer when he was only 45 years old that he survived."
"Today, my father is 75 years old and in relatively good health.
"
"I went in for my colonoscopy on January 10, 2017."
"Although no polyps were present during this screening (or during any screening I had prior), the doctor took tissue samples for a biopsy."
"A week later, the results came back and showed that I did in fact have colon cancer."
"On February 2, 2017, I underwent surgery to get rid of the cancer.
"
"Fortunately, because the cancer was found early enough, the surgery was successful."
"But I never would have found it early if I hadn’t been screened.
"
"Now, I’m encouraging my wife to get a colonoscopy."
People tell me that they are scared to get screened and scared to see what the screening might reveal.
But I think it’s scarier if you have a tumor that the doctor can’t remove.
"I have a few brothers, and all of them have been screened."
"One of my brothers routinely has polyps that are removed.
"
"If I hadn’t been screened I wouldn’t have been able to see my son go off to college, or enjoy this next chapter of my life with my wife and family."
"Today, I have a positive outlook on the life ahead of me."
I also started exercising again and changing my diet.
I’ve been getting back to the old me.
"Getting screened made me want to go enjoy every day.
"
">Facebook
>Twitter
>LinkedIn
>Syndicate"
"
Abdominal pain, aches, or cramps may be symptoms of colorectal cancer."
"If you have any symptoms that worry you, be sure to see your doctor right away.
"
"Colorectal polyps (abnormal growths in the colon or rectum that can turn into cancer if not removed) and colorectal cancer don’t always cause symptoms, especially at first."
Someone could have polyps or colorectal cancer and not know it.
"That is why getting screened regularly for colorectal cancer is so important.
"
"If you have symptoms, they may include—
>A change in bowel habits.
"
">Blood in or on your stool (bowel movement).
"
">Diarrhea, constipation, or feeling that the bowel does not empty all the way.
"
">Abdominal pain, aches, or cramps that don’t go away.
"
">Weight loss and you don’t know why.
"
"If you have any of these symptoms, talk to your doctor."
They may be caused by something other than cancer.
"The only way to know what is causing them is to see your doctor.
"
">Facebook
>Twitter
>LinkedIn
>Syndicate"
"
This diagram shows the location of the stomach, small intestine, cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.
"
Colorectal cancer is a disease in which cells in the colon or rectum grow out of control.
"Sometimes it is called colon cancer, for short."
The colon is the large intestine or large bowel.
"The rectum is the passageway that connects the colon to the anus.
"
"Sometimes abnormal growths, called polyps, form in the colon or rectum."
"Over time, some polyps may turn into cancer."
Screening tests can find polyps so they can be removed before turning into cancer.
"Screening also helps find colorectal cancer at an early stage, when treatment works best.
"
">Facebook
>Twitter
>LinkedIn
>Syndicate"
"
>General Information About Childhood Colorectal Cancer
>Stages of Childhood Colorectal Cancer
>Treatment Option Overview
>Treatment of Childhood Colorectal Cancer
>Treatment of Recurrent Childhood Colorectal Cancer
>To Learn More About Childhood Colorectal Cancer
>About This PDQ Summary"
"
>Colorectal cancer is a disease in which malignant (cancer)
		  cells form in the tissues of the colon or the rectum.
"
">Having certain inherited syndromes increases the risk of colorectal cancer.
"
">Signs and symptoms of colorectal cancer include pain in the abdomen, constipation, and diarrhea.
"
">Tests that examine the colon and rectum are used to diagnose colorectal cancer.
"
>Certain factors affect prognosis (chance of recovery).
"
The colon is part of the body's digestive system ."
"The digestive system removes and processes nutrients ( vitamins , minerals , carbohydrates , fats, proteins , and water) from foods and helps pass waste material out of the body."
"The digestive system is made up of the mouth, throat , esophagus , stomach , and the small and large intestines ."
The colon (large bowel ) is the main part of the large intestine and is about 5 feet long in an adult.
"Together, the rectum and anal canal make up the last part of the large intestine and are 6 to 8 inches long."
The anal canal ends at the anus (the opening of the large intestine to the outside of the body).
"
Anything that increases your chance of getting a disease is called a risk factor ."
Having a risk factor does not mean that you will get cancer ; not having risk factors doesn't mean that you will not get cancer.
"Talk with your child's doctor if you think your child may be at risk.
"
Childhood colorectal cancer may be part of an inherited syndrome .
Some colorectal cancers in young people are linked to a gene mutation that causes polyps (growths in the mucous membrane that lines the colon) to form that may turn into cancer later.
"The risk of colorectal cancer is increased by having inherited conditions , such as the following:
>Familial adenomatous polyposis
           (FAP).
"
">Attenuated FAP
           .
"
">MUTYH-associated polyposis
           .
"
">Oligopolyposis
           .
>Change in the
           NTHL1 gene
           .
"
">Juvenile polyposis syndrome
           .
"
">Cowden syndrome
           .
"
">Peutz-Jeghers syndrome
           .
"
">Neurofibromatosis type 1
           (NF1).
"
Polyps that form in the colon of children who do not have an inherited syndrome are not linked to an increased risk of cancer.
"
Signs and symptoms of childhood colorectal cancer usually depend on where the tumor forms."
"These and other signs and symptoms may be caused by colorectal cancer or by other conditions.
"
"Check with your child's doctor if your child has any of the following:
>Tumors of the rectum or lower colon may cause  pain in the
           abdomen
           ,
           constipation
           , or
           diarrhea
           .
"
>Tumors in the part of the colon on the left side of the body may cause:A lump in the abdomen.
Weight loss for no known reason.
"Nausea
              and
              vomiting
              .Loss of
              appetite
              .Blood
              in the
              stool
              .Anemia
              (tiredness, dizziness, fast or irregular heartbeat, shortness of breath, pale skin).
"
">A lump in the abdomen.
"
">Weight loss for no known reason.
"
">Nausea
              and
              vomiting
              .
"
">Loss of
              appetite
              .
"
">Blood
              in the
              stool
              .
"
">Anemia
              (tiredness, dizziness, fast or irregular heartbeat, shortness of breath, pale skin).
"
>Tumors in the part of the colon on the right side of the body may cause:Pain in the abdomen.
Blood in the stool.
Constipation or diarrhea.
Nausea and vomiting.
"Weight loss for no known reason.
"
">Pain in the abdomen.
"
">Blood in the stool.
"
">Constipation or diarrhea.
"
">Nausea and vomiting.
"
>Weight loss for no known reason.
"
The following tests and procedures may be used:
>Physical exam and health history:
           "
"An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual."
"A history of the patient’s health habits and past illnesses and treatments will also be taken.
"
">Colonoscopy
           : A procedure to look inside the rectum and colon for polyps,
           abnormal
           areas, or cancer."
"A
           colonoscope
           is inserted through the rectum into the colon.  "
"A colonoscope is a thin, tube-like instrument with a light and a
           lens
           for viewing."
"It also has a  tool to remove polyps or
           tissue
           samples, which are checked under a
           microscope
           for signs of cancer.
"
">Barium enema
           : A series of
           x-rays
           of the lower
           gastrointestinal tract
           .  "
"A liquid that contains
           barium
           (a silver-white
           metallic
           compound
           ) is put into the rectum."
The barium coats the lower gastrointestinal tract and x-rays are taken.  
"This procedure is also called a lower GI series.
"
">Fecal occult blood test
           : A test to check stool (solid waste) for blood that can only be seen with a microscope."
"Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.
"
">Complete blood count (CBC)
           : A procedure in which a sample of blood is drawn and checked for the following:The number of
              red blood cells
              ,
              white blood cells
              , and
              platelets
              .The amount of
              hemoglobin
              (the protein that carries
              oxygen
              ) in the red blood cells."
"The portion of the blood sample made up of red blood cells.
"
">The number of
              red blood cells
              ,
              white blood cells
              , and
              platelets
              .
"
">The amount of
              hemoglobin
              (the protein that carries
              oxygen
              ) in the red blood cells.
"
">The portion of the blood sample made up of red blood cells.
"
">Carcinoembryonic antigen (CEA) assay
           : A test that measures the level of
           CEA
           in the blood."
CEA is released into the bloodstream from both cancer cells and normal cells.
"When found in higher than normal amounts, it can be a sign of colorectal cancer or other conditions."
"
Prognosis depends on the following:
>Whether the tumor was completely removed by
           surgery
           .
>"
"Whether the cancer has spread to other parts of the body, such as the
           lymph nodes
           ,
           lung
           ,
           liver
           ,
           pelvis
           ,
           ovaries
           , or bone.
"
">Whether the cancer has just been
           diagnosed
           or has
           recurred
           (come back)."
"
>After colorectal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the colon or rectum or to other parts of the body.
"
">There are three ways that cancer spreads in the body.
"
">Cancer may spread from where it began to other parts of the body.
"
>Sometimes childhood colorectal cancer recurs (comes back) after treatment.
"
To plan treatment, it is important to know whether cancer cells have spread within the colon or rectum or to other parts of the body."
The process used to find out if cancer has spread is called staging .
It is important to know the stage in order to plan treatment.
The results of the tests used to diagnose cancer are often also used to stage the disease.
"(See the General Information section.)
"
"In children, the cancer has often spread to the lymph nodes , outside the colon or rectum, or to other organs in the abdomen at diagnosis."
"The following tests and procedures may be used to find out if cancer has spread:
>Chest x-ray
           : An
           x-ray
           of the organs and bones inside the chest.  "
"An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
"
">PET scan (positron emission tomography scan)
           : A procedure to find
           malignant
           tumor
           cells in the body.  "
"A small amount of
           radioactive glucose
           (sugar) is
           injected
           into a
           vein
           .  "
"The PET
           scanner
           rotates around the body and makes a picture of where
           glucose
           is being used in the body.  "
"Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
"
">MRI (magnetic resonance imaging)
           : A procedure that uses a magnet,
           radio waves
           , and a computer to make a series of detailed pictures of areas of the body, such as the chest, abdomen, and
           pelvis
           ."
"This procedure is also called nuclear magnetic resonance imaging (NMRI).
"
">CT scan (CAT scan)
           : A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, taken from different angles.  "
The pictures are made by a computer linked to an x-ray machine.
"A
           dye
           may be injected into a vein or swallowed to help the organs or
           tissues
           show up more clearly.  "
"This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
"
">Bone scan
           : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone.  "
"A very small amount of
           radioactive
           material is injected into a vein and travels through the bloodstream.  "
The radioactive material collects in the bones with cancer and is detected by a scanner.
"
Cancer can spread through tissue , the lymph system , and the blood :
>Tissue."
"The cancer spreads from where it began by growing into nearby areas.
"
>Lymph system.
The cancer spreads from where it began by getting into the lymph system.
"The cancer travels through the
           lymph vessels
           to other parts of the body.
"
>Blood.
The cancer spreads from where it began by getting into the blood.
"The cancer travels through the
           blood vessels
           to other parts of the body."
"
"
"When cancer spreads to another part of the body, it is called metastasis ."
"Cancer cells break away from where they began (the primary tumor ) and travel through the lymph system or blood.
"
>Lymph system.
"The cancer gets into the lymph system, travels through the lymph vessels, and forms a
           tumor
           (
           metastatic
           tumor) in another part of the body.
"
>Blood.
"The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
"
The metastatic tumor is the same type of cancer as the primary tumor .
"For example, if colorectal cancer spreads to the bone, the cancer cells in the bone are actually colorectal cancer cells."
"The disease is metastatic colorectal cancer, not bone cancer ."
"
Childhood colorectal cancer may come back in the colon, rectum, or in other parts of the body."
"
>There are different types of treatment for children with colorectal cancer.
"
">Children with colorectal cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.
"
">Four types of standard treatment are used:SurgeryRadiation therapyChemotherapyImmunotherapy
>Surgery
>Radiation therapy
>Chemotherapy
>Immunotherapy
>New types of treatment are being tested in clinical trials."
"Targeted therapy
>Targeted therapy
>Treatment for childhood colorectal cancer may cause side effects.
"
">Patients may want to think about taking part in a clinical trial.
"
">Patients can enter clinical trials before, during, or after starting their cancer treatment.
"
>Follow-up tests may be needed.
"
Some treatments are standard (the currently used treatment), and some are being tested in clinical trials ."
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer .
"When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
"
"Because cancer in children is rare, taking part in a clinical trial should be considered."
Some clinical trials are open only to patients who have not started treatment.
"
Treatment will be overseen by a pediatric oncologist , a doctor who specializes in treating children with cancer ."
The pediatric oncologist works with other pediatric health professionals who are experts in treating children with cancer and who specialize in certain areas of medicine .
"This may include the following specialists and others:
>Pediatrician
           .
>Pediatric
           gastroenterologist
           .
>Pediatric surgeon
           .
>Radiation oncologist
           .
>Pathologist
           .
>Pediatric nurse specialist
           .
"
">Social worker
           .
>Rehabilitation specialist
           .
"
">Psychologist
           .
"
">Child-life specialist
           ."
"
Surgery to remove the cancer is done if the cancer has not spread to other parts of the body at diagnosis ."
"
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing."
External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
"
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing."
"When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body ( systemic chemotherapy )."
Chemotherapy using more than one drug is called combination chemotherapy .
"
Immunotherapy is a treatment that uses the patient’s immune system to fight cancer."
"Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer."
"This cancer treatment is a type of biologic therapy .
"
Immune checkpoint inhibitor therapy is a type of immunotherapy.
"Some types of immune cells , such as T cells , and some cancer cells have certain proteins , called checkpoint proteins, on their surface that keep immune responses in check."
"When cancer cells have large amounts of these proteins, they will not be attacked and killed by T cells."
"Immune checkpoint inhibitors block these proteins and the ability of T cells to kill cancer cells is increased.
"
"There are two types of immune checkpoint inhibitor therapy:
>PD-1
            and
            PD-L1
            inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check."
PD-L1 is a protein found on some types of cancer cells.
"When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell."
PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other.
"This allows the T cells to kill cancer cells.
            "
"Nivolumab
            is a type of PD-1 inhibitor that has been used to treat children 12 years and older with
            recurrent
            colorectal cancer
            .
"
">CTLA-4
            inhibitor."
CTLA-4 is a protein on the surface of T cells that helps keep the body’s immune responses in check.
"When CTLA-4 attaches to another protein called B7 on a cancer cell, it stops the T cell from killing the cancer cell."
"CTLA-4 inhibitors attach to CTLA-4 and allow the T cells to kill cancer cells.
            "
"Ipilimumab
            is used to treat children 12 years and older with recurrent colorectal cancer."
"
This summary section describes treatments that are being studied in clinical trials ."
It may not mention every new treatment being studied.
Information about clinical trials is available from the NCI website .
"
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells."
"Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.
"
Targeted therapy is being studied for the treatment of childhood colorectal cancer that has recurred (come back).
"
To learn about side effects that begin during treatment for cancer, see Side Effects .
"
Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects .
"Late effects of cancer treatment may include the following:
>Physical problems.
"
">Changes in mood, feelings, thinking, learning, or memory.
"
">Second cancers
           (new types of cancer) or other
           conditions
           .
"
Some late effects may be treated or controlled.
It is important to talk with your child's doctors about the possible late effects caused by some treatments.
See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.
"
For some patients, taking part in a clinical trial may be the best treatment choice."
Clinical trials are part of the cancer research process.
"Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment .
"
Many of today's standard treatments for cancer are based on earlier clinical trials.
"Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
"
Patients who take part in clinical trials also help improve the way cancer will be treated in the future.
"Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward."
"
Some clinical trials only include patients who have not yet received treatment."
Other trials test treatments for patients whose cancer has not gotten better.
"There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
"
Clinical trials are taking place in many parts of the country.
Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage.
Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
"
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated."
Some tests will be repeated in order to see how well the treatment is working.
"Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
"
Some of the tests will continue to be done from time to time after treatment has ended.
The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back).
These tests are sometimes called follow-up tests or check-ups.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of newly diagnosed colorectal cancer in children may include the following:
>Surgery
          to remove the
          tumor
          if it has not spread.
"
">Radiation therapy
          and
          chemotherapy
          for tumors in the
          rectum
          or lower
          colon
          .
"
">Combination chemotherapy
          , for
          advanced
          colorectal cancer.
"
">Immunotherapy
          with
          immune checkpoint inhibitors
          (
          ipilimumab
          and
          nivolumab
          ).
"
"Children with certain familial colorectal cancer syndromes may be treated with the following:
>Surgery to remove the colon before
          cancer
          forms.
"
">Medicine
          to decrease the number of
          polyps
          in the colon.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of recurrent colorectal cancer in children may include the following:
>A
          clinical trial
          that checks a sample of the patient's
          tumor
          for certain
          gene
          changes."
"The type of
          targeted therapy
          that will be given to the patient depends on the type of gene change.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For more information from the National Cancer Institute about childhood colorectal cancer , see the following:
>Colorectal Cancer Home Page
>Computed Tomography (CT) Scans and Cancer
>Immunotherapy to Treat Cancer
>Targeted Cancer Therapies
For more childhood cancer information and other general cancer resources, see the following:
>About Cancer
>Childhood Cancers
>CureSearch for Children's Cancer
>Late Effects of Treatment for Childhood Cancer
>Adolescents and Young Adults with Cancer
>Children with Cancer: A Guide for Parents
>Cancer in Children and Adolescents
>Staging
>Coping with Cancer
>Questions to Ask Your Doctor about Cancer
>For Survivors and Caregivers"
"
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database."
"The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine."
Most summaries come in two versions.
The health professional versions have detailed information written in technical language.
"The patient versions are written in easy-to-understand, nontechnical language."
"Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish .
"
PDQ is a service of the NCI.
The NCI is part of the National Institutes of Health (NIH).
NIH is the federal government’s center of biomedical research.
The PDQ summaries are based on an independent review of the medical literature.
They are not policy statements of the NCI or the NIH.
"
This PDQ cancer information summary has current information about the treatment of childhood colorectal cancer."
"It is meant to inform and help patients, families, and caregivers."
It does not give formal guidelines or recommendations for making decisions about health care.
"
Editorial Boards write the PDQ cancer information summaries and keep them up to date."
These Boards are made up of experts in cancer treatment and other specialties related to cancer.
The summaries are reviewed regularly and changes are made when there is new information.
"The date on each summary (""Updated"") is the date of the most recent change.
"
"The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board ."
"
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another."
Trials are based on past studies and what has been learned in the laboratory.
Each trial answers certain scientific questions in order to find new and better ways to help cancer patients.
"During treatment clinical trials, information is collected about the effects of a new treatment and how well it works."
"If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become ""standard."""
Patients may want to think about taking part in a clinical trial.
"Some clinical trials are open only to patients who have not started treatment.
"
Clinical trials can be found online at NCI's website .
"For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237)."
"
PDQ is a registered trademark."
The content of PDQ documents can be used freely as text.
It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly.
"However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
"
"The best way to cite this PDQ summary is:
PDQ® Pediatric Treatment Editorial Board."
PDQ Childhood Colorectal Cancer Treatment.
"Bethesda, MD: National Cancer Institute."
Updated <MM/DD/YYYY>.
Available at: https://www.cancer.gov/types/colorectal/patient/child-colorectal-treatment-pdq .
"Accessed <MM/DD/YYYY>.
"
"Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only."
"If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner."
It cannot be given by the National Cancer Institute.
"Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online ."
"Visuals Online is a collection of more than 3,000 scientific images."
"
The information in these summaries should not be used to make decisions about insurance reimbursement."
More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
"
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page."
"Questions can also be submitted to Cancer.gov through the website’s E-mail Us .
"
">Updated:October 8, 2020
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Childhood Colorectal Cancer Treatment (PDQ®)–Patient Version was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
>General Information About Colon Cancer
>Stages of Colon Cancer
>Treatment Option Overview
>Treatment of Stage 0"
"(Carcinoma in Situ)
>Treatment of Stage I Colon Cancer
>Treatment of Stage II"
"Colon Cancer
>Treatment of Stage III Colon Cancer
>Treatment of Stage IV and Recurrent Colon Cancer
>To Learn More About Colon Cancer
>About This PDQ Summary"
"
>Colon cancer is a disease in which malignant (cancer) cells
		  form in the tissues of the colon.
"
">Health history affects the risk of developing colon cancer.
"
">Signs of colon cancer include blood in the stool or a change in bowel habits.
"
">Tests that examine the colon and rectum are
		  used to diagnose colon cancer.
"
">Certain factors affect  prognosis
		  (chance of recovery) and treatment options."
"
The colon is part of the body’s digestive system ."
"The digestive system removes and processes nutrients ( vitamins , minerals , carbohydrates , fats, proteins , and water) from foods and helps pass waste material out of the body."
"The digestive system is made up of the esophagus , stomach , and the small and large intestines ."
The colon (large bowel ) is the main part of the large intestine and is about 5 feet long.
"Together, the rectum and anal canal make up the last part of the large intestine and are about 6-8 inches long."
"The anal canal ends at the anus (the opening of the large intestine to the outside of the body).
"
Gastrointestinal stromal tumors can occur in the colon.
"See the PDQ summary on Gastrointestinal Stromal Tumors Treatment (Adult) for more information.
"
See the PDQ summary about Childhood Colorectal Cancer Treatment for information about colorectal cancer in children.
"
Anything that increases your chance of getting a disease is called a risk factor ."
Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer.
"Talk to your doctor if you think you may be at risk for colorectal cancer .
"
"Risk factors for colorectal cancer include the following:
>Having a
            family history
            of
            colon
            or
            rectal cancer
            in a
            first-degree relative
            (parent,
            sibling
            , or child).
"
">Having a
            personal history
            of cancer of the
            colon
            ,
            rectum
            , or
            ovary
            .
"
">Having a personal history of high-risk
            adenomas
            (
            colorectal
            polyps
            that are 1 centimeter or larger in size or that have
            cells
            that look
            abnormal
            under a
            microscope
            ).
"
">Having
            inherited
            changes in certain
            genes
            that increase the risk of
            familial adenomatous polyposis
            (FAP) or
            Lynch syndrome
            (hereditary nonpolyposis colorectal cancer).
"
">Having a personal history of
            chronic
            ulcerative colitis
            or
            Crohn disease
            for 8 years or more.
"
">Having three or more
            alcoholic
            drinks per day.
"
">Smoking
            cigarettes
            .
"
">Being Black.
"
">Obesity
            .
"
Older age is a main risk factor for most cancers.
The chance of getting cancer increases as you get older.
"
These and other signs and symptoms may be caused by colon cancer or by other conditions."
"Check with your doctor if you have any of the following:
>A change in bowel
			 habits.
"
">Blood
           (either bright red or very dark) in the
           stool
           .
"
">Diarrhea
           ,
           constipation
           , or feeling that the bowel does not
			 empty all the way.
"
">Stools that are narrower than usual.
>Frequent gas pains,
           bloating
           ,
			 fullness, or cramps.
"
">Weight loss for no known reason.
"
">Feeling very tired.
"
">Vomiting
           ."
"
The following tests and procedures may be used:
>Physical exam and health history
           : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual."
"A history of the patient’s health habits and past illnesses and treatments will also be taken.
"
">Digital rectal exam
           : An exam of the rectum."
"The doctor or
           nurse
           inserts a
           lubricated
           , gloved finger into the rectum to feel for lumps or anything else that seems unusual.
"
">Fecal occult
			 blood test (FOBT)
           : A test to check stool (solid waste) for blood that can only be seen with a
           microscope
           .  "
A small sample of stool is placed on a special card or in a special container and returned to the doctor or laboratory for testing.
"Blood in the stool may be a sign of
           polyps
           , cancer, or other conditions."
"There are two types of FOBTs:Guaiac FOBT
              : The sample of stool on the special card is tested with a
              chemical
              ."
"If there is blood in the stool, the special card changes color."
"Immunochemical FOBT
              :"
A liquid is added to the stool sample.
"This mixture is
              injected
              into a machine that contains
              antibodies
              that can detect blood in the stool."
"If there is blood in the stool, a line appears in a window in the machine."
"This test is also called fecal immunochemical test or FIT.
"
"There are two types of FOBTs:
>Guaiac FOBT
              : The sample of stool on the special card is tested with a
              chemical
              ."
"If there is blood in the stool, the special card changes color.
"
">Immunochemical FOBT
              :"
A liquid is added to the stool sample.
"This mixture is
              injected
              into a machine that contains
              antibodies
              that can detect blood in the stool."
"If there is blood in the stool, a line appears in a window in the machine."
"This test is also called fecal immunochemical test or FIT.
"
">Sigmoidoscopy
           : A procedure to look inside the rectum and
           sigmoid (lower) colon
           for polyps (small areas of bulging
           tissue
           ), other
           abnormal
           areas, or cancer."
"A
           sigmoidoscope
           is inserted through the rectum into the sigmoid colon.  "
"A sigmoidoscope is a thin, tube-like instrument with a light and a
           lens
           for viewing."
"It may also have a  tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.
"
">Colonoscopy
           : A procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer."
"A
           colonoscope
           is inserted through the rectum into the colon.  "
"A colonoscope is a thin, tube-like instrument with a light and a lens for viewing."
"It may also have a  tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.
"
">Virtual colonoscopy
           : A procedure that uses a series of
           x-rays
           called
           computed tomography
           to make a series of pictures of the
				colon."
"A computer puts the pictures together to create detailed images that may
				show polyps and anything else that seems unusual on the inside surface of the colon."
"This test is also called colonography or CT colonography.
"
">Biopsy
           :  "
"The removal of
           cells
           or tissues so they can be viewed under a microscope by a
           pathologist
           to check for signs of cancer.
"
">DNA stool test
           :"
"This test checks DNA in stool  cells for
           genetic
           changes that may be a sign of  colorectal cancer."
"
The prognosis and treatment options depend on the following:
>The
           stage
           of the cancer (whether the
		  cancer is in the inner lining of the colon only or has spread through the colon wall, or  has spread to
           lymph nodes
           or other
		  places in the body).
"
">Whether the cancer has blocked or made a hole in the colon.
"
">Whether there are any cancer cells left after
           surgery
           .
"
">Whether the cancer has
           recurred
           .
"
">The patient’s general health.
"
The prognosis also depends on the blood levels of carcinoembryonic antigen (CEA) before treatment begins.
CEA is a substance in the blood that may be increased when cancer is present.
"
>After colon cancer has been diagnosed, tests are done
		  to find out if cancer cells have spread within the colon or to other parts of
		  the body.
"
">There are three ways that cancer spreads in the body.
"
">Cancer may spread from where it began to other parts of the body.
"
>The following stages are used for colon cancer:Stage 0
(Carcinoma in Situ)Stage
"IStage IIStage IIIStage IV
>Stage 0"
"(Carcinoma in Situ)
>Stage I
>Stage II
>Stage III
>Stage IV
>Colon cancer can recur (come back) after it has been treated."
"
The process used to find out if cancer has spread within the colon or to other parts of the body is called staging ."
The information gathered from the staging process determines the stage of the disease .
"It is important to know the stage in order to plan treatment.
"
"The following tests and procedures may be used in the staging process:
>CT scan (CAT scan)
           :  "
"A procedure that makes a series of detailed pictures of areas inside the body, such as the
           abdomen
           ,
           pelvis
           ,  or chest,     taken from different angles.  "
"The pictures are made by a computer linked to an
           x-ray
           machine."
"A
           dye
           may be
           injected
           into a
           vein
           or swallowed to help the
           organs
           or
           tissues
           show up more clearly.  "
"This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
"
">MRI (magnetic resonance imaging)
           :  "
"A procedure that uses a magnet,
           radio waves
           , and a computer to make a series of detailed pictures of areas inside the colon."
"A substance called
           gadolinium
           is injected into the patient through a vein."
"The gadolinium collects around the cancer
           cells
           so they show up brighter in the picture."
"This procedure is also called nuclear magnetic resonance imaging (NMRI).
"
">PET scan (positron emission tomography scan)
           : A procedure to find
           malignant
           tumor
           cells in the body."
"A small amount of
           radioactive
           glucose
           (sugar) is injected into a vein."
"The PET
           scanner
           rotates around the body and makes a picture of where glucose is being used in the body."
"Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
"
">Chest x-ray
           : An x-ray of the organs and bones inside the chest.  "
"An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
"
">Surgery
           : A procedure to remove the tumor and see how far it has spread through the colon.
"
">Lymph node biopsy
           :"
"The removal of all or part of a
           lymph node
           ."
"A
           pathologist
           views the lymph node tissue under a
           microscope
           to check for cancer cells."
"This may be done during surgery or by
           endoscopic ultrasound-guided fine needle aspiration
           biopsy.
"
">Complete blood
			 count (CBC)
           : A procedure in which a sample of
           blood
           is drawn and
			 checked for the following:The number of
              red blood cells
              ,
              white blood cells
              , and
              platelets
              .The amount of
              hemoglobin
              (the
              protein
              that carries
              oxygen
              ) in
				  the red blood cells."
"The portion of the blood sample made up of red blood
				  cells.
"
">The number of
              red blood cells
              ,
              white blood cells
              , and
              platelets
              .
"
">The amount of
              hemoglobin
              (the
              protein
              that carries
              oxygen
              ) in
				  the red blood cells.
"
">The portion of the blood sample made up of red blood
				  cells.
"
">Carcinoembryonic antigen (CEA) assay
           : A test that measures the level of CEA in the blood."
CEA is released into the bloodstream from both cancer cells and normal cells.
"When found in higher than normal amounts, it can be a
           sign
           of
           colon cancer
           or other
           conditions
           ."
"
Cancer can spread through tissue , the lymph system , and the blood :
>Tissue."
"The cancer spreads from where it began by growing into nearby areas.
"
>Lymph system.
The cancer spreads from where it began by getting into the lymph system.
"The cancer travels through the
           lymph vessels
           to other parts of the body.
"
>Blood.
The cancer spreads from where it began by getting into the blood.
"The cancer travels through the
           blood vessels
           to other parts of the body."
"
"
"When cancer spreads to another part of the body, it is called metastasis ."
"Cancer cells break away from where they began (the primary tumor ) and travel through the lymph system or blood.
"
>Lymph system.
"The cancer gets into the lymph system, travels through the lymph vessels, and forms a
           tumor
           (
           metastatic
           tumor) in another part of the body.
"
>Blood.
"The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
"
The metastatic tumor is the same type of cancer as the primary tumor.
"For example, if colon cancer spreads to the lung , the cancer cells in the lung are actually colon cancer cells."
"The disease is metastatic colon cancer, not lung cancer ."
"
In stage 0 , abnormal cells are found in the mucosa (innermost layer) of the colon wall."
These abnormal cells may become cancer and spread into nearby normal tissue .
Stage 0 is also called carcinoma in situ.
"
In stage I colon cancer , cancer has formed in the mucosa (innermost layer) of the colon wall and has spread to the submucosa (layer of tissue next to the mucosa) or to the muscle layer of the colon wall."
"
Stage II colon cancer is divided into stages IIA, IIB, and IIC.
"
">Stage IIA:
            Cancer
            has spread through the muscle layer of the
            colon
            wall to the
            serosa
            (outermost layer) of the colon wall.
"
">Stage IIB:
            Cancer
            has spread through the
            serosa
            (outermost layer) of the
            colon
            wall to the
            tissue
            that lines the
            organs
            in the
            abdomen
            (
            visceral peritoneum
            ).
"
">Stage IIC:
            Cancer
            has spread through the
            serosa
            (outermost layer) of the
            colon
            wall to nearby
            organs
            ."
"
Stage III colon cancer is divided into stages IIIA , IIIB , and IIIC .
"
"In stage IIIA , cancer has spread:
>through the
            mucosa
            (innermost layer) of the
            colon
            wall to the
            submucosa
            (layer of
            tissue
            next to the mucosa) or to the muscle layer of the colon wall."
"Cancer has spread to one to three nearby
            lymph nodes
            or cancer
            cells
            have formed in tissue near the lymph nodes; or
>through the mucosa (innermost layer) of the colon wall to the submucosa (layer of tissue next to the mucosa)."
"Cancer has spread to four to six nearby lymph nodes.
"
"In stage IIIB , cancer has spread:
>through the muscle layer of the
            colon
            wall to the
            serosa
            (outermost layer) of the colon wall or has spread through the serosa to the
            tissue
            that lines the
            organs
            in the
            abdomen
            (
            visceral peritoneum
            )."
"Cancer has spread to one to three nearby
            lymph nodes
            or cancer
            cells
            have formed in tissue near the lymph nodes; or
>to the muscle layer or to the serosa (outermost layer) of the colon wall."
"Cancer has spread to four to six nearby lymph nodes; or
>through the
            mucosa
            (innermost layer) of the colon wall to the
            submucosa
            (layer of tissue next to the mucosa) or to the muscle layer of the colon wall."
"Cancer has spread to seven or more nearby lymph nodes.
"
"In stage IIIC , cancer has spread:
>through the
            serosa
            (outermost layer) of the
            colon
            wall to the
            tissue
            that lines the
            organs
            in the
            abdomen
            (
            visceral peritoneum
            )."
"Cancer has spread to four to six nearby
            lymph nodes
            ; or
>through the muscle layer of the colon wall to the serosa (outermost layer) of the colon wall or has spread through the serosa to the tissue that lines the organs in the abdomen (visceral peritoneum)."
"Cancer has spread to seven or more nearby lymph nodes; or
>through the serosa (outermost layer) of the colon wall to nearby organs."
"Cancer has spread to one or more nearby lymph nodes or cancer
            cells
            have formed in tissue near the lymph nodes."
"
Stage IV colon cancer is divided into stages IVA, IVB, and IVC.
"
">Stage IVA:
            Cancer
            has spread to one area or
            organ
            that is not near the
            colon
            , such as the
            liver
            ,
            lung
            ,
            ovary
            , or a distant
            lymph node
            .
"
">Stage IVB:
            Cancer
            has spread to more than one area or
            organ
            that is not near the
            colon
            , such as the
            liver
            ,
            lung
            ,
            ovary
            , or a distant
            lymph node
            .
"
">Stage IVC:
            Cancer
            has spread to the
            tissue
            that lines the wall of the
            abdomen
            and may have spread to other areas or
            organs
            ."
"
The cancer may come back in the colon or in other parts of the body, such as the liver, lungs, or both."
"
>There are different types of treatment for patients with colon
		  cancer.
"
">Seven types of standard treatment are used:SurgeryRadiofrequency ablationCryosurgeryChemotherapyRadiation therapyTargeted therapyImmunotherapy
>Surgery
>Radiofrequency ablation
>Cryosurgery
>Chemotherapy
>Radiation therapy
>Targeted therapy
>Immunotherapy
>New types of treatment are being tested in clinical trials.
"
">Treatment for colon cancer may cause side effects.
"
">Patients may want to think about taking part in a clinical trial.
"
">Patients can enter clinical trials before, during, or after starting their cancer treatment.
"
>Follow-up tests may be needed.
"
Different types of treatment are available for patients with colon cancer ."
"Some treatments are standard (the currently used treatment), and some are being tested in clinical trials ."
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer .
"When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment."
Patients may want to think about taking part in a clinical trial.
Some clinical trials are open only to patients who have not started treatment.
"
Surgery (removing the cancer in an operation) is the most common treatment for all stages of colon cancer."
"A doctor may remove the cancer using one of the following types of surgery:
>Local
            excision
            : If the
				cancer is found at a very early stage, the doctor may remove it without cutting
				through the
            abdominal
            wall."
"Instead,
				the doctor may put a tube with a cutting tool through the
            rectum
            into the
            colon
            and cut the cancer out."
"This
				is called a local excision."
"If the cancer is found in a
            polyp
            (a small bulging area of
            tissue
            ), the operation is called a
            polypectomy
            .
"
">Resection
            of the colon with
            anastomosis
            : If the cancer is
				larger, the doctor will perform a partial
            colectomy
            (removing the cancer and a small amount
				of healthy tissue around it)."
"The
				doctor may then perform an anastomosis (sewing the healthy parts of the colon
				together)."
"The doctor will also usually remove
            lymph nodes
            near the colon and examine them under
				a
            microscope
            to see whether they contain cancer.
"
">Resection of the colon with
            colostomy
            : If the doctor is not
				able to sew the 2 ends of the colon back together, a
            stoma
            (an opening) is made on the
				outside of the body for waste to pass through."
"This procedure is called a
				colostomy."
A bag is placed around the stoma to collect the waste.
"Sometimes the colostomy is
				needed only until the lower colon has healed, and then it can be reversed."
"If
				the doctor needs to remove the entire lower colon, however, the colostomy may
				be permanent.
"
"After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left."
"Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy ."
"
Radiofrequency ablation is the use of a special probe with tiny electrodes that kill cancer cells ."
Sometimes the probe is inserted directly through the skin and only local anesthesia is needed.
"In other cases, the probe is inserted through an incision in the abdomen ."
This is done in the hospital with general anesthesia .
"
Cryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue."
This type of treatment is also called cryotherapy.
"
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing."
"When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body ( systemic chemotherapy )."
"When chemotherapy is placed directly into the cerebrospinal fluid , an organ , or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas ( regional chemotherapy ).
"
Chemoembolization of the hepatic artery may be used to treat cancer that has spread to the liver .
This involves blocking the hepatic artery (the main artery that supplies blood to the liver) and injecting anticancer drugs between the blockage and the liver.
The liver’s arteries then deliver the drugs throughout the liver.
Only a small amount of the drug reaches other parts of the body.
"The blockage may be temporary or permanent, depending on what is used to block the artery."
"The liver continues to receive some blood from the hepatic portal vein , which carries blood from the stomach and intestine .
"
"The way the chemotherapy is given depends on the type and stage of the cancer being treated.
"
See Drugs Approved for Colon and Rectal Cancer for more information.
"
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing."
"There are two types of radiation therapy:
>External radiation therapy
            uses a machine outside the body to send radiation toward the area of the body with cancer.
"
">Internal radiation therapy
            uses a
            radioactive
            substance sealed in needles,
            seeds
            , wires, or
            catheters
            that are placed directly into or near the cancer.
"
The way the radiation therapy is given depends on the type and stage of the cancer being treated.
External radiation therapy is used as palliative therapy to relieve symptoms and improve quality of life .
"
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells."
"Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.
"
"Types of targeted therapies used in the treatment of colon cancer include the following:
>Monoclonal antibodies
            : Monoclonal antibodies are
            immune system
            proteins
            made in the laboratory to treat many diseases, including cancer."
"As a cancer treatment, these
            antibodies
            can attach to a specific target on cancer cells or other cells that may help cancer cells grow."
"The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading."
"Monoclonal antibodies are given by
            infusion
            ."
"They may be used alone or to carry drugs,
            toxins
            , or radioactive material directly to cancer cells."
"There are different types of monoclonal antibody therapy:Vascular endothelial growth factor
               (VEGF) inhibitor therapy: Cancer cells make a substance called
               VEGF
               ,  which causes new
               blood vessels
               to form (
               angiogenesis
               ) and helps the cancer grow."
VEGF inhibitors block VEGF and stop new blood vessels from forming.
"This may kill cancer cells because they need new blood vessels to grow.
               Bevacizumab
               and
               ramucirumab
               are VEGF inhibitors and
               angiogenesis inhibitors
               .Epidermal growth factor receptor (EGFR) inhibitor
               therapy:
               EGFRs
               are proteins found on the surface of certain cells, including cancer cells.
               "
"Epidermal growth factor
               attaches to the EGFR on the surface of the cell and causes the cells to grow and divide."
"EGFR inhibitors block the
               receptor
               and stop the epidermal growth factor from attaching to the cancer cell."
"This stops the cancer cell from growing and dividing.
               "
"Cetuximab
               and
               panitumumab
               are EGFR inhibitors.
"
"There are different types of monoclonal antibody therapy:
>Vascular endothelial growth factor
               (VEGF) inhibitor therapy:"
"Cancer cells make a substance called
               VEGF
               ,  which causes new
               blood vessels
               to form (
               angiogenesis
               ) and helps the cancer grow."
VEGF inhibitors block VEGF and stop new blood vessels from forming.
"This may kill cancer cells because they need new blood vessels to grow.
               Bevacizumab
               and
               ramucirumab
               are VEGF inhibitors and
               angiogenesis inhibitors
               .
"
">Epidermal growth factor receptor (EGFR) inhibitor
               therapy:
               EGFRs
               are proteins found on the surface of certain cells, including cancer cells.
               "
"Epidermal growth factor
               attaches to the EGFR on the surface of the cell and causes the cells to grow and divide."
"EGFR inhibitors block the
               receptor
               and stop the epidermal growth factor from attaching to the cancer cell."
"This stops the cancer cell from growing and dividing.
               "
"Cetuximab
               and
               panitumumab
               are EGFR inhibitors.
"
">Angiogenesis inhibitors: Angiogenesis inhibitors stop the growth of new blood vessels that
            tumors
            need to grow."
"Ziv-aflibercept
               is a
               vascular endothelial growth factor trap
               that blocks an enzyme needed for the growth of new blood vessels in tumors."
"Regorafenib
               is used to treat
               colorectal cancer
               that has spread to other parts of the body and has not gotten better with other treatment."
"It blocks the action of certain proteins, including vascular endothelial growth factor."
This may help keep cancer cells from growing and may kill them.
"It may also prevent the growth of new blood vessels that tumors need to grow.
"
">Ziv-aflibercept
               is a
               vascular endothelial growth factor trap
               that blocks an enzyme needed for the growth of new blood vessels in tumors.
"
">Regorafenib
               is used to treat
               colorectal cancer
               that has spread to other parts of the body and has not gotten better with other treatment."
"It blocks the action of certain proteins, including vascular endothelial growth factor."
This may help keep cancer cells from growing and may kill them.
"It may also prevent the growth of new blood vessels that tumors need to grow.
"
">Protein kinase inhibitor
            therapy:"
This treatment blocks a protein needed for cancer cells to divide.
"Protein kinase inhibitors include:BRAF inhibitors
               that block the activity of proteins made by
               mutant
               BRAF
               genes.
               "
"Encorafenib
               is a BRAF inhibitor.
"
">BRAF inhibitors
               that block the activity of proteins made by
               mutant
               BRAF
               genes.
               "
"Encorafenib
               is a BRAF inhibitor.
"
See Drugs Approved for Colon and Rectal Cancer for more information.
"
Immunotherapy is a treatment that uses the patient's immune system to fight cancer."
"Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer."
"This cancer treatment is a type of biologic therapy .
"
Immune checkpoint inhibitor therapy:
"Immune checkpoint inhibitors block proteins called checkpoints that are made by some types of immune system cells, such as T cells , and some cancer cells."
These checkpoints help keep immune responses from being too strong and sometimes can keep T cells from killing cancer cells.
"When these checkpoints are blocked, T cells can kill cancer cells better."
"They are used to treat some patients with metastatic colorectal cancer.
"
"There are two types of immune checkpoint inhibitor therapy:
>CTLA-4
            inhibitor therapy: CTLA-4 is a protein on the surface of T cells that helps keep the body’s immune responses in check."
"When CTLA-4 attaches to another protein called B7 on a cancer cell, it stops the T cell from killing the cancer cell."
"CTLA-4 inhibitors attach to CTLA-4 and allow the T cells to kill cancer cells.
            "
"Ipilimumab
            is a type of CTLA-4 inhibitor.
"
">PD-1
            and
            PD-L1
            inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check."
PD-L1 is a protein found on some types of cancer cells.
"When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell."
PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other.
"This allows the T cells to kill cancer cells.
            "
"Pembrolizumab
            and
            nivolumab
            are types of PD-1 inhibitors.
"
See Drugs Approved for Colon and Rectal Cancer for more information.
"
Information about clinical trials is available from the NCI website ."
"
For information about side effects caused by treatment for cancer, see our Side Effects page."
"
For some patients, taking part in a clinical trial may be the best treatment choice."
Clinical trials are part of the cancer research process.
"Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment .
"
Many of today's standard treatments for cancer are based on earlier clinical trials.
"Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
"
Patients who take part in clinical trials also help improve the way cancer will be treated in the future.
"Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward."
"
Some clinical trials only include patients who have not yet received treatment."
Other trials test treatments for patients whose cancer has not gotten better.
"There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
"
Clinical trials are taking place in many parts of the country.
Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage.
Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
"
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated."
Some tests will be repeated in order to see how well the treatment is working.
"Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
"
Some of the tests will continue to be done from time to time after treatment has ended.
The results of these tests can show if your condition has changed or if the cancer has recurred (come back).
These tests are sometimes called follow-up tests or check-ups.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
Treatment of stage 0
"( carcinoma in situ ) may include the following types of surgery :
>Local
          excision
          or simple
          polypectomy
          .
>Resection
          and
          anastomosis
          ."
"This is done when the
          tumor
          is
			 too large to remove by local excision.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of stage I colon cancer usually includes the following:
>Resection
          and
          anastomosis
          .
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of stage II colon cancer may include the following:
>Resection
          and
          anastomosis
          .
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of stage III colon cancer may include the following:
>Resection
          and
          anastomosis
          which may be followed by
          chemotherapy
          .
"
">Clinical trials
          of new chemotherapy
          regimens
          after
          surgery
          .
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of stage IV and recurrent colon cancer may include the following:
>Local
          excision
          for
          tumors
          that have
          recurred
          .
"
">Resection
          with or without
          anastomosis
          .
"
">Surgery
          to remove parts of other
          organs
          , such as the
          liver
          ,
          lungs
          , and
          ovaries
          , where the
          cancer
          may have recurred or spread."
"Treatment of cancer that has spread to the liver may also include the following:Chemotherapy
             given before surgery to shrink the tumor, after surgery, or both before and after."
"Radiofrequency ablation
             or
             cryosurgery
             , for patients who cannot have surgery."
"Chemoembolization
             of the
             hepatic artery
             .
"
">Chemotherapy
             given before surgery to shrink the tumor, after surgery, or both before and after.
>Radiofrequency ablation
             or
             cryosurgery
             , for patients who cannot have surgery.
"
">Chemoembolization
             of the
             hepatic artery
             .
"
">Radiation therapy
          or
          chemotherapy
          may be offered to some patients as
          palliative therapy
          to relieve
          symptoms
          and improve
          quality of life
          .
"
">Chemotherapy and/or
          targeted therapy
          with a
          monoclonal antibody
          or an
          angiogenesis inhibitor
          .
"
">Targeted therapy with a
          protein kinase inhibitor
          and a monoclonal antibody in patients with a certain change in the
          BRAF
          gene.
"
">Immunotherapy
          .
"
">Clinical trials
          of chemotherapy and/or targeted therapy.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For more information from the National Cancer Institute about colon cancer, see the following:
>Colorectal Cancer Home Page
>Colorectal Cancer Prevention
>Colorectal Cancer Screening
>Screening Tests to Detect Colorectal Cancer and Polyps
>Childhood Colorectal Cancer Treatment
>Cryosurgery to Treat Cancer
>Drugs Approved for Colon and Rectal Cancer
>Targeted Cancer Therapies
>Immunotherapy to Treat Cancer
>Genetic Testing for Inherited Cancer Susceptibility Syndromes
For general cancer information and other resources from the National Cancer Institute, see the following:
>About Cancer
>Staging
>Chemotherapy and You: Support for People With Cancer
>Radiation Therapy and You: Support for People With Cancer
>Coping with Cancer
>Questions to Ask Your Doctor about Cancer
>For Survivors and Caregivers"
"
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database."
"The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine."
Most summaries come in two versions.
The health professional versions have detailed information written in technical language.
"The patient versions are written in easy-to-understand, nontechnical language."
"Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish .
"
PDQ is a service of the NCI.
The NCI is part of the National Institutes of Health (NIH).
NIH is the federal government’s center of biomedical research.
The PDQ summaries are based on an independent review of the medical literature.
They are not policy statements of the NCI or the NIH.
"
This PDQ cancer information summary has current information about the treatment of colon cancer."
"It is meant to inform and help patients, families, and caregivers."
It does not give formal guidelines or recommendations for making decisions about health care.
"
Editorial Boards write the PDQ cancer information summaries and keep them up to date."
These Boards are made up of experts in cancer treatment and other specialties related to cancer.
The summaries are reviewed regularly and changes are made when there is new information.
"The date on each summary (""Updated"") is the date of the most recent change.
"
"The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board ."
"
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another."
Trials are based on past studies and what has been learned in the laboratory.
Each trial answers certain scientific questions in order to find new and better ways to help cancer patients.
"During treatment clinical trials, information is collected about the effects of a new treatment and how well it works."
"If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become ""standard."""
Patients may want to think about taking part in a clinical trial.
"Some clinical trials are open only to patients who have not started treatment.
"
Clinical trials can be found online at NCI's website .
"For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237)."
"
PDQ is a registered trademark."
The content of PDQ documents can be used freely as text.
It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly.
"However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
"
"The best way to cite this PDQ summary is:
PDQ® Adult Treatment Editorial Board."
PDQ Colon Cancer Treatment.
"Bethesda, MD: National Cancer Institute."
Updated <MM/DD/YYYY>.
Available at: https://www.cancer.gov/types/colorectal/patient/colon-treatment-pdq .
Accessed <MM/DD/YYYY>.
"[PMID: 26389319]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only."
"If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner."
It cannot be given by the National Cancer Institute.
"Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online ."
"Visuals Online is a collection of more than 3,000 scientific images."
"
The information in these summaries should not be used to make decisions about insurance reimbursement."
More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
"
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page."
"Questions can also be submitted to Cancer.gov through the website’s E-mail Us .
"
">Updated:April 6, 2022
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Colon Cancer Treatment (PDQ®)–Patient Version was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
>What is prevention?
>General Information About Colorectal Cancer
>Colorectal Cancer Prevention
>About This PDQ Summary"
"
Cancer prevention is action taken to lower the chance of getting cancer."
"By preventing cancer, the number of new cases of cancer in a group or population is lowered."
"Hopefully, this will lower the number of deaths caused by cancer.
"
"To prevent new cancers from starting, scientists look at risk factors and protective factors ."
"Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.
"
"Some risk factors for cancer can be avoided, but many cannot."
"For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided."
Regular exercise and a healthy diet may be protective factors for some types of cancer.
"Avoiding risk factors and increasing protective factors may lower your risk, but it does not mean that you will not get cancer.
"
"Different ways to prevent cancer are being studied, including:
>Changing lifestyle or eating habits.
"
">Avoiding things known to cause cancer.
"
">Taking
          medicines
          to treat a
          precancerous
          condition
          or to keep cancer from starting."
"
>Colorectal cancer is a disease in which malignant (cancer)
		  cells form in the tissues of the colon or the rectum.
"
">Colorectal cancer is the third leading cause of death from
			 cancer in the United States."
"
The colon is part of the body's digestive system ."
"The digestive system removes and processes nutrients ( vitamins , minerals , carbohydrates , fats, proteins , and water) from foods and helps pass waste material out of the body."
"The digestive system is made up of the mouth, throat , esophagus , stomach , and the small and large intestines ."
The colon (large bowel ) is the first part of the large intestine and is about 5 feet long.
"Together, the rectum and anal canal make up the last part of the large intestine and are 6 to 8 inches long."
"The anal canal ends at the anus (the opening of the large intestine to the outside of the body).
"
"Cancer that begins in the colon is called colon cancer , and cancer that begins in the rectum is called rectal cancer ."
"Cancer that affects either of these organs may also be called colorectal cancer .
"
"See the following PDQ summaries for more information about colorectal cancer:
>Colorectal Cancer Screening
>Colon Cancer Treatment
>Rectal Cancer Treatment
>Genetics of Colorectal Cancer"
"
Between 2011 and 2019, the number of new colorectal cancer cases in the United States decreased slightly per year in people aged 50 years and older, but increased slightly per year in people younger than 50 years."
"For the past 20 years, the rate of deaths from colorectal cancer has been decreasing in both men and women."
"The number of new cases and the number of deaths are higher in Black people compared with other races; however, studies have found no evidence that Black people have higher rates of precancerous lesions.
"
Finding and treating colorectal cancer early may prevent death from colorectal cancer.
Screening tests may be used to help find colorectal cancer.
"
>Avoiding risk factors and increasing protective factors may
		  help     prevent cancer.
"
">The following
           risk
           factors increase the risk of colorectal cancer:AgeFamily history of colorectal cancerPersonal historyInherited riskAlcoholCigarette smokingRaceObesity
>Age
>Family history of colorectal cancer
>Personal history
>Inherited risk
>Alcohol
>Cigarette smoking
>Race
>Obesity
>"
"The following
           protective
           factors decrease the risk of colorectal cancer:Physical activityAspirinCombination hormone replacement therapyPolyp removal
>Physical activity
>Aspirin
>Combination hormone replacement therapy
>Polyp removal
>"
"It is not clear if the following affect the risk of colorectal cancer:Nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirinCalciumDiet
>Nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin
>Calcium
>Diet
>The following factors do not affect the risk of colorectal cancer:Hormone replacement therapy with estrogen onlyStatins
>Hormone replacement therapy with estrogen only
>Statins
>Cancer prevention  clinical trials are used to study ways to prevent cancer.
"
>New ways to prevent colorectal cancer are being studied in clinical trials.
"
Avoiding cancer risk factors may help prevent certain cancers."
"Risk factors include smoking, being overweight , and not getting enough exercise."
Increasing protective factors such as quitting smoking and exercising may also help prevent some cancers.
Talk to your doctor or other health care professional about how you might lower your risk of cancer.
"
The risk of colorectal cancer increases after age 50."
Most cases of colorectal cancer are diagnosed after age 50.
"
Having a parent, brother, sister, or child with colorectal cancer doubles a person's risk of colorectal cancer."
"
Having a personal history of the following conditions increases the risk of colorectal cancer:
>Previous colorectal cancer.
"
">High-risk
            adenomas
            (colorectal
            polyps
            that are 1
            centimeter
            or larger in size or that have cells that look
            abnormal
            under a
            microscope
            ).
"
">Ovarian cancer
            .
"
">Inflammatory bowel disease
            (such as
            ulcerative colitis
            or
            Crohn disease
            )."
"
The risk of colorectal cancer is increased when certain gene changes linked to familial adenomatous polyposis (FAP) or hereditary nonpolyposis colon cancer (HNPCC or Lynch Syndrome) are inherited ."
"
Drinking 3 or more alcoholic beverages per day increases the risk of colorectal cancer."
Drinking alcohol is also linked to the risk of forming large colorectal adenomas (benign tumors).
"
Cigarette smoking is linked to an increased risk of colorectal cancer and death from colorectal cancer.
"
Smoking cigarettes is also linked to an increased risk of forming colorectal adenomas.
Cigarette smokers who have had surgery to remove colorectal adenomas are at an increased risk for the adenomas to recur (come back).
"
Black individuals have an increased risk of colorectal cancer and death from colorectal cancer compared to other races."
"
Obesity is linked to an increased risk of colorectal cancer and death from colorectal cancer."
"
A lifestyle that includes regular physical activity is linked to a decreased risk of colorectal cancer."
"
Studies have shown that taking aspirin daily for at least two years lowers the risk of colorectal cancer and the risk of death from colorectal cancer."
"The decrease in risk begins 10 to 20 years after patients start taking aspirin.
"
The possible harms of aspirin use (100 mg or less) daily or every other day include an increased risk of stroke and bleeding in the stomach and intestines .
"These risks may be greater among the elderly, men, and those with conditions linked to a higher than normal risk of bleeding."
"
Studies have shown that combination hormone replacement therapy (HRT) that includes both estrogen and progestin lowers the risk of invasive colorectal cancer in postmenopausal women.
"
"However, in women who take combination HRT and do develop colorectal cancer, the cancer is more likely to be advanced when it is diagnosed and the risk of dying from colorectal cancer is not decreased.
"
"The possible harms of combination HRT include an increased risk of having:
>Breast cancer
            .
"
">Heart disease.
"
">Blood clots
            ."
"
Most colorectal polyps are adenomas, which may develop into cancer."
Removing colorectal polyps that are larger than 1 centimeter (pea-sized) may lower the risk of colorectal cancer.
"It is not known if removing smaller polyps lowers the risk of colorectal cancer.
"
The possible harms of polyp removal during colonoscopy or sigmoidoscopy include a tear in the wall of the colon and bleeding.
"
It is not known if the use of nonsteroidal anti-inflammatory drugs or NSAIDs (such as sulindac , celecoxib , naproxen , and ibuprofen ) lowers the risk of colorectal cancer.
"
Studies have shown that taking the nonsteroidal anti-inflammatory drug celecoxib reduces the risk of colorectal adenomas (benign tumors) coming back after they have been removed.
"It is not clear if this results in a lower risk of colorectal cancer.
"
Taking sulindac or celecoxib has been shown to reduce the number and size of polyps that form in the colon and rectum of people with familial adenomatous polyposis (FAP).
"It is not clear if this results in a lower risk of colorectal cancer.
"
"The possible harms of NSAIDs include:
>Kidney
            problems.
"
">Bleeding in the stomach, intestines, or brain.
"
">Heart problems such as heart attack and
            congestive heart failure
            ."
"
It is not known if taking calcium supplements lowers the risk of colorectal cancer."
"
It is not known if a diet low in fat and meat and high in fiber , fruits, and vegetables lowers the risk of colorectal cancer.
"
"Some studies have shown that a diet high in fat, proteins , calories , and meat increases the risk of colorectal cancer, but other studies have not."
"
Hormone replacement therapy with estrogen only does not lower the risk of having invasive colorectal cancer or the risk of dying from colorectal cancer."
"
Studies have shown that taking statins ( drugs that lower cholesterol ) does not increase or decrease the risk of colorectal cancer."
"
Cancer prevention clinical trials are used to study ways to lower the risk of developing certain types of cancer."
Some cancer prevention trials are conducted with healthy people who have not had cancer but who have an increased risk for cancer.
Other prevention trials are conducted with people who have had cancer and are trying to prevent another cancer of the same type or to lower their chance of developing a new type of cancer.
"Other trials are done with healthy volunteers who are not known to have any risk factors for cancer.
"
The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer.
"These may include exercising more or quitting smoking or taking certain medicines , vitamins , minerals , or food supplements ."
"
Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage."
Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
"
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database."
"The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine."
Most summaries come in two versions.
The health professional versions have detailed information written in technical language.
"The patient versions are written in easy-to-understand, nontechnical language."
"Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish .
"
PDQ is a service of the NCI.
The NCI is part of the National Institutes of Health (NIH).
NIH is the federal government’s center of biomedical research.
The PDQ summaries are based on an independent review of the medical literature.
They are not policy statements of the NCI or the NIH.
"
This PDQ cancer information summary has current information about colorectal cancer prevention."
"It is meant to inform and help patients, families, and caregivers."
It does not give formal guidelines or recommendations for making decisions about health care.
"
Editorial Boards write the PDQ cancer information summaries and keep them up to date."
These Boards are made up of experts in cancer treatment and other specialties related to cancer.
The summaries are reviewed regularly and changes are made when there is new information.
"The date on each summary (""Updated"") is the date of the most recent change.
"
"The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Screening and Prevention Editorial Board ."
"
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another."
Trials are based on past studies and what has been learned in the laboratory.
Each trial answers certain scientific questions in order to find new and better ways to help cancer patients.
"During treatment clinical trials, information is collected about the effects of a new treatment and how well it works."
"If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become ""standard."""
Patients may want to think about taking part in a clinical trial.
"Some clinical trials are open only to patients who have not started treatment.
"
Clinical trials can be found online at NCI's website .
"For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237)."
"
PDQ is a registered trademark."
The content of PDQ documents can be used freely as text.
It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly.
"However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
"
"The best way to cite this PDQ summary is:
PDQ® Screening and Prevention Editorial Board."
PDQ Colorectal Cancer Prevention.
"Bethesda, MD: National Cancer Institute."
Updated <MM/DD/YYYY>.
Available at: https://www.cancer.gov/types/colorectal/patient/colorectal-prevention-pdq .
Accessed <MM/DD/YYYY>.
"[PMID: 26389376]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only."
"If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner."
It cannot be given by the National Cancer Institute.
"Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online ."
"Visuals Online is a collection of more than 3,000 scientific images."
"
The information in these summaries should not be used to make decisions about insurance reimbursement."
More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
"
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page."
"Questions can also be submitted to Cancer.gov through the website’s E-mail Us .
"
">Updated:October 25, 2023
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Colorectal Cancer Prevention (PDQ®)–Patient Version was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
>What is screening?
>General Information About Colorectal Cancer
>Colorectal Cancer Screening
>Risks of Colorectal Cancer Screening
>About This PDQ Summary"
"
Screening is looking for cancer before a person has any symptoms ."
This can help find cancer at an early stage .
"When abnormal tissue or cancer is found early, it may be easier to treat."
"By the time symptoms appear, cancer may have begun to spread.
"
Scientists are trying to better understand which people are more likely to get certain types of cancer.
They also study the things we do and the things around us to see if they cause cancer.
"This information helps doctors recommend who should be screened for cancer, which screening tests should be used, and how often the tests should be done.
"
It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test.
Screening tests are given when you have no cancer symptoms.
"Screening tests may be repeated on a regular basis.
"
"If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer."
These are called diagnostic tests .
"
>Colorectal cancer is a disease in which malignant (cancer)
		  cells form in the tissues of the colon or the rectum.
"
">Colorectal cancer is the third leading cause of death from
		  cancer in the United States.
"
>Different factors increase or decrease the risk of getting colorectal cancer.
"
The colon and rectum are parts of the body's digestive system ."
"The digestive system removes and processes nutrients ( vitamins , minerals , carbohydrates , fats, proteins , and water) from foods and helps pass waste material out of the body."
"The digestive system is made up of the mouth, throat , esophagus , stomach , and the small and large intestines ."
The colon (large bowel ) is the first part of the large intestine and is about 5 feet long.
"Together, the rectum and anal canal make up the last part of the large intestine and are 6-8 inches long."
"The anal canal ends at the anus (the opening of the large intestine to the outside of the body).
"
"Cancer that begins in the colon is called colon cancer , and cancer that begins in the rectum is called rectal cancer ."
"Cancer that begins in either of these organs may also be called colorectal cancer .
"
"Other PDQ summaries containing information related to colorectal cancer include the following:
>Colorectal Cancer Prevention
>Colon Cancer Treatment
>Rectal Cancer Treatment
>Genetics of Colorectal Cancer"
"
Between 2011 and 2019, the number of new colorectal cancer cases in the United States decreased slightly per year in patients aged 50 years and older, due to increased screening for colorectal cancer."
"In patients younger than 50 years, the number of new colorectal cancer cases increased slightly per year."
"From 2012 to 2020, deaths from colorectal cancer declined slightly each year."
Colorectal cancer is found more often in men than in women.
"
Anything that increases your chance of getting a disease is called a risk factor ."
"Anything that decreases your chance of getting a disease is called a protective factor .
"
"For more information about risk factors and protective factors for colorectal cancer, see Colorectal Cancer Prevention ."
"
>Tests are used to screen for different types of cancer when a person does not have symptoms.
"
">Studies show that some screening tests for colorectal cancer help find cancer at an early stage and may decrease the number of deaths from the disease.
"
">The following types of tests are  used to screen for colorectal
		  cancer:Fecal occult blood testSigmoidoscopyColonoscopyVirtual colonoscopyDNA stool test
>Fecal occult blood test
>Sigmoidoscopy
>Colonoscopy
>Virtual colonoscopy
>DNA stool test
>Studies have shown that screening for colorectal cancer using digital rectal exam does not decrease the number of deaths from the disease.
"
>Screening tests for colorectal cancer are being studied in clinical trials.
"
Scientists study screening tests to find those with the fewest harms and most benefits."
Cancer screening trials also are meant to show whether early detection (finding cancer before it causes symptoms ) helps a person live longer or decreases a person's chance of dying from the disease.
"For some types of cancer, the chance of recovery is better if the disease is found and treated at an early stage ."
"
A fecal occult blood test (FOBT) is a test to check stool (solid waste) for blood that can only be seen with a microscope ."
A small sample of stool is placed on a special card or in a special container and returned to the doctor or laboratory for testing.
"Blood in the stool may be a sign of polyps , cancer, or other conditions .
"
"There are two types of FOBTs:
>Guaiac FOBT:
            "
"The sample of stool on the special card is tested with a
            chemical
            ."
"If there is blood in the stool, the special card changes color.
"
">Immunochemical FOBT:
            "
A liquid is added to the stool sample.
"This mixture is
            injected
            into a machine that contains
            antibodies
            that can detect blood in the stool."
"If there is blood in the stool, a line appears in a window in the machine."
This test is also called fecal immunochemical test or FIT.
"
Sigmoidoscopy is a procedure to look inside the rectum and sigmoid (lower) colon for polyps, abnormal areas, or cancer."
A sigmoidoscope is inserted through the rectum into the sigmoid colon.
"A sigmoidoscope is a thin, tube-like instrument with a light and a lens for viewing."
"It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer."
"
Colonoscopy is a procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer."
A colonoscope is inserted through the rectum into the colon.
"A colonoscope is a thin, tube-like instrument with a light and a lens for viewing."
"It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer."
"
Virtual colonoscopy is a procedure that uses a series of x-rays called computed tomography to make a series of pictures of the colon."
A computer puts the pictures together to create detailed images that may show polyps and anything else that seems unusual on the inside surface of the colon.
"This test is also called computed tomography colonography or CTC.
"
Clinical trials are comparing virtual colonoscopy with other colorectal cancer screening tests.
"Some clinical trials are testing whether drinking a contrast material that coats the stool, instead of using laxatives to empty the colon, shows polyps clearly."
"
This test checks DNA in stool cells for genetic changes that may be a sign of colorectal cancer."
"
A digital rectal exam (DRE) is an exam of the rectum that may be done as part of a routine physical exam ."
"A doctor or nurse inserts a lubricated , gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual."
Study results have shown that DRE does not work as a screening method for colorectal cancer.
"
Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage."
Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
"
>Screening tests have risks."
False-negative test results can occur.
"False-positive test results can occur.
"
">False-negative test results can occur.
"
">False-positive test results can occur.
"
">The following  colorectal cancer screening tests have risks:ColonoscopySigmoidoscopyVirtual colonoscopyFecal occult blood test (FOBT) or DNA stool test
>Colonoscopy
>Sigmoidoscopy
>Virtual colonoscopy
>Fecal occult blood test (FOBT) or DNA stool test"
"
Decisions about screening tests can be difficult."
Not all screening tests are helpful and most have risks.
Different screening tests have different risks or harms.
"Screening tests may cause anxiety when you are thinking about or getting ready for the test, or when there is a positive test result ."
"Before having any screening test, you may want to discuss the test with your doctor."
"It is important to know the risks of the test, and whether it has been proven to reduce the risk of dying from cancer .
"
Talk to your doctor about your risk for colorectal cancer and the need for screening tests.
"
Screening test results may appear to be normal even though colorectal cancer is present."
A person who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if there are symptoms .
"
Screening test results may appear to be abnormal even though no cancer is present."
"A false-positive test result (one that shows there is cancer when there really isn't) can cause anxiety and is usually followed by more tests (such as biopsy ), which also have risks."
"
Serious problems caused by colonoscopy are rare, but can include tears in the lining of the colon and bleeding."
These problems can be serious and need to be treated in a hospital.
"Tearing of the lining of the colon and bleeding occur more often when a biopsy or polypectomy is done.
"
Sedation is used to decrease the discomfort from the procedure.
"Sedation may cause heart and lung problems, such as irregular heartbeat, heart attack, or trouble breathing."
"
There are fewer complications with a sigmoidoscopy than with a colonoscopy."
"Although tears in the lining of the colon and bleeding can occur, they are less common than with a colonoscopy."
"There is usually no sedation with sigmoidoscopy, lowering the risk of complications."
"
Virtual colonoscopy has fewer possible physical harms than either colonoscopy or sigmoidoscopy."
The harms of being exposed to radiation from x-rays used in virtual colonoscopy are not known.
"Virtual colonoscopy often finds problems with organs other than the colon, including the kidneys , chest, liver , ovaries , spleen , and pancreas ."
"Some of these findings lead to more testing, such as colonoscopy, that may not improve the patient's health."
"
The results of an FOBT or DNA stool test may appear to be abnormal even though no cancer is found."
"A positive test result may lead to more testing, including colonoscopy."
"
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database."
"The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine."
Most summaries come in two versions.
The health professional versions have detailed information written in technical language.
"The patient versions are written in easy-to-understand, nontechnical language."
"Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish .
"
PDQ is a service of the NCI.
The NCI is part of the National Institutes of Health (NIH).
NIH is the federal government’s center of biomedical research.
The PDQ summaries are based on an independent review of the medical literature.
They are not policy statements of the NCI or the NIH.
"
This PDQ cancer information summary has current information about colorectal cancer screening."
"It is meant to inform and help patients, families, and caregivers."
It does not give formal guidelines or recommendations for making decisions about health care.
"
Editorial Boards write the PDQ cancer information summaries and keep them up to date."
These Boards are made up of experts in cancer treatment and other specialties related to cancer.
The summaries are reviewed regularly and changes are made when there is new information.
"The date on each summary (""Updated"") is the date of the most recent change.
"
"The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Screening and Prevention Editorial Board ."
"
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another."
Trials are based on past studies and what has been learned in the laboratory.
Each trial answers certain scientific questions in order to find new and better ways to help cancer patients.
"During treatment clinical trials, information is collected about the effects of a new treatment and how well it works."
"If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become ""standard."""
Patients may want to think about taking part in a clinical trial.
"Some clinical trials are open only to patients who have not started treatment.
"
Clinical trials can be found online at NCI's website .
"For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237)."
"
PDQ is a registered trademark."
The content of PDQ documents can be used freely as text.
It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly.
"However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
"
"The best way to cite this PDQ summary is:
PDQ® Screening and Prevention Editorial Board."
PDQ Colorectal Cancer Screening.
"Bethesda, MD: National Cancer Institute."
Updated <MM/DD/YYYY>.
Available at: https://www.cancer.gov/types/colorectal/patient/colorectal-screening-pdq .
Accessed <MM/DD/YYYY>.
"[PMID: 26389230]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only."
"If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner."
It cannot be given by the National Cancer Institute.
"Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online ."
"Visuals Online is a collection of more than 3,000 scientific images."
"
The information in these summaries should not be used to make decisions about insurance reimbursement."
More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
"
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page."
"Questions can also be submitted to Cancer.gov through the website’s E-mail Us .
"
">Updated:October 20, 2023
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Colorectal Cancer Screening (PDQ®)–Patient Version was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
>General Information About Rectal Cancer
>Stages of Rectal Cancer
>Treatment Option Overview
>Treatment of Stage 0  (Carcinoma in Situ)
>Treatment of Stage I Rectal Cancer
>Treatment of Stages II and III Rectal Cancer
>Treatment of Stage IV and Recurrent Rectal Cancer
>To Learn More About Rectal Cancer
>About This PDQ Summary"
"
>Rectal cancer is a disease in which malignant (cancer) cells
		  form in the tissues of the rectum.
"
">Health history affects the risk of developing rectal cancer.
"
">Signs of rectal cancer include a change in bowel
		  habits or blood in the stool.
"
">Tests that examine the rectum and colon are used to diagnose  rectal cancer.
"
">Certain factors affect  prognosis
		  (chance of recovery) and treatment options."
"
"
The rectum is part of the body’s digestive system .
"The digestive system takes in nutrients ( vitamins , minerals , carbohydrates , fats, proteins , and water) from foods and helps pass waste material out of the body."
"The digestive system is made up of the esophagus , stomach , and the small and large intestines ."
The colon (large bowel ) is the first part of the large intestine and is about 5 feet long.
"Together, the rectum and anal canal make up the last part of the large intestine and are 6 to 8 inches long."
The anal canal ends at the anus (the opening of the large intestine to the outside of the body).
"
Anything that increases your chance of getting a disease is called a risk factor ."
Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer.
"Talk to your doctor if you think you may be at risk for colorectal cancer .
"
"Risk factors for colorectal cancer include the following:
>Having a
            family history
            of
            colon
            or
            rectal cancer
            in a
            first-degree relative
            (parent,
            sibling
            , or child).
"
">Having a
            personal history
            of cancer of the
            colon
            ,
            rectum
            , or
            ovary
            .
"
">Having a personal history of high-risk
            adenomas
            (
            colorectal
            polyps
            that are 1 centimeter or larger in size or that have
            cells
            that look
            abnormal
            under a
            microscope
            ).
"
">Having
            inherited
            changes in certain
            genes
            that increase the risk of
            familial adenomatous polyposis
            (FAP) or
            Lynch syndrome
            (hereditary nonpolyposis colorectal cancer).
"
">Having a personal history of
            chronic
            ulcerative colitis
            or
            Crohn disease
            for 8 years or more.
"
">Having three or more
            alcoholic
            drinks per day.
"
">Smoking
            cigarettes
            .
"
">Being Black.
"
">Obesity
            .
"
Older age is a main risk factor for most cancers.
The chance of getting cancer increases as you get older.
"
These and other signs and symptoms may be caused by rectal cancer or by other conditions."
"Check with your doctor if you have any of the following:
>Blood
           (either bright red or very dark) in the
           stool
           .
"
>A change in bowel habits.
"Diarrhea
              .Constipation
              .Feeling that the bowel does not
			 empty completely."
"Stools that are narrower or have a different shape than usual.
"
">Diarrhea
              .
"
">Constipation
              .
"
">Feeling that the bowel does not
			 empty completely.
"
">Stools that are narrower or have a different shape than usual.
>General
           abdominal
           discomfort (frequent gas pains,
           bloating
           , fullness, or
           cramps
           ).
"
">Change in
           appetite
           .
"
">Weight loss  for no known reason.
"
>Feeling very tired.
"
In addition to asking about your personal and family health history and doing a physical exam , your doctor may perform the following tests and procedures:
>Digital rectal exam (DRE)
           : An exam of the rectum.  "
"The doctor or
           nurse
           inserts a
           lubricated
           , gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual."
"In women, the
           vagina
           may also be examined.
"
">Colonoscopy
           :  "
"A procedure to look inside the rectum and colon for polyps (small pieces of bulging
           tissue
           ),
           abnormal
           areas, or
           cancer
           ."
"A
           colonoscope
           is a thin, tube-like instrument with a light and a
           lens
           for viewing."
"It may also have a  tool to remove polyps or tissue samples, which are checked under a
           microscope
           for signs of cancer.
"
">Biopsy
           : The removal
			 of
           cells
           or tissues so they can be viewed under a microscope to check for signs of cancer.
           "
"Tumor
           tissue that is removed during the biopsy may be checked  to see if the patient is likely to have the
           gene
           mutation
           that causes
           HNPCC
           .  "
"This may help to plan treatment.
"
">Immunohistochemistry
           : A laboratory test that uses
           antibodies
           to check for certain
           antigens
           (markers) in a sample of a patient’s tissue."
"The antibodies are usually linked to an
           enzyme
           or a fluorescent dye."
"After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope."
"This type of test is used to help
           diagnose
           cancer and to help tell one type of cancer from another type of cancer.
"
">Carcinoembryonic antigen (CEA) assay
           : A test that measures the level of CEA in the blood."
CEA is released into the bloodstream from both cancer cells and normal cells.
"When found in higher than normal amounts, it can be a sign of rectal cancer or other conditions.
"
">Microsatellite instability (MSI)
           : A laboratory test in  which tumor tissue is checked for cells that may have a defect in genes involved in
           DNA
           repair."
"The findings may indicate whether or not the patient has  a type of cancer linked to  an
           inherited cancer syndrome
           such as HNPCC (also known as Lynch syndrome)."
"
The prognosis and treatment options depend on the following:
>The
           stage
           of the cancer (whether it
		  affects the inner lining of the rectum only, involves the whole rectum, or has
		  spread to
           lymph nodes
           , nearby
           organs
           , or other places in the body).
"
">Whether the cancer is related to a defect in genes involved in DNA repair.
"
">Whether the tumor has spread into or through the bowel wall.
"
">Where the cancer is found in the rectum.
"
">Whether the bowel is blocked or has a hole in it.
"
">Whether all of the  tumor can be removed by
           surgery
           .
"
">The patient’s general health.
"
">Whether the cancer has just been diagnosed or has
           recurred
           (come back)."
"
>After rectal cancer has been diagnosed, tests are done
		  to find out if cancer cells have spread within the rectum or to other parts of
		  the body.
"
">There are three ways that cancer spreads in the body.
"
">Cancer may spread from where it began to other parts of the body.
"
>The following stages are used for rectal cancer:Stage 0
(Carcinoma in Situ)Stage
"IStage IIStage IIIStage IV
>Stage 0"
"(Carcinoma in Situ)
>Stage I
>Stage II
>Stage III
>Stage IV
>Rectal cancer can recur (come back) after it has been treated."
"
The process used to find out whether cancer has spread within the rectum or to other parts of the body is called staging ."
The information gathered from the staging process determines the stage of the disease.
"It is important to know the stage in order to plan treatment.
"
"The following tests and procedures may be used in the staging process:
>Chest x-ray
           :"
"An x-ray of the
           organs
           and bones inside the chest.  "
"An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
"
">Colonoscopy
           :  "
"A procedure to look inside the rectum and
           colon
           for
           polyps
           (small pieces of bulging
           tissue
           ).
           "
"abnormal
           areas, or cancer."
"A
           colonoscope
           is a thin, tube-like instrument with a light and a
           lens
           for viewing."
"It may also have a  tool to remove polyps or tissue samples, which are checked under a
           microscope
           for
           signs
           of cancer.
"
">CT scan (CAT scan)
           :
		  "
"A procedure that makes a series of detailed pictures of areas inside the body,     such as the
           abdomen
           ,
           pelvis
           , or chest, taken from different angles.  "
The pictures are made by a computer linked to an x-ray machine.
"A
           dye
           may be
           injected
           into a
           vein
           or swallowed to help the organs or tissues show up more clearly.  "
"This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
"
">MRI (magnetic
		  resonance imaging)
           :  "
"A procedure that uses a magnet,
           radio waves
           , and a computer to make a series of detailed pictures of areas inside the body."
"This procedure is also called nuclear magnetic resonance imaging (NMRI).
"
">PET scan (positron emission tomography scan)
           : A procedure to find
           malignant
           tumor
           cells
           in the body."
"A small amount of
           radioactive
           glucose
           (sugar) is injected into a vein."
"The PET
           scanner
           rotates around the body and makes a picture of where glucose is being used in the body."
"Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
"
">Endorectal ultrasound
           : A procedure used to examine the rectum and nearby organs."
"An
           ultrasound transducer
           (probe) is inserted into the rectum and used to bounce high-energy sound waves (
           ultrasound
           ) off internal tissues or organs and make echoes."
"The echoes form a picture of body tissues called a
           sonogram
           ."
The doctor can identify tumors by looking at the sonogram.
This procedure is also called transrectal ultrasound.
"
Cancer can spread through tissue , the lymph system , and the blood :
>Tissue."
"The cancer spreads from where it began by growing into nearby areas.
"
>Lymph system.
The cancer spreads from where it began by getting into the lymph system.
"The cancer travels through the
           lymph vessels
           to other parts of the body.
"
>Blood.
The cancer spreads from where it began by getting into the blood.
"The cancer travels through the
           blood vessels
           to other parts of the body."
"
"
"When cancer spreads to another part of the body, it is called metastasis ."
"Cancer cells break away from where they began (the primary tumor ) and travel through the lymph system or blood.
"
>Lymph system.
"The cancer gets into the lymph system, travels through the lymph vessels, and forms a
           tumor
           (
           metastatic
           tumor) in another part of the body.
"
>Blood.
"The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
"
The metastatic tumor is the same type of cancer as the primary tumor.
"For example, if rectal cancer spreads to the lung , the cancer cells in the lung are actually rectal cancer cells."
"The disease is metastatic rectal cancer, not lung cancer ."
"
In stage 0 rectal cancer , abnormal cells are found in the mucosa (innermost layer) of the rectum wall."
These abnormal cells may become cancer and spread into nearby normal tissue .
Stage 0 is also called carcinoma in situ.
"
In stage I rectal cancer , cancer has formed in the mucosa (innermost layer) of the rectum wall and has spread to the submucosa (layer of tissue next to the mucosa) or to the muscle layer of the rectum wall."
"
Stage II rectal cancer is divided into stages IIA, IIB, and IIC.
"
">Stage IIA:
            Cancer
            has spread through the muscle layer of the
            rectum
            wall to the
            serosa
            (outermost layer) of the rectum wall.
"
">Stage IIB:
            Cancer
            has spread through the
            serosa
            (outermost layer) of the
            rectum
            wall to the
            tissue
            that lines the
            organs
            in the
            abdomen
            (visceral peritoneum).
"
">Stage IIC:
            Cancer
            has spread through the
            serosa
            (outermost layer) of the
            rectum
            wall to nearby
            organs
            ."
"
Stage III rectal cancer is divided into stages IIIA , IIIB , and IIIC .
"
"In stage IIIA , cancer has spread:
>through the
            mucosa
            (innermost layer) of the
            rectum
            wall to the
            submucosa
            (layer of
            tissue
            next to the mucosa) or to the muscle layer of the rectum wall."
"Cancer has spread to one to three nearby
            lymph nodes
            or cancer
            cells
            have formed in
            tissue
            near the
            lymph nodes
            ; or
>through the mucosa (innermost layer) of the rectum wall to the submucosa (layer of tissue next to the mucosa)."
"Cancer has spread to four to six nearby lymph nodes.
"
"In stage IIIB , cancer has spread:
>through the muscle layer of the
            rectum
            wall to the
            serosa
            (outermost layer) of the rectum wall or has spread through the serosa to the
            tissue
            that lines the
            organs
            in the
            abdomen
            (visceral peritoneum)."
"Cancer has spread to one to three nearby
            lymph nodes
            or cancer
            cells
            have formed in tissue near the lymph nodes; or
>to the muscle layer or to the serosa (outermost layer) of the rectum wall."
"Cancer has spread to four to six nearby lymph nodes; or
>through the
            mucosa
            (innermost layer) of the rectum wall to the
            submucosa
            (layer of tissue next to the mucosa) or to the muscle layer of the rectum wall."
"Cancer has spread to seven or more nearby lymph nodes.
"
"In stage IIIC , cancer has spread:
>through the
            serosa
            (outermost layer) of the
            rectum
            wall to the
            tissue
            that lines the
            organs
            in the
            abdomen
            (visceral peritoneum)."
"Cancer has spread to four to six nearby
            lymph nodes
            ; or
>through the muscle layer of the rectum wall to the
            serosa
            (outermost layer) of the rectum wall or has spread through the serosa to the tissue that lines the organs in the abdomen (visceral peritoneum)."
"Cancer has spread to seven or more nearby lymph nodes; or
>through the serosa (outermost layer) of the rectum wall to nearby organs."
"Cancer has spread to one or more nearby lymph nodes or cancer
            cells
            have formed in tissue near the lymph nodes."
"
Stage IV rectal cancer is divided into stages IVA, IVB, and IVC.
"
">Stage IVA:
            Cancer
            has spread to one area or
            organ
            that is not near the
            rectum
            , such as the
            liver
            ,
            lung
            ,
            prostate
            , or a distant
            lymph node
            .
"
">Stage IVB:
            Cancer
            has spread to more than one area or
            organ
            that is not near the
            rectum
            , such as the
            liver
            ,
            lung
            ,
            prostate
            , or a distant
            lymph node
            .
"
">Stage IVC:
            Cancer
            has spread to the
            tissue
            that lines the wall of the
            abdomen
            and may have spread to other areas or
            organs
            ."
"
The cancer may come back in the rectum or in other parts of the body, such as the colon, pelvis, liver, or lungs."
"
>There are different types of treatment for patients with rectal
		  cancer.
"
">The following types of treatment are used:SurgeryRadiation
			 therapyChemotherapyActive surveillanceTargeted therapyImmunotherapy
>Surgery
>Radiation
			 therapy
>Chemotherapy
>Active surveillance
>Targeted therapy
>Immunotherapy
>Other types of treatment are being tested in clinical
		  trials.
"
">Treatment for rectal cancer may cause side effects.
"
">Patients may want to think about taking part in a clinical trial.
"
">Patients can enter clinical trials before, during, or after starting their cancer treatment.
"
>Follow-up tests may be needed.
"
Different types of treatment are available for patients with rectal cancer ."
"Some treatments are standard (the currently used treatment), and some are being tested in clinical trials ."
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer .
"When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment."
Patients may want to think about taking part in a clinical trial.
Some clinical trials are open only to patients who have not started treatment.
"
Surgery is the most common treatment for all stages of rectal cancer."
"The cancer is removed using one of the following types of surgery:
>Polypectomy
            : If the cancer is found in a
            polyp
            (a small piece of bulging
            tissue
            ), the polyp is often removed during a
            colonoscopy
            .
"
">Local
            excision
            : If the cancer is found on the inside surface of the
            rectum
            and has not spread into the wall of the rectum, the cancer and  a small amount of surrounding healthy tissue is removed.
"
">Resection
            : If
				the cancer has spread into the wall of the rectum, the section of the
				rectum with cancer and nearby healthy tissue is removed."
"Sometimes the tissue between the rectum and the
            abdominal
            wall is also removed."
"The
            lymph nodes
            near the rectum are removed and checked under a
            microscope
            for
            signs
            of cancer.
"
">Radiofrequency ablation
            : The use of a special probe   with tiny
            electrodes
            that kill cancer
            cells
            ."
"Sometimes   the probe is inserted directly through the skin and only
            local anesthesia
            is needed."
"In other cases,   the probe is inserted through an
            incision
            in the
            abdomen
            ."
"This is done in the hospital with
            general anesthesia
            .
"
">Cryosurgery
            : A treatment that uses an instrument to freeze and destroy
            abnormal
            tissue."
"This type of treatment is also called cryotherapy.
"
">Pelvic exenteration
            :"
"If the cancer has spread to other
            organs
            near the rectum, the lower
            colon
            , rectum, and
            bladder
            are removed.  "
"In women, the
            cervix
            ,
            vagina
            ,
            ovaries
            , and nearby lymph nodes may be removed.  "
"In men, the
            prostate
            may be removed."
"Artificial openings (
            stoma
            ) are made for
            urine
            and
            stool
            to flow from the body to a collection bag.
"
"After the cancer is removed, the surgeon will either:
>do an
            anastomosis
            (sew the healthy parts of the
				rectum together, sew the remaining rectum to the colon, or sew the colon to the
            anus
            );
            or
>make a stoma (an opening) from the rectum to the outside of the body for waste to pass through."
"This procedure is done if the cancer is too close to the anus and is called
				a
            colostomy
            ."
A bag is placed around the stoma to collect the waste.
"Sometimes the colostomy is needed only until the rectum has
				healed, and then it can be reversed."
"If the entire
				rectum is removed, however, the colostomy may be permanent.
"
"Radiation therapy and/or chemotherapy may be given before surgery to shrink the tumor , make it easier to remove the cancer, and help with bowel control after surgery."
Treatment given before surgery is called neoadjuvant therapy .
"After all the cancer that can be seen at the time of the surgery is removed, some patients may be given radiation therapy and/or chemotherapy after surgery to kill any cancer cells that are left."
"Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy ."
"
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing."
"External radiation therapy uses a machine outside the body to send radiation toward the cancer.
"
Short-course preoperative radiation therapy is used in some types of rectal cancer.
"This treatment uses fewer and lower doses of radiation than standard treatment, followed by surgery several days after the last dose."
"
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing."
"When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body ( systemic chemotherapy )."
"When chemotherapy is placed directly in the cerebrospinal fluid , an organ, or a body cavity such as the abdomen , the drugs mainly affect cancer cells in those areas ( regional chemotherapy ).
"
Chemoembolization of the hepatic artery is a type of regional chemotherapy that may be used to treat cancer that has spread to the liver .
This is done by blocking the hepatic artery (the main artery that supplies blood to the liver) and injecting anticancer drugs between the blockage and the liver.
The liver’s arteries then carry the drugs into the liver.
Only a small amount of the drug reaches other parts of the body.
"The blockage may be temporary or permanent, depending on what is used to block the artery."
"The liver continues to receive some blood from the hepatic portal vein , which carries blood from the stomach and intestine .
"
"The way the chemotherapy is given depends on the type and stage of the cancer being treated.
"
"For more information, see Drugs Approved for Colon and Rectal Cancer ."
"
Active surveillance is closely following a patient's condition without giving any treatment unless there are changes in test results."
It is used to find early signs that the condition is getting worse.
"In active surveillance, patients are given certain exams and tests to check if the cancer is growing."
"When the cancer begins to grow, treatment is given to cure the cancer."
"Tests include the following:
>Digital rectal exam
            .
"
">MRI
            .
"
">Endoscopy
            .
"
">Sigmoidoscopy
            .
"
">CT scan
            .
"
">Carcinoembryonic antigen (CEA) assay
            ."
"
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells.
"
"Types of targeted therapies used in the treatment of rectal cancer include the following:
>Monoclonal antibodies
            : Monoclonal antibodies are
            immune system
            proteins
            made in the laboratory to treat many diseases, including cancer."
"As a cancer treatment, these
            antibodies
            can attach to a specific target on cancer cells or other cells that may help cancer cells grow.  "
"The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading."
"Monoclonal antibodies are given by
            infusion
            ."
"They may be used alone or to carry drugs,
            toxins
            , or radioactive material directly to cancer cells."
"There are different types of monoclonal antibody
             therapy
             :Vascular endothelial growth factor
               (VEGF) inhibitor therapy:"
"Cancer cells make a substance called
               VEGF
               ,  which causes new
               blood vessels
               to form (
               angiogenesis
               ) and helps the cancer grow."
VEGF inhibitors block VEGF and stop new blood vessels from forming.
"This may kill cancer cells because they need new blood vessels to grow.
               Bevacizumab
               and
               ramucirumab
               are VEGF inhibitors and
               angiogenesis inhibitors
               .Epidermal growth factor receptor (EGFR) inhibitor
               therapy:
               EGFRs
               are proteins found on the surface of certain cells, including cancer cells.
               "
"Epidermal growth factor
               attaches to the EGFR on the surface of the cell and causes the cells to grow and divide."
"EGFR inhibitors block the
               receptor
               and stop the epidermal growth factor from attaching to the cancer cell."
"This stops the cancer cell from growing and dividing.
               "
"Cetuximab
               and
               panitumumab
               are EGFR inhibitors.
"
"There are different types of monoclonal antibody therapy :
>Vascular endothelial growth factor
               (VEGF) inhibitor therapy:"
"Cancer cells make a substance called
               VEGF
               ,  which causes new
               blood vessels
               to form (
               angiogenesis
               ) and helps the cancer grow."
VEGF inhibitors block VEGF and stop new blood vessels from forming.
"This may kill cancer cells because they need new blood vessels to grow.
               Bevacizumab
               and
               ramucirumab
               are VEGF inhibitors and
               angiogenesis inhibitors
               .
"
">Epidermal growth factor receptor (EGFR) inhibitor
               therapy:
               EGFRs
               are proteins found on the surface of certain cells, including cancer cells.
               "
"Epidermal growth factor
               attaches to the EGFR on the surface of the cell and causes the cells to grow and divide."
"EGFR inhibitors block the
               receptor
               and stop the epidermal growth factor from attaching to the cancer cell."
"This stops the cancer cell from growing and dividing.
               "
"Cetuximab
               and
               panitumumab
               are EGFR inhibitors.
"
">Angiogenesis inhibitors: Angiogenesis inhibitors stop the growth of new blood vessels that
            tumors
            need to grow."
"Ziv-aflibercept
               is a
               vascular endothelial growth factor trap
               that blocks an enzyme needed for the growth of new blood vessels in tumors."
"Regorafenib
               is used to treat
               colorectal cancer
               that has spread to other parts of the body and has not gotten better with other treatment."
"It blocks the action of certain proteins, including vascular endothelial growth factor."
This may help keep cancer cells from growing and may kill them.
"It may also prevent the growth of new blood vessels that tumors need to grow.
"
">Ziv-aflibercept
               is a
               vascular endothelial growth factor trap
               that blocks an enzyme needed for the growth of new blood vessels in tumors.
"
">Regorafenib
               is used to treat
               colorectal cancer
               that has spread to other parts of the body and has not gotten better with other treatment."
"It blocks the action of certain proteins, including vascular endothelial growth factor."
This may help keep cancer cells from growing and may kill them.
"It may also prevent the growth of new blood vessels that tumors need to grow.
"
">Protein kinase inhibitor
            therapy:"
This treatment blocks a protein needed for cancer cells to divide.
"Protein kinase inhibitors include:BRAF inhibitors
               that block the activity of proteins made by
               mutant
               BRAF
               genes.
               "
"Encorafenib
               is a BRAF inhibitor.
"
">BRAF inhibitors
               that block the activity of proteins made by
               mutant
               BRAF
               genes.
               "
"Encorafenib
               is a BRAF inhibitor.
"
"For more information, see Drugs Approved for Colon and Rectal Cancer ."
"
Immunotherapy is a treatment that uses the patient's immune system to fight cancer."
"Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.
"
Immune checkpoint inhibitor therapy:
"Immune checkpoint inhibitors block proteins called checkpoints that are made by some types of immune system cells, such as T cells , and some cancer cells."
These checkpoints help keep immune responses from being too strong and sometimes can keep T cells from killing cancer cells.
"When these checkpoints are blocked, T cells can kill cancer cells better."
"They are used to treat some patients with metastatic colorectal cancer.
"
"There are two types of immune checkpoint inhibitor therapy:
>CTLA-4
            inhibitor therapy: CTLA-4 is a protein on the surface of T cells that helps keep the body’s immune responses in check."
"When CTLA-4 attaches to another protein called B7 on a cancer cell, it stops the T cell from killing the cancer cell."
"CTLA-4 inhibitors attach to CTLA-4 and allow the T cells to kill cancer cells.
            "
"Ipilimumab
            is a type of CTLA-4 inhibitor.
"
">PD-1
            and
            PD-L1
            inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check."
PD-L1 is a protein found on some types of cancer cells.
"When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell."
PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other.
"This allows the T cells to kill cancer cells.
            "
"Pembrolizumab
            and
            nivolumab
            are types of PD-1 inhibitors.
            "
"Dostarlimab
            is a PD-1 inhibitor being studied in clinical trials.
"
"For more information, see Drugs Approved for Colon and Rectal Cancer ."
"
Information about clinical trials is available from the NCI website ."
"
For information about side effects caused by treatment for cancer, see our Side Effects page."
"
For some patients, taking part in a clinical trial may be the best treatment choice."
Clinical trials are part of the cancer research process.
"Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment .
"
Many of today's standard treatments for cancer are based on earlier clinical trials.
"Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
"
Patients who take part in clinical trials also help improve the way cancer will be treated in the future.
"Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward."
"
Some clinical trials only include patients who have not yet received treatment."
Other trials test treatments for patients whose cancer has not gotten better.
"There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
"
Clinical trials are taking place in many parts of the country.
Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage.
Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
"
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated."
Some tests will be repeated in order to see how well the treatment is working.
"Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
"
Some of the tests will continue to be done from time to time after treatment has ended.
The results of these tests can show if your condition has changed or if the cancer has recurred (come back).
"These tests are sometimes called follow-up tests or check-ups.
"
"After treatment for rectal cancer, a blood test to measure amounts of carcinoembryonic antigen (a substance in the blood that may be increased when cancer is present) may be done to see if the cancer has come back."
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of stage 0 may include the following:
>Simple
          polypectomy
          .
>Local
          excision
          .
"
">Resection
          (when the
          tumor
          is too large to remove by local excision).
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of stage I rectal cancer may include the following:
>Local
          excision
          .
"
">Resection
          .
"
">Resection
          with
          radiation therapy
          and
          chemotherapy
          after
          surgery
          .
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of stage II and stage III rectal cancer may include the following:
>Chemotherapy
          combined with
          radiation therapy
          , followed by
          surgery
          .
>Short-course  radiation therapy followed by surgery and chemotherapy.
"
">Surgery followed by chemotherapy combined with radiation therapy.
"
">Surgery.
"
">Chemotherapy combined with radiation therapy, followed by
          active surveillance
          .    "
"Surgery may be done if the
          cancer
          recurs
          (comes back).
"
">Immunotherapy
          (for treatment of
          tumors
          that may have a defect in
          genes
          involved in
          DNA
          repair).
"
">A
          clinical trial
          of a new treatment strategy.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of stage IV and recurrent rectal cancer may include the following:
>Surgery
          with or without
          chemotherapy
          or
          radiation therapy
          .
"
">Systemic chemotherapy
          with or without
          targeted therapy
          (
          angiogenesis inhibitor
          ).
"
">Systemic chemotherapy with or without
          immunotherapy
          (
          immune checkpoint inhibitor
          therapy
          ).
"
">Chemotherapy to control the growth of the
          tumor
          .
>Radiation therapy, chemotherapy, or a combination of both, as
          palliative therapy
          to relieve
          symptoms
          and improve the
          quality of life
          .
"
">Placement of a
          stent
          to help keep the
          rectum
          open if it is partly blocked by the tumor, as palliative therapy to relieve symptoms and improve the quality of life.
"
">Targeted therapy with a
          protein kinase inhibitor
          and a
          monoclonal antibody
          in patients with a certain change in the
          BRAF
          gene.
"
">Immunotherapy.
"
">Clinical trials
          of chemotherapy and/or targeted therapy.
"
"Treatment of rectal cancer that has spread to other organs depends on where the cancer has spread.
"
">Treatment for areas of cancer that have spread to the
          liver
          includes the following:Surgery to remove the tumor."
"Chemotherapy may be given before surgery, to shrink the tumor."
"Cryosurgery
             or
             radiofrequency ablation
             .Chemoembolization
             and/or systemic chemotherapy."
"A clinical trial of  chemoembolization combined with radiation therapy to the tumors in the liver.
"
>Surgery to remove the tumor.
"Chemotherapy may be given before surgery, to shrink the tumor.
"
">Cryosurgery
             or
             radiofrequency ablation
             .
"
">Chemoembolization
             and/or systemic chemotherapy.
"
">A clinical trial of  chemoembolization combined with radiation therapy to the tumors in the liver.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For more information from the National Cancer Institute about rectal cancer, see:
>Colorectal Cancer Home Page
>Colorectal Cancer Prevention
>Colorectal Cancer Screening
>Screening Tests to Detect Colorectal Cancer and Polyps
>Childhood Colorectal Cancer Treatment
>Cryosurgery to Treat Cancer
>Drugs Approved for Colon and Rectal Cancer
>Targeted Therapy to Treat Cancer
>Immunotherapy to Treat Cancer
>Genetic Testing for Inherited Cancer Susceptibility Syndromes
For general cancer information and other resources from the National Cancer Institute, see the following:
>About Cancer
>Staging
>Chemotherapy and You: Support for People With Cancer
>Radiation Therapy and You: Support for People With Cancer
>Coping with Cancer
>Questions to Ask Your Doctor about Cancer
>For Survivors and Caregivers"
"
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database."
"The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine."
Most summaries come in two versions.
The health professional versions have detailed information written in technical language.
"The patient versions are written in easy-to-understand, nontechnical language."
"Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish .
"
PDQ is a service of the NCI.
The NCI is part of the National Institutes of Health (NIH).
NIH is the federal government’s center of biomedical research.
The PDQ summaries are based on an independent review of the medical literature.
They are not policy statements of the NCI or the NIH.
"
This PDQ cancer information summary has current information about the treatment of rectal cancer."
"It is meant to inform and help patients, families, and caregivers."
It does not give formal guidelines or recommendations for making decisions about health care.
"
Editorial Boards write the PDQ cancer information summaries and keep them up to date."
These Boards are made up of experts in cancer treatment and other specialties related to cancer.
The summaries are reviewed regularly and changes are made when there is new information.
"The date on each summary (""Updated"") is the date of the most recent change.
"
"The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board ."
"
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another."
Trials are based on past studies and what has been learned in the laboratory.
Each trial answers certain scientific questions in order to find new and better ways to help cancer patients.
"During treatment clinical trials, information is collected about the effects of a new treatment and how well it works."
"If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become ""standard."""
Patients may want to think about taking part in a clinical trial.
"Some clinical trials are open only to patients who have not started treatment.
"
Clinical trials can be found online at NCI's website .
"For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237)."
"
PDQ is a registered trademark."
The content of PDQ documents can be used freely as text.
It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly.
"However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
"
"The best way to cite this PDQ summary is:
PDQ® Adult Treatment Editorial Board."
PDQ Rectal Cancer Treatment.
"Bethesda, MD: National Cancer Institute."
Updated <MM/DD/YYYY>.
Available at: https://www.cancer.gov/types/colorectal/patient/rectal-treatment-pdq .
Accessed <MM/DD/YYYY>.
"[PMID: 26389378]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only."
"If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner."
It cannot be given by the National Cancer Institute.
"Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online ."
"Visuals Online is a collection of more than 3,000 scientific images."
"
The information in these summaries should not be used to make decisions about insurance reimbursement."
More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
"
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page."
"Questions can also be submitted to Cancer.gov through the website’s E-mail Us .
"
">Updated:May 15, 2023
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Rectal Cancer Treatment (PDQ®)–Patient Version was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
CDC’s Screen for Life: National Colorectal Cancer Action Campaign informs men and women who are 45 years old or older about the importance of getting screened for colorectal cancer regularly."
Screening tests help find precancerous polyps (abnormal growths) so they can be removed before they turn into cancer.
This prevents colorectal cancer.
"Screening also can find this cancer early, when treatment works best."
But many adults have not been screened as recommended.
"
Campaign development is based on an extensive review of communication and behavioral science literature."
"Since 1999, CDC has conducted more than 225 focus groups nationally to assess knowledge, behaviors, and screening practices related to colorectal cancer, and to test campaign messages and materials with audiences the campaign intends to reach."
"The focus groups have been segmented by gender, age (45 to 54, 55 to 64, and 65 or older), and ethnicity (mixed ethnicities, African American, and Hispanic)."
Input is also sought from state health departments on the types of materials that would be most helpful to local efforts.
See a list of publications.
"
>Screening for colorectal cancer saves lives.
"
">Colorectal cancer is a leading cause of cancer death in the United States.
"
">If you’re 45 or older, see your doctor and get screened for colorectal cancer.
"
>There are several screening test options.
"Talk to your doctor about which is right for you.
"
">Screening helps prevent colorectal cancer by finding precancerous polyps (abnormal growths) so they can be removed before they turn into cancer.
"
">Screening helps find colorectal cancer early, when treatment can be very effective.
"
>Don’t wait for symptoms to be checked.
"Precancerous polyps and colorectal cancer don’t always cause symptoms, especially early on.
"
>You need to get screened even if you have no family history.
Most colorectal cancers occur in people with no family history of the disease.
"
In 2005, Screen for Life began a partnership with the Entertainment Industry Foundation’s National Colorectal Cancer Research Alliance, cofounded by Katie Couric, to create public service announcements with celebrities."
Some have been affected by colorectal cancer personally.
"Screen for Life is also proud to partner with 50 state health departments, two tribal organizations, the District of Columbia, and CDC’s Colorectal Cancer Control Program award recipients."
These partners use campaign messages and materials at the community level to increase awareness about colorectal cancer.
"
In 2005, Screen for Life and the Entertainment Industry Foundation’s National Colorectal Cancer Research Alliance, co-founded by Katie Couric, developed “Picture of Health” PSAs.
"
"In early 2007, actor Jimmy Smits explained how colorectal cancer screening saves lives in English and Spanish PSAs.
"
"In 2007, actress Diane Keaton talked about her grandmother’s death from colorectal cancer in new PSAs.
"
"In 2009, actor and musician Terrence Howard joined Screen for Life and shared how his mother’s death from colon cancer affected his whole family.
"
"In 2012, in partnership with EIF/NCCRA, a new PSA titled “No Excuses” was displayed in a window at Rockefeller Center in New York City during Colorectal Cancer Awareness Month.
"
"In February 2013, Screen for Life distributed new TV and radio PSAs featuring actress Meryl Streep.
"
"In 2015, Screen for Life developed new PSAs featuring long-time campaign partner, Katie Couric, cofounder of the National Colorectal Cancer Research Alliance.
"
"In 2016, the campaign developed a fresh new design for campaign materials.
"
"In 2018, the campaign debuted new animated PSAs to counter common myths about colorectal cancer screening."
"
PSAs are distributed nationally to a broad range of television, radio, and print media outlets."
"Television PSAs are distributed to about 3,500 national and local broadcast and cable outlets in all 210 U.S. media markets, as well as to national networks, national and regional cable systems, and local cable systems."
"Radio PSAs are distributed to about 1,500 radio stations that appeal to older adults, African American people, and/or Hispanic people."
"Print PSAs are sent to about 350 print outlets, including magazines and daily and weekly newspapers."
"Dioramas are distributed to about 50 major U.S. airports and other out-of-home placement locales including shopping malls, transit systems (such as bus shelters, buses, and trains), office buildings, and retail outlets."
"
As funding allows, the campaign uses search engine marketing and digital advertising to reach target audiences and to direct them to Screen for Life resources."
These efforts have garnered more than 360 million impressions and 2 million clicks to web pages.
"
Through August 2020, Screen for Life public service announcements (PSAs) have generated more than $300 million in donated ad value and 21 billion impressions (the number of times they have been seen or heard)."
"To provide ecological measures of screening behaviors over time, CDC monitors colorectal cancer screening rates through the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS)."
"Findings from BRFSS and NHIS show that testing among adults has increased in the last decade, but it is still too low."
"
>Cooper CP, Gelb CA.
         "
"Opportunities to expand colorectal cancer screening participation.
         "
"Journal of Women’s Health
         2016;25(10):990-995.
>Cooper CP, Gelb CA, Chu J.
         Life cycle of television public service announcements disseminated through donated airtime.
         "
"Preventive Medicine Reports
         2015;2:202–205.
>Cooper CP, Gelb CA, Lobb K.
         Celebrity appeal: Reaching women to promote colorectal cancer screening.
         "
"Journal of Women’s Health
         2015;24(3):169–173.
"
">Ekwueme DU, Howard DH, Gelb CA, Rim SH, Cooper CP.
         "
"Analysis of the benefits and costs of a national campaign to promote colorectal cancer screening: CDC’s Screen for Life National Colorectal Cancer Action Campaign.
         "
"Health Promotion Practice
         2014;15(5):750–758.
"
">Cooper CP, Gelb CA, Hawkins NA.
         "
How many “get screened” messages does it take?
"Evidence from colorectal cancer screening promotion in the United States, 2012.
         "
"Preventive Medicine
         2013;60:27–32.
"
">Cooper CP, Gelb CA, Chu J, Polonec L.
         Can donated media placements reach intended audiences?
         Health Promotion Practice
         2013;14(5):656–662.
"
">Ekwueme DU, Howard D, Gelb C, Rim SH, Cooper C.
         Analysis of the benefits and costs of a national campaign to promote colorectal cancer screening: CDC’s Screen for Life: National Colorectal Cancer Action Campaign.
         "
"Value in Health
         2013;16(3):A142.
"
">Cooper CP, Gelb CA, Jameson H, Macario E, Jorgensen CM, Seeff L.
         Developing English and Spanish television public service announcements to promote colorectal cancer screening.
         "
"Health Promotion Practice
         2005;6(4):385–393.
"
">Cooper CP, Williams KN, Carey KA, Fowler CS, Frank M, Gelb CA.
         "
"Advertising campaign on a major Internet search engine to promote colorectal cancer screening.
         "
"British Medical Journal
         2004;328(7449):1179–1180.
"
">Jorgensen C, Gelb CA, Richards TB, Cooper CP."
"Centers for Disease Control and Prevention.
         "
"Donated television airplay of colorectal cancer education public service announcements—United States, 1999–2002.
         "
"MMWR
         2003;52(10):196–199.
>Jorgensen CM, Gelb CA, Merritt TL, Seeff LC.
         "
"Observations from the CDC: CDC’s Screen for Life: A national colorectal cancer action campaign.
         "
"Journal of Women’s Health and Gender-Based Medicine
         2001;10(5):417–422.
"
"Videos, print materials, social media posts and images, and graphics.
"
">Facebook
>Twitter
>LinkedIn
>Syndicate"
"
Eastern Iowa Health Center helps immigrants, refugees, people who are experiencing homelessness, and many others access health care."
"Watch their video and read their story.
"
"CDC aims to reduce colorectal cancer incidence and deaths, as part of the agency’s overarching goal of ensuring that people are healthy in every stage of life."
"
CDC’s Colorectal Cancer Control Program provides funding to state health departments, universities, Tribes, and other organizations to increase colorectal cancer screening rates by implementing evidence-based interventions (strategies shown to increase cancer screening) described in the Guide to Community Preventive Services.
"
"CDC’s National Comprehensive Cancer Control Program funds state, Tribal, territorial, and U.S. Pacific Island jurisdiction programs to implement specific colorectal cancer strategies identified in their cancer control plans."
"
CDC conducts a variety of colorectal cancer research activities—
>Analyzing colorectal cancer screening rates from ongoing national surveillance systems, such as the
         Behavioral Risk Factor Surveillance System
         and the
         National Health Interview Survey.
"
">Funding projects across the nation to identify effective intervention approaches for promoting colorectal cancer screening among diverse populations.
"
">Assessing prevention behaviors among colorectal cancer survivors.
"
">Assessing the impact of socioeconomic and cultural factors on colorectal cancer survivor participation in post-treatment colon examinations.
"
">Measuring costs, cost efficiencies, and potential cost savings from colorectal cancer screening.
"
>Funding a project to assess use of patient navigation to improve uptake of genetic counseling and testing among colorectal cancer patients.
"
CDC’s Screen for Life: National Colorectal Cancer Action Campaign is a multimedia effort promoting colorectal cancer screening."
"Launched in 1999, this campaign informs people about colorectal cancer and the importance of screening."
"
CDC is a founding member of the National Colorectal Cancer Roundtable, a network of public and private organizations that promote colorectal cancer awareness and screening on the national level."
"
>Increasing awareness of screening recommendations among health care providers.
"
">Providing
         guidance and tools for clinicians
         on the optimal ways to implement screening for colorectal cancer to help ensure that patients receive maximum benefit.
"
">Promoting increased
         patient-provider communication
         about colorectal cancer screening.
"
">Facebook
>Twitter
>LinkedIn
>Syndicate"
"
>General Information About Childhood Gastrointestinal Neuroendocrine Tumors
>Stages of Gastrointestinal Neuroendocrine Tumors
>Treatment Option Overview
>Treatment of Gastrointestinal Neuroendocrine Tumors
>Treatment of Recurrent Gastrointestinal Neuroendocrine Tumors
>To Learn More About Gastrointestinal Neuroendocrine Tumors
>About This PDQ Summary"
"
>A gastrointestinal neuroendocrine tumor forms in neuroendocrine cells in the lining of the digestive tract, appendix, and other organs in the abdomen.
"
">Signs and symptoms of gastrointestinal neuroendocrine tumors  depend on where the tumor forms.
"
">Tests that examine the digestive tract, liver, and pancreas are used to diagnose gastrointestinal neuroendocrine tumors.
"
>Certain factors affect prognosis (chance of recovery).
"
Gastrointestinal neuroendocrine tumors (also called gastrointestinal carcinoid tumors) form from a certain type of neuroendocrine cell (a type of cell that is like a nerve cell and a hormone -making cell)."
"These cells are scattered throughout the chest and abdomen , but most are found in certain organs in the abdomen."
"Neuroendocrine cells in the digestive tract make hormones that help control digestive juices and the muscles used in moving food through the stomach and intestines .
"
Most gastrointestinal neuroendocrine tumors in children form in the appendix (a pouch that sticks out from the first part of the large intestine near the end of the small intestine ).
The tumor is often found during surgery to remove the appendix.
"They also form in the digestive tract (lining of the stomach or intestines ), pancreas , and liver .
"
"These tumors are usually small, slow-growing, and benign (not cancer )."
Some tumors may be malignant (cancer) and spread to other places in the body.
"
Check with your child's doctor if you are concerned about signs and symptoms that may be caused by gastrointestinal neuroendocrine tumors or by other conditions .
"
"Neuroendocrine tumors in the appendix may cause the following signs and symptoms:
>Abdominal
           pain, especially on the lower right side of the abdomen.
"
">Fever
           .
"
">Nausea
           and
           vomiting
           .
"
">Diarrhea
           .
"
Gastrointestinal neuroendocrine tumors that are not in the appendix may release hormones and other substances.
Carcinoid syndrome occurs when a neuroendocrine tumor in the digestive tract releases the hormone serotonin and other substances.
It may cause any of the following signs and symptoms.
"Check with your child’s doctor if your child has any of the following:
>Redness and a warm feeling in the face, neck, and upper chest.
"
">A fast heartbeat.
>Trouble breathing.
"
">Sudden drop in
           blood pressure
           (restlessness,
           confusion
           , weakness, dizziness, and pale, cool, and clammy skin).
"
>Diarrhea.
"
The following tests and procedures may be used:
>Physical exam and health history
           : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual."
"A history of the patient’s health habits and past illnesses and treatments will also be taken.
"
">Blood chemistry studies
           : A procedure in which a
           blood
           sample is checked to measure the amounts of certain substances released into the blood by organs and
           tissues
           in the body."
"An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
"
">MRI (magnetic resonance imaging)
           : A procedure that uses a magnet and
           radio waves
           to make a series of detailed pictures of areas inside the body.  "
The pictures are made by a computer.  
"This procedure is also called nuclear magnetic resonance imaging (NMRI).
"
">PET scan (positron emission tomography scan)
           : A procedure to find
           malignant
           tumor cells in the body.  "
"A small amount of
           radioactive
           glucose
           (sugar) is
           injected
           into a
           vein
           .  "
"The PET
           scanner
           rotates around the body and makes a picture of where glucose is being used in the body.  "
"Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
"
">CT scan (CAT scan)
           : A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles.  "
"The pictures are made by a computer linked to an
           x-ray
           machine.  "
"This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
"
">Ultrasound exam
           : A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes.  "
"The echoes form a picture of body tissues called a
           sonogram
           ."
"The picture can be printed to be looked at later.
"
">Twenty-four-hour urine test
           : A test in which urine is collected for 24 hours to measure the amounts of certain substances, such as hormones."
An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
"The urine sample is checked to see if it contains
           5-HIAA
           (a breakdown product of the hormone serotonin which may be made by neuroendocrine tumors)."
"This test is used to help
           diagnose
           carcinoid syndrome.
"
">Somatostatin receptor scintigraphy
           : A type of
           radionuclide scan
           that may be used to find tumors."
"A very small amount of
           radioactive
           octreotide
           (a hormone that attaches to tumors) is
           injected
           into a
           vein
           and travels through the blood."
The radioactive octreotide attaches to the tumor and a special camera that detects radioactivity is used to show where the tumors are in the body.
This procedure is also called octreotide scan and SRS.
"
Prognosis depends on the following:
>Where the tumor first formed in the body.
"
">The size of the tumor.
"
">Whether the tumor has spread to other parts of the body.
"
">Whether the tumor is newly diagnosed or has
           recurred
           (come back).
"
The prognosis for neuroendocrine tumors in the appendix in children is usually excellent after surgery to remove the tumor.
Gastrointestinal neuroendocrine tumors that are not in the appendix are usually larger or have spread to other parts of the body at the time of diagnosis and do not respond well to chemotherapy .
Larger tumors are more likely to recur (come back).
"
>After a gastrointestinal neuroendocrine tumor has been diagnosed, tests are done to find out if cancer cells have spread to nearby areas or to other parts of the body.
"
">There are three ways that cancer spreads in the body.
"
>Cancer may spread from where it began to other parts of the body.
"
The process used to find out if cancer has spread to nearby areas or other parts of the body is called staging ."
"There is no standard staging system for childhood gastrointestinal neuroendocrine tumors .
"
"Neuroendocrine tumors of the appendix are not known to spread, but other gastrointestinal neuroendocrine tumors may spread."
"The results of tests and procedures done to diagnose gastrointestinal neuroendocrine tumors are used to help make decisions about treatment.
"
Sometimes childhood gastrointestinal neuroendocrine tumors recur (come back) after treatment.
"
Cancer can spread through tissue , the lymph system , and the blood :
>Tissue."
"The cancer spreads from where it began by growing into nearby areas.
"
>Lymph system.
The cancer spreads from where it began by getting into the lymph system.
"The cancer travels through the
           lymph vessels
           to other parts of the body.
"
>Blood.
The cancer spreads from where it began by getting into the blood.
"The cancer travels through the
           blood vessels
           to other parts of the body."
"
"
"When cancer spreads to another part of the body, it is called metastasis ."
"Cancer cells break away from where they began (the primary tumor ) and travel through the lymph system or blood.
"
>Lymph system.
"The cancer gets into the lymph system, travels through the lymph vessels, and forms a
           tumor
           (
           metastatic
           tumor) in another part of the body.
"
>Blood.
"The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
"
The metastatic tumor is the same type of cancer as the primary tumor .
"For example, if neuroendocrine tumor cells in the small intestine spread to the liver , the cancer cells in the liver are actually neuroendocrine tumor cells."
"The cells in the liver are metastatic neuroendocrine tumor cells, not liver cancer ."
"
>There are different types of treatment for children with gastrointestinal neuroendocrine tumors.
"
">Children with gastrointestinal neuroendocrine tumors not in the appendix should have their treatment planned by a team of doctors who are experts in treating childhood cancer.
"
">Five types of standard treatment are used:SurgeryEmbolizationHormone therapyPeptide receptor radionuclide therapyTargeted therapy
>Surgery
>Embolization
>Hormone therapy
>Peptide receptor radionuclide therapy
>Targeted therapy
>New types of treatment are being tested in clinical trials.
"
">Treatment of gastrointestinal neuroendocrine tumors may cause side effects.
"
">Patients may want to think about taking part in a clinical trial.
"
">Patients can enter clinical trials before, during, or after starting their cancer treatment.
"
>Follow-up tests may be needed.
"
Some treatments are standard (the currently used treatment), and some are being tested in clinical trials ."
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer .
"When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
"
"Because cancer in children is rare, taking part in a clinical trial should be considered."
Some clinical trials are open only to patients who have not started treatment.
"
Treatment will be overseen by a pediatric oncologist , a doctor who specializes in treating children with cancer ."
The pediatric oncologist works with other pediatric health professionals who are experts in treating children with cancer and who specialize in certain areas of medicine .
"This may include the following specialists and others:
>Pediatrician
           .
"
">Pediatric surgeon
           .
"
">Pathologist
           .
"
">Pediatric
           endocrinologist
           .
"
">Pediatric nurse specialist
           .
"
">Social worker
           .
>Rehabilitation specialist
           .
"
">Psychologist
           .
"
">Child-life specialist
           ."
"
Surgery to remove the tumor is the only treatment needed for neuroendocrine tumors in the appendix ."
"
Embolization is a treatment in which contrast dye and particles are injected into the hepatic artery through a catheter (thin tube)."
"The particles block the artery , cutting off blood flow to the tumor."
Sometimes a small amount of a radioactive substance is attached to the particles.
Most of the radiation is trapped near the tumor to kill the cancer cells .
This is called radioembolization .
"
Hormone therapy with a somatostatin analogue ( octreotide or lanreotide ) may be used to treat gastrointestinal neuroendocrine tumors that have spread or cannot be removed by surgery."
This treatment stops extra hormones from being made by the neuroendocrine tumor.
Octreotide or lanreotide are somatostatin analogues which are injected under the skin or into the muscle.
"
Sometimes a small amount of a radioactive substance is attached to the somatostatin analogue drugs octreotide or lanreotide to kill the cancer cells."
"
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells."
"Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.
"
">Tyrosine kinase inhibitors
            : These targeted therapy drugs block signals needed for tumors to grow.
            "
"Sunitinib
            is used to treat gastrointestinal neuroendocrine tumors that are not in the appendix.
>mTOR inhibitors
            : A type of targeted therapy that stops the
            protein
            that helps cells divide and survive.
            "
"Everolimus
            is used to treat gastrointestinal neuroendocrine tumors that are not in the appendix."
"
Information about clinical trials is available from the NCI website ."
"
To learn about side effects that begin during treatment for cancer, see Side Effects .
"
Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects .
"Late effects of cancer treatment may include:
>Physical problems.
"
">Changes in mood, feelings, thinking, learning, or memory.
"
">Second cancers
           (new types of cancer) or other
           conditions
           .
"
Some late effects may be treated or controlled.
It is important to talk with your child's doctors about the possible late effects caused by some treatments.
See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.
"
For some patients, taking part in a clinical trial may be the best treatment choice."
Clinical trials are part of the cancer research process.
"Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment .
"
Many of today's standard treatments for cancer are based on earlier clinical trials.
"Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
"
Patients who take part in clinical trials also help improve the way cancer will be treated in the future.
"Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward."
"
Some clinical trials only include patients who have not yet received treatment."
Other trials test treatments for patients whose cancer has not gotten better.
"There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
"
Clinical trials are taking place in many parts of the country.
Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage.
Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
"
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated."
Some tests will be repeated in order to see how well the treatment is working.
"Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
"
Some of the tests will continue to be done from time to time after treatment has ended.
The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back).
These tests are sometimes called follow-up tests or check-ups.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of newly diagnosed neuroendocrine tumors in the appendix in children may include the following:
>Surgery
          to remove  the appendix.
"
"Treatment of newly diagnosed neuroendocrine tumors in the large intestine , pancreas , or stomach is usually surgery.
"
"Treatment of newly diagnosed tumors that cannot be removed by surgery, multiple tumors, or tumors that have spread may include the following:
>Embolization
          .
"
">Hormone therapy
          with a somatostatin
          analogue
          (
          octreotide
          or
          lanreotide
          ).
"
">Peptide receptor radionuclide therapy
          .
"
">Targeted therapy
          with a
          tyrosine kinase inhibitor
          (
          sunitinib
          ) or an
          mTOR inhibitor
          (
          everolimus
          ).
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatment listed below, see the Treatment Option Overview section.
"
"Treatment of recurrent gastrointestinal neuroendocrine tumors in children may include the following:
>A
          clinical trial
          that checks a sample of the patient's tumor for certain
          gene
          changes."
"The type of
          targeted therapy
          that will be given to the patient depends on the type of gene change.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For more information from the National Cancer Institute about gastrointestinal neuroendocrine tumors , see the following:
>Gastrointestinal Carcinoid Tumors Home Page
>Computed Tomography (CT) Scans and Cancer
>Targeted Cancer Therapies
For more childhood cancer information and other general cancer resources, see the following:
>About Cancer
>Childhood Cancers
>CureSearch for Children's Cancer
>Late Effects of Treatment for Childhood Cancer
>Adolescents and Young Adults with Cancer
>Children with Cancer: A Guide for Parents
>Cancer in Children and Adolescents
>Staging
>Coping with Cancer
>Questions to Ask Your Doctor about Cancer
>For Survivors and Caregivers"
"
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database."
"The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine."
Most summaries come in two versions.
The health professional versions have detailed information written in technical language.
"The patient versions are written in easy-to-understand, nontechnical language."
"Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish .
"
PDQ is a service of the NCI.
The NCI is part of the National Institutes of Health (NIH).
NIH is the federal government’s center of biomedical research.
The PDQ summaries are based on an independent review of the medical literature.
They are not policy statements of the NCI or the NIH.
"
This PDQ cancer information summary has current information about the treatment of childhood gastrointestinal neuroendocrine tumors."
"It is meant to inform and help patients, families, and caregivers."
It does not give formal guidelines or recommendations for making decisions about health care.
"
Editorial Boards write the PDQ cancer information summaries and keep them up to date."
These Boards are made up of experts in cancer treatment and other specialties related to cancer.
The summaries are reviewed regularly and changes are made when there is new information.
"The date on each summary (""Updated"") is the date of the most recent change.
"
"The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board ."
"
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another."
Trials are based on past studies and what has been learned in the laboratory.
Each trial answers certain scientific questions in order to find new and better ways to help cancer patients.
"During treatment clinical trials, information is collected about the effects of a new treatment and how well it works."
"If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become ""standard."""
Patients may want to think about taking part in a clinical trial.
"Some clinical trials are open only to patients who have not started treatment.
"
Clinical trials can be found online at NCI's website .
"For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237)."
"
PDQ is a registered trademark."
The content of PDQ documents can be used freely as text.
It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly.
"However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
"
"The best way to cite this PDQ summary is:
PDQ® Pediatric Treatment Editorial Board."
PDQ Childhood Gastrointestinal Neuroendocrine Tumors Treatment.
"Bethesda, MD: National Cancer Institute."
Updated <MM/DD/YYYY>.
Available at: https://www.cancer.gov/types/gi-neuroendocrine-tumors/patient/child-gi-neuroendocrine-treatment-pdq .
"Accessed <MM/DD/YYYY>.
"
"Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only."
"If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner."
It cannot be given by the National Cancer Institute.
"Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online ."
"Visuals Online is a collection of more than 3,000 scientific images."
"
The information in these summaries should not be used to make decisions about insurance reimbursement."
More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
"
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page."
"Questions can also be submitted to Cancer.gov through the website’s E-mail Us .
"
">Updated:December 22, 2022
"
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"
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"
>General Information About Gastrointestinal Neuroendocrine Tumors
>Stages of Gastrointestinal Neuroendocrine Tumors
>Treatment Option Overview
>Treatment of Neuroendocrine Tumors in the Stomach
>Treatment of Neuroendocrine Tumors in the Small Intestine
>Treatment of Neuroendocrine Tumors in the Appendix
>Treatment of Neuroendocrine Tumors in the Colon
>Treatment of Neuroendocrine Tumors in the Rectum
>Treatment of Metastatic Gastrointestinal Neuroendocrine Tumors
>Treatment of Recurrent Gastrointestinal Neuroendocrine Tumors
>To Learn More About Gastrointestinal Neuroendocrine Tumors
>About This PDQ Summary"
"
>A gastrointestinal neuroendocrine tumor is cancer that  forms in the lining of the gastrointestinal tract.
"
">Health history  can affect the risk of   GI neuroendocrine tumors.
"
">Some GI neuroendocrine tumors have no signs or symptoms in the early stages.
"
">Carcinoid syndrome may occur if the tumor spreads to the liver or other parts of the body.
"
">Imaging studies and tests that examine the blood and  urine are used to diagnose GI neuroendocrine tumors.
"
>Certain factors affect prognosis (chance of recovery) and treatment options.
"
The gastrointestinal (GI) tract is part of the body's digestive system , a series of hollow, muscular organs joined in a long, twisting tube from the mouth to the anus."
"The digestive tract processes nutrients in foods that are eaten and helps pass waste material out of the body:
>Food moves from the throat to the stomach through a tube called the esophagus.
"
">After food enters the stomach, it is broken down by stomach muscles that mix the food and liquid with digestive juices.
"
">After leaving the stomach, partly digested food passes into the small intestine and then into the large intestine.
>The end of the large intestine, called the rectum, stores the waste from the digested food until it is pushed out of the anus during a bowel movement.
"
Gastrointestinal (GI) neuroendocrine tumors (also called gastrointestinal carcinoid tumors) form from a certain type of neuroendocrine cell (a type of cell that is like a nerve cell and a hormone -making cell).
These cells are scattered throughout the chest and abdomen but most are found in the GI tract.
Neuroendocrine cells make hormones that help control digestive juices and the muscles used in moving food through the stomach and intestines .
"A GI neuroendocrine tumor may also make hormones and release them into the body.
"
GI neuroendocrine tumors are rare and most grow very slowly.
"Most of them occur in the small intestine, rectum, and appendix ."
"Sometimes more than one tumor will form.
"
"See the following for information about other types of neuroendocrine tumors:
>Pancreatic Neuroendocrine Tumors (Islet Cell Tumors)"
"Treatment
>Childhood Gastrointestinal Neuroendocrine Tumors Treatment"
"
Anything that increases a person's chance of getting a disease is called a risk factor ."
"Not every person with one or more of these risk factors will develop GI neuroendocrine tumors, and they can develop in people who don't have any known risk factors."
"Talk to your doctor if you think you may be at risk.
"
"Risk factors for GI neuroendocrine tumors include the following:
>Having a
           family history
           of
           multiple endocrine neoplasia type 1 (MEN1) syndrome
           or
           neurofibromatosis type 1 (NF1) syndrome
           .
"
">Having certain
           conditions
           that affect the stomach's ability to make stomach
           acid
           , such as atrophic
           gastritis
           ,
           pernicious anemia
           , or
           Zollinger-Ellison syndrome
           ."
"
Signs and symptoms may be caused by the growth of the tumor and/or the hormones the tumor makes."
"Some tumors, especially tumors of the stomach or appendix , may not cause signs or symptoms."
"Neuroendocrine tumors are often found during tests or treatments for other conditions.
"
"Neuroendocrine tumors in the small intestine (duodenum, jejunum, and ileum), colon, and rectum sometimes cause signs or symptoms as they grow or because of the hormones they make."
Other conditions may cause the same signs or symptoms.
"Check with your doctor if you have any of the following:
>DuodenumSigns and symptoms of GI neuroendocrine tumors in the duodenum (first part of the small intestine, that connects to the stomach) may include the following:Abdominal
              pain."
"Constipation
              .Diarrhea
              .Change in
              stool
              color."
"Nausea
              .Vomiting
              .Jaundice
              (yellowing of the skin and whites of the eyes).Heartburn.
"
"Signs and symptoms of GI neuroendocrine tumors in the duodenum (first part of the small intestine, that connects to the stomach) may include the following:
>Abdominal
              pain.
"
">Constipation
              .
"
">Diarrhea
              .
"
">Change in
              stool
              color.
"
">Nausea
              .
"
">Vomiting
              .
"
">Jaundice
              (yellowing of the skin and whites of the eyes).
"
">Heartburn.
"
">Jejunum and ileumSigns and symptoms of GI neuroendocrine tumors in the jejunum (middle part of the small intestine) and ileum (last part of the small intestine, that connects to the colon) may include the following:Abdominal
              pain."
Weight loss for no known reason.
Feeling very tired.
"Feeling bloatedDiarrhea
              .Nausea
              .Vomiting.
"
"Signs and symptoms of GI neuroendocrine tumors in the jejunum (middle part of the small intestine) and ileum (last part of the small intestine, that connects to the colon) may include the following:
>Abdominal
              pain.
"
">Weight loss for no known reason.
"
">Feeling very tired.
"
">Feeling bloated
>Diarrhea
              .
"
">Nausea
              .
"
">Vomiting.
>"
ColonSigns and symptoms of GI neuroendocrine tumors in the colon may include the following:Abdominal pain.
"Weight loss for no known reason.
"
"Signs and symptoms of GI neuroendocrine tumors in the colon may include the following:
>Abdominal pain.
"
">Weight loss for no known reason.
"
">RectumSigns and symptoms of GI neuroendocrine tumors in the rectum may include the following:Blood
              in the stool."
Pain in the rectum.
"Constipation
              .
"
"Signs and symptoms of GI neuroendocrine tumors in the rectum may include the following:
>Blood
              in the stool.
"
">Pain in the rectum.
"
">Constipation
              ."
"
The hormones made by GI neuroendocrine tumors are usually destroyed by liver enzymes in the blood."
"If the tumor has spread to the liver and the liver enzymes cannot destroy the extra hormones made by the tumor, high amounts of these hormones may remain in the body and cause carcinoid syndrome ."
This can also happen if tumor cells enter the blood.
"Signs and symptoms of carcinoid syndrome include the following:
>Redness or a feeling of warmth in the face and neck.
"
">Abdominal pain.
"
">Feeling bloated.
"
">Diarrhea.
>Wheezing or other trouble breathing.
"
">Fast heartbeat.
"
These signs and symptoms may be caused by GI neuroendocrine tumors or by other conditions.
Talk to your doctor if you have any of these signs or symptoms.
"
In addition to asking about your personal and family health history and doing a physical exam , your doctor may perform the following tests and procedures:
>Blood chemistry studies
           : A procedure in which a blood sample is checked to measure the amounts of certain substances, such as hormones,  released into the blood by organs and
           tissues
           in the body."
An unusual (higher or lower than normal) amount of a substance can be a sign of disease.  
The blood sample is  checked to see if it contains a  hormone produced by neuroendocrine tumors.
"This test is  used to help
           diagnose
           carcinoid syndrome.
"
">Tumor marker test
           : A procedure in which a sample of blood,
           urine
           , or tissue is checked to measure the amounts of certain substances, such as
           chromogranin A
           , made by organs, tissues, or tumor cells in the body."
Chromogranin A is a tumor marker.
"It has been linked to
           neuroendocrine tumors
           when found in increased levels in the body.
"
">Twenty-four-hour urine test
           : A test in which urine is collected for 24 hours to measure the amounts of certain substances, such as
           5-HIAA
           or
           serotonin
           (hormone)."
An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
"This test is  used to help diagnose carcinoid syndrome.
"
">MIBG scan
           : A procedure used to find neuroendocrine tumors."
A very small amount of radioactive material called MIBG (metaiodobenzylguanidine) is injected into a vein and travels through the bloodstream.
"Neuroendocrine tumors take up the radioactive material and are detected by a device that measures radiation.
"
">CT scan (CAT scan)
           : A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles.  "
"The pictures are made by a computer linked to an
           x-ray
           machine."
A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.  
"This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
"
">MRI (magnetic resonance imaging)
           : A procedure that uses a magnet,
           radio waves
           , and a computer to make a series of detailed pictures of areas inside the body."
"This procedure is also called nuclear magnetic resonance imaging
>PET scan (positron emission tomography scan)
           : A procedure to find
           malignant
           tumor cells in the body.  "
"A small amount of
           radioactive
           glucose
           (sugar) is injected into a vein.  "
"The PET
           scanner
           rotates around the body and makes a picture of where glucose is being used in the body.  "
"Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.
"
">Endoscopic ultrasound (EUS)
           : A procedure in which an
           endoscope
           is inserted into the body, usually through the mouth or rectum.  "
"An endoscope is a thin, tube-like instrument with a light and a
           lens
           for viewing."
"A probe at the end of the endoscope is used to bounce high-energy sound waves (
           ultrasound
           ) off internal tissues or organs, such as the stomach, small intestine, colon, or rectum, and make echoes.  "
"The echoes form a picture of body tissues called a
           sonogram
           .  "
"This procedure is also called endosonography.
"
">Upper endoscopy
           :  "
"A procedure to look at organs and tissues inside the body to check for
           abnormal
           areas.  "
"An endoscope  is inserted through the mouth and passed through the
           esophagus
           into the stomach.  "
Sometimes the endoscope also is passed from the stomach into the small intestine.
"An endoscope is a thin, tube-like instrument with a light and a lens for viewing."
"It may also have a tool to remove tissue or
           lymph node
           samples, which are checked under a
           microscope
           for signs of disease.
"
">Colonoscopy
           : A procedure to look inside the rectum and colon for
           polyps
           , abnormal areas, or cancer."
"A
           colonoscope
           is inserted through the rectum into the colon."
"A colonoscope is a thin, tube-like instrument with a light and a lens for viewing."
"It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.
"
">Capsule endoscopy
           : A procedure used to see  all of the small intestine."
The patient swallows a  capsule that contains a tiny camera.
"As the capsule moves through the gastrointestinal tract, the camera takes pictures and sends them to a receiver worn on the outside of the body.
"
">Biopsy
           : The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer."
Tissue samples may be taken during endoscopy and colonoscopy.
"
The prognosis and treatment options depend on the following:
>Where the tumor is in the gastrointestinal tract.
"
">The size of the tumor.
"
">Whether the cancer has spread from the stomach and intestines to other parts of the body, such as the liver or lymph nodes.
"
">Whether the patient has carcinoid syndrome or has carcinoid heart syndrome.
"
">Whether the cancer can be completely removed by
           surgery
           .
"
">Whether the cancer is newly diagnosed or has
           recurred
           ."
"
>After a gastrointestinal neuroendocrine tumor has been diagnosed, tests are done to find out if cancer cells have spread within the stomach and intestines or to other parts of the body.
"
">There are three ways that cancer spreads in the body.
"
">Cancer may spread from where it began to other parts of the body.
"
>The plan for cancer treatment depends on where the neuroendocrine tumor is found and whether it can be removed by surgery.
"
Staging is the process used to find out how far the cancer has spread."
The information gathered from the staging process determines the stage of the disease.
The results of tests and procedures used to diagnose gastrointestinal (GI) neuroendocrine tumors may also be used for staging.
See the General Information section for a description of these tests and procedures.
"A bone scan may be done to check if there are rapidly dividing cells , such as cancer cells, in the bone."
A very small amount of radioactive material is injected into a vein and travels through the bloodstream.
The radioactive material collects in the bones with cancer and is detected by a scanner .
"
Cancer can spread through tissue , the lymph system , and the blood :
>Tissue."
"The cancer spreads from where it began by growing into nearby areas.
"
>Lymph system.
The cancer spreads from where it began by getting into the lymph system.
"The cancer travels through the
           lymph vessels
           to other parts of the body.
"
>Blood.
The cancer spreads from where it began by getting into the blood.
"The cancer travels through the
           blood vessels
           to other parts of the body."
"
"
"When cancer spreads to another part of the body, it is called metastasis ."
"Cancer cells break away from where they began (the primary tumor ) and travel through the lymph system or blood.
"
>Lymph system.
"The cancer gets into the lymph system, travels through the lymph vessels, and forms a
           tumor
           (
           metastatic
           tumor) in another part of the body.
"
>Blood.
"The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
"
The metastatic tumor is the same type of tumor as the primary tumor.
"For example, if a GI neuroendocrine tumor spreads to the liver , the tumor cells in the liver are actually GI neuroendocrine tumor cells."
"The disease is metastatic GI neuroendocrine tumor, not liver cancer ."
"
For many cancers it is important to know the stage of the cancer in order to plan treatment."
"However, the treatment of GI neuroendocrine tumors is not based on the stage of the cancer."
"Treatment depends mainly on whether the tumor can be removed by surgery and if the tumor has spread.
"
"Treatment is based on whether the tumor:
>Can be completely removed by surgery.
"
">Has spread to other parts of the body.
"
>Has come back after treatment.
"The tumor may come back in the
           stomach
           or
           intestines
           or in other parts of the body.
"
>Has not gotten better with treatment.
"
>There are different types of treatment for patients with
		  gastrointestinal neuroendocrine tumors.
"
">The following types of treatment are used:SurgeryRadiation therapyChemotherapyHormone therapy
>Surgery
>Radiation therapy
>Chemotherapy
>Hormone therapy
>Treatment for carcinoid syndrome may also be needed.
"
>New types of treatment are being tested in clinical trials.
"Targeted therapy
>Targeted therapy
>Treatment for gastrointestinal neuroendocrine tumors may cause side effects.
"
">Patients may want to think about taking part in a clinical trial.
"
">Patients can enter clinical trials before, during, or after starting their cancer treatment.
"
>Follow-up tests may be needed.
"
Different types of treatment are available for patients with gastrointestinal neuroendocrine (GI) tumors ."
"Some treatments are standard (the currently used treatment), and some are being tested in clinical trials ."
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer .
"When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment."
Patients may want to think about taking part in a clinical trial.
Some clinical trials are open only to patients who have not started treatment.
"
Treatment of GI neuroendocrine tumors usually includes surgery ."
"One of the following surgical procedures may be used:
>Endoscopic
            resection
            :"
"Surgery to remove a small
            tumor
            that is on the inside lining of the
            GI
            tract."
"An
            endoscope
            is inserted through the mouth and passed through the
            esophagus
            to the
            stomach
            and sometimes, the
            duodenum
            ."
"An endoscope is a thin, tube-like instrument with a light, a
            lens
            for viewing, and a tool for removing tumor
            tissue
            .
"
">Local
            excision
            :"
"Surgery to remove the tumor and a small amount of normal tissue around it.
"
">Resection
            :"
"Surgery to remove part or all of the
            organ
            that contains cancer."
"Nearby
            lymph nodes
            may also be removed.
"
">Cryosurgery
            : A treatment that uses an instrument to freeze and destroy the tumor."
This type of treatment is also called cryotherapy.
"The doctor may use
            ultrasound
            to guide the instrument.
"
">Radiofrequency ablation
            : The use of a special probe with tiny electrodes that release high-energy
            radio waves
            (similar to microwaves) that kill cancer
            cells
            ."
"The probe may be inserted through the skin or through an
            incision
            (cut) in the
            abdomen
            .
"
">Liver
            transplant
            :"
"Surgery to remove the whole liver and replace it with a healthy
            donated
            liver.
"
">Hepatic artery
            embolization
            : A procedure to  embolize (block) the hepatic artery, which is the main
            blood vessel
            that brings
            blood
            into the liver."
Blocking the flow of blood to the liver helps kill cancer cells growing there.
"
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing."
"There are two types of radiation therapy:
>External radiation therapy
            uses a machine outside the body to send radiation toward the area of the body with cancer.
"
">Internal radiation therapy
            uses a
            radioactive
            substance sealed in needles,
            seeds
            , wires, or
            catheters
            that are placed directly into or near the cancer.
"
Radiopharmaceutical therapy is a type of internal radiation therapy.
"Radiation is given to the tumor using a drug that has a radioactive substance, such as iodine I 131, attached to it."
"The radioactive substance kills the tumor cells.
"
External and internal radiation therapy are used to treat GI neuroendocrine tumors that have spread to other parts of the body.
"
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing."
"When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body ( systemic chemotherapy )."
"When chemotherapy is placed directly into the cerebrospinal fluid , an organ , or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas ( regional chemotherapy ).
"
Chemoembolization of the hepatic artery is a type of regional chemotherapy that may be used to treat a GI neuroendocrine tumor that has spread to the liver.
The anticancer drug is injected into the hepatic artery through a catheter (thin tube).
"The drug is mixed with a substance that embolizes (blocks) the artery, and cuts off blood flow to the tumor."
Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body.
"The blockage may be temporary or permanent, depending on the substance used to block the artery."
The tumor is prevented from getting the oxygen and nutrients it needs to grow.
"The liver continues to receive blood from the hepatic portal vein , which carries blood from the stomach and intestine .
"
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
"
Hormone therapy with a somatostatin analog is a treatment that stops extra hormones from being made."
GI neuroendocrine tumors are treated with octreotide or lanreotide which are injected under the skin or into the muscle.
Octreotide and lanreotide may also have a small effect on stopping tumor growth.
"
Treatment of carcinoid syndrome may include the following:
>Hormone therapy with a somatostatin analog stops extra hormones from being made."
"Carcinoid syndrome is treated with octreotide or lanreotide to lessen flushing and
           diarrhea
           ."
"Octreotide and lanreotide may also help slow tumor growth.
"
">Interferon
           therapy stimulates the body’s
           immune system
           to work better and lessens flushing and diarrhea."
"Interferon may also help slow tumor growth.
"
">Taking
           medicine
           for diarrhea.
"
">Taking medicine for skin rashes.
"
">Taking medicine to breathe easier.
"
">Taking medicine before having
           anesthesia
           for a medical procedure.
"
"Other ways to help treat carcinoid syndrome include avoiding things that cause flushing or difficulty breathing such as alcohol , nuts, certain cheeses and foods with capsaicin , such as chili peppers."
"Avoiding stressful situations and certain types of physical activity can also help treat carcinoid syndrome.
"
"For some patients with carcinoid heart syndrome, a heart valve replacement may be done."
"
This summary section describes treatments that are being studied in clinical trials."
It may not mention every new treatment being studied.
Information about clinical trials is available from the NCI website .
"
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells."
Several types of targeted therapy are being studied in the treatment of GI neuroendocrine tumors.
"
For information about side effects caused by treatment for cancer, see our Side Effects page."
"
For some patients, taking part in a clinical trial may be the best treatment choice."
Clinical trials are part of the cancer research process.
"Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment .
"
Many of today's standard treatments for cancer are based on earlier clinical trials.
"Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
"
Patients who take part in clinical trials also help improve the way cancer will be treated in the future.
"Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward."
"
Some clinical trials only include patients who have not yet received treatment."
Other trials test treatments for patients whose cancer has not gotten better.
"There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
"
Clinical trials are taking place in many parts of the country.
Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage.
Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
"
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated."
Some tests will be repeated in order to see how well the treatment is working.
"Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
"
Some of the tests will continue to be done from time to time after treatment has ended.
The results of these tests can show if your condition has changed or if the cancer has recurred (come back).
These tests are sometimes called follow-up tests or check-ups.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of gastrointestinal (GI) neuroendocrine tumors in the stomach may include the following:
>Endoscopic
          surgery
          (
          resection
          ) for small
          tumors
          .
"
>Surgery (resection) to remove part or all of the stomach.
"Nearby
          lymph nodes
          for larger tumors, tumors that grow deep into the stomach wall, or tumors that are growing and spreading quickly may also be removed.
"
"For patients with GI neuroendocrine tumors in the stomach and MEN1 syndrome , treatment may also include:
>Surgery (resection) to remove tumors in the
          duodenum
          (first part of the
          small intestine
          , that connects to the stomach).
"
">Hormone therapy
          .
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"It is not clear what the best treatment is for gastrointestinal (GI) neuroendocrine tumors in the duodenum (first part of the small intestine , that connects to the stomach )."
"Treatment may include the following:
>Endoscopic
          surgery
          (
          resection
          ) for small
          tumors
          .
"
">Surgery (
          local
          excision
          ) to remove slightly larger tumors.
"
">Surgery (resection) to remove the tumor and nearby
          lymph nodes
          .
"
"Treatment of GI neuroendocrine tumors in the jejunum (middle part of the small intestine) and ileum (last part of the small intestine, that connects to the colon ) may include the following:
>Surgery (resection) to remove the tumor and the
          membrane
          that connects the
          intestines
          to the back of the
          abdominal
          wall."
"Nearby
          lymph nodes
          are also removed.
"
">A second surgery to remove the membrane that connects the intestines to the back of the abdominal wall, if any tumor remains or the tumor continues to grow.
"
">Hormone therapy
          .
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of gastrointestinal (GI) neuroendocrine tumors in the appendix may include the following:
>Surgery
          (
          resection
          ) to remove the appendix.
"
">Surgery (resection) to remove the right side of the
          colon
          including the appendix."
"Nearby
          lymph nodes
          are also removed.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of gastrointestinal (GI) neuroendocrine tumors in the colon may include the following:
>Surgery
          (
          resection
          ) to remove part of the colon and nearby
          lymph nodes
          , in order to remove as much of the
          cancer
          as possible.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of gastrointestinal (GI) neuroendocrine tumors in the rectum may include the following:
>Endoscopic
          surgery
          (
          resection
          ) for
          tumors
          that are smaller than 1
          centimeter
          .
"
">Surgery (resection) for tumors that are larger than 2 centimeters or that have spread to the muscle layer of the
          rectal
          wall."
"This may be either:surgery to remove part of the rectum; orsurgery to remove  the
             anus
             , the rectum, and part of the
             colon
             through an
             incision
             made in the
             abdomen
             .
"
">surgery to remove part of the rectum; or
>surgery to remove  the
             anus
             , the rectum, and part of the
             colon
             through an
             incision
             made in the
             abdomen
             .
"
It is not clear what the best treatment is for tumors that are 1 to 2 centimeters.
"Treatment may include the following:
>Endoscopic surgery (resection).
"
">Surgery (resection) to remove part of the rectum.
"
">Surgery (resection) to remove the anus, the rectum, and part of the colon through an incision made in the abdomen.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Distant metastases
Treatment of distant metastases of gastrointestinal (GI) neuroendocrine tumors is usually palliative therapy to relieve symptoms and improve quality of life ."
"Treatment may include the following:
>Surgery
          (
          resection
          ) to remove as much of the
          tumor
          as possible.
"
">Hormone therapy
          .
"
">Radiopharmaceutical
          therapy
          .
"
">External radiation therapy
          for
          cancer
          that has spread to the bone,
          brain
          , or
          spinal cord
          .
"
">A
          clinical trial
          of a new treatment.
"
"Liver metastases
Treatment of cancer that has spread to the liver may include the following:
>Surgery (
          local
          excision
          ) to remove the tumor from the liver.
"
">Hepatic artery
          embolization
          .
"
">Cryosurgery
          .
"
">Radiofrequency ablation
          .
"
">Liver
          transplant
          .
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of recurrent gastrointestinal (GI) neuroendocrine tumors may include the following:
>Surgery
          (
          local
          excision
          ) to remove part or all of the
          tumor
          .
"
">A
          clinical trial
          of a new treatment.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For more information from the National Cancer Institute about gastrointestinal neuroendocrine tumors, see the following:
>Gastrointestinal Carcinoid Tumors Home Page
>Cryosurgery to Treat Cancer
>Targeted Therapy to Treat Cancer
For general cancer information and other resources from the National Cancer Institute, see the following:
>About Cancer
>Staging
>Chemotherapy and You: Support for People With Cancer
>Radiation Therapy and You: Support for People With Cancer
>Coping with Cancer
>Questions to Ask Your Doctor about Cancer
>For Survivors and Caregivers"
"
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database."
"The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine."
Most summaries come in two versions.
The health professional versions have detailed information written in technical language.
"The patient versions are written in easy-to-understand, nontechnical language."
"Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish .
"
PDQ is a service of the NCI.
The NCI is part of the National Institutes of Health (NIH).
NIH is the federal government’s center of biomedical research.
The PDQ summaries are based on an independent review of the medical literature.
They are not policy statements of the NCI or the NIH.
"
This PDQ cancer information summary has current information about the treatment of adult gastrointestinal neuroendocrine tumors."
"It is meant to inform and help patients, families, and caregivers."
It does not give formal guidelines or recommendations for making decisions about health care.
"
Editorial Boards write the PDQ cancer information summaries and keep them up to date."
These Boards are made up of experts in cancer treatment and other specialties related to cancer.
The summaries are reviewed regularly and changes are made when there is new information.
"The date on each summary (""Updated"") is the date of the most recent change.
"
"The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board ."
"
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another."
Trials are based on past studies and what has been learned in the laboratory.
Each trial answers certain scientific questions in order to find new and better ways to help cancer patients.
"During treatment clinical trials, information is collected about the effects of a new treatment and how well it works."
"If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become ""standard."""
Patients may want to think about taking part in a clinical trial.
"Some clinical trials are open only to patients who have not started treatment.
"
Clinical trials can be found online at NCI's website .
"For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237)."
"
PDQ is a registered trademark."
The content of PDQ documents can be used freely as text.
It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly.
"However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
"
"The best way to cite this PDQ summary is:
PDQ® Adult Treatment Editorial Board."
PDQ Gastrointestinal Neuroendocrine Tumors Treatment.
"Bethesda, MD: National Cancer Institute."
Updated <MM/DD/YYYY>.
Available at: https://www.cancer.gov/types/gi-neuroendocrine-tumors/patient/gi-neuroendocrine-treatment-pdq .
Accessed <MM/DD/YYYY>.
"[PMID: 26389212]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only."
"If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner."
It cannot be given by the National Cancer Institute.
"Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online ."
"Visuals Online is a collection of more than 3,000 scientific images."
"
The information in these summaries should not be used to make decisions about insurance reimbursement."
More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
"
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page."
"Questions can also be submitted to Cancer.gov through the website’s E-mail Us .
"
">Updated:June 22, 2023
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Gastrointestinal Neuroendocrine Tumors Treatment (PDQ®)–Patient Version was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
Anatomy of the liver."
"The liver is in the upper abdomen near the stomach, intestines, gallbladder, and pancreas."
The liver has four lobes.
Two lobes are on the front and two small lobes (not shown) are on the back of the liver.
"Intrahepatic bile ducts are a network of small tubes that carry bile inside the liver.
"
"© 2010 Terese Winslow LLC, U.S. Govt. has certain rights."
Used with Permission.
"Contact artist at www.teresewinslow.com for licensing.
"
Cancer is a disease in which cells in the body grow out of control.
"When cancer starts in the liver, it is called liver cancer."
"Each year in the United States, about 25,000 men and 11,000 women get liver cancer, and about 19,000 men and 9,000 women die from the disease."
"The percentage of Americans who get liver cancer rose for several decades, but is now declining."
Liver cancer is more common in other parts of the world than in the United States.
"
The liver is located on the upper right side of the body, behind the lower ribs."
"The liver does many jobs, including—
>Storing nutrients.
"
">Removing waste products and worn-out cells from the blood.
"
">Filtering and processing chemicals in food, alcohol, and medications.
"
">Producing
         bile,
         a solution that helps digest fats and eliminate waste products."
"
In its early stages, liver cancer may not have symptoms that can be seen or felt."
"However, as the cancer grows larger, people may notice one or more of these common symptoms."
It’s important to remember that these symptoms could also be caused by other health conditions.
"If you have any of these symptoms, talk to your doctor.
"
"Liver cancer symptoms may include—
>Discomfort in the upper abdomen on the right side.
"
">A swollen abdomen.
"
">A hard lump on the right side just below the rib cage.
"
">Pain near the right shoulder blade or in the back.
"
">Jaundice (yellowing of the skin and whites of the eyes).
"
">Easy bruising or bleeding.
>Unusual tiredness.
"
">Nausea and vomiting.
"
">Loss of appetite.
"
">Weight loss for no known reason.
"
"An illness caught Gary off guard, and test results found something he never expected."
Read his story.
"
Behaviors and conditions that increase risk for getting liver cancer are—
>Being overweight or
         having obesity.
"
">Having a long-term
         hepatitis B virus
         or
         hepatitis C virus
         infection.
"
">Smoking cigarettes.
"
">Drinking alcohol.
"
">Having
         cirrhosis
         (scarring of the liver, which can also be caused by hepatitis and alcohol use).
"
">Having
         nonalcoholic fatty liver disease
         (extra fat in the liver that is not caused by alcohol).
"
">Having
         diabetes.
"
">Having
         hemochromatosis,
         a condition where the body takes up and stores more iron than it needs.
"
">Eating foods that have
         aflatoxin
         (a fungus that can grow on foods, such as grains and nuts that have not been stored properly)."
"
You can lower your risk of getting liver cancer in the following ways—
>Keep a
         healthy weight.
"
">Get vaccinated against Hepatitis B. The
         Hepatitis B vaccine
         is recommended for all infants at birth and for adults who may be at increased risk.
"
">Get
         tested
         for Hepatitis C, and get
         medical care
         if you have it.
"
">Don’t smoke, or
         quit
         if you do.
"
">Avoid drinking too much
         alcohol."
"
The Data Visualizations tool makes it easy for anyone to explore and use the latest official federal government cancer data from United States Cancer Statistics."
"It includes the latest cancer data covering the U.S. population.
"
">Liver and Bile Duct Cancer
          (National Cancer Institute)
>Video: Hepatitis and Liver Cancer Statistics
          (National Cancer Institute)
>Alcohol and Cancer
>Viral Hepatitis and Liver Cancer Prevention Profiles
>Facebook
>Twitter
>LinkedIn
>Syndicate"
"
Bile duct cancer is a rare disease in which malignant (cancer) cells form in the bile ducts."
"Bile duct cancer is also called cholangiocarcinoma.
"
"A network of tubes, called ducts, connects the liver , gallbladder , and small intestine ."
This network begins in the liver where many small ducts collect bile (a fluid made by the liver to break down fats during digestion).
"The small ducts come together to form the right and left hepatic ducts, which lead out of the liver."
The two ducts join outside the liver and form the common hepatic duct .
The cystic duct connects the gallbladder to the common hepatic duct.
"Bile from the liver passes through the hepatic ducts, common hepatic duct, and cystic duct and is stored in the gallbladder.
"
"
There are two types of bile duct cancer:
>Intrahepatic bile duct cancer
          : This type of cancer forms in the bile ducts inside the liver."
Only a small number of bile duct cancers are intrahepatic.
"Intrahepatic bile duct cancers are also called intrahepatic cholangiocarcinomas.
"
">Extrahepatic bile duct cancer
          : This type of cancer forms in the bile ducts outside the liver."
"The two types of extrahepatic bile duct cancer are perihilar bile duct cancer and distal bile duct cancer:Perihilar bile duct cancer
             : This type of cancer is found in the area where the right and left bile ducts exit the liver and join to form the common hepatic duct."
Perihilar bile duct cancer is also called a Klatskin tumor or perihilar cholangiocarcinoma.
"Distal bile duct cancer
             : This type of cancer is found in the area where the ducts from the liver and gallbladder join to form the common bile duct."
"The common bile duct passes through the
             pancreas
             and ends in the small intestine."
"Distal bile duct cancer is also called extrahepatic cholangiocarcinoma.
"
">Perihilar bile duct cancer
             : This type of cancer is found in the area where the right and left bile ducts exit the liver and join to form the common hepatic duct."
"Perihilar bile duct cancer is also called a Klatskin tumor or perihilar cholangiocarcinoma.
"
">Distal bile duct cancer
             : This type of cancer is found in the area where the ducts from the liver and gallbladder join to form the common bile duct."
"The common bile duct passes through the
             pancreas
             and ends in the small intestine."
"
These and other signs and symptoms may be caused by bile duct cancer or by other conditions."
"Check with your doctor if you have any of the following:
>jaundice (yellowing of the skin or whites of the eyes)
>dark urine
>clay colored stool
>pain in the abdomen
>fever
>itchy skin
>nausea and vomiting
>weight loss for an unknown reason
There are no routine screening tests to check for bile duct cancer before signs and symptoms occur."
"To learn about tests that are used to diagnose bile duct cancer, see Bile Duct Cancer Diagnosis .
"
">Updated:July 1, 2022
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “What Is Bile Duct Cancer (Cholangiocarcinoma)?"
"was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
Anything that increases your chance of getting a disease is called a risk factor."
There are several risk factors associated with bile duct cancer .
"Not everyone with one or more of these risk factors will develop the disease, and the disease will develop in some people who don’t have any known risk factors."
"People who think they may be at risk should discuss this with their doctor.
"
"Risk factors for bile duct cancer include the following conditions:
>primary sclerosing cholangitis (a
        progressive disease
        in which the
        bile ducts
        become blocked by
        inflammation
        and scarring)
>chronic
        ulcerative colitis
>cysts
        in the bile ducts (cysts block the flow of
        bile
        and can cause swollen bile ducts, inflammation, and
        infection
        )
>infection with a Chinese liver fluke
        parasite
There are actions you can take that can help to decrease your risk of getting cancer."
"To learn more about ways to prevent cancer, see Cancer Prevention Overview .
"
">Updated:May 18, 2022
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Bile Duct Cancer Causes and Risk Factors was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
Procedures that make pictures of the bile ducts and the nearby area help diagnose bile duct cancer (cholangiocarcinoma) and show how far the cancer has spread."
"The process used to find out if cancer cells have spread within and around the bile ducts or to distant parts of the body is called staging.
"
"In order to plan treatment, it is important to know if the bile duct cancer can be removed by surgery."
"Tests and procedures to detect, diagnose, and stage bile duct cancer are usually done at the same time."
"Every person will not receive all the tests described below.
"
"The following tests and procedures may be used:
>Physical exam and health history
          :"
"A physical exam of the body will be done to check a person's health, including checking for signs of disease, such as lumps or anything else that seems unusual."
"A history of the patient’s health habits and past illnesses and treatments will also be taken.
"
">Liver function tests
          : During this procedure a blood sample is checked to measure the amounts of
          bilirubin
          and alkaline phosphatase released into the blood by the liver."
"A higher than normal amount of these substances can be a sign of liver disease that may be caused by bile duct cancer.
"
">Laboratory tests
          : These medical tests use samples of
          tissue
          , blood, urine, or other substances in the body in order to help diagnose disease, plan and check treatment, or monitor the disease over time.
"
">Carcinoembryonic antigen (CEA) and CA 19-9 tumor marker test
          : Tumor markers are released into the blood by organs, tissues, or
          tumor
          cells in the body."
"Increased levels of CEA and CA 19-9 may be a sign of bile duct cancer.
"
">Ultrasound exam
          : This procedure uses high-energy sound waves (ultrasound) that are bounced off internal tissues or organs, such as the abdomen, and make echoes."
"The echoes form a picture of body tissues called a sonogram.
"
">CT scan (CAT scan)
          : This procedure uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body, such as the abdomen, taken from different angles."
"A dye may be
          injected
          into a vein or swallowed to help the organs or tissues show up more clearly."
"This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
"
">Magnetic resonance imaging (MRI)
          : This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
"
">Magnetic resonance cholangiopancreatography (MRCP)
          : This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body such as the liver, bile ducts,
          gallbladder
          ,
          pancreas
          , and
          pancreatic duct
          .
"
Different procedures may be used to obtain a sample of tissue and diagnose bile duct cancer. 
Cells and tissues are removed during a biopsy so they can be viewed under a microscope by a pathologist to check for signs of cancer.
"The type of procedure used depends on whether the patient is well enough to have surgery.
"
"Types of biopsy procedures include the following:
>Laparoscopy
          : This surgical procedure is done to look at the organs inside the abdomen, such as the bile ducts and liver, to check for signs of cancer."
"Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions."
"Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples to be checked for signs of cancer.
"
">Percutaneous transhepatic cholangiography (PTC)
          : This procedure is used to x-ray the liver and bile ducts."
A thin needle is inserted through the skin below the ribs and into the liver.
Dye is injected into the liver or bile ducts and an x-ray is taken.
A sample of tissue is removed and checked for signs of cancer.
"If the bile duct is blocked, a thin, flexible tube called a stent may be left in the liver to drain
          bile
          into the
          small intestine
          or a collection bag outside the body."
"This procedure may be used when a patient cannot have surgery.
"
">Endoscopic retrograde cholangiopancreatography (ERCP)
          : This procedure is used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine."
"Sometimes bile duct cancer causes these ducts to narrow and block or slow the flow of bile, causing
          jaundice
          ."
"An endoscope (thin, tube-like instrument with a light and a lens for viewing) is passed through the mouth and stomach and into the small intestine."
Dye is injected through the endoscope into the bile ducts and an x-ray is taken.
A sample of tissue is removed and checked for signs of cancer.
"If the bile duct is blocked, a thin tube may be inserted into the duct to unblock it."
This tube (or stent) may be left in place to keep the duct open.
"This procedure may be used when a patient cannot have surgery.
"
">Endoscopic ultrasound (EUS)
          : During this procedure an endoscope is inserted into the body, usually through the mouth or
          rectum
          ."
A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes.
The echoes form a picture of body tissues called a sonogram.
A sample of tissue is removed and checked for signs of cancer.
This procedure is also called endosonography.
"
Once bile duct cancer has been diagnosed, the prognosis (chance of recovery) and treatment options depend on the following:
>whether the cancer is in the upper or lower part of the bile duct system
>the stage of the cancer (whether it affects only the bile ducts or has spread to the liver, lymph nodes, or other places in the body)
>whether the cancer has spread to nearby nerves or veins
>whether the cancer can be completely removed by surgery
>whether the patient has other conditions, such as primary sclerosing cholangitis
>whether the level of CA 19-9 is higher than normal
>whether the cancer has just been diagnosed or has recurred (come back)
"
Treatment options may also depend on the symptoms caused by the cancer.
Bile duct cancer is usually found after it has spread and can rarely be completely removed by surgery.
"Palliative therapy may relieve symptoms and improve the patient's quality of life.
"
">Updated:May 18, 2022
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Bile Duct Cancer Diagnosis was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
"
This page describes the stages of bile duct cancer (cholangiocarcinoma) for adults.
The stage describes the extent of cancer in the body.
Knowing the stage helps the doctor plan the best treatment. 
Bile duct cancer stages are described using the TNM staging system . 
"To learn more about TNM and how cancer stages are described, see Cancer Staging .
"
"To learn about the tests and procedures used to diagnose and stage bile duct cancer, see Bile Duct Cancer Diagnosis ."
"
>Stage 0:
          In stage 0 intrahepatic bile duct cancer (carcinoma in situ), abnormal cells are found in the innermost layer of
          tissue
          lining   the
          intrahepatic bile duct
          ."
"These abnormal cells are not actually cancer but may become cancer and spread into nearby normal tissue.
"
">Stage I:
          Stage I intrahepatic bile duct cancer is divided into stages IA and IB.In stage IA, cancer has formed in an intrahepatic bile duct and the
             tumor
             is 5 centimeters or smaller."
"In stage IB, cancer has formed in an intrahepatic bile duct and the tumor is larger than 5 centimeters.
"
">In stage IA, cancer has formed in an intrahepatic bile duct and the
             tumor
             is 5 centimeters or smaller.
"
">In stage IB, cancer has formed in an intrahepatic bile duct and the tumor is larger than 5 centimeters.
"
">Stage II:
          In stage II intrahepatic bile duct cancer, either of the following is found:the tumor has spread through the wall of an intrahepatic bile duct and into a blood vessel; ormore than one tumor has formed in the intrahepatic bile duct and may have spread into a blood vessel.
"
">the tumor has spread through the wall of an intrahepatic bile duct and into a blood vessel; or
>more than one tumor has formed in the intrahepatic bile duct and may have spread into a blood vessel.
"
">Stage III:
          Stage III intrahepatic bile duct cancer is divided into stages IIIA and IIIB.In stage IIIA"
", the tumor has spread through the capsule (outer lining) of the
             liver
             .In stage IIIB, cancer has spread to organs or tissues near the liver, such as the
             duodenum
             ,
             colon
             , stomach,
             common bile duct
             ,
             abdominal
             wall,
             diaphragm
             , or the part of the
             vena cava
             behind the liver, or the cancer has spread to nearby
             lymph nodes
             .
"
">In stage IIIA, the tumor has spread through the capsule (outer lining) of the
             liver
             .
"
">In stage IIIB, cancer has spread to organs or tissues near the liver, such as the
             duodenum
             ,
             colon
             , stomach,
             common bile duct
             ,
             abdominal
             wall,
             diaphragm
             , or the part of the
             vena cava
             behind the liver, or the cancer has spread to nearby
             lymph nodes
             .
"
">Stage IV:
          In stage IV intrahepatic bile duct cancer, cancer has spread to other parts of the body, such as the bone, lungs, distant lymph nodes, or tissue lining the wall of the abdomen and most organs in the abdomen."
"
>Stage 0:
          In stage 0 perihilar bile duct cancer (carcinoma in situ), abnormal cells are found in the innermost layer of tissue lining the perihilar bile duct."
These abnormal cells are not actually cancer but may become cancer and spread into nearby normal tissue.
"Stage 0 is also called high-grade dysplasia.
"
">Stage I:
          In stage I perihilar bile duct cancer, cancer has formed in the innermost layer of tissue lining the perihilar bile duct and has spread into the muscle layer or
          fibrous
          tissue layer of the perihilar bile duct wall.
"
">Stage II:
          In stage II perihilar bile duct cancer, cancer has spread through the wall of the perihilar bile duct to nearby fatty tissue or to liver tissue.
"
">Stage III:
          Stage III perihilar bile duct cancer is divided into stages IIIA, IIIB, and IIIC.Stage IIIA: Cancer has spread to branches on one side of the
             hepatic artery
             or of the
             portal vein
             .Stage"
IIIB:
"Cancer has spread to one or more of the following:the main part of the portal vein or its branches on both sidesthe common hepatic arterythe right
                hepatic
                duct and the left branch of the hepatic artery or of the portal veinthe left hepatic duct and the right branch of the hepatic artery or of the portal veinStage IIIC: Cancer has spread to 1 to 3 nearby lymph nodes.
"
">Stage IIIA: Cancer has spread to branches on one side of the
             hepatic artery
             or of the
             portal vein
             .
"
>Stage IIIB:
"Cancer has spread to one or more of the following:the main part of the portal vein or its branches on both sidesthe common hepatic arterythe right
                hepatic
                duct and the left branch of the hepatic artery or of the portal veinthe left hepatic duct and the right branch of the hepatic artery or of the portal vein
>the main part of the portal vein or its branches on both sides
>the common hepatic artery
>the right
                hepatic
                duct and the left branch of the hepatic artery or of the portal vein
>the left hepatic duct and the right branch of the hepatic artery or of the portal vein
>Stage IIIC:"
"Cancer has spread to 1 to 3 nearby lymph nodes.
"
">Stage IV:
          Stage IV perihilar bile duct cancer is divided into stages IVA and IVB.Stage IVA: Cancer has spread to 4 or more nearby lymph nodes."
Stage IVB:
"Cancer has spread to other parts of the body, such as the liver, lung, bone, brain, skin, distant lymph nodes, or tissue lining the wall of the abdomen and most organs in the abdomen.
"
">Stage IVA: Cancer has spread to 4 or more nearby lymph nodes.
"
>Stage IVB:
"Cancer has spread to other parts of the body, such as the liver, lung, bone, brain, skin, distant lymph nodes, or tissue lining the wall of the abdomen and most organs in the abdomen."
"
>Stage 0:
          In stage 0 distal bile duct cancer (carcinoma in situ), abnormal cells are found in the innermost layer of tissue lining the distal bile duct."
These abnormal cells are not actually cancer but may become cancer and spread into nearby normal tissue.
"Stage 0 is also called high-grade dysplasia.
"
">Stage I:
          In stage I distal bile duct cancer, cancer has formed and spread fewer than 5 millimeters into the wall of the distal bile duct.
"
">Stage II:
          Stage II distal bile duct cancer is divided into stages IIA and IIB.Stage IIA: Cancer has spreadfewer than 5 millimeters into the wall of the distal bile duct and has spread to 1 to 3 nearby lymph nodes; or5 to 12 millimeters into the wall of the distal bile duct."
Stage IIB:
Cancer has spread 5 millimeters or more into the wall of the distal bile duct.
"Cancer may have spread to 1 to 3 nearby lymph nodes.
"
">Stage IIA: Cancer has spreadfewer than 5 millimeters into the wall of the distal bile duct and has spread to 1 to 3 nearby lymph nodes; or5 to 12 millimeters into the wall of the distal bile duct.
>fewer than 5 millimeters into the wall of the distal bile duct and has spread to 1 to 3 nearby lymph nodes; or
>5 to 12 millimeters into the wall of the distal bile duct.
"
>Stage IIB:
Cancer has spread 5 millimeters or more into the wall of the distal bile duct.
"Cancer may have spread to 1 to 3 nearby lymph nodes.
"
">Stage III:
          Stage III distal bile duct cancer is divided into stages IIIA and IIIB.Stage IIIA: Cancer has spread into the wall of the distal bile duct and to 4 or more nearby lymph nodes."
Stage IIIB:
Cancer has spread to the large vessels that carry blood to the organs in the abdomen.
"Cancer may have spread to 1 or more nearby lymph nodes.
"
">Stage IIIA: Cancer has spread into the wall of the distal bile duct and to 4 or more nearby lymph nodes.
"
>Stage IIIB:
Cancer has spread to the large vessels that carry blood to the organs in the abdomen.
"Cancer may have spread to 1 or more nearby lymph nodes.
"
">Stage IV:
          In stage IV distal bile duct cancer, cancer has spread to other parts of the body, such as the liver, lungs, or tissue lining the wall of the abdomen and most organs in the abdomen.
"
"For bile duct cancer, the following groups are used to plan treatment:"
"
The cancer is in an area, such as the lower part of the common bile duct or perihilar area, where it can be removed completely by surgery."
"
Unresectable cancer cannot be removed completely by surgery."
"Most patients with bile duct cancer cannot have their cancer completely removed by surgery.
"
Metastasis is the spread of cancer from the primary site (place where it started) to other places in the body. 
"Metastatic bile duct cancer may have spread to the liver, other parts of the abdominal cavity , or to distant parts of the body. "
"To learn more about metastatic cancer, see Metastatic Cancer: When Cancer Spreads .
"
Recurrent bile duct cancer is cancer that has come back after treatment.
"The cancer may come back in the bile ducts, liver, or gallbladder ."
"Less often, it may come back in distant parts of the body.  "
"To learn more about recurrent cancer, see Recurrent Cancer: When Cancer Comes Back .
"
"To learn about treatment options, see Bile Duct Cancer Treatment .
"
">Updated:June 2, 2023
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Bile Duct Cancer Stages was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
"
This page describes the different types of treatment for bile duct cancer (cholangiocarcinoma).
Which of these treatments a patient receives will depend on whether the cancer can be completely removed with surgery (resectable) or not (unresectable).
"To learn more, see treatment of resectable and treatment of unresectable bile duct cancer.
"
">Types of treatment
>Treatment of resectable (localized) bile duct cancer
>Treatment of unresectable bile duct cancer (including metastatic or recurrent disease)"
"
The following types of surgery are used to treat bile duct cancer:
>Removal of the bile duct
           : This surgical procedure is done to remove part of the bile duct if the
           tumor
           is small and is in the bile duct only.
           "
"Lymph nodes
           are removed and
           tissue
           from the lymph nodes is viewed under a microscope to see if there is cancer.
"
">Partial hepatectomy
           :"
"This is a surgical procedure to remove the part of the
           liver
           where cancer is found."
"The part removed may be a wedge of tissue, an entire
           lobe
           , or a larger part of the liver, along with some normal tissue around it.
"
">Whipple procedure
           : During this surgical procedure the head of the
           pancreas
           , the
           gallbladder
           , part of the stomach, part of the
           small intestine
           , and the bile duct are removed."
"Enough of the pancreas is left to make digestive juices and
           insulin
           .
"
"After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may receive chemotherapy or radiation therapy to kill any cancer cells that are left."
Treatment given after surgery to lower the risk that the cancer will come back is called adjuvant therapy.
"It is not yet known whether chemotherapy or radiation therapy given after surgery helps keep the cancer from coming back.
"
"The following types of palliative surgery may be done to relieve symptoms caused by a blocked bile duct and improve quality of life:
>Biliary bypass
           : If cancer is blocking the bile duct and
           bile
           is building up in the gallbladder, a biliary bypass may be done."
"During this operation, the doctor will cut the gallbladder or bile duct in the area before the blockage and sew it to the part of the bile duct that is past the blockage or to the small intestine."
"This type of surgery creates a new pathway around the blocked area.
"
">Endoscopic stent placement
           : If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin, flexible tube) to drain bile that has built up in the area."
"The doctor may place the stent through a
           catheter
           that drains the bile into a bag on the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.
"
">Percutaneous transhepatic biliary drainage
           : This procedure is used to x-ray the liver and bile ducts."
A thin needle is inserted through the skin below the ribs and into the liver.
Dye is injected into the liver or bile ducts and an x-ray is taken.
"If the bile duct is blocked, a stent may be left in the liver to drain bile into the small intestine or a collection bag outside the body."
"
Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing."
"These are the main ways radiation might be given to treat bile duct cancer:
>External radiation therapy
           : A machine outside the body sends radiation toward the area of the body with cancer."
Radiation is given in a series of treatments to allow healthy cells to recover and to make radiation more effective.
"The number of treatments is based on details about the cancer, such as the size and location of the tumor."
It is not known whether external radiation therapy helps in the treatment of resectable bile duct cancer.
"In unresectable,
            metastatic
            , or
            recurrent
            bile duct cancer, new ways to improve the effect of external radiation therapy on cancer cells are being studied:Hyperthermia therapy
              : Body tissue is exposed to high temperatures to make cancer cells more sensitive to the effects of radiation therapy and certain anticancer drugs."
"Radiosensitizers
              : Drugs called radiosensitizers make cancer cells more sensitive to radiation therapy."
"Combining radiation therapy with radiosensitizers may kill more cancer cells.
"
It is not known whether external radiation therapy helps in the treatment of resectable bile duct cancer.
"In unresectable, metastatic , or recurrent bile duct cancer, new ways to improve the effect of external radiation therapy on cancer cells are being studied:
>Hyperthermia therapy
              : Body tissue is exposed to high temperatures to make cancer cells more sensitive to the effects of radiation therapy and certain anticancer drugs.
"
">Radiosensitizers
              : Drugs called radiosensitizers make cancer cells more sensitive to radiation therapy."
"Combining radiation therapy with radiosensitizers may kill more cancer cells.
"
">Internal radiation therapy
           : A
           radioactive
           substance is sealed in needles,
           seeds
           , wires, or catheters that are placed directly into or near the bile duct.
"
"External and internal radiation therapy are used to treat bile duct cancer and may also be used as palliative therapy to relieve symptoms and improve quality of life.
"
"To learn more about radiation therapy and its side effects, see Radiation Therapy to Treat Cancer and Radiation Therapy Side Effects ."
"
Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing."
"There are two main types of chemotherapy used to treat bile duct cancer.
"
">Systemic chemotherapy
           : When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body."
"Systemic chemotherapy is used to treat unresectable, metastatic, or recurrent bile duct cancer."
"The following chemotherapy drugs may be used:gemcitabine and cisplatincapecitabine and oxaliplatin (XELOX)gemcitabine and oxaliplatin
              (GEMOX)gemcitabine
              and
              capecitabine
Systemic chemotherapy is used to treat unresectable, metastatic, or recurrent bile duct cancer."
"The following chemotherapy drugs may be used:
>gemcitabine and cisplatin
>capecitabine and oxaliplatin (XELOX)
>gemcitabine and oxaliplatin
              (GEMOX)
>gemcitabine
              and
              capecitabine
>Regional chemotherapy
           :"
"When chemotherapy is placed directly into an organ, or a body
           cavity
           such as the abdomen, the drugs mainly affect cancer cells in those areas."
"In unresectable, metastatic, or recurrent bile duct cancer, intra-arterial embolization is being studied."
It is a procedure in which the blood supply to a tumor is blocked after anticancer drugs are given in blood vessels near the tumor.
"Sometimes, the anticancer drugs are attached to small beads that are injected into an artery that feeds the tumor."
The beads block blood flow to the tumor as they release the drug.
"This allows a higher amount of drug to reach the tumor for a longer period of time, which may kill more cancer cells.
"
"In unresectable, metastatic, or recurrent bile duct cancer, intra-arterial embolization is being studied."
It is a procedure in which the blood supply to a tumor is blocked after anticancer drugs are given in blood vessels near the tumor.
"Sometimes, the anticancer drugs are attached to small beads that are injected into an artery that feeds the tumor."
The beads block blood flow to the tumor as they release the drug.
"This allows a higher amount of drug to reach the tumor for a longer period of time, which may kill more cancer cells.
"
"It is not known whether systemic chemotherapy helps in the treatment of resectable bile duct cancer.
"
"To learn about the different ways chemotherapy works against cancer, what to expect when receiving chemotherapy, and how to manage chemotherapy side effects, see Chemotherapy to Treat Cancer ."
"
In a liver transplant, the entire liver is removed and replaced with a healthy donated liver."
A liver transplant may be done in patients with perihilar bile duct cancer.
"If the patient has to wait for a donated liver, other treatment is given as needed."
"
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells."
Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.
"The following targeted therapies are being studied in patients with bile duct cancer that is locally advanced and cannot be removed by surgery or has spread to other parts of the body:
>ivosidenib
>pemigatinib
>infigratinib
To learn more about how targeted therapy works against cancer, what to expect when having targeted therapy, and targeted therapy side effects, see Targeted Therapy to Treat Cancer ."
"
Immunotherapy is a treatment that uses the patient's immune system to fight cancer."
"Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.
"
Immune checkpoint inhibitor therapy is a type of immunotherapy.
"The following immune checkpoint inhibitor may be used to treat bile duct cancer:
>pembrolizumab
>durvalumab
To learn more about how immunotherapy works against cancer and immunotherapy side effects, see Immunotherapy to Treat Cancer and Immunotherapy Side Effects ."
"
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. "
"For some patients, taking part in a clinical trial may be an option.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. "
"Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
"
"To learn more about clinical trials, see Clinical Trials Information for Patients and Caregivers ."
"
If the cancer has not spread and is in a place where surgery can be safely done, the tumor and some of the tissue around it will be removed."
This lowers the chance of the cancer coming back.
"Chemotherapy with or without radiation therapy may be given after surgery.
"
"Treatment of resectable intrahepatic bile duct cancer may include the following:
>surgery to remove the cancer, which may include partial hepatectomy with or without embolization before surgery
Treatment of resectable perihilar bile duct cancer may include the following:
>surgery to remove the cancer, which may include partial hepatectomy
>stent placement or percutaneous transhepatic biliary drainage as palliative therapy, to         relieve
          jaundice
          and other symptoms and improve     the quality of    life
Treatment of resectable distal bile duct cancer may include the following:
>surgery to remove the cancer, which may include a Whipple procedure
>stent placement or percutaneous transhepatic biliary drainage as palliative therapy, to relieve jaundice and other symptoms and improve the quality of life
Adjuvant therapy for resectable bile duct cancer may include the following:
>chemotherapy
>external-beam radiation therapy
>a clinical trial of adjuvant therapy"
"
Most people with bile duct cancer cannot have their cancer completely removed with surgery."
"This may be the case if the cancer has spread too far, the cancer is in a place that is too difficult to completely remove with surgery, or the patient is not healthy enough for surgery.
"
"Treatment of unresectable bile duct cancer (including metastatic or recurrent disease) may include the following:
>stent placement or biliary bypass as palliative treatment to relieve symptoms and improve the quality of   life
>external or internal radiation therapy as palliative treatment to relieve symptoms and improve the quality of life
>combination chemotherapy
>an immunotherapy drug
>a clinical trial of various combinations of chemotherapy
>a clinical trial of immunotherapy in patients with mutations (changes) in certain
          genes
>a clinical trial of targeted therapy in patients with mutations in certain genes
>Updated:March 31, 2023
If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Bile Duct Cancer Treatment was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
Liver cancer can be caused by long-term infections with hepatitis C virus (HCV) or hepatitis B virus (HBV)."
"The opioid epidemic has increased the number of people who inject drugs in the United States, which may lead to an increased risk of HBV and HCV transmission through use of shared equipment.1These factors may contribute to the increase in liver cancer in the United States.2
Although the risk of developing liver cancer is low, surviving liver cancer is very difficult."
"For every 100,000 people, 8 new liver and intrahepatic bile duct cancer cases are reported, and 7 people die of these diseases, according to 2019 data from United States Cancer Statistics.3
"
CDC conducted a demonstration project to build sustainable partnerships with local organizations to improve knowledge and awareness of the link between injecting drugs and getting hepatitis and liver cancer.
"Four National Comprehensive Cancer Control Program (NCCCP) recipients in Iowa, Mississippi, West Virginia, and the American Indian Cancer Foundation (AICAF), which serves Native communities in Minnesota, participated in the project."
"
Educating health care providers about the link between the opioid crisis and increased rates of viral hepatitis and liver cancer can improve their knowledge and awareness of liver cancer and their ability and intention to—
>Talk about these topics with their colleagues and patients.
"
">Identify patients at risk.
"
">Refer patients at risk for HBV and HCV screening and HBV vaccination.
"
"NCCCP recipients collaborated with partners to—
>Develop and distribute provider education materials.
>Plan, host, and record live educational activities through webinars and Project ECHO®educational sessions.
"
">Offer continuing medical education (CME) credits for completed educational sessions.
"
">Collect data to track participation in webinars and ECHO educational sessions, as well as changes in knowledge, awareness, ability, and intent of providers who received materials and participated in the webinars and sessions."
"
Educating patients at risk for liver cancer about the link between the opioid crisis and increased rates of viral hepatitis and liver cancer can improve their knowledge and awareness of liver cancer."
"It can also improve their ability and intention to talk about these topics with their health care provider, be screened for HBV and HCV, and be vaccinated for HBV.
"
"Staff from one NCCCP recipient collaborated with partners to—
>Distribute patient education materials.
"
">Conduct in-person educational sessions.
"
">Collect data to track participation in the in-person sessions and changes in knowledge, awareness, ability, and intent of patients who participated."
"
Encouraging providers to identify patients at risk for HBV and HCV, assess for risk factors such as opioid or injection drug use, and follow guidelines for testing based on patient age and risk level can help improve the delivery of viral hepatitis services.
"
"Staff from one NCCCP recipient collaborated with partners to—
>Provide an opportunity for community-focused primary care providers who participated in the ECHO educational sessions to present cases of HCV-positive patients and seek consultation to determine the appropriate course of treatment.
"
">Review and revise the case presentation form so that providers could better assess for risk factors (such as opioid or injection drug use) and HBV infection status (current or past).
"
>Collect data to track the number and types of cases presented and courses of treatment recommended.
"
Comprehensive syringe services programs are community-based prevention programs that can provide a range of services, such as—
>Links to substance use disorder treatment.
"
">Access to and disposal of sterile syringes and injection equipment.
"
">Education about overdose and safer injection practices.
"
">Vaccination, testing, and links to care and treatment for infectious diseases.
"
"Staff from one NCCCP recipient collaborated with partners to—
>Conduct community engagement and outreach, including distribution and collection of harm reduction materials.
"
">Provide mobile HBV and HCV screening and medical services during outreach events.
"
">Collect data to track hepatitis screening, treatment, and the distribution and collection of harm reduction materials."
"
>2 webinars were delivered.66 providers attended the webinars.48 providers stated their intention to apply for CME credit.
>66 providers attended the webinars.
"
">48 providers stated their intention to apply for CME credit.
"
">8 educational sessions were delivered—251 providers participated in the ECHO sessions.
           "
"†85 providers were awarded CMEs.
"
">251 providers participated in the ECHO sessions.
           "
"†
>85 providers were awarded CMEs.
"
">8 educational materials were developed—More than 300 providers received the materials.
"
>More than 300 providers received the materials.
"
>2 in-person educational sessions were delivered.
"
>41 patients participated in the sessions.
"
>14 ECHO sessions on HCV were conducted.
"
>99 cases were presented across all sessions.
"Of these cases—All cases presented were for patients diagnosed with chronic HCV.52 unique providers participated across all sessions.42 hepatitis A vaccines and 48 HBV vaccines were administered during the project period.14 patients were in the queue to begin HCV treatment during the project period.
           "
"‡11 patients were started on HCV treatment during the project period.5 patients completed HCV treatment during the project period.
"
">All cases presented were for patients diagnosed with chronic HCV.
"
">52 unique providers participated across all sessions.
>42 hepatitis A vaccines and 48 HBV vaccines were administered during the project period.
"
">14 patients were in the queue to begin HCV treatment during the project period.
           "
"‡
>11 patients were started on HCV treatment during the project period.
"
>5 patients completed HCV treatment during the project period.
"
>1 new data collection system was developed to monitor progress.
"
">145 outreach events or locations were visited, including encampment street outreach events in South Minneapolis and onsite testing events at a local community clinic.
"
">28 clients were screened for hepatitis B, 38 clients were screened for hepatitis C, and 115 clients were treated for hepatitis C during the project period.
"
">More than 100,000 clean syringes and other harm reduction materials were distributed over the course of the project during outreach events, including encampment street outreach events in South Minneapolis and onsite testing events at a local community clinic.
>39,135 harm reduction materials were collected over the course of the project.
"
†This number does not represent the number of unique participants.
"Some providers likely attended multiple sessions over the course of the project.‡These patients were in the queue during the project period because of requirements that must be met before HCV treatment can begin, such as waiting for lab results to arrive, the COVID vaccine interaction period to end, or the patient to return for a follow-up visit."
"
>NCCCP recipients encountered several challenges, including the COVID-19 public health emergency, contracting issues, limited staffing and staff changes, competing staff priorities, and limited funding."
"Maintaining flexibility and being creative and willing to change plans when challenges arise is essential.
"
">When starting a new project, early and frequent engagement with partners will help ensure that contracts are established in a timely fashion."
"This approach was especially important during the COVID-19 public health emergency.
"
>Technical assistance is a strong facilitator for success.
"CDC helped NCCCP recipients plan, implement, and evaluate their efforts and troubleshoot challenges throughout the project."
"CDC also helped recipients develop content for educational materials and sessions, measures for evaluation, and questions for data collection instruments.
"
">Simultaneous strategy implementation and evaluation helps ensure that NCCCP recipients and partners have a clear understanding of the work.
"
">When developing educational content, it is helpful to adapt information from credible sources that already exist rather than creating new content.
"
"NCCCP recipients developed the following publicly available resources as part of this demonstration project—
>Recorded ECHO Series Address Hepatitis C, A Risk Factor for Liver Cancer,
          Iowa Cancer Consortium
>HIV and HCV Co-Infection Overview,
          Iowa Primary Care Association, Project ECHO®
>How Do We Provide HCV Care for Individuals Experiencing Homelessness?,
          Iowa Primary Care Association, Project ECHO®
>Addressing the Emerging Viral Hepatitis, HIV, and Opioid Use Disorder Epidemics in Rural Communities,
          Iowa Primary Care Association, Project ECHO®
>Hepatitis Landscape in West Virginia,
          West Virginia Immunization Network
>Centers for Disease Control and Prevention, Division of Viral Hepatitis.
          "
"People Who Use or Inject Drugs and Viral Hepatitis.
          "
"Last reviewed August 24, 2020.
"
">National Academies of Sciences, Engineering, and Medicine. 2017.
          "
"A National Strategy for the Elimination of Hepatitis B and C: Phase Two Report.
          "
"Washington, DC:"
The National Academies Press.
"DOI: 10.17226/24731.
>Cancer Statistics at a Glance.
          "
U.S. Cancer Statistics Working Group.
"U.S. Cancer Statistics Data Visualizations Tool, based on 2021 submission data (1999–2019): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute;
          www.cdc.gov/cancer/dataviz
          , released in June 2022.
"
"Implementing promising strategies to reduce the risk for viral hepatitis and liver cancer among people who inject drugs
>Facebook
>Twitter
>LinkedIn
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"
Liver cancer can be caused by long-term infections with hepatitis C virus (HCV) or hepatitis B virus (HBV)."
"The opioid epidemic has increased the number of people who inject drugs in the United States, which may lead to an increased risk of HCV and HBV transmission through use of shared equipment.1These factors may contribute to the increase in liver cancer in the United States.2
Although the risk of developing liver cancer is low, surviving liver cancer is very difficult."
"For every 100,000 people, 8 new liver and intrahepatic bile duct cancer cases are reported, and 7 people die of these diseases, according to 2019 data from United States Cancer Statistics.3
From 2000 through 2020, there were 20,780 confirmed cases of long-term HCV infections reported to the Iowa Department of Public Health."
"In 2020, a total of 825 Iowans were newly diagnosed with a chronic HCV infection; of these, 30% were younger than 40, and 71% reported using injection drugs.4In addition, the incidence rate of new liver and intrahepatic bile duct cancer cases in Iowa has increased substantially, from 1.7 cases per 100,000 in 1975 to 1979 to 6.9 cases per 100,000 in 2018 to 2019.5"
"
CDC provides funding, guidance, and technical assistance to its National Comprehensive Cancer Control Program (NCCCP) recipients to create, carry out, and evaluate plans to prevent and control cancer."
"In 2019, CDC started a 3-year demonstration project, working with four NCCCP recipients to build sustainable partnerships with local organizations to improve knowledge and awareness of the link between injecting drugs and getting hepatitis and liver cancer."
"
The Iowa Comprehensive Cancer Control Program at the Iowa state health department participated in a CDC demonstration project to put promising or proven liver cancer prevention strategies into action."
The goal was to reduce the incidence of HBV and HCV infections and opioid overdose and decrease liver cancer rates among people who inject drugs.
"
Iowa’s cancer program partnered with the Iowa Primary Care Association and Des Moines University to—
>Educate Iowa providers (primary care, medication-assisted treatment, substance use disorders, and behavioral health) on the relationship between opioid injection, HBV, HCV, and liver cancer.
"
">Plan, host, and record educational sessions through the primary care association HCV and behavioral health
         Project ECHO®
         platforms.
"
">Offer continuing medical education (CME) credits for completed educational sessions through the university.
"
">Make recorded versions of educational sessions available through the primary care association SharePoint site and the university website.
"
">Collect data to track participation in the live educational sessions, as well as changes in knowledge, awareness, ability, and intent of participating providers to talk to their patients about HBV and HCV."
"
Iowa’s cancer program partnered with the state’s primary care association to—
>Provide an opportunity for community-focused primary care providers who participated in the HCV ECHO to virtually present cases of HCV-positive patients and seek consultation to determine the appropriate course of treatment.
"
">Review and revise the case presentation form so that providers could better assess for risk factors (such as opioid or injection drug use) and HBV infection status (current or past).
"
>Collect data to track the number and types of cases presented and courses of treatment recommended.
"
>8 live educational sessions were delivered through the HCV and behavioral health ECHO platforms.
"
">251 providers (not all unique) participated across the 8 live sessions.
"
">All 8 sessions were made available to registered participants through the primary care association SharePoint site.
"
">3 recorded sessions on HCV were made available on the university website.
"
">6 sessions were approved by the university for CME credits; 85 participants were awarded CME credits during the project period.
"
">24 providers completed the retrospective pre-post assessment to assess changes in knowledge, awareness, ability, and intent."
"
>14 ECHO sessions on HCV were conducted.
"
>99 cases were presented across all sessions.
"Of these cases—All cases presented were for patients diagnosed with chronic HCV.52 unique providers participated across all sessions.42 hepatitis A vaccines and 48 HBV vaccines were administered during the project period.14 patients were in the queue to begin HCV treatment during the project period.†11 patients were started on HCV treatment during the project period.5 patients completed HCV treatment during the project period.
"
">All cases presented were for patients diagnosed with chronic HCV.
"
">52 unique providers participated across all sessions.
>42 hepatitis A vaccines and 48 HBV vaccines were administered during the project period.
"
">14 patients were in the queue to begin HCV treatment during the project period.†
>11 patients were started on HCV treatment during the project period.
"
">5 patients completed HCV treatment during the project period.
"
"†These patients were in the queue during the project period because of requirements that must be met before HCV treatment can begin such as waiting for lab results to arrive, the COVID vaccine interaction period to end, or the patient to return for a follow-up visit."
"
>ECHO educational session speakers often only presented on one of the three topics (opioids, viral hepatitis, or liver cancer) instead of tying them together."
"Prepared slides or bullet points for presenters are essential for integrating the three topics and making the connection between them.
"
>Getting providers to complete the retrospective pre-post assessment for the educational sessions was challenging.
"Making completion of the assessment a requirement for receiving CME credits and providing information on why the assessment is important may help boost response rates.
"
">The ECHO case presentations on HCV provide a forum to address the barriers to care (such as Medicaid restrictions) that many patients face when referral to a specialist is required.
"
">Including case outcome fields (such as treatment started date, treatment completed date, vaccine series started date, and vaccine series completed date) on case presentation forms will help to track final outcomes of patients whose cases were presented during the ECHO presentations.
"
">Recorded ECHO Series Address Hepatitis C, A Risk Factor for Liver Cancer,
          Iowa Cancer Consortium
>HIV and HCV Co-Infection Overview,
          Iowa Primary Care Association, Project ECHO® (free registration required)
>How Do We Provide HCV Care for Individuals Experiencing Homelessness?,
          Iowa Primary Care Association, Project ECHO® (free registration required)
>Addressing the Emerging Viral Hepatitis, HIV, and Opioid Use Disorder Epidemics in Rural Communities,
          Iowa Primary Care Association, Project ECHO® (free registration required)
Katie JonesManager, Comprehensive Cancer Control ProgramIowa Department of Public HealthOffice: 515-204-7073
>Centers for Disease Control and Prevention, Division of Viral Hepatitis.
          "
"People Who Use or Inject Drugs and Viral Hepatitis.
          "
"Last reviewed August 24, 2020.
"
">National Academies of Sciences, Engineering, and Medicine.
          "
"A national strategy for the elimination of hepatitis B and C: phase two report.
          "
The National Academies Press; 2017.
"DOI: 10.17226/24731.
>Cancer Statistics at a Glance.
          "
U.S. Cancer Statistics Working Group.
"U.S. Cancer Statistics Data Visualizations Tool, based on 2021 submission data (1999-2019): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute."
June 2022.
"Accessed June 30, 2022.
"
">Iowa Department of Public Health, Bureau of HIV, STD, and Hepatitis.
          "
State of Iowa Hepatitis C Virus (HCV) End-of-Year 2020 Surveillance Report.
"[PDF-1.2MB]
          Des Moines: Iowa Department of Public Health, 2021.
"
>University of Iowa College of Public Health.
"(2017).
          "
Cancer in Iowa.
"[PDF-9.6MB]
>Facebook
>Twitter
>LinkedIn
>Syndicate"
"
Liver cancer can be caused by long-term infections with hepatitis C virus (HCV) or hepatitis B virus (HBV)."
"The opioid epidemic has increased the number of people who inject drugs in the United States, which may lead to an increased risk of HCV and HBV transmission through use of shared equipment.1These factors may contribute to the increase in liver cancer in the United States.2
Although the risk of developing liver cancer is low, surviving liver cancer is very difficult."
"For every 100,000 people, 8 new liver and intrahepatic bile duct cancer cases are reported, and 7 people die of these diseases, according to 2019 data from United States Cancer Statistics.3
The Mississippi State Department of Health reported that opioid-related deaths accounted for 3 of 4 suspected overdose deaths in 2020.4From 2013 to 2016, HCV prevalence was estimated to be about 1 in 100 adults, or about 23,500 people living with HCV in Mississippi.5In addition, from 2015 to 2019, Mississippi was ranked 4th in the nation for liver cancer mortality, with a rate of 8.3 deaths per 100,000 people.6These data highlight the burden of opioid abuse, HCV, and liver cancer in the state."
"
CDC provides funding, guidance, and technical assistance to its National Comprehensive Cancer Control Program (NCCCP) recipients to create, carry out, and evaluate plans to prevent and control cancer."
"In 2019, CDC started a 3-year demonstration project, working with four NCCCP recipients to build sustainable partnerships with local organizations to improve knowledge and awareness of the link between injecting drugs and getting hepatitis and liver cancer."
"
The Mississippi Comprehensive Cancer Control Program at the state health department participated in a CDC demonstration project to put promising or proven liver cancer prevention strategies into action."
The goal was to reduce the incidence of HBV and HCV infections and opioid overdose and decrease liver cancer rates among people who inject drugs.
"
Mississippi’s cancer program partnered with the Communicare Haven House (Haven House) and Coastal Family Health Center, Inc. to—
>Create and distribute three infographics on HBV risk and vaccination and HCV risk and screening to educate health care providers about the link between the opioid crisis and increased rates of viral hepatitis and liver cancer.
>Create and distribute a brief highlighting state data on opioid use, viral hepatitis, and liver cancer.
"
">Collect data to track changes in knowledge, awareness, ability, and intent of participating providers to talk to their patients about HBV and HCV."
"
Mississippi’s cancer program partnered with Haven House to—
>Distribute two infographics on HBV risk and vaccination and HCV risk and screening to educate residential patients at high risk about the link between the opioid crisis and increased rates of viral hepatitis and liver cancer.
"
">Conduct in-person educational sessions that included two videos about symptoms, risks, prevention, and treatment of HBV and HCV.
>Collect data to track changes in knowledge, awareness, ability, and intent of patients to be screened."
"
>300 providers were sent 3 infographics and a data brief in a series of 4 emails.
>48 providers completed the pre-test and 53 providers completed the post-test."
"Statistically significant improvements were identified in providers’ intent to talk to patients about HBV and HCV (significance was assessed at P<0.05).
"
>Statistically significant improvements were identified in providers’ intent to talk to patients about HBV and HCV (significance was assessed at P<0.05).
"
>2 in-person educational sessions were delivered.
"
>41 patients participated in the sessions.
"Statistically significant improvements were identified in patients’ knowledge and awareness of HBV and HCV and in their intent to be screened (significance was assessed at P<0.05).
"
>Statistically significant improvements were identified in patients’ knowledge and awareness of HBV and HCV and in their intent to be screened (significance was assessed at P<0.05).
"
>Getting providers to complete a pre-post assessment for the educational materials was challenging."
"Offering continuing medical education (CME) credits as an incentive, making completion of the assessment a requirement for receiving CME credits, and providing information on why the assessment is important may help boost response rates.
"
>Patients showed interest in the information being shared during the educational sessions.
"Providing onsite HBV and HCV screening, vaccination, and treatment services after the sessions could be an effective strategy to reach people at high risk.
"
Mississippi’s cancer program developed two resources as part of this demonstration project.
"Contact Catherine Young, Mississippi’s cancer program director, to get a copy of these resources.
"
>Hepatitis C:
"What You Should Know
>Connecting Opioid Use, Viral Hepatitis & Liver Cancer Prevention Profile
Catherine C. Young, MSMDirector, Comprehensive Cancer Control ProgramOffice of Preventive Health and Health EquityMississippi State Department of HealthOffice: 601-206-1077
>Centers for Disease Control and Prevention, Division of Viral Hepatitis.
          "
"People Who Use or Inject Drugs and Viral Hepatitis.
          "
"Last reviewed August 24, 2020.
"
">National Academies of Sciences, Engineering, and Medicine.
          "
"A national strategy for the elimination of hepatitis B and C: phase two report.
          "
The National Academies Press; 2017.
"DOI: 10.17226/24731.
>Cancer Statistics at a Glance.
          "
U.S. Cancer Statistics Working Group.
"U.S. Cancer Statistics Data Visualizations Tool, based on 2021 submission data (1999-2019): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute."
June 2022.
"Accessed June 30, 2022.
"
">Provisional Data Report, First Quarter 2022."
The Mississippi Opioid and Heroin Data Collaborative.
July 2022.
"Accessed November 9, 2022.
>Bradley H, Hall EW, Rosenthal EM, et al.
          Hepatitis C virus prevalence in 50 U.S. states and D.C. by sex, birth cohort, and race: 2013-2016.
          "
Hepatology Communications.
2020;4(3):355-370.
"DOI: 10.1002/hep4.1457.
>Death Rate Report by State, 2016–2020, Liver and Bile Duct."
"State Cancer Profiles.
          "
Centers for Disease Control and Prevention and National Cancer Institute.
"Accessed January 25, 2022.
"
">Facebook
>Twitter
>LinkedIn
>Syndicate"
"
Liver cancer can be caused by long-term infections with hepatitis C virus (HCV) or hepatitis B virus (HBV)."
"The opioid epidemic has increased the number of people who inject drugs in the United States, which may lead to an increased risk of HCV and HBV transmission through use of shared equipment.1These factors may contribute to the increase in liver cancer in the United States.2
Although the risk of developing liver cancer is low, surviving liver cancer is very difficult."
"For every 100,000 people, 8 new liver and intrahepatic bile duct cancer cases are reported, and 7 people die of these diseases, according to 2019 data from United States Cancer Statistics.3
From 1999 to 2015, American Indian and Alaska Native (AI/AN) people had the highest drug overdose death rates—22.1 per 100,000 in metropolitan areas and 19.8 per 100,000 in nonmetropolitan areas.4The HCV-related death rate among AI/AN people in the Northwest is three times higher than the rate among non-Hispanic White people (19.6 versus 5.9 per 100,000).5The liver cancer incidence rate among AI/AN people is two times higher than that of non-Hispanic Whites (11.9 versus 5.5 per 100,000).6"
"
CDC provides funding, guidance, and technical assistance to its National Comprehensive Cancer Control Program (NCCCP) recipients to create, carry out, and evaluate plans to prevent and control cancer."
"In 2019, CDC started a 3-year demonstration project, working with four NCCCP recipients to build sustainable partnerships with local organizations to improve knowledge and awareness of the link between injecting drugs and getting hepatitis and liver cancer."
"
The American Indian Cancer Foundation participated in a CDC demonstration project to put promising or proven liver cancer prevention strategies into action."
The goal was to reduce the incidence of HBV and HCV infections and opioid overdose and decrease liver cancer rates among people who inject drugs.
"
The American Indian Cancer Foundation partnered with the Native American Community Clinic to—
>Develop and distribute a news brief email and three educational resources to educate clinic providers about hepatitis B, hepatitis C, and liver cancer.
"
">Work with the Mayo Clinic to develop and set up a webinar to educate community clinic medical staff about liver cancer incidence, risk factors, screening and prevention, and treatment.
"
">Collect data to track the number of emails sent; the number of providers who received the news brief email; the number of providers who participated in the webinar; and changes in knowledge, awareness, ability, and intent of participating providers to talk to their patients about HBV and HCV."
"
The American Indian Cancer Foundation partnered with the Native American Community Clinic to—
>Conduct community engagement and outreach, including distribution and collection of harm reduction materials.
"
">Provide mobile HBV and HCV screening and medical services during outreach events.
"
">Collect data to track hepatitis screening, treatment, and the distribution and collection of harm reduction materials."
"
>1 medical oncologist who specialized in gastrointestinal cancers, including liver cancer, from the Mayo Clinic presented the webinar and led a question and answer session with community clinic providers."
"The discussion focused on how community clinic providers can apply what they learned to their work.
>11 community clinic providers received the news brief email and education resources."
"Educational resources were also provided to the clinic for continued dissemination to providers and patients.
>7 providers completed the pre-assessment and 1 provider completed the post-assessment to assess changes in knowledge, awareness, ability, and intent.
"
">12 of 14 invited community clinic medical providers attended the webinar, which improved the information provided in the news brief email and resources.
>5 providers completed the pre-assessment and 6 providers completed the post-assessment to assess changes in knowledge, awareness, ability, and intent."
"
>1 new data collection system was developed to monitor progress.
"
">145 outreach events or locations were visited, including encampment street outreach events in South Minneapolis and onsite testing events at a local community clinic.
"
">28 clients were screened for hepatitis B, 38 clients screened for hepatitis C, and 115 clients treated for hepatitis C during the project period.
"
">More than 100,000 clean syringes and other harm reduction materials were distributed outreach events, including encampment street outreach events in South Minneapolis and onsite testing events at a local community clinic.
"
">39,135 harm reduction materials were collected over the course of the project."
"
>Getting providers to complete pre- and post-assessments for the webinar and news brief emails was challenging."
"Providing incentives, such as 1 free hour of administrative time or continuing medical education (CME) credits for participating, and requiring completion of the evaluation forms to receive the CME credits may help boost participation.
"
">When working with partners, being flexible and able to change plans when challenges arise is essential."
"Over the course of this project, the American Indian Cancer Foundation and the local community clinic worked together to overcome multiple challenges, including staff changes and the COVID-19 public health emergency, to carry out a successful demonstration project.
"
The American Indian Cancer Foundation developed the following resources as part of this demonstration project.
"Contact Lindsey Petras, the cancer program director, to get a copy of these resources.
"
">Liver Cancer Overview
>What Is Hepatitis B?
>"
"Hepatitis C
Lindsey PetrasCancer Program ManagerAmerican Indian Cancer FoundationOffice: 612-314-4848
>Centers for Disease Control and Prevention, Division of Viral Hepatitis.
          "
"People Who Use or Inject Drugs and Viral Hepatitis.
          "
"Last reviewed August 24, 2020.
"
">National Academies of Sciences, Engineering, and Medicine.
          "
"A national strategy for the elimination of hepatitis B and C: phase two report.
          "
The National Academies Press; 2017.
"DOI: 10.17226/24731.
>Cancer Statistics at a Glance.
          "
U.S. Cancer Statistics Working Group.
"U.S. Cancer Statistics Data Visualizations Tool, based on 2021 submission data (1999-2019): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute."
June 2022.
"Accessed June 30, 2022.
"
">Mack KA, Jones CM, Ballesteros MF.
          "
"Illicit drug use, illicit drug use disorders, and drug overdose deaths in metropolitan and nonmetropolitan areas—United States.
          "
"MMWR Surveillance Summaries
          2017;66(SS-19):1–12."
"DOI: 10.15585/mmwr.ss6619a1.
"
">Hatcher SM, Joshi S, Robinson BF, Weiser T.
          Hepatitis C-related mortality among American Indian/Alaska Native persons in the northwestern United States, 2006–2012.
          "
"Public Health Reports
          2020;135(1):66–73."
"DOI: 10.1177/0033354919887748.
>Islami F, Goding Sauer A, Miller KD, Siegel RL, Fedewa SA, Jacobs EJ, McCullough ML, Patel AV, Ma J, Soerjomataram I, Flanders WD, Brawley OW, Gapstur SM, Jemal A.
          Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States.
          "
CA:
"A Cancer Journal for Clinicians
          2018;68(1):31–54."
"DOI: 10.3322/caac.21440.
>Facebook
>Twitter
>LinkedIn
>Syndicate"
"
Liver cancer can be caused by long-term infections with hepatitis C virus (HCV) or hepatitis B virus (HBV)."
"The opioid epidemic has increased the number of people who inject drugs in the United States, which may lead to an increased risk of HCV and HBV transmission through use of shared equipment.1These factors may contribute to the increase in liver cancer in the United States.2
Although the risk of developing liver cancer is low, surviving liver cancer is very difficult."
"For every 100,000 people, 8 new liver and intrahepatic bile duct cancer cases are reported, and 7 people die of these diseases, according to 2019 data from United States Cancer Statistics.3
In 2019, West Virginia’s rate of HBV was 4.2 per 100,000, among the highest in the United States.4In 2015, the state reported nearly 5 times the national average of acute HCV cases—3.4 per 100,000 compared to 0.7 per 100,000 for the overall United States.5West Virginia surveillance data from 2012 to 2015 showed that 25%–40% of acute HCV cases reported injection drug use as a potential risk factor for their infection.6West Virginia has also ranked highest in the country for drug overdose deaths each year from 2014 to 2020.7In addition, the age-adjusted incidence rate for liver cancer in West Virginia from 2010 to 2014 was 6 per 100,000, and the death rate was 5.4 per 100,000.8"
"
CDC provides funding, guidance, and technical assistance to its National Comprehensive Cancer Control Program (NCCCP) recipients to create, carry out, and evaluate plans to prevent and control cancer."
"In 2019, CDC started a 3-year demonstration project, working with four NCCCP recipients to build sustainable partnerships with local organizations to improve knowledge and awareness of the link between injecting drugs and getting hepatitis and liver cancer."
"
The West Virginia Department of Health and Human Resources’ Bureau for Public Health participated in a CDC demonstration project to put promising or proven liver cancer prevention strategies into action."
The goal was to reduce the incidence of HBV and HCV infections and opioid overdose and decrease liver cancer rates among people who inject drugs.
"
West Virginia partnered with the West Virginia Immunization Network to—
>Develop and conduct a webinar to educate health care and public health professionals about the connection between injection drug use, viral hepatitis, and liver cancer.
"
">Work with internal and external experts to develop and facilitate the webinar.
"
">Collect data to track participation the number of people who registered for and participated in the webinar, as well as changes in the knowledge, awareness, ability, and intent of participating providers to talk to their patients about HBV and HCV."
"
>178 providers clicked on the registration link, 80 registered, and 54 attended the live webinar.
>80 providers completed the pre assessment and 39 of the 54 providers who attended the webinar completed the post assessment to assess changes in knowledge, awareness, ability, and intent.
"
">Statistically significant increases in knowledge, awareness, ability, and intent were seen from pre to post webinar (significance assessed at P<0.05).
"
">48 of the 80 total registrants indicated plans to request continuing education units (CEUs), including 11 dental CEUs, 34 nursing CEUs, 2 pharmacy CEUs, and 1 physician CEU."
"
>Pivoting from in-person to virtual strategies due to the COVID-19 pandemic, navigating restrictive legislative changes in the state during the project period related to harm reduction programs, and working internally and with partners to ease the burdens of staffing changes was challenging."
"Maintaining flexibility and being willing to modify plans when these challenges arise is essential.
"
">Offering CEU credits and requiring completion of pre and post assessments in order to receive CEU credits likely increased participation in the webinar evaluation.
"
">When starting a new project, establishing contracts with partners in a timely fashion, especially during the COVID-19 pandemic, requires early and frequent engagement with contract staff.
"
">Hepatitis Landscape in West Virginia,
          West Virginia Immunization Network
Megan Ross, MPH, CHESEpidemiologistBureau for Public Health, Division of Health Promotion and Chronic DiseaseWest Virginia Department of Health and Human Resources
>Centers for Disease Control and Prevention, Division of Viral Hepatitis.
          "
"People Who Use or Inject Drugs and Viral Hepatitis.
          "
"Last reviewed August 24, 2020.
"
">National Academies of Sciences, Engineering, and Medicine.
          "
"A national strategy for the elimination of hepatitis B and C: phase two report.
          "
"The National Academies Press; 2017.
"
">Cancer Statistics at a Glance.
          "
U.S. Cancer Statistics Working Group.
"U.S. Cancer Statistics Data Visualizations Tool, based on 2021 submission data (1999-2019): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute."
June 2022.
"Accessed June 30, 2022.
"
">Viral Hepatitis Surveillance Report – United States, 2019.
          "
Centers for Disease Control and Prevention.
"Accessed August 22, 2022.
"
">Paul DP, Botre N, Philips M, Abboud J, Coustasse A."
The continuing epidemic of hepatitis C in the United States: the case of West Virginia.
"In: Proceedings of the Northeast Business & Economics Association 2018 Conference; 2018:230–236.
>Harm Reduction Programs."
"West Virginia Department of Health and Human Resources, Office of Epidemiology and Prevention Services."
"Accessed August 22, 2022.
"
">Drug Overdose Mortality by State.
          "
Centers for Disease Control and Prevention.
"Accessed August 26, 2022.
>2017"
West Virginia Cancer Burden Report.
"[PDF-6.1MB]
          West Virginia Department of Health and Human Resources and West Virginia University Cancer Institute."
"West Virginia University Cancer Institute; 2017.
"
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>Twitter
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"
Primary liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver."
Cancer that forms in other parts of the body and spreads to the liver is not primary liver cancer.
The liver is one of the largest organs in the body.
It has two lobes and fills the upper right side of the abdomen inside the rib cage.
"The main functions of the liver include the following:
>to make
        bile
        to help digest fat that comes from food
>to store glycogen (sugar), which the body uses for energy
>to filter harmful substances from the blood so they can be passed from the body in stools and urine"
"
Hepatocellular carcinoma and bile duct cancer (cholangiocarcinoma) are the main types of adult primary liver cancer.
"
Most adult primary liver cancers are hepatocellular carcinomas.
"This type of liver cancer is the third leading cause of cancer-related deaths worldwide.
"
Primary liver cancer can occur in both adults and children.
"However, treatment for children is different than treatment for adults."
"For more information, see Childhood Liver Cancer ."
"
These and other signs and symptoms may be caused by adult primary liver cancer or by other conditions."
"Check with your doctor if you have any of the following:
>a hard lump on the right side just below the rib cage
>discomfort in the upper abdomen on the right side
>a swollen abdomen
>pain near the right  shoulder blade or in the back
>jaundice  
    (yellowing of the skin and whites of the eyes)
>easy bruising or bleeding
>unusual tiredness or weakness
>nausea and vomiting
>loss of appetite or feelings of fullness after eating a small meal
>weight loss for no known reason
>pale, chalky
          bowel movements
          and dark urine
>fever
>Updated:May 18, 2022
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “What Is Liver Cancer?"
"was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
Worldwide, liver cancer is the sixth most common cancer and the third leading cause of cancer death."
"In the United States, rates are highest in American Indian or Alaska Native individuals."
"
The most common type of liver cancer in adults, hepatocellular carcinoma (HCC), typically develops in people with chronic (long-lasting) liver disease caused by hepatitis virus infection or cirrhosis."
Men are more likely to develop HCC than women.
"People with multiple risk factors have an even higher risk.
"
Many risk factors have been associated with liver cancer.
"Not everyone with one or more of these risk factors will develop the disease, and the disease will develop in some people who don’t have any known risk factors."
"Risk factors include the following:
>Hepatitis B virus (HBV) infection
          : HBV can be transmitted in blood,
          semen
          , or other body fluids."
"The infection can be passed from mother to child during childbirth, through sexual contact, or by sharing needles that are used to inject  drugs."
It can cause inflammation (swelling) of the liver that leads to cancer.
"Routine HBV
          vaccination
          in infancy is reducing the incidence of HBV infection."
"Chronic HBV infection is the leading cause of liver cancer in Asia and Africa.
"
">Hepatitis C virus (HCV) infection
          : HCV can be transmitted in the blood."
"The infection can be spread by sharing needles that are used to inject drugs or, less often, through sexual contact."
"In the past, it was also spread during
          blood transfusions
          or organ
          transplants
          ."
"Today, blood banks test all donated blood for HCV, which greatly lowers the risk of getting the virus from blood transfusions."
It can cause cirrhosis that may lead to liver cancer.
"Chronic HCV infection is the leading cause of liver cancer in North America, Europe, and Japan.
"
">Cirrhosis
          : The risk of developing liver cancer is increased for people who have cirrhosis, a disease in which healthy liver
          tissue
          is replaced by
          scar tissue
          ."
The scar tissue blocks the flow of blood through the liver and keeps it from working as it should.
"Chronic
          alcoholism
          and chronic hepatitis infections are common causes of cirrhosis."
"People with HCV-related cirrhosis have a higher risk of developing liver cancer than people with cirrhosis related to HBV or alcohol use.
"
">Heavy alcohol use
          :"
"Heavy alcohol use can cause cirrhosis, which is a risk factor for liver cancer."
Liver cancer can also occur in heavy alcohol users who do not have cirrhosis.
"Heavy alcohol users who have cirrhosis are ten times more likely to develop liver cancer, compared with heavy alcohol users who do not have cirrhosis."
"Studies have shown there is also an increased risk of liver cancer in people with HBV or HCV infection who use alcohol heavily.
"
"Studies have shown there is also an increased risk of liver cancer in people with HBV or HCV infection who use alcohol heavily.
"
">Aflatoxin B1
          : The risk of developing liver cancer may be increased by eating foods that contain aflatoxin B1 (poison from a
          fungus
          that can grow on foods, such as corn and nuts, that have been stored in hot, humid places)."
"It is most common in sub-Saharan Africa, Southeast Asia, and China.
"
">Nonalcoholic steatohepatitis (NASH)
          :"
NASH is a condition that can cause cirrhosis that may lead to liver cancer.
"It is the most severe form of nonalcoholic fatty liver disease, where there is an
          abnormal
          amount of fat in the liver."
"In some people, this can cause inflammation and injury to the
          cells
          of the liver."
Having NASH-related cirrhosis increases the risk of developing liver cancer.
"Liver cancer has also been found in people with NASH who do not have cirrhosis.
"
Having NASH-related cirrhosis increases the risk of developing liver cancer.
"Liver cancer has also been found in people with NASH who do not have cirrhosis.
"
">Cigarette smoking
          : Cigarette smoking has been linked to a higher risk of liver cancer."
"The risk increases with the number of cigarettes smoked per day and the number of years the person has smoked.
"
">Other conditions
          : Certain rare medical and
          genetic
          conditions may increase the risk of liver cancer."
"These conditions include the following:untreated
             hereditary hemochromatosisalpha-1 antitrypsin deficiencyglycogen storage diseaseporphyria cutanea tardaWilson disease
>untreated
             hereditary hemochromatosis
>alpha-1 antitrypsin deficiency
>glycogen storage disease
>porphyria cutanea tarda
>Wilson disease"
"
Cancer prevention is action taken to lower the chance of getting cancer."
"By preventing cancer, the number of new cases of cancer in a group or population is lowered."
"Hopefully, this will lower the number of deaths caused by cancer.
"
Anything that increases your chance of getting cancer is called a risk factor.
Anything that lowers your chance of getting cancer is called a cancer protective factor.
"Prevention includes avoiding risk factors and increasing protective factors.
"
"The following are protective factors for liver cancer:
>Getting the hepatitis B vaccine
          :"
"Preventing HBV infection (by being
          vaccinated
          for HBV as a newborn) has been shown to lower the risk of liver cancer in children."
"It is not yet known if being vaccinated lowers the risk of liver cancer in adults.
"
">Getting treatment for chronic hepatitis B infection
          : Treatment options for people with chronic HBV infection include
          interferon
          and
          nucleos(t)ide
          analog
          therapy."
"These treatments may reduce the risk of developing liver cancer.
"
">Reducing exposure to aflatoxin B1
          : Replacing foods that contain high amounts of aflatoxin B1 with foods that contain a much lower level of the poison can reduce the risk of liver cancer.
"
">Updated:June 26, 2023
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Liver Cancer Causes, Risk Factors, and Prevention was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
Tests that examine the liver and the blood are used to detect and diagnose liver cancer ."
"Every person will not receive all the tests described below.
"
"The following tests and procedures may be used:
>Physical exam and health history:
          "
"A physical exam of the body will be done to check a person’s health, including checking for signs of disease, such as lumps or anything else that seems unusual."
"A history of the patient’s health habits and past illnesses and treatments will also be taken.
"
">Alpha-fetoprotein (AFP) tumor marker test:
          Tumor markers are released into the blood by organs, tissues, or
          tumor
          cells in the body."
An increased level of AFP in the blood may be a sign of liver cancer.
"Other cancers and certain noncancerous conditions, including
          cirrhosis
          and
          hepatitis
          , may also increase AFP levels."
"Sometimes the AFP level is normal even when there is liver cancer.
"
">Liver function tests:
          These blood tests measure the amounts of certain substances released into the blood by the liver."
"A higher-than-normal amount of a substance can be a sign of liver cancer.
"
">CT scan (CAT scan):
          "
"This procedure uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body, such as the abdomen, taken from different angles."
"A dye may be
          injected
          into a vein or swallowed to help the organs or tissues show up more clearly."
"This procedure is also called computed tomography, computerized tomography, or computerized axial tomography."
"Images may be taken at three different times after the dye is injected, to get the best picture of
          abnormal
          areas in the liver."
This is called triple-phase CT.
"A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
"
">Magnetic resonance imaging (MRI):
          This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the liver."
"To create detailed pictures of blood vessels in and near the liver, dye is injected into a vein."
This procedure is called magnetic resonance angiography.
"Images may be taken at three different times after the dye is injected, to get the best picture of abnormal areas in the liver."
"This is called triple-phase MRI.
>Ultrasound exam:
          "
This procedure uses high-energy sound waves (ultrasound) that are bounced off the liver and make echoes.
"The echoes form a picture of the liver called a sonogram.
"
">Biopsy:
          "
"During a biopsy, cells or tissues are removed so they can be viewed under a microscope by a
          pathologist
          to check for signs of cancer."
"Procedures used to collect the sample of cells or tissues include the following:Fine-needle aspiration biopsy:
             A  sample of fluid, tissue, or cells is removed using a thin needle."
"Core needle biopsy:
             "
A  sample of cells or tissue is removed using a slightly wider needle.
"Laparoscopy:
             "
This surgical procedure is done to look at the organs inside the abdomen to check for signs of disease.
"Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions."
Another instrument is inserted through the same or another incision to remove the tissue samples.
A biopsy is not always needed to diagnose liver cancer.
"Sometimes the doctors can diagnose liver cancer based on the results of imaging tests such as CT scans and MRI.
"
">Fine-needle aspiration biopsy:
             A  sample of fluid, tissue, or cells is removed using a thin needle.
"
">Core needle biopsy:
             A  sample of cells or tissue is removed using a slightly wider needle.
"
">Laparoscopy:
             "
This surgical procedure is done to look at the organs inside the abdomen to check for signs of disease.
"Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions."
"Another instrument is inserted through the same or another incision to remove the tissue samples.
"
A biopsy is not always needed to diagnose liver cancer.
"Sometimes the doctors can diagnose liver cancer based on the results of imaging tests such as CT scans and MRI.
"
"After primary liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body."
"The process of determining the size and location of the cancer and whether it has spread is called staging.
"
"Some of the tests and procedures used to diagnose liver cancer, such as CT scan and MRI, may be used in the staging process."
"A positron emission tomography (PET) scan may also be used:
>PET scan:
          "
"This procedure is used to find
          malignant
          tumor cells in the body."
A small amount of radioactive glucose (sugar) is injected into a vein.
The PET scanner rotates around the body and makes a picture of where glucose is being used in the body.
Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
"
Once liver cancer has been diagnosed, the prognosis (chance of recovery) and treatment options depend on the following:
>the stage of the cancer (the size of the tumor, whether it affects part or all of the liver, or has spread to other places in the body)
>how well the liver is working
>the patient’s general health, including whether there is cirrhosis of the liver
Finding and treating liver cancer early may prevent death from liver cancer.
"
"Learn more about trends and statistics for liver cancer .
"
">Updated:July 1, 2022
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Liver Cancer Diagnosis was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
Screening is looking for cancer before a person has any symptoms."
This can help find cancer at an early stage.
"When abnormal tissue or cancer is found early, it may be easier to treat.
"
It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test.
Screening tests are given when you have no cancer symptoms.
"If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer."
These are called diagnostic tests.
"
"
"Although there is no standard or routine screening tests for liver cancer , the following tests are being used or studied to screen for it:"
"
Ultrasound is a procedure in which high-energy waves (ultrasound) are bounced off the liver and make echoes."
The echoes form a picture of the liver called a sonogram.
"
CT scan is a procedure that makes a series of detailed pictures of the liver, taken from different angles."
The pictures are made by a computer linked to an x-ray machine.
A dye may be injected into a vein or swallowed to help the liver show up more clearly.
This procedure is also called CAT scan or computed tomography.
"
Tumor markers , also called biomarkers, are substances made by the tumor that may be found in the blood, other body fluids, or tissues."
"A high level of a specific tumor marker may mean that a certain type of cancer is present in the body.
"
Alpha-fetoprotein (AFP) is the most widely used tumor marker for detecting liver cancer.
"However, other cancers and certain conditions, including pregnancy, hepatitis , and other types of cancer, may also increase AFP levels.
"
"Specific tumor markers that may lead to early detection of liver cancer are being studied.
"
"Doctors use these screening tests to find, or diagnose, liver cancer."
Learn more about Liver Cancer Diagnosis .
"
Decisions about screening tests can be difficult."
Not all screening tests are helpful and most have risk of harms associated with them.
"Before having any screening test, you may want to discuss the test with your doctor."
"It is important to be aware of any possible harms of the test and whether the test has been proven to reduce the risk of dying from cancer.
"
"The risks of liver cancer screening include the following:
>False-negative test results can occur.
          "
Screening test results may appear to be normal even though liver cancer is present.
"A person who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if there are symptoms.
"
">False-positive test results can occur.
          "
Screening test results may appear to be abnormal even though no cancer is present.
"A false-positive test result (one that shows there is cancer when there really isn't) can cause
          anxiety
          and is usually followed by diagnostic tests and procedures, such as a liver
          biopsy
          , which also have risks.
"
">Procedures to diagnose liver cancer can cause complications.
          "
Abnormal screening results may be followed up with a liver biopsy to diagnose liver cancer.
"Liver biopsy may cause the following rare, but serious,
          complications
          :hemorrhagetrouble breathingleakage of
             bile
             , which can cause an infection of the lining of the abdomena small puncture (hole) in an organ in the abdomenspread of cancer cells along the needle path where the biopsy needle is inserted and withdrawn (taken out)
>hemorrhage
>trouble breathing
>leakage of
             bile
             , which can cause an infection of the lining of the abdomen
>a small puncture (hole) in an organ in the abdomen
>spread of cancer cells along the needle path where the biopsy needle is inserted and withdrawn (taken out)
"
"Your doctor can advise you about your risk for liver cancer and your need for screening tests.
>Updated:May 18, 2022
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Liver Cancer Screening was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
This page describes the stages of liver cancer for adults.
The stage describes the extent of cancer in the body.
"Knowing the stage of liver cancer helps the doctor plan the best treatment.
"
"To learn about liver cancer stages for children, see Stages of hepatoblastoma .
"
"To learn about the tests and procedures used to diagnose and stage primary liver cancer, see Liver Cancer Diagnosis .
"
There are several staging systems for liver cancer.
The Barcelona Clinic Liver Cancer (BCLC) Staging System is widely used to stage primary liver cancer.
"The system is used to predict the patient’s chance of recovery and to plan treatment, based on the following:
>whether the cancer has spread within the liver or to other parts of the body
>how well the liver is working
>the general health and wellness of the patient
>the symptoms caused by the cancer
The BCLC staging system has five stages:
>stage 0: very early
>stage A: early
>stage B: immediate
>stage C: advanced
>stage D: end-stage
For liver cancer in adults, stages are also grouped according to how the cancer may be treated:
>Localized
        liver cancer has not spread outside the liver and can be removed by surgery."
"This includes BCLC stages 0, A, and B.
>Locally advanced
        liver cancer has not spread from the liver to distant parts of the body but cannot be safely removed by surgery."
"This includes BCLC stage C.
>Metastatic liver cancer is cancer that has spread from the liver to distant parts of the body."
Metastatic liver cancer cannot be completely removed by surgery.
"This includes BCLC stage D. To learn more about metastatic cancer, see
        Metastatic Cancer: When Cancer Spreads
        .
>Recurrent liver cancer is cancer that came back after treatment."
The cancer may come back in the liver or in other parts of the body.
"To learn more about recurrent cancer, see
        Recurrent Cancer: When Cancer Comes Back
        .
"
"To learn about other ways cancer stages can be described, see Cancer Staging .
"
"To learn about treatment options, see Liver Cancer Treatment .
"
">Updated:May 18, 2022
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Liver Cancer Stages was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
There are different types of treatment for patients with liver cancer ."
"Some treatments are standard (the currently used treatment), and some are being tested in clinical trials.
"
">Types of treatment
>Treatment of localized liver cancer
>Treatment of locally advanced or metastatic liver cancer
>Treatment of recurrent liver cancer"
"
Surveillance is used for lesions smaller than 1 centimeter found during screening."
Follow-up every 3 months is common.
Surveillance is closely watching a patient's condition but not giving any treatment unless there are changes in test results that show the condition is getting worse.
"During active surveillance, certain exams and tests are done on a regular schedule."
"
A partial hepatectomy (surgery to remove the part of the liver where cancer is found) may be done."
"A wedge of tissue, an entire lobe , or a larger part of the liver, along with some of the healthy tissue around it is removed."
The remaining liver tissue takes over the functions of the liver and may regrow.
"
In a liver transplant, the entire liver is removed and replaced with a healthy donated liver."
A liver transplant may be done when the disease is in the liver only and a donated liver can be found.
"If the patient has to wait for a donated liver, other treatment is given as needed."
"
Ablation therapy removes or destroys tissue."
"Different types of ablation therapy are used for liver cancer:
>Radiofrequency ablation:
           "
"Special needles are inserted directly through the skin or through an
           incision
           in the
           abdomen
           to reach the
           tumor
           ."
"High-energy
           radio waves
           heat the needles and tumor which kills cancer cells.
"
">Microwave therapy:
           "
The tumor is exposed to high temperatures created by microwaves.
"This can damage and kill cancer cells or make them more sensitive to the effects of radiation and certain anticancer drugs.
"
">Percutaneous ethanol injection:
           A small needle is used to inject ethanol (pure alcohol)"
directly into a tumor to kill cancer cells.
Several treatments may be needed.
"Usually local
           anesthesia
           is used, but if the patient has many tumors in the liver, general anesthesia may be used.
"
">Cryoablation:
           "
An instrument is used to freeze and destroy cancer cells.
This type of treatment is also called cryotherapy and cryosurgery.
"The doctor may use
           ultrasound
           to guide the instrument."
"To learn more, see
           Cryosurgery to Treat Cancer
           .
"
">Electroporation therapy:
           Electrical pulses are sent through an
           electrode
           placed in a tumor to kill cancer cells."
Electroporation therapy is being studied in clinical trials.
"
Embolization therapy is used for patients who cannot have surgery to remove the tumor or ablation therapy and whose tumor has not spread outside the liver."
Embolization therapy is the use of substances to block or decrease the flow of blood through the hepatic artery to the tumor.
"When the tumor does not get the oxygen and nutrients it needs, it will not continue to grow.
"
The liver receives blood from the hepatic portal vein and the hepatic artery.
Blood that comes into the liver from the hepatic portal vein usually goes to the healthy liver tissue.
Blood that comes from the hepatic artery usually goes to the tumor.
"When the hepatic artery is blocked during embolization therapy, the healthy liver tissue continues to receive blood from the hepatic portal vein.
"
"There are two main types of embolization therapy:
>Transarterial embolization (TAE):
           A small incision (cut) is made in the inner thigh and a catheter (thin, flexible tube) is inserted and threaded up into the hepatic artery."
"Once the catheter is in place, a substance that blocks the hepatic artery and stops blood flow to the tumor is injected.
"
">Transarterial chemoembolization (TACE):
           "
This procedure is like TAE except an anticancer drug is also given.
The procedure can be done by attaching the anticancer drug to small beads that are injected into the hepatic artery or by injecting the anticancer drug through the catheter into the hepatic artery and then injecting the substance to block the hepatic artery.
Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body.
This type of treatment is also called chemoembolization.
"
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells."
"Targeted therapies used to treat advanced liver cancer include the following:
>bevacizumab
>cabozantinib
>lenvatinib
>ramucirumab
>regorafenib
>sorafenib
To learn more about targeted therapy and its side effects, see Targeted Therapy to Treat Cancer ."
"
Immunotherapy is a treatment that uses the patient's immune system to fight cancer."
"Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.
"
Immune checkpoint inhibitors are a type of immunotherapy.
"Immune checkpoint inhibitors that may be used to treat liver cancer include the following:
>atezolizumab
           with the targeted therapy bevacizumab
>nivolumab
           with
           ipilimumab
>pembrolizumab
>durvalumab
           with
           tremelimumab
To learn more about immunotherapy and its side effects, see Immunotherapy to Treat Cancer and Immunotherapy Side Effects ."
"
External radiation therapy uses a machine outside the body to send high-energy x-rays or other types of radiation toward the area of the body with cancer."
Radiation is given in a series of treatments to allow healthy cells to recover and to make radiation more effective.
"The number of treatments is based on details about the cancer, such as the size and location of the tumor."
"Certain ways of giving external radiation therapy can help keep radiation from damaging nearby healthy tissue:
>Conformal radiation therapy:
           Conformal radiation therapy uses a computer to make a 3-dimensional, or 3-D, picture of the tumor and shapes the radiation beams to fit the tumor."
"This allows a high dose of radiation to reach the tumor and causes less damage to nearby healthy tissue.
"
">Stereotactic body radiation therapy:
           Stereotactic body radiation therapy uses special equipment to place the patient in the same position for each radiation treatment."
"Once a day for several days, a radiation machine aims a larger than usual dose of radiation directly at the tumor."
"By having the patient in the same position for each treatment, there is less damage to nearby healthy tissue."
"This procedure is also called stereotactic external-beam radiation therapy and stereotaxic radiation therapy.
"
">Proton beam radiation therapy:
           Proton beam radiation therapy is a type of high-energy, external radiation therapy that uses streams of protons (tiny particles with a positive charge) to kill tumor cells."
"This type of treatment can lower the amount of radiation damage to healthy tissue near a tumor.
"
"To learn more about radiation therapy and its side effects, see Radiation Therapy to Treat Cancer and Radiation Therapy Side Effects ."
"
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. "
"For some patients, taking part in a clinical trial may be an option.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. "
"Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
"
"To learn more about clinical trials, see Clinical Trials Information for Patients and Caregivers ."
"
Treatment of localized liver cancer may include the following:
>surveillance for lesions smaller than 1 centimeter
>total hepatectomy transplant
>partial hepatectomy
>ablation of the tumor using one of the following methods:radiofrequency ablationmicrowave therapypercutaneous ethanol injectioncryoablation
>radiofrequency ablation
>microwave therapy
>percutaneous ethanol injection
>cryoablation"
"
Treatment of locally advanced or metastatic liver cancer may include the following:
>embolization therapy using transarterial embolization (TAE) or transarterial chemoembolization (TACE) in people with locally advanced liver cancer.
"
">targeted therapy with lenvatinib, sorafenib, regorafenib, cabozantinib, bevacizumab, or ramucirumab
>immune checkpoint inhibitor therapy with pembrolizumab, nivolumab with ipilimumab, durvalumab with tremelimumab, or atezolizumab with the targeted therapy bevacizumab
>radiation therapy"
"
Treatment options for recurrent primary liver cancer may include the following:
>total hepatectomy and liver transplant
>partial hepatectomy
>ablation
>transarterial chemoembolization and targeted therapy with sorafenib as
          palliative therapy
          to relieve symptoms and improve quality of life
>Updated:October 26, 2023
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Liver Cancer Treatment was originally published by the National Cancer Institute.”
"
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"
>General Information About Childhood Pancreatic Cancer
>Stages of Childhood Pancreatic Cancer
>Treatment Option Overview
>Treatment of Childhood Pancreatic Cancer
>Treatment of Recurrent Childhood Pancreatic Cancer
>To Learn More About Childhood Pancreatic Cancer
>About This PDQ Summary"
"
>Pancreatic cancer is a disease in which malignant (cancer)
		  cells form in the tissues of the pancreas.
"
">There are four types of pancreatic cancer in children.
"
">Signs and symptoms of pancreatic cancer include feeling tired and weight loss.
"
>Tests that examine the pancreas are used to help diagnose pancreatic cancer.
"
The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side."
"The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail."
"The pancreas lies between the stomach and the spine .
"
"There are two kinds of cells in the pancreas:
>Endocrine pancreas cells
           make
           hormones
           , such as
           insulin
           and
           glucagon
           , that help control
           blood sugar
           levels."
"Both of these hormones help the body use and store the energy it gets
			 from food."
Endocrine pancreas cells cluster together in many small groups (islets) throughout the pancreas.
"Endocrine pancreas cells are also called
           islet cells
           or islets of Langerhans.
"
">Exocrine pancreas cells
           make
           enzymes
           that are released into the
           small intestine
           to help the body
           digest
           food."
"Most of the pancreas is made of
           ducts
           and small sacs at the end of the ducts that are lined with
           exocrine cells
           ."
"
The four types of pancreatic cancer in children include the following:
>Solid pseudopapillary tumor of the pancreas.
           "
"This is the most common type of
           pancreatic tumor
           in children."
It  most commonly affects females that are older adolescents and young adults.
"These slow-growing
           tumors
           have both
           cyst
           -like  and solid parts."
"Solid pseudopapillary tumor of the pancreas is unlikely to spread to other parts of the body and the
           prognosis
           is very good."
"Occasionally, the tumor may spread to the
           liver
           ,
           lung
           , or
           lymph nodes
           .
"
">Pancreatoblastoma.
           "
It usually occurs in children aged 10 years or younger.
"Children with
           Beckwith-Wiedemann syndrome
           and
           familial adenomatous polyposis
           (FAP)
           syndrome
           have an increased risk of developing pancreatoblastoma."
"These slow-growing tumors often make the
           tumor marker
           alpha-fetoprotein
           ."
"These tumors may also make
           adrenocorticotropic hormone
           (ACTH) and antidiuretic hormone (ADH)."
"Pancreatoblastoma may spread to the liver, lung, or lymph nodes."
"The prognosis for children with pancreatoblastoma is good.
"
">Islet cell tumors.
           "
"These tumors are not common in children and can be
           benign
           or
           malignant
           ."
"Islet cell tumors may occur in children with
           multiple endocrine neoplasia type 1
           (MEN1) syndrome."
"(See the
           PDQ
           summary on
           Childhood Multiple Endocrine Neoplasia"
"[MEN] Syndromes Treatment
           for more information.)"
"The most common types of islet cell tumors are
           insulinomas
           and
           gastrinomas
           ."
"Other types of islet cell tumors are
           ACTHoma
           and
           VIPoma
           ."
"These tumors may make hormones, such as
           insulin
           ,
           gastrin
           , ACTH, or ADH."
"When too much of a hormone is made,
           signs
           and
           symptoms
           of disease occur."
"These tumors are also called pancreatic neuroendocrine tumors (pancreatic NETs).
"
">Pancreatic carcinoma.
           "
Pancreatic carcinoma is very rare in children.
"The two types of pancreatic carcinoma are acinar cell carcinoma and ductal
           adenocarcinoma
           ."
"
General signs and symptoms of pancreatic cancer may include the following:
>Feeling tired.
"
">Weight loss for no known reason.
"
">Loss of
           appetite
           .
"
">Stomach discomfort.
"
">Lump in the
           abdomen
           .
"
"In children, some pancreatic tumors do not secrete hormones and there are no signs and symptoms of disease."
"This makes it hard to diagnose pancreatic cancer early.
"
Pancreatic tumors that do secrete hormones may cause signs and symptoms.
"The signs and symptoms depend on the type of hormone being made.
"
"If the tumor secretes insulin, signs and symptoms that may occur include the following:
>Low blood sugar."
"This can cause blurred vision, headache, and feeling lightheaded, tired, weak, shaky, nervous, irritable, sweaty,
           confused
           , or hungry.
"
">Changes in behavior.
"
">Seizures
           .
"
">Coma
           .
"
"If the tumor secretes gastrin, signs and symptoms that may occur include the following:
>Stomach
           ulcers
           that keep coming back.
"
">Pain in the abdomen, which may spread to the back."
"The pain may come and go and it may go away after taking an antacid.
"
">The flow of stomach contents back into the
           esophagus
           (
           gastroesophageal reflux
           ).
"
">Diarrhea
           .
"
"Signs and symptoms caused by tumors that make other types of hormones, such as ACTH or ADH, may include the following:
>Watery diarrhea.
"
">Dehydration
           (feeling thirsty, making less
           urine
           , dry skin and mouth, headaches, dizziness, or feeling tired).
"
">Low
           sodium
           (salt) level in the
           blood
           (confusion, sleepiness, muscle weakness, and seizures).
"
">Weight loss or gain for no known reason.
"
">Round face and thin arms and legs.
"
">Feeling very tired and weak.
"
">High blood pressure
           .
"
">Purple or pink stretch marks on the skin.
"
Check with your child’s doctor if you see any of these problems in your child.
Other conditions that are not pancreatic cancer may cause these same signs and symptoms.
"
The following tests and procedures may be used:
>Physical exam and health history
           : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual."
"A history of the patient’s health habits and past illnesses and treatments will also be taken.
"
">Chest x-ray
           : An
           x-ray
           of the
           organs
           and bones inside the chest.  "
"An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
"
">CT scan (CAT scan)
           : A procedure that makes a series of detailed pictures of areas inside the body, such as the chest and abdomen, taken from different angles.  "
The pictures are made by a computer linked to an x-ray machine.
"A
           dye
           may be
           injected
           into a
           vein
           or swallowed to help the organs or
           tissues
           show up more clearly.  "
"This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
"
">MRI (magnetic resonance imaging)
           : A procedure that uses a magnet,
           radio waves
           , and a computer to make a series of detailed pictures of areas inside the body, such as the chest and abdomen."
"This procedure is also called nuclear magnetic resonance imaging (NMRI).
"
">PET scan (positron emission tomography scan)
           : A procedure to find malignant tumor cells in the body.  "
"A small amount of
           radioactive glucose
           (sugar) is injected into a vein.  "
"The PET
           scanner
           rotates around the body and makes a picture of where
           glucose
           is being used in the body.  "
"Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
"
">Endoscopic ultrasound (EUS)
           : A procedure in which an
           endoscope
           is inserted into the body, usually through the mouth or
           rectum
           ."
"An endoscope is a thin, tube-like instrument with a light and a
           lens
           for viewing."
"A probe at the end of the endoscope is used to bounce high-energy sound waves (
           ultrasound
           ) off internal tissues or organs and make echoes."
"The echoes form a picture of body tissues called a
           sonogram
           ."
"This procedure is also called endosonography.
"
">Somatostatin receptor scintigraphy
           : A type of
           radionuclide scan
           used to find pancreatic tumors."
"A very small amount of
           radioactive
           octreotide
           (a hormone that attaches to
           carcinoid tumors
           ) is injected into a vein and travels through the bloodstream."
The radioactive octreotide attaches to the tumor and a special camera that detects radioactivity is used to show where the tumors are in the body.
"This procedure is used to diagnose islet cell tumors.
"
">Biopsy
           : The removal of cells or tissues so they can be viewed under a
           microscope
           by a
           pathologist
           to check for signs of cancer."
"Procedures used to obtain a tissue sample include the following:Core-needle biopsy
              : A procedure to remove tissue using a wide needle."
"Laparoscopy
              : A surgical procedure to look at the organs inside the abdomen to check for signs of disease."
"Small
              incisions
              (cuts) are made in the wall of the abdomen and a
              laparoscope
              (a thin, lighted tube) is inserted into one of the incisions."
Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples.
"Laparotomy
              : A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease."
The size of the incision depends on the reason the laparotomy is being done.
"Sometimes tissue samples are taken.
"
">Core-needle biopsy
              : A procedure to remove tissue using a wide needle.
"
">Laparoscopy
              : A surgical procedure to look at the organs inside the abdomen to check for signs of disease."
"Small
              incisions
              (cuts) are made in the wall of the abdomen and a
              laparoscope
              (a thin, lighted tube) is inserted into one of the incisions."
"Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples.
"
">Laparotomy
              : A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease."
The size of the incision depends on the reason the laparotomy is being done.
Sometimes tissue samples are taken.
"
>If cancer has formed in the pancreas, tests are done to find out if cancer cells have spread to nearby areas or to other parts of the body.
"
">There are three ways that cancer spreads in the body.
"
>Cancer may spread from where it began to other parts of the body.
"
The process used to find out if cancer has spread from the pancreas to nearby areas or to other parts of the body is called staging ."
There is no standard system for staging childhood pancreatic cancer .
"The results of the tests and procedures done to diagnose cancer are used to help make decisions about treatment.
"
Sometimes childhood pancreatic cancer recurs (comes back) after treatment.
It may come back in the pancreas or other parts of the body.
"
Cancer can spread through tissue , the lymph system , and the blood :
>Tissue."
"The cancer spreads from where it began by growing into nearby areas.
"
>Lymph system.
The cancer spreads from where it began by getting into the lymph system.
"The cancer travels through the
           lymph vessels
           to other parts of the body.
"
>Blood.
The cancer spreads from where it began by getting into the blood.
"The cancer travels through the
           blood vessels
           to other parts of the body."
"
"
"When cancer spreads to another part of the body, it is called metastasis ."
"Cancer cells break away from where they began (the primary tumor ) and travel through the lymph system or blood.
"
>Lymph system.
"The cancer gets into the lymph system, travels through the lymph vessels, and forms a
           tumor
           (
           metastatic
           tumor) in another part of the body.
"
>Blood.
"The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
"
The metastatic tumor is the same type of cancer as the primary tumor .
"For example, if pancreatic cancer spreads to the lung , the cancer cells in the lung are actually pancreas cancer cells."
"The disease is metastatic pancreatic cancer, not lung cancer ."
"
>There are different types of treatment for children with pancreatic cancer.
"
">Children with pancreatic cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.
"
">Three types of standard treatment are used:SurgeryChemotherapyTargeted therapy
>Surgery
>Chemotherapy
>Targeted therapy
>New types of treatment are being tested in clinical trials.
"
">Treatment for childhood pancreatic cancer may cause side effects.
"
">Patients may want to think about taking part in a clinical trial.
"
">Patients can enter clinical trials before, during, or after starting their cancer treatment.
"
>Follow-up tests may be needed.
"
Some treatments are standard (the currently used treatment), and some are being tested in clinical trials ."
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer .
"When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
"
"Because cancer in children is rare, taking part in a clinical trial should be considered."
Some clinical trials are open only to patients who have not started treatment.
"
Treatment will be overseen by a pediatric oncologist , a doctor who specializes in treating children with cancer ."
The pediatric oncologist works with other pediatric health professionals who are experts in treating children with cancer and who specialize in certain areas of medicine .
"This may include the following specialists and others:
>Pediatrician
           .
"
">Pediatric surgeon
           .
"
">Pathologist
           .
"
">Endocrinologist
           .
"
">Pediatric nurse specialist
           .
"
">Social worker
           .
>Rehabilitation specialist
           .
"
">Psychologist
           .
"
">Child-life specialist
           ."
"
Surgery to remove the tumor is used to treat most types of pancreatic cancer ."
"For cancer in the head of the pancreas , a Whipple procedure may be done."
"
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells , either by killing the cells or by stopping them from dividing."
"When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body ( systemic chemotherapy )."
"
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells."
"Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.
"
">mTOR inhibitor
            therapy
            : mTOR inhibitor drugs stop the
            protein
            that helps cells divide and survive."
"This type of drug is used to treat
            islet cell tumors
            and is being studied to treat
            pancreatic
            carcinoma
            ."
"
Information about clinical trials is available from the NCI website ."
"
To learn about side effects that begin during treatment for cancer, see Side Effects .
"
Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects .
"Late effects of cancer treatment may include:
>Physical problems.
"
">Changes in mood, feelings, thinking, learning, or memory.
"
">Second cancers
           (new types of cancer) or other
           conditions
           .
"
Some late effects may be treated or controlled.
It is important to talk with your child's doctors about the possible late effects caused by some treatments.
See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.
"
For some patients, taking part in a clinical trial may be the best treatment choice."
Clinical trials are part of the cancer research process.
"Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment .
"
Many of today's standard treatments for cancer are based on earlier clinical trials.
"Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
"
Patients who take part in clinical trials also help improve the way cancer will be treated in the future.
"Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward."
"
Some clinical trials only include patients who have not yet received treatment."
Other trials test treatments for patients whose cancer has not gotten better.
"There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
"
Clinical trials are taking place in many parts of the country.
Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage.
Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
"
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated."
Some tests will be repeated in order to see how well the treatment is working.
"Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
"
Some of the tests will continue to be done from time to time after treatment has ended.
The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back).
These tests are sometimes called follow-up tests or check-ups.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of newly diagnosed solid pseudopapillary tumor of the pancreas in children may include the following:
>Surgery
          to remove the tumor."
"A
          Whipple procedure
          may be done for tumors in the head of the pancreas.
"
">Chemotherapy
          for tumors that cannot be removed by surgery or have spread to other parts of the body.
"
"Treatment of newly diagnosed pancreatoblastoma in children may include the following:
>Surgery to remove the tumor.  "
"A Whipple procedure may be done for tumors in the head of the pancreas.
"
>Chemotherapy may be given to shrink the tumor before surgery.
"More chemotherapy may be given after surgery for large tumors, tumors that could not initially be removed by surgery, and tumors that have spread to other parts of the body.
"
">Chemotherapy may be given if the tumor does not
          respond
          to treatment or comes back.
"
"Treatment of newly diagnosed islet cell tumors in children may include drugs to treat symptoms caused by hormones and the following:
>Surgery to remove the tumor.
"
">Chemotherapy and
          targeted therapy
          (
          mTOR inhibitor
          therapy
          ) for tumors that cannot be removed by surgery or that have spread to other parts of the body.
"
There are few reported cases of pancreatic carcinoma in children.
"(See the PDQ summary on Pancreatic Cancer Treatment [Adult] for possible treatment options.)
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients."
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of recurrent pancreatic cancer in children may include the following:
>A
          clinical trial
          that checks a sample of the patient's
          tumor
          for certain
          gene
          changes."
"The type of
          targeted therapy
          that will be given to the patient depends on the type of gene change.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For more information from the National Cancer Institute about pancreatic cancer , see the following:
>Pancreatic Cancer Home Page
>Computed Tomography (CT) Scans and Cancer
>Targeted Cancer Therapies
For more childhood cancer information and other general cancer resources, see the following:
>About Cancer
>Childhood Cancers
>CureSearch for Children's Cancer
>Late Effects of Treatment for Childhood Cancer
>Adolescents and Young Adults with Cancer
>Children with Cancer: A Guide for Parents
>Cancer in Children and Adolescents
>Staging
>Coping with Cancer
>Questions to Ask Your Doctor about Cancer
>For Survivors and Caregivers"
"
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database."
"The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine."
Most summaries come in two versions.
The health professional versions have detailed information written in technical language.
"The patient versions are written in easy-to-understand, nontechnical language."
"Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish .
"
PDQ is a service of the NCI.
The NCI is part of the National Institutes of Health (NIH).
NIH is the federal government’s center of biomedical research.
The PDQ summaries are based on an independent review of the medical literature.
They are not policy statements of the NCI or the NIH.
"
This PDQ cancer information summary has current information about the treatment of childhood pancreatic cancer."
"It is meant to inform and help patients, families, and caregivers."
It does not give formal guidelines or recommendations for making decisions about health care.
"
Editorial Boards write the PDQ cancer information summaries and keep them up to date."
These Boards are made up of experts in cancer treatment and other specialties related to cancer.
The summaries are reviewed regularly and changes are made when there is new information.
"The date on each summary (""Updated"") is the date of the most recent change.
"
"The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board ."
"
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another."
Trials are based on past studies and what has been learned in the laboratory.
Each trial answers certain scientific questions in order to find new and better ways to help cancer patients.
"During treatment clinical trials, information is collected about the effects of a new treatment and how well it works."
"If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become ""standard."""
Patients may want to think about taking part in a clinical trial.
"Some clinical trials are open only to patients who have not started treatment.
"
Clinical trials can be found online at NCI's website .
"For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237)."
"
PDQ is a registered trademark."
The content of PDQ documents can be used freely as text.
It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly.
"However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
"
"The best way to cite this PDQ summary is:
PDQ® Pediatric Treatment Editorial Board."
PDQ Childhood Pancreatic Cancer Treatment.
"Bethesda, MD: National Cancer Institute."
Updated <MM/DD/YYYY>.
Available at: https://www.cancer.gov/types/pancreatic/patient/child-pancreatic-treatment-pdq .
"Accessed <MM/DD/YYYY>.
"
"Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only."
"If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner."
It cannot be given by the National Cancer Institute.
"Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online ."
"Visuals Online is a collection of more than 3,000 scientific images."
"
The information in these summaries should not be used to make decisions about insurance reimbursement."
More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
"
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page."
"Questions can also be submitted to Cancer.gov through the website’s E-mail Us .
"
">Updated:February 19, 2021
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Childhood Pancreatic Cancer Treatment (PDQ®)–Patient Version was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
>General Information About Pancreatic Cancer
>Stages of Pancreatic Cancer
>Treatment Option Overview
>Treatment of Resectable or  Borderline Resectable Pancreatic Cancer
>Treatment of Locally Advanced Pancreatic Cancer
>Treatment of Metastatic  or  Recurrent Pancreatic Cancer
>Palliative Therapy
>To Learn More About Pancreatic Cancer
>About This PDQ Summary"
"
>Pancreatic cancer is a disease in which malignant (cancer)
		  cells form in the tissues of the pancreas.
"
">Smoking and health history can affect the risk of pancreatic cancer.
"
">Signs and symptoms of pancreatic cancer include jaundice, pain, and
		  weight loss.
"
">Pancreatic cancer is difficult to diagnose
		  early.
"
">Tests that examine the pancreas are used to diagnose and stage pancreatic cancer.
"
">Certain factors affect prognosis (chance
		  of recovery) and treatment options."
"
The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side."
"The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail."
"The pancreas lies between the stomach and the spine .
"
"The pancreas has two main jobs in the body:
>To make
           juices
           that help
           digest
           (break down) food.
"
">To make
           hormones
           , such as
           insulin
           and
           glucagon
           , that help control
           blood sugar
           levels."
"Both of these hormones help the body use and store the energy it gets
			 from food.
"
The digestive juices are made by exocrine pancreas cells and the hormones are made by endocrine pancreas cells .
"About 95% of pancreatic cancers begin in exocrine cells .
"
This summary is about exocrine pancreatic cancer.
"For information on endocrine pancreatic cancer, see the summary on Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment ."
"
Anything that increases your risk of getting a disease is called a risk factor ."
Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer.
"Talk with your doctor if you think you may be at risk.
"
"Risk factors for pancreatic cancer include the following:
>Smoking.
>Being very overweight.
"
">Having a personal history of
           diabetes
           or
           chronic
           pancreatitis
           .
"
">Having a
           family history
           of pancreatic cancer or pancreatitis.
"
">Having certain
           hereditary
           conditions
           , such as:Multiple endocrine neoplasia type 1 (MEN1)
			 syndrome
              .Hereditary nonpolyposis colon
			 cancer
              (HNPCC; Lynch syndrome).von
			 Hippel-Lindau syndrome
              .Peutz-Jeghers syndrome
              .Hereditary"
"breast and ovarian cancer syndrome
              .Familial
			 atypical multiple mole melanoma (FAMMM) syndrome
              .Ataxia-telangiectasia
              .
"
">Multiple endocrine neoplasia type 1 (MEN1)
			 syndrome
              .
"
">Hereditary nonpolyposis colon
			 cancer
              (HNPCC; Lynch syndrome).
"
">von
			 Hippel-Lindau syndrome
              .
"
">Peutz-Jeghers syndrome
              .
"
">Hereditary breast and ovarian cancer syndrome
              .
"
">Familial
			 atypical multiple mole melanoma (FAMMM) syndrome
              .
"
">Ataxia-telangiectasia
              ."
"
Pancreatic cancer may not cause early signs or symptoms ."
Signs and symptoms may be caused by pancreatic cancer or by other conditions.
"Check with your doctor if you have any of the following:
>Jaundice
           (yellowing of the skin and whites of the eyes).
"
">Light-colored
           stools
           .
"
">Dark
           urine
           .
"
">Pain in the upper or middle
           abdomen
           and back.
"
">Weight loss for no known reason.
"
">Loss of
           appetite
           .
"
>Feeling very tired.
"
Pancreatic cancer is difficult to detect and diagnose for the following reasons:
>There aren’t any noticeable signs or symptoms in the early
           stages
           of pancreatic
			 cancer.
"
">The signs and symptoms of pancreatic cancer, when present, are like the
			 signs and symptoms of many other illnesses.
"
">The pancreas is hidden behind other
           organs
           such as the
			 stomach,
           small intestine
           ,
           liver
           ,
           gallbladder
           ,
           spleen
           , and
           bile
			 ducts
           ."
"
Pancreatic cancer is usually diagnosed with tests and procedures that make pictures of the pancreas and the area around it."
The process used to find out if cancer cells have spread within and around the pancreas is called staging .
"Tests and procedures to detect, diagnose, and stage pancreatic cancer are usually done at the same time."
"In order to plan treatment, it is important to know the stage of the disease and whether or not the pancreatic cancer can be removed by surgery .
"
"The following tests and procedures may be used:
>Physical exam and health history
           : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual."
"A history of the patient’s health habits and past illnesses and treatments will also be taken.
"
">Blood chemistry studies
           : A procedure in which a blood sample is checked to measure the amounts of certain substances, such as
           bilirubin
           , released into the blood by organs and
           tissues
           in the body."
"An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
"
">Tumor marker test
           : A procedure in which a sample of blood,
           urine
           , or tissue is checked to measure the amounts of certain substances, such as
           CA 19-9
           , and
           carcinoembryonic antigen
           (CEA), made by organs, tissues, or
           tumor
           cells in the body."
Certain substances are linked to specific types of cancer when found in increased levels in the body.
"These are called
           tumor markers
           .
"
">MRI (magnetic
			 resonance imaging)
           : A procedure that uses a magnet,
           radio waves
           , and a computer to make a series of detailed pictures of areas inside the body."
"This procedure is also called nuclear magnetic resonance imaging (NMRI).
"
">CT scan (CAT
			 scan)
           : A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles.  "
"The pictures are made by a computer linked to an
           x-ray
           machine."
"A dye may be
           injected
           into a
           vein
           or swallowed to help the organs or tissues show up more clearly.  "
"This procedure is also called computed tomography, computerized tomography, or computerized axial tomography."
"A
           spiral
           or
           helical CT
           scan
           makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
"
">PET scan (positron
			 emission tomography scan)
           : A procedure to find
           malignant
           tumor
           cells in the body.  "
"A small amount of
           radioactive
           glucose
           (sugar) is injected into a vein.  "
The PET scanner rotates around the body and makes a picture of where glucose is being used in the body.  
Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
A PET scan and CT scan may be done at the same time.
"This is called a
           PET-CT
           .
"
">Abdominal ultrasound
           : An ultrasound exam used to make pictures of the inside of the abdomen."
"The
           ultrasound transducer
           is pressed against the skin of the abdomen and directs high-energy sound waves (ultrasound) into the abdomen."
The sound waves bounce off the internal tissues and  organs and make echoes.  
"The transducer receives the echoes and sends them to a computer, which uses the echoes to make pictures called
           sonograms
           ."
"The picture can be printed to be looked at later.
"
">Endoscopic
			 ultrasound (EUS)
           : A procedure in which an
           endoscope
           is inserted into the body, usually through the mouth or
           rectum
           ."
"An endoscope is a thin, tube-like instrument with a light and a
           lens
           for viewing.  "
A probe at the end of the endoscope   is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes.  
The echoes form a picture of body tissues called a sonogram.  
"This procedure is also called endosonography.
"
">Endoscopic
			 retrograde cholangiopancreatography (ERCP)
           :"
"A procedure used to x-ray the
           ducts
           (tubes) that carry
           bile
           from the liver to the gallbladder and from the gallbladder to the small intestine.  "
"Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice.  "
"An endoscope (a thin, lighted tube) is passed through the mouth,
           esophagus
           , and stomach into the first part of the small intestine.  "
"A
           catheter
           (a smaller tube) is then inserted through the endoscope into the pancreatic ducts.  "
"A
           dye
           is injected through the catheter into the ducts and an x-ray is taken.  "
"If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it.  "
"This tube (or
           stent
           ) may be left in place to keep the duct open.  "
"Tissue samples may also be taken.
"
">Percutaneous
			 transhepatic cholangiography (PTC)
           : A procedure used to x-ray the liver and bile ducts.  "
A thin needle is inserted through the skin below the ribs and into the liver.  
Dye is injected into the liver or bile ducts and an x-ray is taken.  
"If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to
           drain
           bile into the small intestine or a collection bag outside the body."
"This test is done only if
           ERCP
           cannot be
			 done.
"
">Laparoscopy
           : A
           surgical
           procedure to look at the organs inside the abdomen to check for signs of disease.  "
"Small
           incisions
           (cuts) are made in the wall of the abdomen and a
           laparoscope
           (a thin, lighted tube) is inserted into one of the incisions."
"The laparoscope may have an ultrasound probe at the end in order to bounce high-energy sound waves off internal organs, such as the pancreas."
This is called laparoscopic ultrasound.
"Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples from the pancreas or a sample of
           fluid
           from the abdomen to check for cancer.
"
">Biopsy
           : The removal of cells or tissues so they can be viewed under a
           microscope
           by a
           pathologist
           to check for signs of cancer."
"There are several ways to do a biopsy for pancreatic cancer.
			 "
"A
           fine needle
           or a
           core needle
           may be inserted into the pancreas during an x-ray or
			 ultrasound to remove cells."
"Tissue
			 may also be removed during a laparoscopy or surgery to remove the tumor."
"
The prognosis and treatment options depend on the following:
>"
"Whether or not the tumor can be removed by surgery.
"
">The stage
		  of the cancer (the size of the tumor and whether the cancer has spread outside
		  the pancreas to nearby tissues or
           lymph
		  nodes
           or to other places in the body).
"
">The patient’s general
		  health.
"
">Whether the cancer has just been diagnosed or has
           recurred
           (come back).
"
"Pancreatic cancer can be controlled only if it is found before it has spread, when it can be completely removed by surgery."
"If the cancer has spread, palliative treatment can improve the patient's quality of life by controlling the symptoms and complications of this disease."
"
>Tests and procedures to stage pancreatic cancer are usually
		  done at the same time as diagnosis.
"
">There are three ways that cancer spreads in the body.
"
">Cancer may spread from where it began to other parts of the body.
"
">The following stages are used for pancreatic
			 cancer:Stage 0"
(Carcinoma in Situ)Stage
"IStage IIStage IIIStage IV
>Stage 0"
"(Carcinoma in Situ)
>Stage I
>Stage II
>Stage III
>Stage IV
>The following groups are used to plan treatment:Resectable pancreatic cancerBorderline resectable pancreatic cancerLocally advanced pancreatic cancerMetastatic pancreatic cancerRecurrent pancreatic cancer
>Resectable pancreatic cancer
>Borderline resectable pancreatic cancer
>Locally advanced pancreatic cancer
>Metastatic pancreatic cancer
>Recurrent pancreatic cancer"
"
The process used to find out if cancer has spread within the pancreas or to other parts of the body is called staging ."
The information gathered from the staging process determines the stage of the disease.
It is important to know the stage of the disease in order to plan treatment.
The results of some of the tests used to diagnose pancreatic cancer are often also used to stage the disease.
See the General Information section for more information.
"
Cancer can spread through tissue , the lymph system , and the blood :
>Tissue."
"The cancer spreads from where it began by growing into nearby areas.
"
>Lymph system.
The cancer spreads from where it began by getting into the lymph system.
"The cancer travels through the
           lymph vessels
           to other parts of the body.
"
>Blood.
The cancer spreads from where it began by getting into the blood.
"The cancer travels through the
           blood vessels
           to other parts of the body."
"
"
"When cancer spreads to another part of the body, it is called metastasis ."
"Cancer cells break away from where they began (the primary tumor ) and travel through the lymph system or blood.
"
>Lymph system.
"The cancer gets into the lymph system, travels through the lymph vessels, and forms a
           tumor
           (
           metastatic
           tumor) in another part of the body.
"
>Blood.
"The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
"
The metastatic tumor is the same type of cancer as the primary tumor.
"For example, if pancreatic cancer spreads to the liver , the cancer cells in the liver are actually pancreatic cancer cells."
"The disease is metastatic pancreatic cancer, not liver cancer."
"
In stage 0 , abnormal cells are found in the lining of the pancreas ."
These abnormal cells may become cancer and spread into nearby normal tissue .
Stage 0 is also called carcinoma in situ .
"
In stage I , cancer has formed and is found in the pancreas only."
"Stage I is divided into stages IA and IB, depending on the size of the tumor .
"
>Stage IA:
"The
            tumor
            is 2
            centimeters
            or smaller.
"
">Stage IB: The
            tumor
            is larger than 2
            centimeters
            but not larger than 4 centimeters."
"
Stage II is divided into stages IIA and IIB, depending on the size of the tumor and where the cancer has spread.
"
>Stage IIA:
"The
            tumor
            is larger than 4
            centimeters
            .
"
>Stage IIB:
"The
            tumor
            is any size and
            cancer
            has spread to 1 to 3 nearby
            lymph nodes
            ."
"
In stage III , the tumor is any size and cancer has spread to:
>four or more nearby
            lymph nodes
            ; or
>the major
            blood vessels
            near the
            pancreas
            ."
"
In stage IV , the tumor is any size and cancer has spread to other parts of the body, such as the liver , lung , or peritoneal cavity (the body cavity that contains most of the organs in the abdomen )."
"
Resectable pancreatic cancer can be removed by surgery because it has not grown into important blood vessels near the tumor."
"
Borderline resectable pancreatic cancer has grown into a major blood vessel or nearby tissue or organs."
"It may be possible to remove the tumor, but there is a high risk that all of the cancer cells will not be removed with surgery."
"
Locally advanced pancreatic cancer has grown into or close to nearby lymph nodes or blood vessels, so surgery cannot completely remove the cancer."
"
Metastatic pancreatic cancer has spread to other organs, so surgery cannot completely remove the cancer."
"
Recurrent pancreatic cancer has recurred (come back) after it has been treated."
The cancer may come back in the pancreas or in other parts of the body.
"
>There are different types of treatment for patients with
		  pancreatic cancer.
"
">The following types of treatment are used:SurgeryRadiation therapyChemotherapyChemoradiation therapyTargeted therapy
>Surgery
>Radiation therapy
>Chemotherapy
>Chemoradiation therapy
>Targeted therapy
>There are treatments for pain caused by pancreatic
		  cancer.
"
">Patients with pancreatic cancer have special nutritional
		  needs.
"
">New types of treatment are being tested in clinical trials.
"
">Treatment for pancreatic cancer may cause side effects.
"
">Patients may want to think about taking part in a clinical trial.
"
">Patients can enter clinical trials before, during, or after starting their cancer treatment.
"
>Follow-up tests may be needed.
"
Different types of treatment are available for patients with pancreatic cancer ."
"Some treatments are standard (the currently used treatment), and some are being tested in clinical trials ."
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer .
"When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment."
Patients may want to think about taking part in a clinical trial.
Some clinical trials are open only to patients who have not started treatment.
"
One of the following types of surgery may be used to take out the tumor :
>Whipple
				procedure
            : A surgical procedure in which the head of the
            pancreas
            , the
            gallbladder
            , part of the
            stomach
            , part of the
            small intestine
            , and the
            bile duct
            are removed.  "
"Enough of the pancreas is left to produce
            digestive
            juices
            and
            insulin
            .
"
">Total
				pancreatectomy
            : This operation removes the whole pancreas, part
				of the stomach, part of the small
				intestine, the
            common bile
				duct
            , the gallbladder, the
            spleen
            , and nearby
            lymph nodes
            .
"
">Distal pancreatectomy
            : Surgery to remove the body and the tail of the
				pancreas."
"The spleen may also be removed if cancer has spread to the spleen.
"
"If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms and improve quality of life :
>Biliary bypass
            : If cancer is blocking the bile duct
				and
            bile
            is building up in the
				gallbladder, a biliary bypass may be done."
"During this operation, the doctor
				will cut the gallbladder or bile duct in the area before the blockage and sew it to the small intestine to
				create a new pathway around the blocked area.
"
">Endoscopic
            stent
            placement: If the tumor is blocking the
				bile duct, surgery may be done to put in a stent (a thin tube) to
            drain
            bile
				that has built up in the area."
"The doctor may place the stent through a
            catheter
            that drains the bile into a bag on the outside
				of the body or the stent may go around the blocked area and drain the bile into
				the small intestine.
"
">Gastric
            bypass:
				If the tumor is blocking the flow of food from the stomach, the stomach may be
				sewn directly to the small intestine so the patient can continue to eat
				normally."
"
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing."
External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
"
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing."
"When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body ( systemic chemotherapy )."
"Combination chemotherapy is treatment using more than one anticancer drug.
"
See Drugs Approved for Pancreatic Cancer for more information.
"
Chemoradiation therapy combines chemotherapy and radiation therapy to increase the effects of both."
"
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells."
Tyrosine kinase inhibitors (TKIs) are targeted therapy drugs that block signals needed for tumors to grow.
"Erlotinib is a type of TKI used to treat pancreatic cancer.
"
See Drugs Approved for Pancreatic Cancer for more information.
"
Pain can occur when the tumor presses on nerves or other organs near the pancreas."
"When pain medicine is not enough, there are treatments that act on nerves in the abdomen to relieve the pain."
The doctor may inject medicine into the area around affected nerves or may cut the nerves to block the feeling of pain.
Radiation therapy with or without chemotherapy can also help relieve pain by shrinking the tumor.
See the PDQ summary on Cancer Pain for more information.
"
Surgery to remove the pancreas may affect its ability to make pancreatic enzymes that help to digest food."
"As a result, patients may have problems digesting food and absorbing nutrients into the body."
"To prevent malnutrition , the doctor may prescribe medicines that replace these enzymes."
"
This summary section describes treatments that are being studied in clinical trials."
It may not mention every new treatment being studied.
Information about clinical trials is available from the NCI website .
"
For information about side effects caused by treatment for cancer, see our Side Effects page."
"
For some patients, taking part in a clinical trial may be the best treatment choice."
Clinical trials are part of the cancer research process.
"Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment .
"
Many of today's standard treatments for cancer are based on earlier clinical trials.
"Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
"
Patients who take part in clinical trials also help improve the way cancer will be treated in the future.
"Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward."
"
Some clinical trials only include patients who have not yet received treatment."
Other trials test treatments for patients whose cancer has not gotten better.
"There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
"
Clinical trials are taking place in many parts of the country.
Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage.
Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
"
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated."
Some tests will be repeated in order to see how well the treatment is working.
"Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
"
Some of the tests will continue to be done from time to time after treatment has ended.
The results of these tests can show if your condition has changed or if the cancer has recurred (come back).
These tests are sometimes called follow-up tests or check-ups.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of resectable or borderline resectable pancreatic cancer may include the following:
>Chemotherapy
          with or without
          radiation therapy
          followed by
          surgery
          .
"
">Surgery.
"
">Surgery followed by chemotherapy.
"
">Surgery followed by
          chemoradiation
          .
"
">A
          clinical trial
          of chemotherapy and/or radiation therapy before surgery.
"
">A clinical trial of chemoradiation followed by surgery and then chemotherapy.
"
">A clinical trial of different ways of giving radiation therapy.
"
"Surgery to remove the tumor may include Whipple procedure , total pancreatectomy , or distal pancreatectomy .
"
Palliative therapy can be started at any stage of disease.
"See the Palliative Therapy section for information about treatments that may improve quality of life or relieve symptoms in patients with pancreatic cancer.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of pancreatic cancer that is locally advanced may include the following:
>Chemotherapy
          with or without
          targeted therapy
          .
"
">Chemotherapy and
          chemoradiation
          .
"
">Surgery
          (
          Whipple procedure
          ,
          total pancreatectomy
          , or
          distal pancreatectomy
          ).
"
">Palliative
          surgery
          or
          stent
          placement to
          bypass
          blocked areas in
          ducts
          or the
          small intestine
          ."
"Some patients may also receive chemotherapy and chemoradiation to shrink the
          tumor
          to allow for surgery.
"
">A
          clinical trial
          of  new anticancer
          therapies
          together with  chemotherapy or chemoradiation.
"
">A clinical trial of
          radiation therapy
          given during surgery or
          internal radiation
          therapy.
"
Palliative therapy can be started at any stage of disease.
"See the Palliative Therapy section for information about treatments that may improve quality of life or relieve symptoms in patients with pancreatic cancer.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of pancreatic cancer that has metastasized or recurred may include the following:
>Chemotherapy
          with or without
          targeted therapy
          .
"
">Clinical trials
          of new anticancer agents with or without chemotherapy.
"
Palliative therapy can be started at any stage of disease.
"See the Palliative Therapy section for information about treatments that may improve quality of life or relieve symptoms in patients with pancreatic cancer.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Palliative therapy can improve the patient's quality of life by controlling the symptoms and complications of pancreatic cancer .
"
"Palliative therapy for pancreatic cancer includes the following:
>Palliative
          surgery
          or
          stent
          placement to
          bypass
          blocked areas
			 in
          ducts
          or the
          small intestine
          .
>Palliative
          radiation therapy
          to help relieve pain by shrinking the
          tumor
          .
"
">An
          injection
          of medicine to  help relieve pain by blocking
          nerves
          in the
          abdomen
          .
"
">Other palliative medical care alone.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For more information from the National Cancer Institute about pancreatic cancer, see the following:
>Pancreatic Cancer Home Page
>Childhood Pancreatic Cancer Treatment
>Drugs Approved for Pancreatic Cancer
>Targeted Cancer Therapies
For general cancer information and other resources from the National Cancer Institute, see the following:
>About Cancer
>Staging
>Chemotherapy and You: Support for People With Cancer
>Radiation Therapy and You: Support for People With Cancer
>Coping with Cancer
>Questions to Ask Your Doctor about Cancer
>For Survivors and Caregivers"
"
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database."
"The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine."
Most summaries come in two versions.
The health professional versions have detailed information written in technical language.
"The patient versions are written in easy-to-understand, nontechnical language."
"Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish .
"
PDQ is a service of the NCI.
The NCI is part of the National Institutes of Health (NIH).
NIH is the federal government’s center of biomedical research.
The PDQ summaries are based on an independent review of the medical literature.
They are not policy statements of the NCI or the NIH.
"
This PDQ cancer information summary has current information about the treatment of adult pancreatic cancer."
"It is meant to inform and help patients, families, and caregivers."
It does not give formal guidelines or recommendations for making decisions about health care.
"
Editorial Boards write the PDQ cancer information summaries and keep them up to date."
These Boards are made up of experts in cancer treatment and other specialties related to cancer.
The summaries are reviewed regularly and changes are made when there is new information.
"The date on each summary (""Updated"") is the date of the most recent change.
"
"The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board ."
"
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another."
Trials are based on past studies and what has been learned in the laboratory.
Each trial answers certain scientific questions in order to find new and better ways to help cancer patients.
"During treatment clinical trials, information is collected about the effects of a new treatment and how well it works."
"If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become ""standard."""
Patients may want to think about taking part in a clinical trial.
"Some clinical trials are open only to patients who have not started treatment.
"
Clinical trials can be found online at NCI's website .
"For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237)."
"
PDQ is a registered trademark."
The content of PDQ documents can be used freely as text.
It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly.
"However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
"
"The best way to cite this PDQ summary is:
PDQ® Adult Treatment Editorial Board."
PDQ Pancreatic Cancer Treatment.
"Bethesda, MD: National Cancer Institute."
Updated <MM/DD/YYYY>.
Available at: https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq .
Accessed <MM/DD/YYYY>.
"[PMID: 26389396]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only."
"If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner."
It cannot be given by the National Cancer Institute.
"Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online ."
"Visuals Online is a collection of more than 3,000 scientific images."
"
The information in these summaries should not be used to make decisions about insurance reimbursement."
More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
"
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page."
"Questions can also be submitted to Cancer.gov through the website’s E-mail Us .
"
">Updated:May 5, 2023
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Pancreatic Cancer Treatment (PDQ®)–Patient Version was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
>General Information About Pancreatic Neuroendocrine Tumors (Islet Cell Tumors)
>Stages of Pancreatic Neuroendocrine Tumors
>Treatment Option Overview
>Treatment of Gastrinoma
>Treatment of Insulinoma
>Treatment of Glucagonoma
>Treatment of Other Pancreatic Neuroendocrine Tumors (Islet Cell Tumors)
>Treatment of Recurrent or Progressive Pancreatic Neuroendocrine Tumors
(Islet Cell Tumors)
>About This PDQ Summary"
"
>Pancreatic neuroendocrine tumors   form in hormone-making cells (islet cells) of the pancreas.
"
">Pancreatic NETs      may or may not cause signs or symptoms.
"
">There are different kinds of functional pancreatic NETs.
"
">Having certain syndromes can increase the risk of pancreatic NETs.
"
">Different types of pancreatic NETs  have different signs and symptoms.
"
">Lab tests and imaging tests are used to diagnose pancreatic NETs.
"
">Other kinds of lab tests are used to check for the specific type of pancreatic NETs.
"
>Certain factors affect prognosis (chance of recovery) and treatment options.
"
The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side."
"The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail."
"The pancreas lies behind the stomach and in front of the spine .
"
"There are two kinds of cells in the pancreas:
>Endocrine pancreas cells
           make several kinds of
           hormones
           (chemicals that control the actions of certain cells or
           organs
           in the body), such as
           insulin
           to control
           blood
           sugar."
They cluster together in many small groups (islets) throughout the pancreas.
"Endocrine pancreas cells are also called
           islet cells
           or islets of Langerhans.
           "
"Tumors
           that form in islet cells are called
           islet cell tumors
           , pancreatic endocrine tumors, or pancreatic neuroendocrine tumors (pancreatic NETs).
"
">Exocrine pancreas cells
           make
           enzymes
           that are released into the
           small intestine
           to help the body
           digest
           food."
"Most of the pancreas is made of
           ducts
           with small sacs at the end of the ducts, which are lined with
           exocrine cells
           .
"
This summary discusses islet cell tumors of the endocrine pancreas.
"See the PDQ summary on Pancreatic Cancer Treatment for information on exocrine pancreatic cancer .
"
Pancreatic neuroendocrine tumors (NETs) may be benign (not cancer ) or malignant (cancer).
"When pancreatic NETs are malignant, they are called pancreatic endocrine cancer or islet cell carcinoma.
"
Pancreatic NETs are much less common than pancreatic exocrine tumors and have a better prognosis .
"
Pancreatic NETs may be functional or nonfunctional :
>Functional tumors make extra amounts of hormones, such as
           gastrin
           , insulin, and
           glucagon
           , that cause
           signs
           and
           symptoms
           .
"
>Nonfunctional tumors do not make extra amounts of hormones.
"Signs and symptoms are caused by the tumor as it spreads and grows. 

"
"Most nonfunctional tumors are
           malignant
           (cancer).
"
Most pancreatic NETs are functional tumors.
"
Pancreatic NETs make different kinds of hormones such as gastrin, insulin, and glucagon."
"Functional pancreatic NETs include the following:
>Gastrinoma:
           "
A tumor that forms in cells that make gastrin.
"Gastrin is a hormone that causes the stomach to release an
           acid
           that helps digest  food."
Both gastrin and stomach acid are increased by   gastrinomas.
"When increased
           stomach acid
           , stomach
           ulcers
           , and
           diarrhea
           are caused by a tumor that makes gastrin, it is called
           Zollinger-Ellison syndrome
           ."
A gastrinoma usually  forms in the head of the pancreas and sometimes forms in the small intestine.
"Most gastrinomas are malignant (cancer).
"
">Insulinoma:
           A tumor that forms in cells that make insulin."
"Insulin is a hormone that controls the amount of
           glucose
           (sugar) in the blood."
"It moves glucose into the cells, where it can be used by the body for energy."
Insulinomas are usually slow-growing tumors that rarely spread.
"An insulinoma forms in the head, body, or tail of the pancreas."
"Insulinomas are usually benign (not cancer).
"
">Glucagonoma:
           A tumor that forms in cells that make glucagon."
Glucagon is a hormone that increases the amount of glucose in the blood.
"It causes the
           liver
           to break down glycogen."
"Too much glucagon causes
           hyperglycemia
           (
           high blood sugar
           )."
A glucagonoma usually forms in the tail of the pancreas.
"Most glucagonomas are malignant (cancer).
"
">Other types of tumors
           : There are other rare types of functional  pancreatic NETs  that make hormones, including hormones that control the balance of sugar, salt, and water in the body."
"These tumors include:VIPomas, which make
              vasoactive intestinal peptide
              ."
VIPoma may also be called Verner-Morrison syndrome.
"Somatostatinomas, which make somatostatin."
"These other types of tumors are grouped together because they are treated in much the same way.
"
">VIPomas, which make
              vasoactive intestinal peptide
              ."
"VIPoma may also be called Verner-Morrison syndrome.
"
">Somatostatinomas, which make somatostatin."
"
Anything that increases your risk of getting a disease is called a risk factor ."
Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer.
"Talk with your doctor if you think you may be at risk.
"
Multiple endocrine neoplasia type 1 (MEN1) syndrome is a risk factor for pancreatic NETs.
"
Signs or symptoms can be caused by the growth of the tumor and/or by hormones the tumor makes or by other conditions ."
Some tumors may not cause signs or symptoms.
"Check with your doctor if you have any of these problems.
"
"Signs and symptoms of a non-functional pancreatic NET
A non-functional pancreatic NET may grow for a long time without causing signs or symptoms."
"It may grow large or spread to other parts of the body before it causes signs or symptoms, such as:
>Diarrhea.
"
">Indigestion.
"
">A lump in the
           abdomen
           .
"
">Pain in the abdomen or back.
"
">Yellowing of the skin and whites of the eyes.
"
"Signs and symptoms of a functional pancreatic NET
The signs and symptoms of a functional pancreatic NET depend on the type of hormone being made.
"
"Too much gastrin may cause:
>Stomach ulcers that keep coming back.
"
">Pain in the abdomen, which may spread to the back."
"The pain may come and go and it may go away after taking an antacid.
"
">The flow of stomach contents back into the
           esophagus
           (
           gastroesophageal reflux
           ).
"
">Diarrhea.
"
"Too much insulin may cause:
>Low
           blood sugar
           ."
"This can cause blurred vision, headache, and feeling lightheaded, tired, weak, shaky, nervous, irritable, sweaty, confused, or hungry.
"
">Fast heartbeat.
"
"Too much glucagon may cause:
>Skin rash on the face, stomach, or legs.
"
>High blood sugar.
"This can cause headaches, frequent
           urination
           , dry skin and mouth, or feeling hungry, thirsty, tired, or weak.
"
">Blood clots
           ."
"Blood clots in the
           lung
           can cause shortness of breath, cough, or pain in the chest."
"Blood clots in the arm or leg can cause pain, swelling, warmth, or redness of the arm or leg.
"
">Diarrhea.
"
">Weight loss for no known reason.
"
">Sore tongue or sores at the corners of the mouth.
"
"Too much vasoactive intestinal peptide (VIP) may cause:
>Very large amounts of watery diarrhea.
"
">Dehydration
           ."
"This can cause feeling thirsty, making less
           urine
           , dry skin and mouth, headaches, dizziness, or feeling tired.
>Low
           potassium
           level in the blood."
"This can cause muscle weakness, aching, or cramps, numbness and tingling, frequent urination, fast heartbeat, and feeling confused or thirsty.
"
">Cramps or pain in the abdomen.
"
">Weight loss for no known reason.
"
"Too much somatostatin may cause:
>High blood sugar."
"This can cause headaches, frequent urination, dry skin and mouth, or feeling hungry, thirsty, tired, or weak.
"
">Diarrhea.
"
">Steatorrhea (very foul-smelling
           stool
           that floats).
"
">Gallstones
           .
"
">Yellowing of the skin and whites of the eyes.
"
">Weight loss for no known reason.
"
A pancreatic NET may also make too much adrenocorticotropic hormone (ACTH) and cause Cushing syndrome .
"Signs and symptoms of Cushing syndrome include the following:
>Headache.
"
">Some loss of vision.
"
">Weight gain in the face, neck, and
           trunk
           of the body, and thin arms and legs.
"
">A lump of fat on the back of the neck.
"
">Thin skin that may have purple or pink stretch marks on the chest or abdomen.
"
">Easy bruising.
"
">Growth of fine hair on the face, upper back, or arms.
"
">Bones that break easily.
"
">Sores or cuts that heal slowly.
"
">Anxiety
           , irritability, and
           depression
           .
"
The treatment of pancreatic NETs that make too much ACTH and Cushing syndrome are not discussed in this summary.
"
The following tests and procedures may be used:
>Physical exam and health history
           : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual."
"A history of the patient’s health habits and past illnesses and treatments will also be taken.
"
">Blood chemistry studies
           : A procedure in which a blood sample is checked to measure the amounts of certain substances, such as glucose (sugar), released into the blood by organs and
           tissues
           in the body."
"An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
"
">Chromogranin A test
           : A test in which a blood sample is checked to measure the amount of chromogranin A in the blood."
"A higher than normal amount of chromogranin A and normal amounts of hormones such as gastrin, insulin, and glucagon can be a sign of a non-functional pancreatic NET.
"
">Abdominal CT scan (CAT scan)
           : A procedure that makes a series of detailed pictures of the abdomen, taken from different angles.  "
"The pictures are made by a computer linked to an
           x-ray
           machine."
"A
           dye
           may be
           injected
           into a
           vein
           or swallowed to help the organs or tissues show up more clearly.  "
"This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
"
">MRI (magnetic resonance imaging)
           : A procedure that uses a magnet,
           radio waves
           , and a computer to make a series of detailed pictures of areas inside the body."
"This procedure is also called nuclear magnetic resonance imaging (NMRI).
"
">Somatostatin receptor scintigraphy
           :

  A type of
           radionuclide scan
           that may be used to find small pancreatic NETs.     "
"A small amount of
           radioactive
           octreotide
           (a hormone that attaches to  tumors) is injected into a
           vein
           and travels through the blood."
The radioactive octreotide attaches to the tumor and a special camera that detects radioactivity is used to show where the tumors are in the body.
"This procedure is also called octreotide scan and SRS.
"
">Endoscopic ultrasound (EUS)
           : A procedure in which an
           endoscope
           is inserted into the body, usually through the mouth or
           rectum
           .  "
"An endoscope is a thin, tube-like instrument with a light and a
           lens
           for viewing."
"A probe at the end of the endoscope is used to bounce high-energy sound waves (
           ultrasound
           ) off internal tissues or organs and make echoes.  "
"The echoes form a picture of body tissues called a
           sonogram
           .  "
"This procedure is also called endosonography.
"
">Endoscopic retrograde cholangiopancreatography (ERCP)
           :  "
"A procedure used to x-ray the ducts (tubes) that carry
           bile
           from the liver to the
           gallbladder
           and from the gallbladder to the small intestine.  "
"Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing
           jaundice
           .  "
"An endoscope  is passed through the mouth, esophagus, and stomach into the first part of the small intestine.  "
"An endoscope is a thin, tube-like instrument with a light and a lens for viewing."
"A
           catheter
           (a smaller tube) is then inserted through the endoscope into the pancreatic ducts.  "
A dye is injected through the catheter into the ducts and an x-ray is taken.  
"If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it.  "
"This tube (or
           stent
           ) may be left in place to keep the duct open.  "
"Tissue samples may also be taken and checked under a
           microscope
           for signs of cancer.
"
">Angiogram
           : A procedure to look at
           blood vessels
           and the flow of blood.  "
"A
           contrast dye
           is injected into the blood vessel.  "
"As the contrast dye moves through the blood vessel, x-rays are taken to see if there are any blockages.
"
">Laparotomy
           : A
           surgical
           procedure in which an
           incision
           (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease."
The size of the incision depends on the reason the laparotomy is being done.
"Sometimes organs are removed or tissue samples are taken and checked under a
           microscope
           for signs of disease.
"
">Intraoperative ultrasound
           : A procedure that uses high-energy sound waves (ultrasound) to create images of internal organs or  tissues during surgery."
"A transducer placed directly on the organ or tissue is used to make the  sound waves, which create echoes."
"The transducer receives the echoes and sends them to a computer, which uses the echoes to make pictures called sonograms.
"
">Biopsy
           : The removal of cells or tissues so they can be viewed under a microscope by a
           pathologist
           to check for signs of cancer."
There are several ways to do a biopsy for pancreatic NETs.
Cells may be removed using a fine or wide needle inserted into the pancreas during an x-ray or ultrasound.
"Tissue may also be removed during a
           laparoscopy
           (a surgical incision made in the wall of the abdomen).
"
">Bone scan
           : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone.  "
A very small amount of radioactive material is injected into a vein and travels through the bloodstream.  
"The radioactive material collects in  bones with cancer and is detected by a
           scanner
           ."
"
The following tests and procedures may be used:
Gastrinoma
>Fasting serum gastrin test
           : A test in which a blood sample is checked to measure the amount of gastrin in the blood."
This test is done after the patient has had nothing to eat or drink for at least 8 hours.  
"Conditions other than gastrinoma can cause an increase in the  amount of gastrin in the blood.
"
">Basal acid output test
           : A test to measure the amount of acid made by the stomach."
The test is done after the patient has had nothing to eat or drink for at least 8 hours.
"A tube is inserted through the nose or
           throat
           , into the stomach."
The stomach contents are removed and four samples of gastric acid are removed through the tube.
"These samples are used to find out the amount of gastric acid  made during the test and the
           pH
           level of the
           gastric
           secretions
           .
"
">Secretin stimulation test
           : If the basal acid output test result is not normal, a secretin stimulation test may be done."
"The tube is moved into the small intestine and samples are taken from the small intestine after  a
           drug
           called
           secretin
           is injected."
Secretin causes the small intestine to make acid.
"When there is a gastrinoma, the secretin causes an increase in how much gastric acid is made and the level of  gastrin in the blood.
"
">Somatostatin receptor scintigraphy
           :

  A type of radionuclide scan that may be used to find small pancreatic NETs."
A small amount of radioactive octreotide (a hormone that attaches to  tumors) is injected into a vein and travels through the blood.
The radioactive octreotide attaches to the tumor and a special camera that detects radioactivity is used to show where the tumors are in the body.
"This procedure is also called octreotide scan and SRS.
"
"Insulinoma
>Fasting serum glucose and insulin test
           : A test in which a blood sample is checked to measure the amounts of glucose (sugar) and insulin in the blood."
"The test is done after the patient has had nothing to eat or drink for at least 24 hours.
"
"Glucagonoma
>Fasting serum glucagon test
           : A test in which a blood sample is checked to measure the amount of glucagon in the blood."
"The test is done after the patient has had nothing to eat or drink for at least 8 hours.
"
"Other tumor types
>VIPomaSerum VIP (vasoactive intestinal peptide) test
              : A test in which a blood sample is checked to measure the amount of VIP.Blood chemistry studies
              : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body."
An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
"In VIPoma, there is a lower than normal amount of potassium."
"Stool analysis
              : A stool sample is checked for a higher than normal
              sodium
              (salt) and potassium levels.
"
">Serum VIP (vasoactive intestinal peptide) test
              : A test in which a blood sample is checked to measure the amount of VIP.
>Blood chemistry studies
              : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body."
An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
"In VIPoma, there is a lower than normal amount of potassium.
"
">Stool analysis
              : A stool sample is checked for a higher than normal
              sodium
              (salt) and potassium levels.
"
">SomatostatinomaFasting serum somatostatin test
              : A test in which a blood sample is checked to measure the amount of somatostatin in the blood."
The test is done after the patient has had nothing to eat or drink for at least 8 hours.
"Somatostatin receptor scintigraphy
              :

  A type of radionuclide scan that may be used to find small pancreatic NETs."
A small amount of radioactive octreotide (a hormone that attaches to  tumors) is injected into a vein and travels through the blood.
The radioactive octreotide attaches to the tumor and a special camera that detects radioactivity is used to show where the tumors are in the body.
"This procedure is also called octreotide scan and SRS.
"
">Fasting serum somatostatin test
              : A test in which a blood sample is checked to measure the amount of somatostatin in the blood."
"The test is done after the patient has had nothing to eat or drink for at least 8 hours.
"
">Somatostatin receptor scintigraphy
              :

  A type of radionuclide scan that may be used to find small pancreatic NETs."
A small amount of radioactive octreotide (a hormone that attaches to  tumors) is injected into a vein and travels through the blood.
The radioactive octreotide attaches to the tumor and a special camera that detects radioactivity is used to show where the tumors are in the body.
This procedure is also called octreotide scan and SRS.
"
Pancreatic NETs can often be cured ."
"The prognosis and treatment options depend on the following:
>"
"The type of cancer cell.
"
">Where the tumor is found in the pancreas.
"
">Whether the tumor has spread to more than one place in the pancreas or to other parts of the body.
"
">Whether the patient has MEN1 syndrome.
"
">The patient's age and  general health.
"
">Whether the cancer has just been
           diagnosed
           or has
           recurred
           (come back)."
"
>The plan for cancer treatment depends on where the NET is found in the pancreas and whether it has spread.
"
">There are three ways that cancer spreads in the body.
"
">Cancer may spread from where it began to other parts of the body.
"
>Pancreatic NETs can recur (come back) after they have been treated.
"
The process used to find out if cancer has spread within the pancreas or to other parts of the body is called staging ."
The results of the tests and procedures used to diagnose pancreatic neuroendocrine tumors (NETs) are also used to find out whether the cancer has spread.
"See the General Information section for a description of these tests and procedures.
"
"Although there is a standard staging system for pancreatic NETs, it is not used to plan treatment."
"Treatment of pancreatic NETs is based on the following:
>"
"Whether the cancer is found in one place in the
           pancreas
           .
"
">Whether the cancer is found in several places in the pancreas.
"
">Whether the cancer has spread to
           lymph nodes
           near the pancreas or to other parts of the body such as the
           liver
           ,
           lung
           ,
           peritoneum
           , or bone."
"
Cancer can spread through tissue , the lymph system , and the blood :
>Tissue."
"The cancer spreads from where it began by growing into nearby areas.
"
>Lymph system.
The cancer spreads from where it began by getting into the lymph system.
"The cancer travels through the
           lymph vessels
           to other parts of the body.
"
>Blood.
The cancer spreads from where it began by getting into the blood.
"The cancer travels through the
           blood vessels
           to other parts of the body."
"
"
"When cancer spreads to another part of the body, it is called metastasis ."
"Cancer cells break away from where they began (the primary tumor ) and travel through the lymph system or blood.
"
>Lymph system.
"The cancer gets into the lymph system, travels through the lymph vessels, and forms a
           tumor
           (
           metastatic
           tumor) in another part of the body.
"
>Blood.
"The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
"
The metastatic tumor is the same type of tumor as the primary tumor.
"For example, if a pancreatic neuroendocrine tumor spreads to the liver, the tumor cells in the liver are actually neuroendocrine tumor cells."
"The disease is metastatic pancreatic neuroendocrine tumor, not liver cancer."
"
The tumors may come back in the pancreas or in other parts of the body."
"
>There are different types of treatment for  patients with pancreatic NETs.
"
">The following types of treatment are used:SurgeryChemotherapyHormone therapyHepatic arterial occlusion or chemoembolizationTargeted therapySupportive care
>Surgery
>Chemotherapy
>Hormone therapy
>Hepatic arterial occlusion or chemoembolization
>Targeted therapy
>Supportive care
>New types of treatment are being tested in clinical 
         trials.
"
">Treatment for pancreatic neuroendocrine tumors may cause side effects.
"
">Patients may want to think about taking part in a 
         clinical trial.
"
">Patients can enter clinical trials before, during, or 
         after starting their cancer treatment.
"
>Follow-up tests may be needed.
"
Different types of treatments are available for patients with pancreatic neuroendocrine tumors (NETs)."
"Some treatments are standard (the currently used treatment), and some are being tested in clinical trials ."
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer .
"When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment."
Patients may want to think about taking part in a clinical trial.
Some clinical trials are open only to patients who have not started treatment.
"
An operation may be done to remove the tumor ."
"One of the following types of surgery may be used:
>Enucleation
            : Surgery to remove the tumor only."
"This may be done when cancer occurs in one place in the
            pancreas
            .
"
">Pancreatoduodenectomy
            : A surgical procedure in which the head of the pancreas, the
            gallbladder
            , nearby
            lymph nodes
            and part of the
            stomach
            ,
            small intestine
            , and
            bile duct
            are removed.  "
"Enough of the pancreas is left to make
            digestive
            juices and
            insulin
            ."
"The
            organs
            removed during this procedure depend on the patient's
            condition
            ."
"This is also called the
            Whipple procedure
            .
"
">Distal pancreatectomy
            : Surgery to remove the body and  tail of the
				pancreas."
"The
            spleen
            may also be removed if cancer has spread to the spleen.
>Total
            gastrectomy
            :"
"Surgery to remove the whole stomach.
"
">Parietal cell vagotomy
            :"
"Surgery to cut the
            nerve
            that causes stomach
            cells
            to make
            acid
            .
"
">Liver
            resection
            :"
"Surgery to remove part or all of the liver.
"
">Radiofrequency ablation
            : The use of a special probe with tiny electrodes that kill cancer cells."
"Sometimes the probe is inserted directly through the skin and only
            local anesthesia
            is needed."
"In other cases, the probe is inserted through an
            incision
            in the
            abdomen
            ."
"This is done in the hospital with
            general anesthesia
            .
"
">Cryosurgical
            ablation
            : A procedure in which
            tissue
            is frozen to destroy
            abnormal
            cells."
"This is usually done with a special instrument that contains liquid nitrogen or liquid
            carbon dioxide
            ."
"The instrument may be used during surgery or
            laparoscopy
            or inserted through the skin."
"This procedure is also called
            cryoablation
            ."
"
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing."
"When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body ( systemic chemotherapy )."
"When chemotherapy is placed directly into the cerebrospinal fluid , an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas ( regional chemotherapy )."
Combination chemotherapy is the use of more than one anticancer drug.
The way the chemotherapy is given depends on the type of the cancer being treated.
"
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing."
Hormones are substances made by glands in the body and circulated in the bloodstream.
Some hormones can cause certain cancers to grow.
"If tests show that the cancer cells have places where hormones can attach ( receptors ), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working."
"
Hepatic arterial occlusion uses drugs, small particles, or other agents to block or reduce the flow of blood to the liver through the hepatic artery (the major blood vessel that carries blood to the liver)."
This is done to kill cancer cells growing in the liver.
The tumor is prevented from getting the oxygen and nutrients it needs to grow.
"The liver continues to receive blood from the hepatic portal vein , which carries blood from the stomach and intestine .
"
Chemotherapy delivered during hepatic arterial occlusion is called chemoembolization .
The anticancer drug is injected into the hepatic artery through a catheter (thin tube).
The drug is mixed with the substance that blocks the artery and cuts off blood flow to the tumor.
"Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body.
"
"The blockage may be temporary or permanent, depending on the substance used to block the artery."
"
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells."
Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.
Certain types of targeted therapies are being studied in the treatment of pancreatic NETs.
"
Supportive care is given to lessen the problems caused by the disease or its treatment."
"Supportive care for pancreatic NETs may include treatment for the following:
>Stomach
            ulcers
            may be treated with drug
            therapy
            such as:Proton pump inhibitor
               drugs such as
               omeprazole
               ,
               lansoprazole
               , or pantoprazole."
"Histamine blocking drugs such as
               cimetidine
               , ranitidine, or famotidine."
"Somatostatin-type drugs such as
               octreotide
               .
"
">Proton pump inhibitor
               drugs such as
               omeprazole
               ,
               lansoprazole
               , or pantoprazole.
"
">Histamine blocking drugs such as
               cimetidine
               , ranitidine, or famotidine.
"
">Somatostatin-type drugs such as
               octreotide
               .
"
">Diarrhea
            may be treated with:Intravenous
               (IV)
               fluids
               with
               electrolytes
               such as
               potassium
               or chloride."
"Somatostatin-type drugs such as octreotide.
"
">Intravenous
               (IV)
               fluids
               with
               electrolytes
               such as
               potassium
               or chloride.
"
">Somatostatin-type drugs such as octreotide.
>Low
            blood sugar
            may be treated by having small, frequent meals or with
            drug therapy
            to maintain a normal blood sugar level.
"
">High blood sugar
            may be treated with drugs taken by mouth or
            insulin
            by
            injection
            ."
"
Information about clinical trials is available from the NCI website ."
"
For information about side effects caused by treatment for cancer, see our Side Effects page."
"
For some patients, taking part in a clinical trial may be the best treatment choice."
Clinical trials are part of the cancer research process.
"Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment .
"
Many of today's standard treatments for cancer are based on earlier clinical trials.
"Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
"
Patients who take part in clinical trials also help improve the way cancer will be treated in the future.
"Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward."
"
Some clinical trials only include patients who have not yet received treatment."
Other trials test treatments for patients whose cancer has not gotten better.
"There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
"
Clinical trials are taking place in many parts of the country.
Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage.
Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
"
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated."
Some tests will be repeated in order to see how well the treatment is working.
"Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
"
Some of the tests will continue to be done from time to time after treatment has ended.
The results of these tests can show if your condition has changed or if the cancer has recurred (come back).
These tests are sometimes called follow-up tests or check-ups.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of gastrinoma may include supportive care and the following:
>For
          symptoms
          caused by too much
          stomach acid
          , treatment may be a
          drug
          that decreases the amount of acid made by the stomach.
"
>
"For a single
          tumor
          in the head of the
          pancreas
          :Surgery
             to remove the tumor."
"Surgery to cut the
             nerve
             that causes stomach
             cells
             to make acid and treatment with a drug that decreases stomach acid."
"Surgery to remove the whole stomach (rare).
"
">Surgery
             to remove the tumor.
"
">Surgery to cut the
             nerve
             that causes stomach
             cells
             to make acid and treatment with a drug that decreases stomach acid.
"
">Surgery to remove the whole stomach (rare).
"
">For a single tumor in the body or tail of the pancreas, treatment is usually surgery to remove the body or  tail of the
				pancreas.
"
">For several tumors in the pancreas, treatment is usually surgery to remove the body or  tail of the
				pancreas."
"If tumor remains after surgery, treatment may include either:Surgery to cut the nerve that causes stomach cells to make acid and treatment with a drug that decreases stomach acid; orSurgery to remove the whole stomach (rare).
"
">Surgery to cut the nerve that causes stomach cells to make acid and treatment with a drug that decreases stomach acid; or
>Surgery to remove the whole stomach (rare).
"
">For one or more tumors in the
          duodenum
          (the part of the
          small intestine
          that connects to the stomach), treatment is usually
          pancreatoduodenectomy
          (surgery to remove the head of the pancreas, the
          gallbladder
          , nearby
          lymph nodes
          and part of the
          stomach
          ,
          small intestine
          , and
          bile duct
          ).
"
">If no tumor is found, treatment may include the following:Surgery to cut the nerve that causes stomach cells to make acid and treatment with a drug that decreases stomach acid."
"Surgery to remove the whole stomach (rare).
"
">Surgery to cut the nerve that causes stomach cells to make acid and treatment with a drug that decreases stomach acid.
"
">Surgery to remove the whole stomach (rare).
"
">If the
          cancer
          has spread to the
          liver
          , treatment may include:Surgery to remove part or all of the liver."
"Radiofrequency ablation
             or
             cryosurgical
             ablation
             .Chemoembolization
             .
"
">Surgery to remove part or all of the liver.
"
">Radiofrequency ablation
             or
             cryosurgical
             ablation
             .
"
">Chemoembolization
             .
"
">If cancer has spread to other parts of the body or does not get better with surgery or drugs to decrease stomach acid, treatment may include:Chemotherapy
             .Hormone therapy
             .
"
">Chemotherapy
             .
"
">Hormone therapy
             .
"
">If the cancer mostly affects the liver and the patient has severe symptoms from
          hormones
          or from the size of tumor, treatment may include:Hepatic arterial occlusion
             , with or without
             systemic chemotherapy
             .Chemoembolization, with or without systemic chemotherapy.
"
">Hepatic arterial occlusion
             , with or without
             systemic chemotherapy
             .
"
">Chemoembolization, with or without systemic chemotherapy.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of insulinoma may include the following:
>"
"For one small
          tumor
          in the head or tail of the
          pancreas
          , treatment is usually
          surgery
          to remove the tumor.
"
">For one large tumor in the head of the pancreas that cannot be removed by surgery, treatment is usually
          pancreatoduodenectomy
          (surgery to remove the head of the pancreas, the
          gallbladder
          , nearby
          lymph nodes
          and part of the
          stomach
          ,
          small intestine
          , and
          bile duct
          ).
"
">For one large tumor  in  the body or tail of the pancreas, treatment is usually a
          distal pancreatectomy
          (surgery to remove the body and  tail of the
				pancreas).
"
">For more than one tumor in the pancreas, treatment is usually surgery to remove any tumors in the head of the pancreas and the body and  tail of the
				pancreas.
"
">For tumors that cannot be removed by surgery, treatment may include the following:Combination chemotherapy
             .Palliative
             drug
             therapy
             to decrease the amount  of
             insulin
             made by the pancreas."
"Hormone therapy
             .Radiofrequency ablation or  cryosurgical ablation.
"
">Combination chemotherapy
             .
"
">Palliative
             drug
             therapy
             to decrease the amount  of
             insulin
             made by the pancreas.
"
">Hormone therapy
             .
"
">Radiofrequency ablation or  cryosurgical ablation.
"
">For cancer that has spread to
          lymph nodes
          or other parts of the body, treatment may include the following:Surgery to remove the cancer."
"Radiofrequency ablation
             or
             cryosurgical
             ablation
             , if the cancer cannot be removed by surgery.
"
">Surgery to remove the cancer.
"
">Radiofrequency ablation
             or
             cryosurgical
             ablation
             , if the cancer cannot be removed by surgery.
"
">If the
          cancer
          mostly affects the
          liver
          and the patient has  severe
          symptoms
          from
          hormones
          or from the size of tumor, treatment may include:Hepatic arterial occlusion
             , with or without
             systemic chemotherapy
             .Chemoembolization
             , with or without systemic chemotherapy.
"
">Hepatic arterial occlusion
             , with or without
             systemic chemotherapy
             .
"
">Chemoembolization
             , with or without systemic chemotherapy.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment may include the following:
>"
"For one small
          tumor
          in the head or tail of the
          pancreas
          , treatment is usually
          surgery
          to remove the tumor.
"
">For one large tumor in the head of the pancreas that cannot be removed by surgery, treatment is usually
          pancreatoduodenectomy
          (surgery to remove the head of the pancreas, the
          gallbladder
          , nearby
          lymph nodes
          and part of the
          stomach
          ,
          small intestine
          , and
          bile duct
          ).
"
">For more than one tumor in the pancreas, treatment is usually surgery to remove the tumor or surgery to remove the body and tail of the pancreas.
"
">For tumors that cannot be removed by surgery, treatment may include the following:Combination chemotherapy
             .Hormone therapy
             .Radiofrequency ablation
             or
             cryosurgical
             ablation.
"
">Combination chemotherapy
             .
"
">Hormone therapy
             .
"
">Radiofrequency ablation
             or
             cryosurgical
             ablation.
"
>
"For cancer that has spread to lymph nodes or other parts of the body, treatment may include the following:Surgery to remove the cancer."
"Radiofrequency ablation or cryosurgical
             ablation
             , if the cancer cannot be removed by surgery.
"
">Surgery to remove the cancer.
"
">Radiofrequency ablation or cryosurgical
             ablation
             , if the cancer cannot be removed by surgery.
"
">If the
          cancer
          mostly affects the
          liver
          and the patient has  severe
          symptoms
          from
          hormones
          or from the size of tumor, treatment may include:Hepatic arterial occlusion
             , with or without
             systemic chemotherapy
             .Chemoembolization
             , with or without systemic chemotherapy.
"
">Hepatic arterial occlusion
             , with or without
             systemic chemotherapy
             .
"
">Chemoembolization
             , with or without systemic chemotherapy.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"For VIPoma, treatment may include the following:
>Fluids
          and
          hormone therapy
          to  replace fluids and
          electrolytes
          that have been lost from the body.
"
">Surgery
          to remove the
          tumor
          and nearby
          lymph nodes
          .
"
>Surgery to remove as much of the tumor as possible when the tumor cannot be completely removed or has spread to distant parts of the body.
"This is
          palliative therapy
          to relieve
          symptoms
          and improve the
          quality of life
          .
"
>
"For tumors that have spread to lymph nodes or other parts of the body, treatment may include the following:Surgery to remove the tumor."
"Radiofrequency ablation
             or
             cryosurgical
             ablation
             , if the tumor cannot be removed by surgery.
"
">Surgery to remove the tumor.
"
">Radiofrequency ablation
             or
             cryosurgical
             ablation
             , if the tumor cannot be removed by surgery.
"
">For tumors that continue to grow during treatment or have spread to other parts of the body, treatment may include the following:Chemotherapy
             .Targeted therapy
             .
"
">Chemotherapy
             .
"
">Targeted therapy
             .
"
"For somatostatinoma, treatment may include the following:
>Surgery to remove the tumor.
"
">For cancer that has spread to distant parts of the body, surgery to remove as much of the cancer as possible to relieve symptoms and improve quality of life.
"
">For tumors that continue to grow during treatment or have spread to other parts of the body, treatment may include the following:Chemotherapy."
"Targeted therapy.
"
">Chemotherapy.
>Targeted therapy.
"
"Treatment of other types of pancreatic neuroendocrine tumors (NETs) may include the following:
>Surgery to remove the tumor.
"
">For cancer that has spread to distant parts of the body, surgery to remove as much of the cancer as possible or hormone therapy to relieve symptoms and improve quality of life.
"
">For tumors that continue to grow during treatment or have spread to other parts of the body, treatment may include the following:Chemotherapy."
"Targeted therapy.
"
">Chemotherapy.
>Targeted therapy.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
>To Learn More About Pancreatic Neuroendocrine Tumors (Islet Cell Tumors)
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of pancreatic neuroendocrine tumors (NETs) that continue to grow during treatment or recur (come back) may include the following:
>Surgery
          to remove the
          tumor
          .
"
">Chemotherapy
          .
>Hormone therapy
          .
"
">Targeted therapy
          .
"
">For
          liver metastases
          :Regional chemotherapy
             .Hepatic arterial occlusion
             or
             chemoembolization
             , with or without
             systemic chemotherapy
             .
"
">Regional chemotherapy
             .
"
">Hepatic arterial occlusion
             or
             chemoembolization
             , with or without
             systemic chemotherapy
             .
"
">A
          clinical trial
          of a new
          therapy
          ."
"
For more information from the National Cancer Institute about pancreatic neuroendocrine tumors (NETs), see the following:
>Pancreatic Cancer Home Page
>Targeted Cancer Therapies
For general cancer information and other resources from the National Cancer Institute, see the following:
>About Cancer
>Staging
>Chemotherapy and You: Support for People With Cancer
>Radiation Therapy and You: Support for People With Cancer
>Coping with Cancer
>Questions to Ask Your Doctor about Cancer
>For Survivors and Caregivers
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients."
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database."
"The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine."
Most summaries come in two versions.
The health professional versions have detailed information written in technical language.
"The patient versions are written in easy-to-understand, nontechnical language."
"Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish .
"
PDQ is a service of the NCI.
The NCI is part of the National Institutes of Health (NIH).
NIH is the federal government’s center of biomedical research.
The PDQ summaries are based on an independent review of the medical literature.
They are not policy statements of the NCI or the NIH.
"
This PDQ cancer information summary has current information about the treatment of pancreatic neuroendocrine tumors (islet cell tumors)."
"It is meant to inform and help patients, families, and caregivers."
It does not give formal guidelines or recommendations for making decisions about health care.
"
Editorial Boards write the PDQ cancer information summaries and keep them up to date."
These Boards are made up of experts in cancer treatment and other specialties related to cancer.
The summaries are reviewed regularly and changes are made when there is new information.
"The date on each summary (""Updated"") is the date of the most recent change.
"
"The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board ."
"
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another."
Trials are based on past studies and what has been learned in the laboratory.
Each trial answers certain scientific questions in order to find new and better ways to help cancer patients.
"During treatment clinical trials, information is collected about the effects of a new treatment and how well it works."
"If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become ""standard."""
Patients may want to think about taking part in a clinical trial.
"Some clinical trials are open only to patients who have not started treatment.
"
Clinical trials can be found online at NCI's website .
"For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237)."
"
PDQ is a registered trademark."
The content of PDQ documents can be used freely as text.
It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly.
"However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
"
"The best way to cite this PDQ summary is:
PDQ® Adult Treatment Editorial Board."
PDQ Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment.
"Bethesda, MD: National Cancer Institute."
Updated <MM/DD/YYYY>.
Available at: https://www.cancer.gov/types/pancreatic/patient/pnet-treatment-pdq .
Accessed <MM/DD/YYYY>.
"[PMID: 26389340]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only."
"If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner."
It cannot be given by the National Cancer Institute.
"Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online ."
"Visuals Online is a collection of more than 3,000 scientific images."
"
The information in these summaries should not be used to make decisions about insurance reimbursement."
More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
"
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page."
"Questions can also be submitted to Cancer.gov through the website’s E-mail Us .
"
">Updated:October 7, 2022
"
"If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions."
"In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ®)–Patient Version was originally published by the National Cancer Institute.”
"
Want to use this content on your website or other digital platform?
"
>General Information About Small  Intestine Cancer
>Stages of Small  Intestine Cancer
>Treatment Option Overview
>Treatment of Small Intestine Adenocarcinoma
>Treatment of Small  Intestine Leiomyosarcoma
>Treatment of Recurrent Small  Intestine Cancer
>To Learn More About Small Intestine Cancer
>About This PDQ Summary"
"
>Small  intestine cancer is a rare disease in which malignant (cancer) cells form in the tissues of the small  intestine.
"
">There are  five types of small intestine cancer.
"
">Diet and health history can affect the risk of developing small  intestine cancer.
"
">Signs and symptoms of small  intestine cancer include unexplained weight loss and abdominal pain.
"
">Tests that examine the small intestine are used to diagnose and stage small  intestine cancer.
"
>Certain factors affect prognosis (chance of recovery) and treatment options.
"
The small intestine is part of the body’s digestive system , which also includes the esophagus , stomach , and large intestine ."
"The digestive system removes and processes nutrients ( vitamins , minerals , carbohydrates , fats, proteins , and water) from foods and helps pass waste material out of the body."
The small intestine is a long tube that connects the stomach to the large intestine.
It folds many times to fit inside the abdomen .
"
The types of cancer found in the small intestine are adenocarcinoma , sarcoma , neuroendocrine tumors , gastrointestinal stromal tumor , and lymphoma ."
"This summary discusses adenocarcinoma and leiomyosarcoma (a type of sarcoma).
"
Adenocarcinoma starts in glandular cells in the lining of the small intestine and is the most common type of small intestine cancer .
Most of these tumors occur in the part of the small intestine near the stomach.
"They may grow and block the intestine.
"
Leiomyosarcoma starts in the smooth muscle cells of the small intestine.
"Most of these tumors occur in the part of the small intestine near the large intestine.
"
"For more information on small intestine cancer, see the following:
>Gastrointestinal Neuroendocrine Tumors Treatment
>Gastrointestinal Stromal Tumors Treatment"
"
Anything that increases a person's chance of getting a disease is called a risk factor ."
"Not every person with one or more of these risk factors will develop small intestine cancer, and it will develop in some people who don't have any known risk factors."
Talk with your doctor if you think you may be at risk.
"Risk factors for small intestine cancer include the following:
>"
"Eating a  high-fat
           diet
           .
"
">Having
           Crohn disease
           .
"
">Having
           celiac disease
           .
"
">Having
           familial adenomatous polyposis
           (FAP)."
"
These and other signs and symptoms may be caused by small intestine cancer or by other conditions ."
"Check with your doctor if you have any of the following:
>Pain or cramps in the middle of the abdomen.
"
">Weight loss with no known reason.
"
">A lump in the abdomen.
"
">Blood
           in the
           stool
           ."
"
Procedures that make pictures of the small intestine and the area around it help diagnose small intestine cancer and show how far the cancer has spread."
"The process used to find out if cancer cells have spread within and around the small intestine is called staging .
"
"In order to plan treatment, it is important to know the type of small intestine cancer and whether the tumor can be removed by surgery ."
"Tests and procedures to detect, diagnose, and stage small intestine cancer are usually done at the same time."
"In addition to asking about your personal and family health history and doing a physical exam , your doctor may perform the following tests and procedures:
>Blood chemistry studies
           : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by
           organs
           and
           tissues
           in the body."
"An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
"
">Liver function tests
           : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the
           liver
           .  "
"A higher than normal amount of a substance can  be a sign of liver disease that may be caused by small intestine cancer.
"
">Endoscopy
           :  "
"A procedure to look at organs and tissues inside the body to check for
           abnormal
           areas."
"There are different types of endoscopy:Upper endoscopy
              : A procedure to look at the inside of the esophagus, stomach, and
              duodenum
              (first part of the small intestine, near the stomach)."
"An
              endoscope
              is inserted  through the mouth and into the esophagus, stomach, and duodenum.  "
"An endoscope is a thin, tube-like instrument with a light and a
              lens
              for viewing."
"It may also have a tool to remove tissue samples, which are checked under a
              microscope
              for signs of cancer."
"Capsule endoscopy
              : A procedure to look at the inside of the small intestine."
A capsule that is about the size of a large pill and contains a light and a tiny wireless camera is swallowed by the patient.
"The capsule travels through the
              digestive tract
              , including the small intestine, and sends many pictures of the inside of the digestive tract to a recorder that is worn around the waist or over the shoulder."
The pictures are sent from the recorder to a computer and viewed by the doctor who checks for signs of cancer.
"The capsule passes out of the body during a
              bowel movement
              .Double balloon endoscopy
              : A procedure to look at the inside of the small intestine."
"A special instrument made up of two tubes (one inside the other) is inserted through the mouth or
              rectum
              and into the small intestine."
The inside  tube (an endoscope with a light and lens for viewing) is moved through part of the small intestine and a balloon at the end of it is inflated to keep the endoscope in place.
"Next, the outer tube is moved through the small intestine to reach the end of the endoscope, and a balloon at the end of the outer tube is inflated to keep it in place."
"Then, the balloon at the end of the endoscope is deflated and the endoscope is moved through the next part of the small intestine."
These steps are repeated many times as the tubes move through the small intestine.
The doctor is able to see the inside of the small intestine through the endoscope and use a tool to remove samples of abnormal tissue.
The tissue samples are checked under a microscope for signs of cancer.
This procedure may be done if the results of a capsule endoscopy are abnormal.
"This procedure is also called double balloon enteroscopy.
"
">Upper endoscopy
              : A procedure to look at the inside of the esophagus, stomach, and
              duodenum
              (first part of the small intestine, near the stomach)."
"An
              endoscope
              is inserted  through the mouth and into the esophagus, stomach, and duodenum.  "
"An endoscope is a thin, tube-like instrument with a light and a
              lens
              for viewing."
"It may also have a tool to remove tissue samples, which are checked under a
              microscope
              for signs of cancer.
"
">Capsule endoscopy
              : A procedure to look at the inside of the small intestine."
A capsule that is about the size of a large pill and contains a light and a tiny wireless camera is swallowed by the patient.
"The capsule travels through the
              digestive tract
              , including the small intestine, and sends many pictures of the inside of the digestive tract to a recorder that is worn around the waist or over the shoulder."
The pictures are sent from the recorder to a computer and viewed by the doctor who checks for signs of cancer.
"The capsule passes out of the body during a
              bowel movement
              .
"
">Double balloon endoscopy
              : A procedure to look at the inside of the small intestine."
"A special instrument made up of two tubes (one inside the other) is inserted through the mouth or
              rectum
              and into the small intestine."
The inside  tube (an endoscope with a light and lens for viewing) is moved through part of the small intestine and a balloon at the end of it is inflated to keep the endoscope in place.
"Next, the outer tube is moved through the small intestine to reach the end of the endoscope, and a balloon at the end of the outer tube is inflated to keep it in place."
"Then, the balloon at the end of the endoscope is deflated and the endoscope is moved through the next part of the small intestine."
These steps are repeated many times as the tubes move through the small intestine.
The doctor is able to see the inside of the small intestine through the endoscope and use a tool to remove samples of abnormal tissue.
The tissue samples are checked under a microscope for signs of cancer.
This procedure may be done if the results of a capsule endoscopy are abnormal.
"This procedure is also called double balloon enteroscopy.
>Laparotomy
           : A
           surgical
           procedure in which an
           incision
           (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease."
The size of the incision depends on the reason the laparotomy is being done.
"Sometimes organs or
           lymph nodes
           are removed or tissue samples are taken and checked under a microscope for signs of disease.
"
">Biopsy
           : The removal of cells or tissues so they can be viewed   under a microscope to check for signs of cancer.  "
This may be done during an endoscopy or laparotomy.  
"The  sample is checked by a
           pathologist
           to see if it contains cancer cells.
"
">Upper GI series with small bowel follow-through
           : A series of
           x-rays
           of the esophagus, stomach, and  small bowel.  "
"The patient drinks a liquid that contains
           barium
           (a silver-white
           metallic
           compound
           ).  "
"The liquid coats the esophagus, stomach, and  small bowel.  "
"X-rays are  taken at different times as the barium travels through the upper
           GI tract
           and small bowel.
"
">CT scan (CAT scan)
           :  "
"A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles.  "
The pictures are made by a computer linked to an x-ray machine.
"A
           dye
           may be
           injected
           into a
           vein
           or swallowed to help the organs or tissues show up more clearly.  "
"This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
"
">MRI (magnetic resonance imaging)
           : A procedure that uses a magnet,
           radio waves
           , and a computer to make a series of detailed pictures of areas inside the body."
This procedure is also called nuclear magnetic resonance imaging (NMRI).
"
The prognosis and treatment options depend on the following:
>"
"The type of small intestine cancer.
"
">Whether the cancer is in the inner lining of the small intestine only or has spread into or beyond the wall of the small intestine.
"
">Whether the cancer has spread to other places in the body, such as the lymph nodes, liver, or
           peritoneum
           (tissue that lines the wall of the abdomen and covers most of the organs in the abdomen).
"
">Whether the cancer can be completely removed by
           surgery
           .
"
">Whether the cancer is newly diagnosed or has
           recurred
           ."
"
>Tests and procedures to stage small intestine cancer are  usually done at the same time as diagnosis.
"
">There are three ways that cancer spreads in the body.
"
">Cancer may spread from where it began to other parts of the body.
"
">Small intestine cancer is  grouped according to whether or not the tumor can be completely removed by surgery.
"
>Small intestine cancer can recur (come back) after it has been treated.
"
Staging is used to find out how far the cancer has spread, but treatment decisions are not based on stage ."
"See the General Information section for a description of tests and procedures used to detect, diagnose , and stage small intestine cancer."
"
Cancer can spread through tissue , the lymph system , and the blood :
>Tissue."
"The cancer spreads from where it began by growing into nearby areas.
"
>Lymph system.
The cancer spreads from where it began by getting into the lymph system.
"The cancer travels through the
           lymph vessels
           to other parts of the body.
"
>Blood.
The cancer spreads from where it began by getting into the blood.
"The cancer travels through the
           blood vessels
           to other parts of the body."
"
"
"When cancer spreads to another part of the body, it is called metastasis ."
"Cancer cells break away from where they began (the primary tumor ) and travel through the lymph system or blood.
"
>Lymph system.
"The cancer gets into the lymph system, travels through the lymph vessels, and forms a
           tumor
           (
           metastatic
           tumor) in another part of the body.
"
>Blood.
"The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
"
The metastatic tumor is the same type of cancer as the primary tumor.
"For example, if small intestine cancer spreads to the liver , the cancer cells in the liver are actually small intestine cancer cells."
"The disease is metastatic small intestine cancer, not liver cancer ."
"
Treatment depends on whether the tumor can be removed by surgery and if the cancer is being treated as a primary tumor or is metastatic cancer ."
"
The cancer may come back in the small intestine or in other parts of the body."
"
>There are different types of treatment for patients with small  intestine cancer.
"
">The following types of treatment are used:SurgeryRadiation therapyChemotherapy
>Surgery
>Radiation therapy
>Chemotherapy
>New types of treatment are being tested in clinical trials."
"ImmunotherapyRadiation therapy with radiosensitizers
>Immunotherapy
>Radiation therapy with radiosensitizers
>Treatment for small intestine cancer may cause side effects.
"
">Patients may want to think about taking part in a clinical trial.
"
">Patients can enter clinical trials before, during, or after starting their cancer treatment.
"
>Follow-up tests may be needed.
"
Different types of treatments are available for patients with small intestine cancer ."
"Some treatments are standard (the currently used treatment), and some are being tested in clinical trials ."
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer.
"When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment."
Patients may want to think about taking part in a clinical trial.
Some clinical trials are open only to patients who have not started treatment.
"
Surgery is the most common treatment of small intestine cancer."
"One of the following types of surgery may be done:
>Resection
            :  Surgery to remove part or all of an
            organ
            that contains cancer."
The resection may include the small intestine and nearby organs (if the cancer has spread).
"The doctor may remove the section of the  small intestine that contains cancer and perform an
            anastomosis
            (joining the cut ends of the intestine
				together)."
"The doctor will usually remove
            lymph nodes
            near the small intestine and examine them under
				a
            microscope
            to see whether they contain cancer.
"
">Bypass
            : Surgery to allow food in the small intestine to go around (bypass) a
            tumor
            that is blocking the intestine but cannot be removed.
"
"After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that are left."
"Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy ."
"
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing."
"External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
"
External radiation therapy is used to treat small intestine cancer.
"
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing."
"When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body ( systemic chemotherapy )."
"
This summary section describes treatments that are being studied in clinical trials."
It may not mention every new treatment being studied.
Information about clinical trials is available from the NCI website .
"
Immunotherapy is a treatment that uses the patient's immune system to fight cancer."
"Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer."
"
Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy."
Combining radiation therapy with radiosensitizers may kill more tumor cells.
"
For information about side effects caused by treatment for cancer, see our Side Effects page."
"
For some patients, taking part in a clinical trial may be the best treatment choice."
Clinical trials are part of the cancer research process.
"Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment .
"
Many of today's standard treatments for cancer are based on earlier clinical trials.
"Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
"
Patients who take part in clinical trials also help improve the way cancer will be treated in the future.
"Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward."
"
Some clinical trials only include patients who have not yet received treatment."
Other trials test treatments for patients whose cancer has not gotten better.
"There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
"
Clinical trials are taking place in many parts of the country.
Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage.
Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
"
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated."
Some tests will be repeated in order to see how well the treatment is working.
"Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
"
Some of the tests will continue to be done from time to time after treatment has ended.
The results of these tests can show if your condition has changed or if the cancer has recurred (come back).
These tests are sometimes called follow-up tests or check-ups.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"When possible, treatment of small intestine adenocarcinoma will be surgery to remove the tumor and some of the normal tissue around it.
"
"Treatment of small intestine adenocarcinoma that cannot be removed by surgery may include the following:
>Surgery to
          bypass
          the tumor.
"
">Radiation therapy
          as
          palliative therapy
          to relieve
          symptoms
          and improve the patient's
          quality of life
          .
"
">A
          clinical trial
          of radiation therapy with
          radiosensitizers
          , with or without
          chemotherapy
          .
"
">A clinical trial of new anticancer
          drugs
          .
"
">A clinical trial of
          immunotherapy
          .
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients."
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"When possible, treatment of small intestine leiomyosarcoma will be surgery to remove the tumor and some of the normal tissue around it.
"
"Treatment of small intestine leiomyosarcoma that cannot be removed by surgery may include the following:
>Surgery (to
          bypass
          the tumor) and
          radiation therapy
          .
"
">Surgery, radiation therapy, or
          chemotherapy
          as
          palliative therapy
          to relieve
          symptoms
          and improve the patient's
          quality of life
          .
"
">A
          clinical trial
          of new anticancer drugs.
"
">A clinical trial of
          immunotherapy
          .
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients."
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For information about the treatments listed below, see the Treatment Option Overview section.
"
"Treatment of recurrent small intestine cancer that has spread to other parts of the body is usually a clinical trial of new anticancer drugs or immunotherapy .
"
"Treatment of locally recurrent small intestine cancer may include the following:
>Surgery
          .
>Radiation therapy
          or
          chemotherapy
          as
          palliative therapy
          to relieve
          symptoms
          and improve the patient's
          quality of life
          .
"
">A clinical trial of radiation therapy with
          radiosensitizers
          , with or without chemotherapy.
"
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.
"You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done."
General information about clinical trials is also available.
"
For more information from the National Cancer Institute about small intestine cancer, see the following:
>Small Intestine Cancer Home Page
>Immunotherapy to Treat Cancer
For general cancer information and other resources from the National Cancer Institute, see the following:
>About Cancer
>Staging
>Chemotherapy and You: Support for People With Cancer
>Radiation Therapy and You: Support for People With Cancer
>Coping with Cancer
>Questions to Ask Your Doctor about Cancer
>For Survivors and Caregivers"
"
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Most summaries come in two versions.
The health professional versions have detailed information written in technical language.
"The patient versions are written in easy-to-understand, nontechnical language."
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"
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NIH is the federal government’s center of biomedical research.
The PDQ summaries are based on an independent review of the medical literature.
They are not policy statements of the NCI or the NIH.
"
This PDQ cancer information summary has current information about the treatment of small intestine cancer."
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It does not give formal guidelines or recommendations for making decisions about health care.
"
Editorial Boards write the PDQ cancer information summaries and keep them up to date."
These Boards are made up of experts in cancer treatment and other specialties related to cancer.
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"
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"
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another."
Trials are based on past studies and what has been learned in the laboratory.
Each trial answers certain scientific questions in order to find new and better ways to help cancer patients.
"During treatment clinical trials, information is collected about the effects of a new treatment and how well it works."
"If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become ""standard."""
Patients may want to think about taking part in a clinical trial.
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"
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"
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PDQ Small Intestine Cancer Treatment.
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Updated <MM/DD/YYYY>.
Available at: https://www.cancer.gov/types/small-intestine/patient/small-intestine-treatment-pdq .
Accessed <MM/DD/YYYY>.
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"

Anal cancer is a type of cancer that starts in the anus."
Cancer starts when cells in the body begin to grow out of control.
"
The anus is the opening at the lower end of the intestines."
"It's where the end of the intestines connect to the outside of the body.
"
"As food is digested, it passes from the stomach to the small intestine."
It then moves from the small intestine into the main part of the large intestine (called the colon ).
The colon absorbs water and salt from the digested food.
The waste matter that's left after going through the colon is known as feces or stool .
"Stool is stored in the last part of the large intestine, called the rectum ."
"From there, stool is passed out of the body through the anus as a bowel movement.


"
"Gastrointestinal system (GI system)



Structures of the anus
The anus is connected to the rectum by the anal canal ."
The anal canal has two ring-shaped muscles (called sphincter muscles ) that keep the anus closed and prevent stool from leaking out.
The anal canal is about 1-1/2 to 2 inches (about 3 to 5 cm) long and goes from the rectum to the anal verge .
The anal verge is where the canal connects to the outside skin at the anus.
"This skin around the anal verge is called the perianal skin (previously called the anal margin ).
"
The inner lining of the anal canal is the mucosa .
Most anal cancers start from cells in the mucosa.
Glands and ducts (tubes leading from the glands) are found under the mucosa.
"The glands make mucus, which acts as a lubricating fluid.
"
"The cells of the anal canal change as they go from the rectum to the anal verge:
>Cells above the anal canal (in the rectum) and in the part of the anal canal close to the rectum are shaped like tiny columns.
"
">Most cells near the middle of the anal canal are shaped like cubes and are called
   transitional cells
   ."
"This area is called the
   transitional zone
   .
"
">About midway down the anal canal is the
   dentate line
   , which is where most of the anal glands empty mucus into the anus.
"
">Below the dentate line are flat (squamous) cells.
"
">At the anal verge, the squamous cells of the lower anal canal merge with the skin just outside the anus."
"This skin around the anal verge (called the
   perianal skin
   or the
   anal margin
   ) is also made up of squamous cells, but it also contains sweat glands and hair follicles, which are not found in the lining of the lower anal canal."
"
Anal cancers are often divided into 2 groups based on where they start:
>Cancers of the anal canal (above the anal verge)
>Cancers of the perianal skin (below the anal verge) – previously called
   cancers of the anal margin
Sometimes, treatment may be different, depending on where the cancer is located."
"But anal cancers can sometimes extend from one area into the other, so it’s hard to know exactly where they started.
"
"
Most (nearly 9 out of 10 cases) "
anal cancers in the United States are squamous cell cancer.
"These tumors start in the squamous cells that line most of the anal canal and the anal margin.
"
"Squamous cell cancers in the anal canal have grown beyond the surface and into the deeper layers of the lining.
"
Squamous cell cancers of the anal margin (perianal skin) can be treated as an anal cancer or like squamous cell cancer of the skin .
"It is important to see an expert if you are diagnosed with perianal cancer to determine the best course of treatment.
"
"
A small number of anal cancers are adenocarcinomas ."
These cancers start in cells that line the upper part of the anus near the rectum.
They can also start in the glands under the anal mucosa that release secretions into the anal canal.
Most anal adenocarcinomas are treated the same as rectal carcinomas.
"For more information, see Colorectal Cancer .
"
Adenocarcinomas can also start in apocrine glands (a type of sweat gland of the perianal skin).
Paget’s disease is a type of apocrine gland carcinoma that spreads through the surface layer of the skin.
"Paget’s disease can affect skin anywhere in the body but most often affects skin of the perianal area, vulva , or breast ."
"
Basal cell carcinomas are a type of skin cancer that can develop in the perianal skin."
"These tumors are much more common in areas of skin exposed to the sun, such as the face and hands."
Very few anal cancers are basal cell carcinomas.
They are often treated with surgery to remove the cancer.
"For more information, see Skin Cancer:"
"
These cancers start in cells in the skin or anal lining that make the brown pigment called melanin ."
Only a very small number of anal cancers are melanomas.
Melanomas are far more common on the skin in other parts of the body.
"If melanomas are found at an early stage (before they have grown deeply into the skin or spread to lymph nodes) they can be removed with surgery, and the outlook for long-term survival is very good."
"But because anal melanomas are hard to see, most are found at a later stage.
"
"If possible, the entire tumor is removed with surgery."
"If all of the tumor can be removed, a cure is possible."
"Sometimes, an abdominoperineal resection (APR) might be recommended.  "
"If the melanoma has spread too far to be removed completely, other treatments may be given."
"
"
"These cancers are much more common in the stomach or small intestine, and rarely start in the anal region."
"When these tumors are found at an early stage, they are removed with surgery."
"If they have spread beyond the anus, they can be treated with drug therapy."
"
Some changes in the anal mucosa are harmless at first, but later might turn into cancer."
These are called pre-cancers .
Pre-cancers might also be called dysplasia .
"Some warts, for example, contain areas of dysplasia that can develop into cancer.
"
Dysplasia in cells of the anus is called anal intraepithelial neoplasia (AIN) or anal squamous intraepithelial lesions (SILs) .
"Depending on how the cells look, AIN or anal SIL can be divided into 2 groups:
>Low-grade SIL (or grade 1 AIN):
   The cells in low-grade SIL look like normal cells."
"Low-grade SIL often goes away without treatment and has a low chance of turning into cancer.
"
">High-grade SIL (or grade 2 AIN or grade 3 AIN)
   :
   "
The cells in high-grade SIL look abnormal.
"High-grade SIL is less likely to go away without treatment and, with time, could become cancer."
"
Many types of tumors can develop in the anus."
"
Polyps are small, bumpy, or mushroom-like growths that form in the mucosa or just under it."
"
Skin tags are benign growths of connective tissue that are covered by squamous cells."
"
Anal warts (also called condylomas ) are growths that form just outside the anus and in the lower anal canal below the dentate line."
Sometimes they can be found just above the dentate line.
They're caused by infection with human papilloma virus (HPV).
People who have or had anal warts are more likely to get anal cancer.
"
In rare cases, benign tumors can grow in other tissues of the anus."
"These include:
>Leiomyomas:
   Benign tumors that develop from smooth muscle cells
>Granular cell tumors:
   Tumors that develop from nerve cells and are composed of cells that contain lots of tiny spots (granules)
>"
"Lipomas:
   Benign tumors that start from fat cells"
"

"
"
"
"



"
"

"
"
"
"
"
"


"
"

Anal cancer is fairly rare – much less common than cancer of the colon or rectum."
"The American Cancer Society estimates for anal cancer in the United States for 2023 are:
>About 9,760 new cases (3,180 in men and 6,580 in women)
>About 1,870 deaths (860 in women and 1,010 in men)
"
The number of new anal cancer cases has been rising for many years.
"Anal cancer is rare in people younger than 35 and is found mainly in older adults, with an average age being in the early 60s."
"It is also more common in White women and Black men.
"
The risk of being diagnosed with anal cancer during one’s lifetime is about 1 in 500.
"The risk is higher in people with certain risk factors for anal cancer.
"
"The number of people who die from anal cancer each year has been rising, but treatment for anal cancer is often very effective, and many patients with this cancer can be cured."
But anal cancer can be a serious condition.
"For information on survival, see Survival Rates by Stage of Anal Cancer .
"
"Visit the American Cancer Society’s Cancer Statistics Center for more key statistics.
"
"

For many people with anal cancer, treatment can remove or destroy the cancer."
Completing treatment can be both stressful and exciting.
"You may be relieved to finish treatment, but it’s hard not to worry about cancer coming back."
"This is very common if you’ve had cancer.
"
"For other people, anal cancer may never go away completely."
Some people may need to get treatments to try to control the cancer for as long as possible.
Learning to live with cancer that doesn't go away can be difficult and very stressful.
"
"
"When you have completed treatment, your doctors will still want to watch you closely."
It's very important to go to all of your follow-up appointments.
"During these visits, your doctors will ask if you are having any problems and may do a physical exam, which will include a rectal exam, an exam of the anus, and an exam to see if any nearby lymph nodes are enlarged."
Blood tests and imaging tests such as CT scans may also be ordered.
"These exams and tests are meant to look for signs of the cancer returning or side effects from treatment.
"
Almost any cancer treatment can have side effects .
"Some might only last for a few days or weeks to months, but others might last a long time."
Some side effects might not even show up until years after you have finished treatment. 
Your doctor visits are a good time to ask questions and to talk about any changes or problems you notice or concerns you have.
"
For people with no signs of anal cancer, many doctors recommend follow-up visits (which may include an anoscopy) with physical exams every 3 to 6 months for at least the first 3 years after treatment."
CT scans or MRIs are also often done regularly for a certain period of time.
These visits may be less often (about every 6 months) for the next several years.
"Some doctors may advise different follow-up schedules.
"
"Close follow-up is very important in the first several months after chemoradiation treatment, especially if not all of the cancer is gone."
"Some tumors continue to shrink after chemoradiation, so the doctor will want to watch the cancer closely during this time to see if more treatment might still be needed."
"
Most people treated for anal cancer don’t need extensive surgery (known as an abdominoperineal resection , or APR)."
"But if you do have an APR, you will need to have a permanent colostomy.
"
"If you have a colostomy, follow-up is important."
You might feel worried or isolated from normal activities.
"A wound, ostomy, continence nurse (WOCN) or enterostomal therapist (a health care professional trained to help people with their colostomies) can teach you how to care for your colostomy."
You can also ask the American Cancer Society about programs offering information and support in your area.
See our colostomy information to learn more .
"
Talk with your doctor about developing a survivorship care plan for you."
"This plan might include:
>A suggested schedule for follow-up
   exams and tests
>A schedule for other tests you might need in the future, such as early detection (screening) tests for other types of cancer, or tests to look for long-term health effects from your cancer
>A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
>Suggestions for things you can do that might improve your health, including possibly lowering your chances of the cancer coming back
>Reminders to keep your appointments with your primary care provider (PCP), who will monitor your general health care"
"
Even after treatment, it’s very important to keep health insurance ."
"Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
"
"At some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history."
It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment.
"
If you have (or have had) anal cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements."
"Unfortunately, it’s not yet clear if there are things you can do that will help.
"
"Adopting healthy behaviors such as not smoking , eating well , getting regular physical activity , and staying at a healthy weight might help, but no one knows for sure."
"However, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of anal cancer or other cancers."
Stopping smoking may also help you tolerate treatments like chemotherapy and radiation much better.
"
So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of anal cancer progressing or coming back."
"This doesn’t mean that no supplements will help, but it’s important to know that none have been proven to do so.
"
"Dietary supplements are not regulated like medicines in the United States – they do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do."
"If you’re thinking about taking any type of nutritional supplement, talk to your health care team."
They can help you decide which ones you can use safely while avoiding those that might be harmful.
"
If the cancer does recur at some point, your treatment options will depend on where the cancer is located, what treatments you’ve had before, and your health."
"For more information on how recurrent cancer is treated, see  Treatment of Anal Cancer, by Stage .
"
"For more general information on recurrence, you may also want to see Understanding Recurrence ."
"
It's normal to feel depressed, anxious, or worried when anal cancer is a part of your life."
Some people are affected more than others.
"But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups, professional counselors, or others."
Learn more in Life After Cancer .
"
Cancer survivors can be affected by a number of health problems, but often a major concern is facing cancer again."
Cancer that comes back after treatment is called a recurrence .
"But some cancer survivors develop a new, unrelated cancer later."
"This is called a second cancer .
"
"Unfortunately, being treated for anal cancer does not mean you cannot get another cancer."
People who have had anal cancer can still get the same types of cancers that other people get.
"In fact, they might be at a higher risk for certain types of cancers.
"
"Survivors of anal cancer can get any type of second cancer, but they have an increased risk of:
>Cancer of the tongue
>Cancer of the tonsil
>Cervical cancer
>Vaginal cancer
>Vulvar cancer
>Lung cancer
>Kaposi sarcoma
People diagnosed with anal cancer before age 50 also have an increased risk of non-Hodgkin lymphoma .
"
"Anal cancer is linked to infection with human papilloma virus (HPV) , and many of these cancers (cancers of the tongue, tonsil, cervix, vulva, and vagina) are also linked to HPV infection."
"
After completing treatment for anal cancer, you should see your doctor regularly to look for any new symptoms or problems, because they could be caused by the cancer coming back or by a new disease or second cancer.
"
"Survivors of anal cancer should follow the American Cancer Society guidelines for the early detection of cancer , such as those for colorectal, breast, cervical, and prostate cancer."
"Screening tests can find some cancers early, when they are likely to be easier to treat."
"For people who have had anal cancer, most experts don’t recommend any additional testing to look for second cancers unless you have symptoms."
"
Survivors of anal cancer should also stay away from tobacco products."
"Smoking increases the risk of many cancers and might further increase the risk of many of the second cancers seen after anal cancer.
"
"To help maintain good health, anal cancer survivors should also:
>Get to and stay at a
   healthy weight
>Keep
   physically active
   and limit the time you spend sitting or lying down
>Follow a
   healthy eating pattern
   that includes plenty of fruits, vegetables, and whole grains, and limits or avoids red and processed meats, sugary drinks, and highly processed foods
>Don't drink
   alcohol
   ."
"If you drink, have no more than 1 drink per day for women or 2 per day for men
These steps may also lower the risk of some other cancers.
"
"See Second Cancers for more information about causes of second cancers.
"
"

Since the cause of many cases of anal cancer is unknown, it’s not possible to prevent this disease completely."
But there are things you can do that might lower your risk of anal cancer.
"
Infection with HPV increases the risk of anal cancer."
"HPV infection can be present for years without causing any symptoms, so even if warts are not seen by the naked eye, that can't be used to tell if someone has HPV."
"Even when someone does not have warts (or any other symptom), they can still be infected with HPV and pass it on to somebody else.
"
Vaccines are available that protect against certain HPV infections.
They protect against infection with HPV subtypes 16 and 18.
"Some can also protect against infections with other HPV subtypes, including some types that cause anal and genital warts.
"
These vaccines can only be used to help prevent HPV infection – they do not help treat an existing infection.
"To work best, the vaccine should be given to children at a young age before they become sexually active.
"
"To learn more, see HPV Vaccines ."
"
Smoking is a known risk factor for anal cancer."
Stopping smoking greatly reduces the risk of developing anal cancer and many other cancers.
"
For people infected with HIV , it’s very important to take medicines (known as highly active antiretroviral therapy , or HAART ) to help keep the HIV infection under control and prevent it from progressing to AIDS."
"This can also lower the risk of long-term HPV infection and anal intraepithelial neoplasia (a kind of anal pre-cancer), which might help lower the risk of anal cancer."
"Compared to other HIV-related cancers, the number of people with HIV who have developed anal cancer while on HAART has actually increased over the years."
"The reasons for this is unknown, but may be because people with HIV on HAART are living longer."
"
Condoms may provide some protection against HPV (and HIV), but they do not prevent infection completely."
"Given this, it is unclear if condom use can reduce the risk of anal cancer.
"
One study found that when condoms are used correctly they can lower the genital HPV infection rate in women – but they must be used every time sex occurs.
"This study did not look at the effect of condom use on anal HPV infection.
"
"Condoms cannot protect completely because they do not cover every possible HPV-infected area of the body, such as skin of the genital or anal area."
HPV can still be passed from one person to another by skin to skin contact with an HPV-infected area of the body that is not covered by a condom.
"Still, condoms may provide some protection against HPV."
Male condom use also seems to help genital HPV infections clear (go away) faster.
"en.
"
"Condom use is also important because it can help protect against AIDS and other sexually transmitted diseases that can be passed on through some body fluids.
"
"

A risk factor is anything that increases your chance of getting a disease such as cancer."
Different cancers have different risk factors.
"Some risk factors, like smoking or diet, can be changed."
"Others, like a person’s age or family history, cannot.
"
Several factors can affect your risk of anal cancer.
"But having a risk factor, or even several risk factors, does not mean that you will get cancer."
"Many people with risk factors will never develop anal cancer, while others with this disease may have few or no known risk factors."
"
Infection by the human papillomavirus (HPV) is the most important risk factor for anal cancer."
Most squamous cell anal cancers are linked to infection with HPV.
"HPV is a group of more than 150 related viruses, the same group of viruses that causes cervical cancer, as well as other kinds of cancer ."
"In fact, women with a history of cervical cancer (or pre-cancer) have an increased risk of anal cancer.
"
">HPV can infect cells on the surface of the skin, and those lining the genitals, anus, mouth and throat, but not the blood or internal organs such as the heart or lungs.
"
>HPV can spread from one person to another during skin-to-skin contact.
"One way HPV spreads is through sexual activity, including vaginal, anal, and even oral sex.
"
>Different types of HPV cause warts on different parts of the body.
"Some cause common warts on the hands and feet; others tend to cause warts on the lips or tongue.
"
"Infection with HPV is common, and in most cases, the body can clear the infection by itself."
"Sometimes, however, the infection does not go away and becomes chronic."
"Chronic infection, especially when it is caused by certain high-risk HPV types, can eventually cause certain cancers, such as anal cancer.
"
"Certain types of HPV are called high-risk because they are strongly linked to cancers including anal cancer, as well as cancer of the cervix, vulva, and vagina in women, penile cancer in men, and cancers of the anus, mouth, and throat in both men and women. "
The high-risk subtype most likely to cause anal cancer is HPV-16.
"Another high-risk type is HPV-18, but this is seen less often with anal cancer.
"
Other types of HPV may cause warts in or around the anal area and on the female and male genital organs.
"These are called low-risk types of HPV because they are seldom linked to cancer.
"
"Although there is currently no cure for HPV infection, there are ways to treat the warts and abnormal cell growth that HPV causes. "
"Also, HPV vaccines are available to help prevent infection by certain types of HPV and some of the cancers linked to those types."
"
People who have had anal warts are more likely to get anal cancer."
This is because people who are infected with HPV subtypes that cause anal and genital warts are also more likely to be infected with HPV subtypes that cause anal cancer.
"
Women who have had cancer of the cervix, vagina , or vulva are at increased risk of anal cancer."
This is probably because these cancers are also caused by infection with HPV.
"
People infected with HIV (the human immunodeficiency virus), the virus that causes AIDS, are much more likely to get anal cancer than those not infected with this virus."
"For more information see HIV Infection, AIDS, and Cancer ."
"
Having multiple sex partners increases the risk of infection with HIV and HPV."
"It also increases the risk of anal cancer.
"
Receptive anal sex also increases the risk of anal cancer in both men and women.
"Because of this, men who have sex with men have a high risk of this cancer."
"
Smoking increases the risk of anal cancer."
"The higher a person's pack-year history of smoking, the higher their risk of developing anal cancer.  "
People who currently smoke are more likely to have cancer of the anus compared with people who do not smoke or have quit smoking.
Quitting smoking seems to reduce the risk.
"
Higher rates of anal cancer occur among people with reduced immunity, such as people with AIDS or people who have had an organ transplant and must take medicines that suppress their immune system."
"
Anal cancer is more common in White women and Black men.
"
"

Researchers have found some risk factors that increase a person’s risk of anal cancer, but the exact cause of anal cancer is not known."
It’s also important to remember that some people with anal cancers do not have any known risk factors and the causes of their cancers are also unknown.
"
Most anal cancers seem to be linked to infection with HPV (the human papillomavirus ."
"While HPV infection seems to be important in the development of anal cancer, the vast majority of people with HPV infections do not get anal cancer.
"
A great deal of research is now being done to learn how HPV might cause anal cancer.
There is good evidence that HPV causes many anal squamous cell carcinomas.
"But the role of this virus in causing anal adenocarcinomas is less certain.
"
More than 150 subtypes of HPV have been found.
The subtype known as HPV-16 is often found in squamous cell carcinoma and is also found in some anal warts.
"Another subtype, HPV-18, is found less often."
Most anal warts are caused by HPV-6 and HPV-11.
"Warts containing HPV-6 or HPV-11 are much less likely to become cancer than those containing HPV-16.
"
HPV makes proteins (E6 and E7) that can shut down 2 important tumor suppressor proteins in normal cells.
These proteins – p53 and Rb – normally work to keep cells from growing out of control.
"When these proteins are not active, cells are more likely to become cancer."
"
"
"When the body is less able to fight off infections, viruses like HPV can become more active, which might trigger the development of anal cancer."
"HIV, the virus that causes AIDS, weakens the body’s immune system, as can medicines used to prevent rejection in patients with organ transplants."
"
Most people know that smoking is the main cause of lung cancer."
"But the cancer-causing chemicals in tobacco smoke can travel from the lungs to the rest of the body, causing other types of cancer as well."
Smoking also seems to make the immune system less effective in fighting HPV infections.
"Many studies have noted an increased rate of anal cancer in people who smoke, and the effect of smoking is especially important in people with other risk factors for anal cancer.
"
"

Many anal cancers can be found early."
Early anal cancers often have signs and symptoms that lead people to see a doctor.
"Unfortunately, some anal cancers may not cause symptoms until they reach an advanced stage."
Other anal cancers can cause symptoms like those of diseases other than cancer.
"This may delay their diagnosis.
"
Anal cancers develop in a part of the digestive tract that your doctor can easily see and get to.
A digital rectal exam (DRE) can find some cases of anal cancer early.
"In this exam, the doctor inserts a gloved, lubricated finger into the anus to feel for unusual lumps or growths."
This test is sometimes used to look for prostate cancer in men (because the prostate gland can be felt through the rectum).
"The rectal exam is also done routinely as part of a pelvic exam on women.
"
The odds that anal cancer can be found early depend on the location and type of the cancer.
Cancers that begin higher up in the anal canal are less likely to cause symptoms and be found early.
"
Looking for a disease like cancer in someone with no symptoms is called screening ."
"The goal of screening is to find cancer at an early stage, when treatment is likely to be most helpful."
"Anal cancer is not common in the United States, so screening the general public for anal cancer is not widely recommended at this time.
"
"Still, some people at increased risk for anal intraepithelial neoplasia (AIN, a potentially pre-cancerous condition) and anal cancer might benefit from screening."
"This includes men who have sex with men (regardless of HIV status), women who have had cervical cancer, vaginal cancer , or vulvar cancer , anyone who is HIV-positive, and anyone who is immunocompromised (such as people who have received an organ transplant or are on long-term steroids)."
"Some experts also recommend screening for anyone with a history of anal warts and women older than 45 years old who are HPV 16 positive.
"
"For these people, some experts recommend screening with regular anal cytology testing (also known as an anal Pap test or anal Pap smear because it is much like a Pap test for cervical cancer)."
"For an anal Pap test, the anal lining is swabbed, and cells that come off on the swab are looked at closely in the lab."
"The anal pap test can then be followed by a DRE or a procedure called an anoscopy .
"
"The anal Pap test has not been studied enough to know how often it should be done, or if it actually reduces the risk of anal cancer by catching AIN early."
"Some experts recommend that the test be done every year in at-risk people who are HIV-positive, and every 2 to 3 years in at-risk people who are HIV-negative."
"But there is no widespread agreement on the best screening schedule, or even exactly which groups of people can benefit from screening.
"
Patients with positive results on an anal Pap test should be referred for a biopsy.
"If AIN is found on the biopsy, it might need to be treated (especially if it is high-grade).
"
"

Some people at high risk for anal cancer are diagnosed by screening tests, such as the digital rectal exam and/or anal Pap test (described in Can Anal Cancer Be Found Early? )."
"Sometimes a doctor will find anal cancer during a routine physical exam or during a minor procedure, such as removing a hemorrhoid."
Treating cancers found this way is often very effective because the tumors are found early.
(This means they're small and haven't spread.)
"But most often anal cancers are found because of signs or symptoms a person is having.
"
"If anal cancer is suspected, exams and tests will be needed to confirm the diagnosis."
"If cancer is found, more tests will be done to help determine the extent ( stage ) of the cancer."
"
If you have symptoms that might be caused by anal cancer, the doctor will ask about your medical history to check for possible risk factors and learn more about your symptoms.
"
Your doctor will also examine you to look for signs of anal cancer or other health problems.
"For women, this will include a pelvic exam and Pap test."
"A digital rectal exam will probably be done, too."
"(This is when the doctor puts a gloved, lubricated finger into your anus and rectum to feel for lumps or other changes)."
"Attention will also be focused on the groin area to see if any large lymph nodes are felt.
"
"If problems or changes are found, your doctor might do other exams or tests to help find the cause."
"If you're being seen by your primary care doctor, you might be referred to a specialist such as a colorectal surgeon or a gastroenterologist (doctors specializing in diseases of the colon, rectum, and anus) for more tests and, if needed, treatment."
"
For anoscopy the doctor uses a short, hollow, firm tube called an anoscope ."
It's 3 to 4 inches long and about 1 inch in diameter and may have a light on the end of it.
The doctor coats the anoscope with a gel and then gently pushes it into the anus and lower rectum.
"By shining a light into this tube, the doctor has a clear view of the lining of the lower rectum and anus."
Samples from abnormal areas (a biopsy) can be taken at the same time.
"You will be awake during this test, but it doesn't usually hurt."
"
The rigid proctosigmoidoscope is a lot like an anoscope, except that it's longer (about 10 inches long)."
"It lets the doctor see the anus, rectum, and the lower part of the sigmoid colon."
You might need to take laxatives or have an enema before this test to make sure your bowels are empty so the doctor can see any abnormal areas clearly.
"
Endoscopy uses a thin, flexible tube with a light and tiny video camera on the end to look inside part of the body."
Many types of endoscopy can be used to look for the cause of anal symptoms.
"A common type is a colonoscopy that can see the anus, rectum, and entire colon. "
"It can also be used to get tissue samples from inside the anal canal, the rectum, and colon (described below under Biopsy)."
"A flexible sigmoidoscopy might be done instead of a colonoscopy, but this only looks at the anal canal, rectum, and lower part of the colon. "
Drugs may be used to make you sleepy during these tests.
"
If a change or growth is seen during an endoscopic exam, your doctor will need to take out a piece of it to see if it's cancer."
This is called a biopsy .
"If the growth is in the anal canal, this can often be done through the scope itself."
Drugs may be used to numb the area before the biopsy is taken.
"Then, a small piece of the tissue is cut out and sent to the lab."
"If the tumor is very small, your doctor might try to remove the entire tumor during the biopsy.
"
A doctor called a pathologist will look at the tissue sample under a microscope.
"If there is cancer, the pathologist will send back a report with the cell type and other details of the cancer, including whether it is related to an HPV infection.
"
Anal cancer sometimes spreads to nearby lymph nodes (bean-sized collections of immune system cells).
Swollen lymph nodes in the groin can be a sign that cancer has spread.
Lymph nodes may also become swollen from an infection.
"Biopsies may be needed to check for cancer spread to nearby lymph nodes.
"
There are many different ways to do a biopsy .
A type called fine-needle aspiration (FNA) is often used to check lymph nodes that might have cancer in them.
"To do this, a small sample of tissue is taken out of the lymph node using a thin, hollow needle."
A pathologist checks this tissue for cancer cells.
"If cancer is found in a lymph node, surgery may be done to remove the lymph nodes in that area."
"
HIV test: If you have risk factors for HIV, your doctor might order a blood test to check for it."
"This information is important because HIV positive patients might need to start treatment for HIV so that their immune system is as normal as possible, before starting cancer treatment."
"
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body."
"Imaging tests might be done for a number of reasons both before and after a diagnosis of anal cancer, including:
>To help find cancer
>To learn how far cancer has spread
>To help see if treatment is working
>To look for signs of cancer coming back after treatment"
"
Ultrasound uses sound waves to make pictures of internal organs or masses."
"This test can be used to see how deep the cancer has grown into the tissues near the anus.
"
For most ultrasound exams a wand-like transducer is moved around on the skin.
"But for anal cancer, the transducer is put into the rectum."
This is called a transrectal or endorectal ultrasound .
"The test can be uncomfortable, but it usually doesn't hurt."
"
CT scans use x-rays to make detailed cross-sectional images of your body."
This is a common test for people with anal cancer.
"This test can help tell if the cancer has spread into the lymph nodes or to other parts of the body, such as the liver, lungs, or other organs.
"
CT-guided needle biopsy:
A CT scan can also be used to guide a biopsy needle right into an area that could be cancer.
"
MRI scans use radio waves and strong magnets instead of x-rays."
"A contrast material called gadolinium may be injected into a vein before the scan to see details better.
"
"This test is sometimes used to see if nearby lymph nodes are enlarged, which might be a sign the cancer has spread there."
MRI can also be used to look at abnormal areas in the liver or the brain and spinal cord that could be cancer spread.
"
A regular x-ray might be done to find out if the cancer has spread to the lungs."
It usually isn’t needed if a CT scan of the chest is done.
"
For a PET scan , a slightly radioactive form of sugar (known as FDG ) is injected into your blood."
"It collects mainly in cancer cells, which makes the cancer show up on the PET scan.
"
PET/CT scan:
"A CT scan can show more details than a PET scan, so a PET scan is often combined with a CT scan using a special machine that can do both at the same time."
"This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed image of that area on the CT scan.
"
"PET/CT scans can be useful:
>If your doctor thinks the cancer might have spread but doesn’t know where."
"They can show spread of cancer to the liver, bones, lymph nodes in the pelvis, or other organs."
"They are not as useful for looking at the brain or spinal cord.
"
In staging anal cancer when you are first diagnosed.
But their role in checking whether treatment is working or after completion of treatment is unproven.
"Most doctors do not recommend PET/CT scans for routine follow up after anal cancer treatment, and most often will order CT or MRI scans to watch for cancer recurrence.
"
"

Sometimes anal cancer causes no symptoms at all."
But bleeding is often the first sign of the disease.
The bleeding is usually minor.
"At first, most people assume the bleeding is caused by hemorrhoids (painful, swollen veins in the anus and rectum that may bleed)."
"Hemorrhoids are a benign and fairly common cause of rectal bleeding.
"
"Important symptoms of anal cancer include:
>Bleeding from the rectum
>Itching in or around the rectum
>A lump or mass at the anal opening
>Pain or a feeling of fullness in the anal area
>Narrowing of stool or other changes in bowel movements
>Abnormal discharge from the anus
>Incontinence of stool (loss of bowel control)
"
">Swollen lymph nodes in the anal or groin areas
Most often these types of symptoms are more likely to be caused by benign (non-cancer) conditions, like hemorrhoids, anal fissures, or anal warts."
"Still, if you have any of these symptoms, it’s important to have them checked by a doctor so that the cause can be found and treated, if needed.
"
"

After someone is diagnosed with anal cancer, doctors will try to figure out if it has spread, and if so, how far."
This process is called staging .
The stage of a cancer describes how much cancer is in the body.
It helps determine how serious the cancer is and how best to treat it .
"Doctors also use a cancer's stage when talking about survival statistics.
"
The stages of anal cancer range from stage I (1) through IV (4).
"As a rule, the lower the number, the less the cancer has spread."
"A higher number, such as stage IV, means cancer has spread more."
"And within a stage, an earlier letter means a lower stage."
"Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way."
"
The staging system most often used for anal cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:
>"
"The extent of the main (primary)
   t
   umor
   (T):
   "
What is the size of the tumor?
"Has it grown into nearby structures or organs?
>"
"The spread to nearby lymph
   n
   odes
   (N):
   Has the cancer spread to nearby lymph nodes?
>The spread (
   m
   etastasis) to distant sites
   (M):
   Has the cancer spread to distant lymph nodes or distant organs such as the liver or lungs?
"
"Numbers or letters after T, N, and M provide more details about each of these factors."
Higher numbers mean the cancer is more advanced.
"Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage."
"For more information see Cancer Staging .
"
"Anal cancer is usually staged based on the results of a physical exam, biopsy, and imaging tests ."
This is called a clinical stage.
"If surgery is done, the pathologic stage (also called the surgical stage ) is determined by examining tissue removed during an operation.
"
"The system described below is the most recent AJCC staging system for anal cancer, effective as of January 2023."
"It is used for tumors in the anal canal and perianal area (also called the anal margin).
"
"Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.
"
"AJCC Stage
Stage grouping
Stage description*
I
T1
N0
M0
The cancer is no more than 2 cm (about 4/5 inch) across (T1)."
"It has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"IIA
T2
N0
M0
The cancer is more than 2 cm (about 4/5 inch) but not more than 5 cm (about 2 inches) across (T2)."
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"IIB
T1-T2
N1
M0
The cancer is no more than 5 cm (about 2 inches) across (T1 or T2) AND it has spread to lymph nodes near the rectum (N1) but not to distant parts of the body (M0).

"
"IIIA


T3
N0
M0
The cancer is larger than 5 cm (about 2 inches) across (T3)."
"It has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"OR
T3
N1
M0
The cancer is larger than 5 cm (about 2 inches) across (T3) AND it has spread to lymph nodes near the rectum (N1) but not to distant parts of the body (M0).
"
"IIIB
T4
N0
M0
The cancer is any size and is growing into nearby organ(s), such as the vagina, urethra (the tube that carries urine out of the bladder), prostate gland, or bladder (T4)."
"It has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"IIIC
T4
N1
M0
The cancer is any size and is growing into nearby organ(s), such as the vagina, urethra (the tube that carries urine out of the bladder), prostate gland, or bladder (T4) AND it has spread to lymph nodes near the rectum (N1) but not to distant parts of the body (M0).
"
"IV
Any T
Any N
M1
"
The cancer can be any size and may or may not have grown into nearby organs (any T).
It may or may not have spread to nearby lymph nodes (any N).
"It has spread to distant organs, such as the liver or lungs (M1).
"
"*The following additional categories are not listed on the table above:
>TX:
   "
"Main tumor cannot be assessed due to lack of information.
"
">T0:
   "
"No evidence of a primary tumor.
"
">NX:
   Regional lymph nodes cannot be assessed due to lack of information.
"
"

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed."
"They can’t tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
"
"Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they can’t predict what will happen in any particular person’s case."
These statistics can be confusing and may lead you to have more questions.
Ask your doctor how these numbers may apply to you.
"
A relative survival rate compares people with the same type and stage of cancer to people in the overall population."
"For example, if the 5-year relative survival rate for a specific stage of anal cancer is 80%, it means that people who have that cancer are, on average, about 80% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed."
"
The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results (SEER) database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer.
"
"The SEER database tracks 5-year relative survival rates for anal cancer in the United States, based on how far the cancer has spread."
"The SEER database, however, does not group cancers by AJCC TNM stages (stage 1, stage 2, stage 3, etc.)."
"Instead, it groups cancers into localized, regional, and distant stages:
>Localized:
   There is no sign that the cancer has spread outside of the anal area.
"
">Regional:
   "
"The cancer has spread outside the anal area to nearby structures or lymph nodes.
"
">Distant:
   "
"The cancer has spread to distant parts of the body, such as the liver or lungs."
"
These numbers are based on people diagnosed with anal cancer between 2012 and 2018.
"
"SEER* stage
5-year relative survival rate
Localized
83%
Regional
67%
Distant
36%
All SEER stages combined
70%
*SEER = Surveillance, Epidemiology, and End Results"
"
>These numbers apply only to the stage of the cancer when it is first diagnosed.
   "
"They do not apply later on if the cancer grows, spreads, or comes back after treatment.
"
">These numbers don’t take everything into account.
   "
Survival rates are grouped based on how far the cancer has spread.
"But other factors, such as your age and overall health, the
   type of anal cancer
   you have, and how well the cancer responds to treatment, can also affect your outlook.
"
">People now being diagnosed with anal cancer may have a better outlook than these numbers show.
   "
"Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least five years earlier.
"
"

It's important to have honest, open discussions with your cancer care team."
"They want to answer all your questions, so that you can make informed treatment and life decisions."
"For instance, consider these questions:"
"
>What
   kind
   of anal cancer do I have?
>Has my cancer spread beyond where it started?
"
">What is the
   stage
   of my cancer and what does this mean in my case?
"
">Will I need other
   tests
   before we can decide on treatment?
>Will I need to see other doctors?
>"
"If I’m concerned about the costs and insurance coverage for my diagnosis and treatment, who can help me?"
"
>How much experience do you have treating this type of cancer?
"
">Should I get a
   second opinion
   ?"
How do I do that?
"Can you recommend someone or a cancer center?
>"
"What are my
   treatment
   choices?
>What treatment would you recommend for me?"
"Why?
>What is the goal of each treatment?
>What are the chances my cancer can be cured with these options?
>How quickly do I need to decide on treatment?
"
">What should I do to be ready for treatment?
>How long will treatment last?"
What will it be like?
"Where will it be done?
>"
What are the risks or side effects of the treatments you suggest?
"How long are they likely to last?
"
">Will I need to have a colostomy?
>How soon do I need to start treatment?
"
">Will treatment affect my daily activities?
>"
"What would my options be if the treatment doesn't work or if the
   cancer comes back
   after treatment?"
"
>How will we know if the treatment is working?
"
">Is there anything I can do to help manage
   side effects
   ?
>What symptoms or side effects should I tell you about right away?
"
">How can I reach you on nights, holidays, or weekends?
"
">Do I need to change what I eat during treatment?
>Are there any limits on what I can do?
>"
"Can you suggest a mental health professional I can see if I start to feel overwhelmed,
   depressed
   , or
   distressed
   ?"
"
>Are there any limits on what I can do?
>"
"What symptoms should I watch for?
>What kind of exercise should I do now?
"
">What type of follow-up will I need after treatment?
>How often will I need to have follow-up exams and imaging tests?
"
">Will I need any blood tests?
"
>How will we know if the cancer has come back?
"What should I watch for?
"
"What will my options be if the cancer comes back?
>How soon after treatment can I return to my normal activities, such as work, school, exercise, or sex?
"
"Along with these sample questions, be sure to write down some of your own."
"For instance, you might want more information about recovery times."
"Or you might want to ask if you qualify for a clinical trial .
"
Doctors are not the only ones who can provide you with information.
"Other health care professionals, such as nurses and social workers, can also answer some of your questions."
"You can find out more about communicating with your health care team in The Doctor-Patient Relationship .
"
"
"
"
Cancer that starts in the anus is called anal cancer."
"It starts when cells in the anus grow out of control and crowd out normal cells.
"
Cancer cells can spread to other parts of the body.
Cancer cells in the anus can sometimes travel to the liver and grow there.
"When cancer cells do this, it’s called metastasis ."
"To doctors, the cancer cells in the new place look just like the ones from the anus.
"
Cancer is always named for the place where it starts.
"So when anus cancer spreads to the liver (or any other place), it’s still called anal cancer."
"It’s not called liver cancer unless it starts from cells in the liver.


"
Ask your doctor to use this picture to show you where the cancer is.
"
The anus is the end of the digestive tract – the channel that food moves through as it’s used by the body."
Solid waste (poop) comes out of the anus.
"
There are many types of anal cancer ."
Most are rare.
"Your doctor can tell you more about the type you have.
"
The most common type is called squamous cell cancer.
"This type of tumor starts in the cells that line the inside of the anus and have grown into the deeper layers of the anus.
"
Anal cancer is also often put into 2 groups depending on where it starts in the anus - the anal canal or the perianal area.
They are sometimes treated differently.
"
>Why do you think I have anal cancer?
>Is there a chance I don’t have cancer?
"
">Would you please write down the kind of cancer you think I might have?
"
>What will happen next?
"
Some anal cancers cause no symptoms at all."
"But symptoms of anal cancer can include changes in your poop, bleeding, itching, and pain or a lump at the anal opening."
The doctor will ask you questions about your health and do a physical exam.
The doctor will also look at your anus and may put a gloved finger inside to check for lumps.
(This is called a rectal exam.
"The rectum is the part of the large intestine that connects to the anus.)
"
"If signs are pointing to anal cancer, more tests will be done."
"Here are some of the tests you may need :

Anoscopy:"
"For this test, a hollow firm tube about 3 to 4 inches long (called an anoscope ) is covered with a gel and gently put into the anus."
A light at the end of this tube lets the doctor see the inside of the lower rectum and anus.
A sample of tissue (a biopsy) can be taken and then tested in the lab.
"You will be awake for this test, but it should not hurt.
"
"Endoscopy: For this test, a flexible (not firm) tube with a tiny video camera and light on the end (called an endoscope ) is put into the anus, rectum, and sometimes the entire colon to look inside."
"This flexible tube is much longer than the anoscope and might be used to make sure that an anal cancer symptom, such as bleeding, is not coming from another area like the rectum or colon."
It can also be used to take out cells (a biopsy ) from inside these areas.
"You will be given medicine to stay drowsy or asleep during this test.
"
"Ultrasound: For this test, a small thin probe is put into the anus and rectum."
"This can be uncomfortable, but should not hurt."
The probe gives off sound waves to make pictures of the inside of the body.
"This test can be used to see how deep the cancer has grown into the tissues around the anus.
"
CT scan or CAT scan:
"A CT scan is like an x-ray, but the pictures of your insides are more detailed."
"CT scans can also be used to help do a biopsy and can show if the cancer has spread.
"
MRI scan: This test uses radio waves and strong magnets instead of x-rays to make detailed pictures.
"This test may be used to check the nearby lymph nodes or the liver for cancer spread.
"
"Chest x-ray: X-rays may be done to see if the cancer has spread to the lungs.
"
PET scan: PET scans use a special kind of sugar that can be seen inside your body with a special camera.
"If there is a cancer, this sugar shows up as “hot spots” where the cancer is found."
This test can help show if the cancer has spread.
"Sometimes, a PET scan is done with a CT scan to see areas of cancer better."
"
In a biopsy, the doctor takes out a small piece of tissue where the cancer seems to be."
The tissue is checked for cancer cells.
A biopsy is the only way to know for sure if you have cancer.
"For anal cancer, a biopsy is most often done during an endoscopy."
"If the tumor is very small and is only on the lining of the anus, the doctor may be able to take out all of the tumor during the biopsy.
"
There are many types of biopsies .
Ask your doctor what kind you will need.
Each type has reasons for and against doing them.
The choice of which type to use depends on your own case.
"
>What tests will I need to have?
>"
"Who will do these tests?
>Where will they be done?
"
>
"Who can explain them to me?
>"
"How and when will I get the results?
>Who will explain the results to me?
>What do I need to do next?"
"
If you have anal cancer, the doctor will want to find out how far it has spread."
This is called staging .
"Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.
"
The stage describes the growth or spread of the cancer through the anus.
"It also tells if the cancer has spread to nearby organs or to organs farther away.
"
"Your cancer can be stage 1, 2, 3, or 4."
"The lower the number, the less the cancer has spread."
"A higher number, like stage 4, means a more serious cancer that has spread beyond the anus."
Be sure to ask the doctor about the cancer stage and what it means.
"
>Do you know the stage of the cancer?
>If not, how and when will you find out the stage of the cancer?
"
">Would you explain to me what the stage means in my case?
>Based on the stage of the cancer, how long do you think I’ll live?
"
>What will happen next?
"
There are many ways to treat anal cancer , including surgery, radiation, chemotherapy, and immunotherapy.
"
Surgery and radiation are used to treat only the cancer.
They do not affect the rest of the body.
Chemo drugs and immunotherapy go through the whole body.
They can reach cancer cells almost anywhere in the body.
"The treatment plan that’s best for you will depend on:
>The stage of the cancer and where it started in the anus (anal canal or perianal area)
"
">The chance that a type of treatment will help
>Your age
>Other health problems you have
>Your feelings about the treatment and the side effects that might come with it"
"
Most people with anal cancer do not need surgery."
"If surgery is needed, the kind of surgery depends on the type of tumor and where it is."
"
A local resection may be done if the cancer is small and has not spread."
Only the tumor and a small rim of tissue around it are taken out.
"In most cases, the muscle that opens and closes the anus is not damaged."
"If so, you’ll be able to control your poop and have it come out the anus."
"
Abdominoperineal resection is not used a lot, but it may be an option if other treatments don’t get rid of the cancer.
"
"For this surgery, the doctor makes 2 cuts: 1 through the belly and 1 around the anus."
"Then the anus and part of the rectum are taken out, and sometimes nearby lymph nodes are taken out, too."
After an APR you’ll have an opening on your lower belly where poop will come out.
(This is called a colostomy .)
"
Any type of surgery can have risks and side effects."
Be sure to ask the doctor what you can expect.
Ask how you will poop after surgery.
"If you have problems, let your doctors know."
They should be able to help you with any problems you might have.
"
Radiation uses high-energy rays (like x-rays) to kill cancer cells."
"In anal cancer, it’s most often given along with chemotherapy."
"Radiation can also be used to relieve symptoms such as pain, bleeding or other problems that happen when the anal cancer has grown very large or has spread to other areas like the bones."
"It’s often given in small doses every day for many weeks.
"
There are 2 main ways radiation can be given.
It's most often aimed at the anus from a machine outside the body.
This is called external beam radiation .
"In some cases, a tube of radioactive seeds might be put right into the anus near the cancer."
This is called brachytherapy .
"
If your doctor suggests radiation treatment, ask about what side effects might happen."
"The most common side effects of radiation are:
>Skin changes where the radiation is given
>Feeling very tired (fatigue)
"
">Bowel movements may hurt
>Nausea
>Diarrhea
>"
"In women, radiation can irritate the vagina."
"This may hurt and can cause vaginal discharge.
"
Most side effects get better after treatment ends and many can be treated.
Some might last longer.
Talk to your cancer care team about what you can expect.
"
Chemo is the short word for chemotherapy – the use of drugs to fight cancer."
The drugs may be given into a vein or taken as pills.
"These drugs go into the blood and spread through the body.
"
Chemo is given in cycles or rounds.
Each round of treatment is followed by a break to give the body time to recover. 
"Most of the time, 2 or more chemo drugs are given."
"Treatment often lasts for many months.
"
Chemo given along with radiation therapy is often the first treatment for most anal cancers.
This is called chemoradiation .
It may cure the cancer without surgery.
"
Chemo might make you feel very tired, sick to your stomach, and cause your hair to fall out."
"But these problems go away after treatment ends.
"
There are ways to treat most chemo side effects.
"If you have side effects, talk to your cancer care team so they can help."
"
Immunotherapy is treatment that boosts your own immune system to attack the anal cancer cells."
"These drugs may be given into a vein.
"
"Side effects of immunotherapy
Immunotherapy can cause different side effects depending on which drug is used."
"These drugs may make you feel tired, sick to your stomach, or cause a rash."
"Most of these problems go away after treatment ends.
"
There are ways to treat most of the side effects caused by immunotherapy.
"If you have side effects, talk to your cancer care team so they can help."
"
Clinical trials are research studies that test new drugs or other treatments in people."
"They compare standard treatments with others that may be better.
"
Clinical trials are one way to get the newest cancer treatment.
They are the best way for doctors to find better ways to treat cancer.
"If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part."
"And if you do sign up for a clinical trial, you can always stop at any time.
"
"If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials."
See Clinical Trials to learn more.
"
"
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms.
These may not always be standard medical treatments.
"These treatments may be vitamins, herbs, special diets, and other things ."
"You may wonder about these treatments.
"
"Some of these are known to help, but many have not been tested."
Some have been shown not to help.
A few have even been found to be harmful.
"Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else."
"
>What treatment do you think is best for me?
>What’s the goal of this treatment?"
"Do you think it could cure the cancer?
>Will treatment include surgery?"
"If so, who will do the surgery?
>What will the surgery be like?"
"How will I poop after surgery?
>"
"What’s the goal of these treatments?
>What side effects could I have from these treatments?
>What can I do about side effects that I might have?
"
">Is there a clinical trial that might be right for me?
>"
What about special vitamins or diets that friends tell me about?
"How will I know if they are safe?
>How soon do I need to start treatment?
"
">What should I do to be ready for treatment?
"
">Is there anything I can do to help the treatment work better?
>"
"What’s the next step?
"
"If you need more information about possible side effects of treatment, visit Managing Cancer-related Side Effects ."
"
You’ll be glad when treatment is over ."
"For years after treatment ends, you will still need to see your cancer doctor."
Be sure to go to all of these follow-up visits.
"You will have exams, blood tests, and maybe other tests to see if the cancer has come back.
"
Follow-up doctor visits after treatment may be needed as often as every 3 to 6 months for at least 3 years.
They will be less often after 3 years or so.
"During these visits, your doctor will ask about any symptoms you’re having and will do a physical exam."
"Blood tests, rectal exams, anoscopy, and imaging tests (like CT scans) might be done.
"
"Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways."
You might be thinking about how to improve your health.
"Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.
"
You can’t change the fact that you have cancer.
"What you can change is how you live the rest of your life – making healthy choices and feeling as good as you can.
"
"

The type of treatment your cancer care team will recommend depends on the type of anal cancer, where it is, and how far it has spread (the stage ).
"
Perianal tumors (previously called anal margin cancers ) are sometimes treated differently from anal canal cancers.
"
"
These cancers have grown into the anal wall but have not grown into nearby organs.
"Most often they have not spread to nearby lymph nodes .
"
Surgery (local resection) might be used to remove some small tumors (usually less than 2 centimeter or 1 inch) that do not involve the sphincter muscle.
"In some cases, this may be followed with chemo and radiation therapy .
"
The standard treatment for anal cancers that cannot be removed without harming the anal sphincter is external beam radiation therapy (EBRT) combined with chemo (called chemoradiation).
"In chemoradiation, the 2 treatments are given over the same time period."
The chemo is usually 5-FU with mitomycin.
This combination of chemo is typically given during the first week and around the fifth week of treatment.
"The EBRT is given daily, Monday through Friday, for 5 to 7 weeks.
"
"If the cancer hasn’t gone away completely after chemoradiation is done, more treatment might be needed."
But it's important to know that it may take months to see the full effects of chemoradiation.
"Because of this, it is important to continue follow-up appointments with your doctors to monitor the cancer through digital rectal examination and anoscopy.  "
Your doctors may watch any remaining cancer for up to 6 months.
"It may continue to shrink and even go away without more treatment.
"
"At 6 months, if cancer is still found, more treatment is often needed."
"Most of the time, a surgery called an abdominoperineal resection (APR) might be recommended."
"In certain cases, only a local resection might be needed."
"
"
"These cancers have grown into nearby organs or spread to nearby lymph nodes , but they have not spread to distant parts of the body.
"
"In most cases, the first treatment will be radiation therapy combined with chemo (chemoradiation)."
"In chemoradiation, both treatments are given over the same time period."
The chemo is usually 5-FU with mitomycin.
This combination of chemo is typically given during the first week and then around the fifth week of treatment.
"The radiation is given daily, Monday through Friday, for 5 to 7 weeks.
"
"If some cancer remains after the chemoradiation, it may be watched closely for up to 6 months because it can take months to see the full effects of treatment.
"
"If more treatment is needed because all of the cancer has not gone away by 6 months, most often a surgery called an abdominoperineal resection (APR) might be recommended."
"If the cancer has spread to or is still present in nearby lymph nodes, they may be removed with surgery or treated with radiation therapy."
"
In this stage, the cancer has spread to distant organs."
"Most often, anal cancer first spreads to the liver, but it can also spread to places such as the lungs, bones, and far away lymph nodes.
"
Treatment is very unlikely to cure these cancers.
"Instead, treatment is aimed at controlling the disease for as long as possible and relieving symptoms as much as possible."
"Chemotherapy, sometimes along with radiation, is usually the standard treatment.
"
"Radiation might be used alone for cancer that has spread to the bones, brain or spinal cord."
"It might also be used for cancer that has spread to far away lymph nodes.
"
"For some advanced anal cancers that have grown on chemotherapy, immunotherapy might be an option.
"
"Because these cancers can be hard to treat, you might also want to think about taking part in a clinical trial of newer treatments."
"
Cancer is called recurrent when it comes back after treatment."
"Recurrence can be local (in or near the same place it started) or distant (spread to organs like the lungs or liver).
"
"If cancer returns in the anus or nearby lymph nodes after treatment, treatment depends on what treatment you had the first time ."
"For example, if you had surgery alone, you may get radiation therapy and chemo (chemoradiation)."
"If you first had chemoradiation, then you might be treated with surgery and/or chemo."
"Treating recurrent anal cancer often requires a surgery called an abdominoperineal resection (APR).
"
"For some people, the cancer will come back in distant sites or organs in the body."
The most common sites are the liver and lungs.
The main treatment for this is usually chemo.
"Chemo might not cure the cancer, but it can often help control it and reduce any symptoms it's causing."
"In other cases, surgery or radiation therapy might be options to help treat these cancers."
"But as with chemo, they are unlikely to cure these cancers, so be sure you understand the goal of any treatments offered.
"
Clinical trials of newer treatments might also be useful for people with recurrent anal cancer.
"
Most people with HIV infection can be given the same treatment as others with anal cancer , and they can have a good outcome."
People with advanced HIV disease and weakened immune systems might need to have less intensive chemotherapy.
"
Melanoma doesn’t respond well to chemotherapy or radiation, so surgery to remove the cancer is the main treatment when possible."
Early stage anal melanomas are treated with surgery to remove the tumor and a rim of surrounding normal tissue (local excision).
"If the tumor is large or has grown into deeper tissues (such as the sphincter muscle) a bigger operation, such as an abdominoperineal resection (APR) might be needed.
"
"If the melanoma has spread to other organs, it's treated like skin melanoma that has spread, often with immunotherapy or targeted therapy drugs."
"For more information about the treatment of advanced melanoma, see Treating Melanoma Skin Cancer .
"
"

Chemotherapy (chemo) is treatment with anti-cancer drugs that can be swallowed in pill form or injected into a vein."
The drugs travel through the bloodstream to reach most parts of the body.
"
Most people with anal cancer will need chemo, but chemo may be recommended in different situations:
>Before surgery (neoadjuvant chemotherapy)
   : Neoadjuvant chemo combined with
   radiation therapy
   (known as
   chemoradiation
   ) is often the first treatment for most anal cancers."
"This can often cure the cancer without the need for
   surgery
   .
"
">After surgery (adjuvant chemotherapy)
   "
:
Adjuvant chemotherapy might be given along with radiation (chemoradiation) after surgery to try to kill any cancer cells that may have been left behind.
"It's done to lower the chance of the cancer coming back.
"
">If the cancer comes back in the groin lymph nodes (recurrence)
   : Chemotherapy might be given alone or sometimes with radiation (if radiation was not given before)
>For metastatic anal cancer:
   If anal cancer has spread to distant parts of the body, such as the liver or lungs, chemo can help keep the cancer under control or relieve symptoms it's causing."
"
In most cases, 2 or more drugs are used at the same time to shrink the cancer.
"
">The main drug combination used to treat anal cancer is 5-fluorouracil (5-FU) and mitomycin.
"
">The combination of 5-FU and cisplatin can also be used, especially in people who can't get mitomycin or for advanced anal cancer.
"
">In certain people who may be older or can’t tolerate 2 chemotherapy drugs, 5-FU alone may be given with radiation.
"
"In these treatments, the 5-FU is given into a vein 24 hours a day for 4 or 5 days."
It's put in a small pump that you can take home with you .
The other drugs are given more quickly on certain other days in the treatment cycle.
"Sometimes, the oral drug capecitabine might be given in place of 5-FU."
Radiation is given 5 days a week for at least 5 weeks.
"Talk to your treatment team about your treatment plan and how and where you will get chemo.
"
"For advanced anal cancer or anal cancer that has already been treated with 5-FU and mitomycin, other options for chemotherapy include:
>Carboplatin with paclitaxel (Taxol)
>5-FU with cisplatin
>Oxaliplatin, Leucovorin and 5-FU
>Docetaxel (Taxotere), cisplatin and 5-FU
>Cisplatin, Leucovorin and 5-FU"
"
Chemo drugs can cause side effects."
These depend on the type and dose of drugs given and how long they are taken.
"Some common side effects include:
>Nausea and vomiting
>Loss of appetite or weight changes
>Hair loss
>Diarrhea
>Mouth sores
Chemo can also damage the blood-producing cells of the bone marrow, which can result in:
>A greater chance of infection (from low white blood cell counts)
>Easy bleeding or bruising (from low blood platelet counts)
>Fatigue or shortness of breath (from low red blood cell counts)
"
"Along with the risks above, some chemo drugs can cause other, less common side effects.
"
"For instance, cisplatin, paclitaxel, oxaliplatin, or docetaxel might cause nerve damage (called peripheral neuropathy )."
"This can lead to numbness, tingling, sensitivity to cold, or pain in the hands and feet.
"
"Most side effects get better over time once treatment stops, but some can last a long time or even be permanent."
"If you're going to get chemo, be sure to discuss the drugs that will be used and their possible side effects.
"
Tell your doctor or nurse about any side effects as soon as you notice them so they can be treated promptly.
"For example, drugs can be used to help control nausea and vomiting."
"In some cases, changing the treatment dosage or delaying or stopping treatment may keep the side effects from getting worse.
"
"

Immunotherapy is the use of medicines to stimulate a person’s own immune system to recognize and destroy cancer cells more effectively."
"
An important part of the immune system is its ability to keep itself from attacking normal cells in the body."
"To do this, it uses “checkpoints” – proteins on immune cells that need to be turned on (or off) to start an immune response."
Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system.
"But drugs that target these checkpoints can be used to treat some people with anal cancer.
"
"Nivolumab (Opdivo) and pembrolizumab (Keytruda) target PD-1, a protein on certain immune cells (called T cells ) that normally helps keep these cells from attacking other cells in the body."
"By blocking PD-1, these drugs boost the immune response against cancer cells."
"This can shrink some tumors or slow their growth.
"
"Nivolumab and pembrolizumab can be used in people with anal cancer that has spread (metastasized) and whose cancer starts growing after getting at least one type of chemotherapy.
"
Nivolumab can be given as an intravenous (IV) infusion every 2 or 4 weeks.
Pembrolizumab can be given as an intravenous (IV) infusion every 3 or 6 weeks.
"
Side effects of these drugs can include fatigue, cough, nausea, itching, skin rash, loss of appetite, constipation, joint pain, and diarrhea.
"
"Other, more serious side effects occur less often.
"
Infusion reactions: Some people might have an infusion reaction while getting these drugs.
"This is like an allergic reaction, and can include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing."
"It’s important to tell your doctor or nurse right away if you have any of these symptoms while getting these drugs.
"
Autoimmune reactions: These drugs work by basically removing one of the defenses on the body’s immune system.
"Sometimes the immune system starts attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, or other organs.
"
It’s very important to report any new side effects to your health care team as soon as possible.
"If serious side effects do occur, treatment may need to be stopped and you may get high doses of corticosteroids to suppress your immune system.
"
"

Radiation therapy uses high-energy x-rays or particles to kill cancer cells."
"Depending on the stage of the anal cancer and other factors, radiation therapy might be used:
>"
"Along with chemotherapy as part of the main treatment for most anal cancers (This is called
   chemoradiation
   .)
"
>After surgery if the doctor is concerned that all of the cancer might not have been removed.
"This might be seen in cancers of the perianal area.
"
">After surgery for some cancers of the perianal area (anal margin) that are at a high risk of coming back
>To help treat cancer that has come back in the groin
   lymph nodes
   after initial treatment
>To help control
   cancer that has spread,
   such as to the lungs or to relieve symptoms it causes such as pain or bleeding"
"
Different types of radiation therapy can be used to treat anal cancer."
"There are 2 main types:
>External beam radiation therapy
>Brachytherapy (internal radiation therapy)"
"
External-beam radiation therapy (EBRT) focuses radiation from outside the body onto the cancer."
"This is the type of radiation therapy most often used to treat anal cancer or its spread to other organs.
"
"Treatment is much like getting an x-ray, but the radiation dose is stronger."
The procedure itself is painless and each treatment lasts only a few minutes.
"Most often, radiation treatments to the anal area are given 5 days a week for 5 to 7 weeks, but this can vary based on the type of EBRT and the reason it’s being given.
"
"Newer techniques allow doctors to give higher doses of radiation to the cancer while reducing the radiation to nearby healthy tissues:
Three-dimensional conformal radiation therapy (3D-CRT) uses special computers to precisely map the location of the cancer."
Radiation beams are then shaped and aimed at the tumor from several directions.
This makes them less likely to damage normal tissues.
"You will most likely be fitted with a plastic mold like a body cast to keep you in the exact same position each time so that the radiation can be aimed more accurately.
"
Intensity-modulated radiation therapy (IMRT) is a form of 3D therapy and the preferred type of EBRT for anal cancer .
It uses a computer-driven machine that rotates around you as it delivers radiation.
"Along with shaping the beams and aiming them from several angles, the intensity (strength) of the beams can be adjusted."
This helps limit the dose reaching normal tissues and can reduce some side effects.
"IMRT lets doctors deliver a higher dose of radiation to the cancer compared to standard techniques.
"
Stereotactic body radiation therapy (SBRT) is a type of radiation that might be used if the anal cancer has come back in the same place or in the nearby lymph nodes.
"It might also be considered for tumors that have limited spread to other parts of the body, such as the brain.
"
"Instead of giving a small dose of radiation each day for several weeks, SBRT uses very focused beams of high-dose radiation given in fewer (usually 1 to 5) treatments."
Several beams are aimed at the tumor from different angles.
"For each treatment, you will lie in a specially designed body frame that keeps you still and in exactly the right place during treatment."
"
Side effects vary based on the part of the body treated and the dose of radiation given."
"Some common short-term side effects include:
>Diarrhea
>Skin changes (like a sunburn) in areas being treated
>Anal irritation and pain (called
   radiation proctitis
   )
>Discomfort during bowel movements
>Tiredness
>Nausea
>Low blood cell counts
In women, radiation may irritate the vagina."
"This can lead to discomfort and discharge.
"
"Most of these side effects get better over time after radiation stops.
"
"Long-term side effects can also occur:
>Damage to anal tissue by radiation may cause scar tissue to form."
"This can sometimes keep the anal sphincter muscle from working as it should, which could lead to problems with bowel movements.
"
">Radiation to the pelvis can weaken the bones, increasing the risk of fractures of the pelvis or hip.
"
>Radiation can damage blood vessels that nourish the lining of the rectum and lead to chronic radiation proctitis (inflammation of the lining of the rectum).
"This can cause rectal bleeding and pain.
"
>Radiation can affect fertility (the ability to have children) .
People with anal cancer should discuss options for sperm banking or egg freezing with their doctor.
"(For more on this, see
   Male Fertility and Cancer
   and
   Female Fertility and Cancer
   .)
"
">Radiation can lead to vaginal dryness and even a narrowing or shortening of the vagina (called
   vaginal stenosis
   ), which can make sex painful."
A woman can help prevent this problem by stretching the walls of her vagina several times a week.
This can be done using a vaginal dilator (a plastic or rubber tube used to stretch out the vagina).
"(To learn more, see
   Sex and the Adult Female With Cancer
   .)
"
">Radiation can lower sexual function in men and impotence is often reported.
"
">If radiation is given to the lymph nodes in the groin, it can lead to swelling problems in the genitals and legs, called
   lymphedema
   ."
"
Brachytherapy is not commonly used to treat anal cancer."
"When it is used, it's usually given as a radiation boost along with external radiation when a tumor isn't responding to regular chemoradiation (chemo plus external radiation).
"
Brachytherapy involves putting small sources of radioactive materials in or near the tumor.
It focuses the radiation in the area of the cancer to minimize radiation damage to normal nearby tissue.
"Interstitial radiation or intracavitary radiation are different types of brachytherapy.
"
"The possible side effects are a lot like those seen with external beam radiation therapy.
"
"

In most cases, surgery is not the first treatment used for anal cancer."
"For people who do need surgery, the type of operation depends on the type and location of the tumor."
"
A local resection is an operation that removes only the tumor, plus a small amount of normal tissue around the tumor."
"It's most often used to treat cancers of the perianal area (also called the anal margin) if the tumor is small and has not spread to nearby tissues or lymph nodes .
"
"In most cases, local resection saves the sphincter muscles that keep stool from coming out until they relax during a bowel movement."
This allows a person to move their bowels normally after the surgery.
"
In the past, an abdominoperineal resection (APR) was a common treatment for anal cancer, but doctors have found that it can almost always be avoided by using radiation therapy and chemotherapy instead."
"Today, APR is used only if other treatments don’t work or if the cancer comes back after treatment.
"
An APR is a major operation.
"The surgeon makes one incision (cut) in the abdomen (belly), and another around the anus to remove the anus, the rectum, and the sigmoid colon."
"The surgeon may also take out some of the nearby lymph nodes in the groin area (called a lymph node dissection ), though this can also be done later.
"
"The anus (and the anal sphincter) is removed, so a new opening needs to be made for stool leave the body."
"To do this, the end of the colon is attached to a small hole (called a stoma ) made on the abdomen."
A bag to collect stool sticks to the body over the opening.
This is called a colostomy .
"
Potential side effects of surgery depend on many things, including the extent of the operation and the person’s health before surgery."
"Most people will have at least some pain after the operation, but it usually can be controlled with medicines."
"Other problems can include reactions to anesthesia, damage to nearby organs, bleeding, blood clots in the legs, and infection.
"
"APR tends to cause more side effects, many of which are long-lasting."
"For instance, after an APR, you might develop scar tissue (called adhesions ) in your belly that can cause organs or tissues to stick together."
"This might cause pain or problems with food moving through the bowels, which can lead to digestive problems.
"
People also need a permanent colostomy after an APR.
"This can take some time to get used to and may mean some lifestyle changes.
"
An APR can sometimes damage the ureters or urethra (tubes that collect your urine) making it difficult to urinate (pee).
"This might mean more surgery.
"
"For men, an APR may cause erection problems, trouble having an orgasm, or less intense orgasms."
"An APR can also damage the nerves that control ejaculation, leading to “dry” orgasms (orgasms without semen).
"
"APR usually does not cause a loss of sexual function for women, but abdominal adhesions (scar tissue) may sometimes cause pain during sex.
"
"More information on dealing with the sexual impact of cancer and its treatment can be found at Sex and the Adult Male With Cancer and Sex and the Adult Female With Cancer .
"
"
"
"
Bile duct cancer (cholangiocarcinoma) is rare."
"About 8,000 people in the United States are diagnosed with it each year."
This includes both intrahepatic (inside the liver) and extrahepatic (outside the liver) bile duct cancers.
"But the actual number of cases is likely to be higher, because these cancers can be hard to diagnose, and some might be misclassified as other types of cancer.
"
"Bile duct cancer is more common in Southeast Asia, mostly because a parasitic infection that can cause bile duct cancer is much more common there."
"
Bile duct cancer is seen mainly in older people, but it can occur in younger people."
"The average age of people in the US diagnosed with cancer of the intrahepatic (inside the liver) bile ducts is 70, and for cancer of the extrahepatic (outside the liver) bile ducts it's 72.
"
The chances of survival for patients with bile duct cancer depend to a large extent on its location and how advanced it is when it's found.
"For more on this, see Survival Statistics for Bile Duct Cancers .
"
"Visit the American Cancer Society’s Cancer Statistics Center for more key statistics.
"
"
"
"
These cancers start in the smaller bile duct branches inside the liver."
"
These cancers start at the hilum, where the left and right hepatic ducts have joined and are just leaving the liver."
These are also called Klatskin tumors.
"
"
"These cancers are found farther down the bile duct, closer to the small intestine."
"Like perihilar cancers, these are extrahepatic bile duct cancers because they start outside of the liver.
"
"
Bile duct cancers can also be divided into types based on how the cancer cells look under the microscope.
"
Nearly all bile duct cancers are cholangiocarcinomas .
"These cancers are a type of adenocarcinoma, which is a cancer that starts in gland cells."
"Cholangiocarcinomas start in the gland cells that line the inside of the ducts.
"
Other types of bile duct cancers are much less common.
"These include sarcomas, lymphomas, and small cell cancers."
"
Not all bile duct tumors are cancer."
"
The most common type of cancer that starts in the liver – much more common than cholangiocarcinoma – is hepatocellular carcinoma ."
"This type of cancer starts in the main cells that make up the liver.
"
"Cancers that start in other organs, such as the colon or rectum, can sometimes spread (metastasize) to the liver."
These metastatic cancers are not true liver cancers.
"For example, colorectal cancer that has spread to the liver is still colorectal cancer, not liver cancer."
The treatment and outlook for cancer that metastasizes to the liver is not the same as for a cancer that starts in the liver.
"For this reason, it’s important to know whether a tumor in the liver started in bile ducts (cholangiocarcinoma), the liver tissue itself (hepatocellular carcinoma), or another organ and has spread to the liver.
"
"

For some people with bile duct cancer, treatment can remove or destroy the cancer."
The end of treatment can be both stressful and exciting.
"You may be relieved to finish treatment, but it’s hard not to worry about cancer coming back."
"This is very common if you’ve had cancer.
"
"For other people, the cancer might never go away completely."
Some people may get regular treatment with chemotherapy or other treatments to try and help keep the cancer in check.
"Learning to live with cancer that doesn't go away can be difficult and very stressful.
"
Life after cancer means returning to some familiar things and also making some new choices.
"
If you have completed treatment, your doctors will still want to watch you closely."
It’s very important to go to all of your follow-up appointments.
"During these visits, your doctors will ask questions about any problems you may have."
"They will examine you and may check lab tests or x-rays and scans to look for signs of cancer or treatment side effects.
"
Almost any cancer treatment can have side effects.
"Some may last for a few weeks to months, but others can last the rest of your life."
"Talk to your cancer care team about any changes or problems you notice and about any questions or concerns you have.
"
There's no follow-up schedule for bile duct cancer for all doctors to follow.
Many doctors recommend blood and/or imaging tests about every 6 months for at least the first couple of years after treatment.
"Then your doctor will probably want to see you once a year.
"
"If the cancer does come back (recur), further treatment will depend on where the cancer is, what treatments you’ve had before, and your overall health."
"For more on how recurrent bile duct cancer is treated, see Treatment Options Based on the Extent of Bile Duct Cancer ."
"For more general information on recurrence, see Understanding Recurrence ."
"
Talk with your doctor about developing a survivorship care plan for you."
"This plan might include:
>A suggested schedule for follow-up exams and tests
>A schedule for other tests you might need in the future, such as
   early detection (screening) tests
   for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
>A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
>Diet and physical activity
   suggestions
>Reminders to keep your appointments with your primary care provider (PCP), who will monitor your general health care"
"
Even after treatment, it’s very important to keep health insurance."
"Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
"
"At some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history."
It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment.
Learn more in Keeping Copies of Important Medical Records .
"
If you have (or have had) bile duct cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements."
"Unfortunately, it’s not yet clear if there are things you can do that will help.
"
"Adopting healthy behaviors such as not smoking , eating well , getting regular physical activity , and staying at a healthy weight might help, but no one knows for sure."
"Still, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of bile duct cancer or other cancers."
"
So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of bile duct cancer progressing or coming back."
"This doesn’t mean that no supplements will help, but it’s important to know that none have been proven to do so.
"
Dietary supplements are not regulated like medicines in the United States.
"They do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do."
"If you’re thinking about taking any type of nutritional supplement, talk to your health care team."
They can help you decide which ones you can use safely while avoiding those that might be harmful.
"
If the cancer does recur at some point, your treatment options will depend on where the cancer is located, what treatments you’ve had before, and your overall health."
"For more information on how recurrent cancer is treated, see  Treatment Options Based on the Extent of Bile Duct Cancer .
"
"For more general information, you may also want to see Understanding Recurrence ."
"
Some amount of feeling depressed, anxious, or worried is normal when cancer is a part of your life."
Some people are affected more than others.
"But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups, professional counselors, or others."
"Learn more in Life After Cancer .
"
"

There's no known way to prevent most bile duct cancers in the US."
"Many of the known risk factors for bile duct cancer, such as age, ethnicity, and bile duct abnormalities, are beyond our control."
"But there are things you can do that might help lower your risk.
"
"Getting to and staying at a healthy weight is one important way a person may reduce their risk of bile duct cancer, as well as many other types of cancer."
"The American Cancer Society recommends that people try to stay at a healthy weight , keep physically active , and follow a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and that limits or avoids red and processed meats, sugary drinks, and highly processed foods."
"To learn more, see the American Cancer Society Guidelines for Diet and Physical Activity for Cancer Prevention .
"
"Other ways that people might be able to reduce their risk of bile duct cancer include:
>Get vaccinated against the hepatitis B virus (HBV) to prevent infection with this virus and the cirrhosis it can cause.
"
">Take precautions to avoid blood-borne or sexually transmitted infections like HBV and other viruses (like hepatitis C virus) to help prevent cirrhosis.
"
">Treat hepatitis infections (such as B and C) to help prevent cirrhosis.
"
">Avoid or limit
    alcohol
    ."
"If you do drink, have no more than 1 drink per day for women or 2 drinks per day for men.
"
">Quit (or don’t start) smoking
    .
"
">Protect yourself against exposure to certain chemicals (see
    Risk Factors for Bile Duct Cancer
    ).
"
"

A risk factor is anything that affects your chance of getting a disease like cancer."
Different cancers have different risk factors.
"Some risk factors, like smoking, can be changed."
"Others, like a person’s age or family history, can’t be changed.
"
"But having a risk factor, or even many risk factors, does not mean that a person will get the disease."
"And many people who get the disease have few or no known risk factors.
"
Researchers have found some risk factors that make a person more likely to develop bile duct cancer.
"
People who have chronic (long-standing) inflammation of the bile ducts have an increased risk of developing bile duct cancer."
"Certain conditions of the liver or bile ducts can cause this, these include:
>Primary sclerosing cholangitis (PSC)
    , a condition in which inflammation of the bile ducts (cholangitis) leads to the formation of scar tissue (sclerosis)."
People with PSC have an increased risk of bile duct cancer.
The cause of the inflammation is not usually known.
"Many people with this disease also have inflammation of the large intestine, called
    ulcerative colitis
    .
"
">Bile duct stones
    , which are a lot like but much smaller than gallstones, can also cause inflammation that increases the risk of bile duct cancer.
>Choledochal cyst disease
    , a rare condition some people are born with."
It causes bile-filled sacs along the bile ducts.
(Choledochal means having to do with the common bile duct.)
"If not treated, the bile sitting in these sacs causes inflammation of the duct walls."
"The cells of the duct wall often have areas of pre-cancerous changes, which, over time, cam progress to bile duct cancer.
"
">Liver fluke infections
    , which occur in some Asian countries when people eat raw or poorly cooked fish that are infected with these tiny parasite worms."
"In humans, these flukes live in the bile ducts and can cause bile duct cancer."
There are several types of liver flukes.
"The ones most closely related to bile duct cancer risk are
    Clonorchis sinensis
    and
    Opisthorchis viverrini.
    "
"Liver fluke infection is rare in the US, but it can affect people who travel to Asia.
"
">Abnormalities where the bile duct and pancreatic duct normally meet
    which can allow digestive juices from the pancreas to reflux (flow back) into the bile ducts."
This backward flow keeps the bile from moving through the bile ducts the way it should.
"People with these abnormalities are at higher risk of bile duct cancer.
"
">Cirrhosis
    , which is damage to the liver caused by scar tissue."
It's caused by irritants like alcohol and diseases like hepatitis.
"Studies have found it raises the risk of bile duct cancer.
"
">Infection with
    hepatitis B virus or hepatitis C virus
    which increases the risk of intrahepatic bile duct cancers."
"This may be at least in part because long-term infections with these viruses can also lead to cirrhosis.
"
Other rare diseases of the liver and bile duct that may increase the risk of developing bile duct cancer include polycystic liver disease and Caroli syndrome (a dilation of the intrahepatic bile ducts present at birth).
"
Inflammatory bowel disease includes ulcerative colitis and Crohn’s disease."
People with these diseases have an increased risk of bile duct cancer.
"
Older people are more likely than younger people to get bile duct cancer."
Most people diagnosed with bile duct cancer are in their 60s or 70s.
"
In the US, the risk of bile duct cancer is highest among Hispanic Americans."
"Worldwide, bile duct cancer is much more common in Southeast Asia and China, largely because of the high rate of infection with liver flukes in these areas."
"
Being overweight or obese can increase the risk of cancers of the gallbladder and bile ducts."
"This could be because obesity increases the risk of gallstones and bile duct stones, as well as the risk of non-alcoholic fatty liver disease."
"But there may be other ways that being overweight can lead to bile duct cancers, such as changes in certain hormones."
"
Non-alcoholic fatty liver disease is the build-up of extra fat in the liver cells that's not caused by alcohol."
"Over time, this can cause swelling and scarring that can progress to cancer."
"
A radioactive substance called Thorotrast (thorium dioxide) was used as a contrast agent for x-rays until the 1950s."
"It was found to increase the risk for bile duct cancer, as well as some types of liver cancer, and is no longer used."
"
A history of bile duct cancer in the family seems to increase a person’s chances of developing this cancer, but the risk is still low because this is a rare disease."
Most bile duct cancers are not found in people with a family history of the disease.
"
People with diabetes (type 1 or type 2) have a higher risk of bile duct cancer."
"This increase in risk is not high, and the overall risk of bile duct cancer in someone with diabetes is still low."
"
People who drink alcohol are more likely to get intrahepatic bile duct cancer."
The risk is higher in those who have liver problems from drinking alcohol.
"
Studies have found other factors that might increase the risk of bile duct cancer, but the links are not as clear."
"These include:
>Smoking
>Chronic pancreatitis (long-term inflammation of the pancreas)
>Infection with
    HIV
    (the virus that causes AIDS)
>"
"Exposure to
    asbestos
>Exposure to
    radon
    or other radioactive chemicals
>Exposure to dioxin, nitrosamines, or polychlorinated biphenyls (PCBs)
"
"

We don’t know the exact cause of most bile duct cancers, but researchers have found some risk factors that make a person more likely to develop bile duct cancer."
"There seems to be a link between this cancer and things that irritate and inflame the bile ducts, whether it’s bile duct stones, infestation with a parasite, or something else.
"
"Scientists are starting to understand how inflammation might lead to certain changes in the DNA of cells, making them grow out of control and form cancers."
"DNA is the chemical in each of our cells that makes up our genes – the instructions for how our cells function.
"
">Genes that control when cells grow, divide into new cells, and die are called
    oncogenes
    .
"
">Genes that slow down cell division or cause cells to die at the right time are called
    tumor suppressor genes
    .
"
Cancers can be caused by DNA changes (mutations) that turn on oncogenes or turn off tumor suppressor genes.
"Changes in many different genes are usually needed for a cell to become cancer.
"
We usually look like our parents because they are the source of our DNA.
But DNA affects more than how we look.
Some people inherit DNA mutations from their parents that greatly increase their risk for certain cancers.
"But inherited gene mutations are not thought to cause very many bile duct cancers.
"
Gene mutations related to bile duct cancers are usually acquired during life rather than being inherited.
"For example, acquired changes in the TP53 tumor suppressor gene are found in most bile duct cancers."
"Other genes that may play a role in bile duct cancers include KRAS , HER2, and ALK ."
Some of the gene changes that lead to bile duct cancer might be caused by inflammation.
But sometimes the cause of these changes is not known.
"Many gene changes might just be random events that sometimes happen inside a cell, without having an outside cause.
"
"

Only a small number of bile duct cancers are found before they have spread too far to be removed by surgery.
"
"The bile ducts are deep inside the body, so small tumors can’t be seen or felt during routine physical exams."
There are no blood tests or other tests that can reliably detect bile duct cancers early enough to be useful as screening tests.
"Because of this, most bile duct cancers are found only after the cancer has grown enough to cause signs or symptoms."
"The most common symptom is jaundice, a yellowing of the skin and eyes, which is caused by a blocked bile duct.
"
"

Most bile duct cancers aren't found until a person goes to a doctor because they have symptoms."
"
If there's reason to suspect that you might have bile duct cancer, your doctor will want to take your complete medical history to check for risk factors and to learn more about your symptoms.
"
A physical exam is done to look for signs of bile duct cancer or other health problems.
"If bile duct cancer is suspected, the exam will focus mostly on the abdomen (belly) to check for any lumps, tenderness, or build-up of fluid."
"The skin and the white part of the eyes will be checked for jaundice (a yellowish color).
"
"If symptoms and/or the results of the physical exam suggest you might have bile duct cancer, tests will be done."
"These could include lab tests, imaging tests, and other procedures."
"
Lab tests might be done to find out how much bilirubin is in your blood."
Bilirubin is the chemical that causes jaundice.
"Problems in the bile ducts, gallbladder, or liver can raise the blood level of bilirubin.
"
"The doctor may also do tests for albumin, liver enzymes (alkaline phosphatase, AST, ALT, and GGT), and certain other substances in your blood."
These may be called liver function tests .
"They can help diagnose bile duct, gallbladder, or liver disease."
"If levels of these substances are higher, it might point to blockage of the bile duct, but they can’t show if it's due to cancer or some other reason."
"
Tumor markers are substances made by cancer cells that can sometimes be found in the blood."
People with bile duct cancer may have high blood levels of the markers called CEA and CA 19-9 .
"High levels of these markers often mean that cancer is present, but the high levels can also be caused by other types of cancer, or even by problems other than cancer."
"Also, not all bile duct cancers make these tumor markers, so low or normal levels don't always mean cancer is not present.
"
"Still, these tests can sometimes be useful after a person is diagnosed with bile duct cancer."
"If the levels of these markers are found to be high, they can be followed over time to help see how well treatment is working."
"
Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body."
"Imaging tests can be done for a number of reasons, including:
>To look for suspicious areas that might be cancer
>To help a doctor guide a biopsy needle into a suspicious area to take a sample for testing
>To learn how far cancer has spread
>To help make treatment decisions
>To help find out if treatment is working
>To look for signs of the cancer coming back after treatment
Imaging tests can often show a bile duct blockage."
"But they often can’t show if the blockage is caused by a tumor or a less serious problem like scarring.
"
People who have (or might have) bile duct cancer may have one or more of these tests:
"
Ultrasound uses sound waves and their echoes to create images of the inside of the body."
A small instrument called a transducer gives off sound waves and picks up the echoes as they bounce off organs inside the body.
"The echoes are converted by a computer into an image on a screen.
"
Abdominal ultrasound: This is often the first imaging test done in people who have symptoms such as jaundice or pain in the right upper part of their abdomen (belly).
"This is an easy test to have done, and it doesn't use radiation."
"You simply lie on a table while a technician moves the transducer on the skin over your abdomen.
"
This type of ultrasound can also be used to guide a needle into a suspicious area or lymph node so that cells can be removed (biopsied) and looked at under a microscope.
"This is called an ultrasound-guided needle biopsy .
"
"Endoscopic or laparoscopic ultrasound: In these techniques, the doctor puts the ultrasound transducer inside your body and closer to the bile duct."
This gives more detailed images than a standard ultrasound.
"The transducer is on the end of a thin, lighted tube that has a camera on it."
"The tube is either passed through your mouth, down through your stomach, and into the small intestine near the bile ducts (endoscopic ultrasound) or through a small surgical cut in the skin on side of your body (laparoscopic ultrasound).
"
"If there's a tumor, the doctor might be able to see how far it has grown and spread, which can help in planning for surgery."
"Ultrasound may be able to show if nearby lymph nodes are enlarged, which can be a sign that cancer has reached them."
Needle biopsies of suspicious areas might be done.
"
A CT scan uses x-rays to make detailed cross-sectional images of your body."
"It can be used to
>Help diagnose bile duct cancer by showing tumors in the area.
"
>Help stage the cancer (find out how far it has spread).
"CT scans can show the organs near the bile duct (especially the liver), as well as lymph nodes and distant organs where cancer might have spread to.
"
">A type of CT known as
   CT angiography
   can be used to look at the blood vessels around the bile ducts."
"This can help determine if
   surgery
   is an option.
"
>Guide a biopsy needle into a suspected tumor.
"This is called a
   CT-guided needle biopsy
   .
   "
"To do it, you stay on the CT scanning table while the doctor advances a biopsy needle through your skin and toward the mass."
CT scans are repeated until the needle is inside the mass.
A small amount of tissue (a sample) is then taken out through the needle.
"
Like CT scans, MRI scans show detailed images of soft tissues in the body."
But MRI scans use radio waves and strong magnets instead of x-rays.
"A contrast material called gadolinium may be injected into a vein before the scan to see details better.
"
MRI scans can provide a great deal of detail and be very helpful in looking at the bile ducts and other organs.
Sometimes they can help tell a benign (non-cancer) tumor from one that's cancer.
"Special types of MRI scans may also be used in people who may have bile duct cancer:
>MR cholangiopancreatography (MRCP)
   can be used to look at the bile ducts and is described below in the section on cholangiography.
"
">MR angiography (MRA)
   looks at blood vessels and is also covered in the section on angiography."
"
A cholangiogram is an imaging test that looks at the bile ducts to see if they're blocked, narrowed, or dilated (widened)."
This can help show if someone might have a tumor that's blocking a duct.
It can also be used to help plan surgery.
"There are several types of cholangiograms, each of which has different pros and cons.
"
Magnetic resonance cholangiopancreatography (MRCP):
This is a way to get images of the bile ducts with the same type of machine used for standard MRIs.
"Neither an endoscope nor an IV contrast agent is used, unlike the other types of cholangiograms."
"Because it's non-invasive (nothing is put in your body), doctors often use MRCP if they just need images of the bile ducts."
"This test can’t be used to get biopsy samples of tumors or to place stents (small tubes) in the ducts to keep them open.
"
Endoscopic retrograde cholangiopancreatography (ERCP):
"In this procedure, a doctor passes a long, flexible tube (endoscope) down your throat, through your stomach, and into the first part of the small intestine."
This is usually done while you are sedated (given medicine to make you sleepy).
A small catheter (tube) is passed out of the end of the endoscope and into the common bile duct.
A small amount of contrast dye is injected through the catheter.
The dye helps outline the bile ducts and pancreatic duct as x-rays are taken.
The images can show narrowing or blockage of these ducts.
"This test is more invasive than MRCP, but it has the advantage of allowing the doctor to take samples of cells or fluid for testing."
"ERCP can also be used to put a stent (a small tube) into a duct to help keep it open.
"
"Percutaneous transhepatic cholangiography (PTC): In this procedure, the doctor puts a thin, hollow needle through the skin of your belly and into a bile duct inside your liver."
You're given medicines through an IV line to make you sleepy before this test.
A local anesthetic is also used to numb the area before putting in the needle.
"A contrast dye is then injected through the needle, and x-rays are taken as it passes through the bile ducts."
"Like ERCP, this test can also be used to take samples of fluid or tissues or to put a stent (small tube) in the bile duct to help keep it open."
"Because it's more invasive, PTC is not usually used unless ERCP has already been tried or can’t be done for some reason."
"
Angiography or an angiogram is an x-ray test for looking at blood vessels in and around the liver and bile ducts."
A thin plastic tube called a catheter is threaded into an artery and a small amount of contrast dye is injected to outline blood vessels.
Then x-rays are taken.
"The images show if blood flow in is blocked anywhere or affected by a tumor, as well as any abnormal blood vessels in the area."
The test can also show if a bile duct cancer has grown through the walls of blood vessels.
"This information is mainly used to help surgeons decide whether a cancer can be removed and to help plan the operation.
"
Angiography can also be done with a CT scan (CT angiography) or an MRI (MR angiography).
These tend to be used more often because they give information about the blood vessels without the need for a catheter.
You may still need an IV line so that a contrast dye can be injected into your bloodstream during the imaging.
"
Doctors may also use special instruments (endoscopes) to go into the body to get a more direct look at the bile duct and nearby areas."
The scopes may be passed through small surgical incisions (cuts) or through natural body openings like the mouth.
"
Laparoscopy is a type of surgery."
"The doctor puts a thin tube with a light and a small video camera on the end (a laparoscope) through a small incision (cut) in the front of your belly to look at the bile ducts, gallbladder, liver, and other nearby organs and tissues."
(Sometimes more than one cut is made.)
"This is typically done in the operating room while drugs are used to put you into a deep sleep and not feel pain (general anesthesia) during the surgery.
"
"Laparoscopy can help doctors plan surgery or other treatments, and can help determine the stage (extent) of the cancer."
"If needed, doctors can also use special instruments put in through the incisions to take out biopsy samples for testing."
"Laparoscopy is often done before surgery to remove the cancer, to help make sure the tumor can be removed completely."
"
This procedure can be done during an ERCP (see above)."
The doctor passes a very thin fiber-optic tube with a tiny camera on the end down through the larger tube used for the ERCP.
From there it can be maneuvered into the bile ducts.
"This lets the doctor see any blockages, stones, or tumors and even biopsy them."
"
Imaging tests might suggest that a bile duct cancer is present, but in many cases samples of bile duct cells or tissue is removed (biopsied) and looked at with a microscope to be sure of the diagnosis.
"
But a biopsy isn't always done before surgery for a possible bile duct cancer.
"If imaging tests show a tumor in the bile duct, the doctor may decide to proceed directly to surgery and to treat the tumor as a bile duct cancer (see Surgery for Bile Duct Cancer )."
"
There are many ways to take biopsy samples to diagnose bile duct cancer.
"
"During cholangiography: If ERCP or PTC is being done, a sample of bile may be collected during the procedure to look for cancer cells in the fluid."
Bile duct cells and tiny pieces of bile duct tissue can also be taken out by biliary brushing.
"Instead of injecting contrast dye and taking x-ray pictures (as for ERCP or PTC), the doctor advances a small brush with a long, flexible handle through the endoscope or needle."
The end of the brush is used to scrape cells and small tissue fragments from the lining of the bile duct.
"These are then looked at with a microscope.
"
During cholangioscopy: Biopsy specimens can also be taken during cholangioscopy.
"This test lets the doctor see the inside surface of the bile duct and take samples of suspicious areas.
"
Needle biopsy:
"For this test, a thin, hollow needle is put through the skin and into the tumor without making a cut in the skin."
(The skin is numbed first with a local anesthetic.)
The needle is usually guided into place using ultrasound or CT scans.
"When the images show that the needle is in the tumor, cells and/or fluid are drawn into the needle and sent to the lab to be tested.
"
"In most cases, this is done as a fine needle aspiration (FNA) biopsy, which uses a very thin needle attached to a syringe to suck out (aspirate) a sample of cells."
"Sometimes, the FNA doesn’t get enough cells for a definite diagnosis, so a core needle biopsy, which uses a slightly larger needle to get a bigger sample, may be done."
"
Along with looking at the biopsy samples with a microscope to see if they contain cancer cells, other lab tests might be done on the samples as well.
"
"For example, cancer cells in the biopsy samples (or surgery samples) might be tested for certain gene or protein changes (sometimes called biomarkers ), such as changes in the FGFR2 and IDH1 genes."
"This can help determine if certain targeted drugs might be helpful in treating the cancer.
"
"For more on biopsies and how samples are tested, see Testing Biopsy and Cytology Specimens for Cancer .
"
"

Bile duct cancer does not usually cause signs or symptoms until later in the course of the disease, but sometimes symptoms can appear sooner and lead to an early diagnosis."
"If the cancer is diagnosed at an early stage, treatment might work better.
"
"When bile duct cancer does cause symptoms, it's usually because a bile duct is blocked."
"Symptoms tend to depend on whether the cancer is in ducts inside the liver (intrahepatic) or in ducts outside the liver (extrahepatic), and include:"
"
Normally, bile is made by the liver and released into the intestine."
"Jaundice occurs when the liver can’t get rid of bile, which contains a greenish-yellow chemical called bilirubin ."
"As a result, bilirubin backs up into the bloodstream and settles in different parts of the body."
"Jaundice can often be seen as a yellowing of the skin and in the white part of the eyes.
"
"Jaundice is the most common symptom of bile duct cancer, but most of the time, jaundice isn't caused by cancer."
It's more often caused by hepatitis (inflammation of the liver) or a gallstone that has traveled to the bile duct.
"But whenever jaundice occurs, a doctor should be seen right away."
"
Excess bilirubin in the skin can also cause itching."
Most people with bile duct cancer notice itching.
"
Bilirubin contributes to the brown color of bowel movements, so if it doesn’t reach the intestines, the color of a person’s stool might be lighter.
"
"If the cancer blocks the release of bile and pancreatic juices into the intestine, a person might not be able to digest fatty foods."
The undigested fat can also cause stools to be unusually pale.
"They might also be bulky, greasy, and float in the toilet."
"
"
"When bilirubin levels in the blood get high, it can also come out in the urine and turn it dark."
"
Early bile duct cancers seldom cause pain, but bigger tumors may cause belly pain, especially below the ribs on the right side."
"
People with bile duct cancer may not feel hungry and may lose weight without trying to do so."
"
Some people with bile duct cancer develop fevers."
"
These are not common symptoms of bile duct cancer, but they may occur in people who develop an infection (cholangitis) as a result of bile duct blockage."
"These symptoms are often seen along with a fever.
"
Keep in mind: Bile duct cancer is rare.
These symptoms are far more likely to be caused by something other than bile duct cancer.
"For example, people with gallstones have many of these same symptoms."
And there are many far more common causes of belly pain than bile duct cancer.
"Also, hepatitis (an inflamed liver most often caused by infection with a virus) is a much more common cause of jaundice.
"
"Still, if you have any of these problems, it’s important to see a doctor right away so the cause can be found and treated, if needed.
"
"

After a person is diagnosed with distal bile duct cancer, doctors will try to figure out if it has spread, and if so, how far."
This process is called staging .
The stage of a cancer describes how much cancer is in the body.
It helps determine how serious the cancer is and how best to treat it.
"Doctors also use a cancer's stage when talking about survival statistics.
"
"The earliest stage distal bile duct cancers are stage 0 , also called carcinoma in situ (CIS) or high-grade biliary intraepithelial neoplasia ."
Stages then range from stages I (1) through IV (4).
"As a rule, the lower the number, the less the cancer has spread."
"A higher number, such as stage IV, means cancer has spread more."
"And within a stage, an earlier letter means a lower stage.
"
"Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way."
"
The staging system most often used for distal bile duct cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:
>The extent (size) of the main
   tumor (T)
   : Has the cancer grown through the wall of the bile duct?"
"Has the cancer reached nearby structures or organs?
>The spread to nearby lymph
   nodes (N)
   : Has the cancer spread to nearby lymph nodes?
>"
"The spread (
   metastasis
   ) to distant sites
   (M)
   : Has the cancer spread to distant lymph nodes or distant organs such as the bones, lungs, or peritoneum (the lining of the abdomen [belly])?
"
"The system described below is the most recent AJCC system, effective January 2018."
It's used only for distal bile duct cancers (those starting below the gallbladder).
"Staging systems for cancers starting in other parts of the bile ducts are described in:
>Intrahepatic Bile Duct Cancer Stages
   (for cancers starting in bile ducts within the liver)
>Perihilar (Hilar) Bile Duct Cancer Stages
   (for cancers starting in the hilum, just outside the liver)
Numbers or letters after T, N, and M provide more details about each of these factors."
"Higher numbers mean the cancer is more advanced.
"
"Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage."
"For more on this, see Cancer Staging .
"
"Distal bile duct cancer is typically given a clinical stage based on the results of a physical exam, biopsy, and imaging tests (described in Tests for Bile Duct Cancer )."
"If surgery is done, the pathologic stage (also called the surgical stage ) is determined by examining the tissue removed during the operation.
"
"Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand."
"

AJCC Stage
Stage grouping
Stage description*
0
Tis
N0
M0
The cancer is only in the mucosa (the innermost layer of cells in the bile duct)."
"It hasn't started growing into the deeper layers (Tis).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"I
T1
N0
M0
The cancer has grown less than 5 mm (about 1/5 of an inch) into the bile duct wall (T1).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"IIA
T2
N0
M0
The cancer has grown between 5 mm (about 1/5 of an inch) and 12 mm (about ½ inch) into the bile duct wall (T2).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"OR
T1
N1
M0
The cancer has grown less than 5 mm (about 1/5 of an inch) into the bile duct wall (T1) and has spread to 1 to 3 nearby lymph nodes (N1).
"
"It has not spread to distant sites (M0).
"
"IIB
T3
N0
M0
The cancer has grown more than 12 mm (about ½ inch) into the bile duct wall (T3).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"OR
T2 or T3
N1
M0
The cancer has grown 5 mm (about 1/5 of an inch) or more into the bile duct wall (T2 or T3) and has spread to 1 to 3 nearby lymph nodes (N1).
"
"It has not spread to distant sites (M0).
"
"IIIA
T1, T2, or T3
N2
M0
The cancer has grown to any depth into the bile duct wall (T1, T2, or T3) and to 4 or more nearby lymph nodes (N2).
"
"It has not spread to distant sites (M0).

"
"IIIB

T4
Any N
M0
The cancer is growing into nearby blood vessels (the celiac artery or its branches, the superior mesenteric artery, and/or the common hepatic artery) (T4)."
"The cancer may or may not have spread to nearby lymph nodes (Any N).
"
"It has not spread to distant sites (M0).
"
"IV
Any T
Any N
M1
"
The cancer has grown to any depth within the bile duct wall and may or may not be growing into nearby blood vessels (Any T).
"It may or may not have spread to nearby lymph nodes (any N).
"
"It has spread to distant organs such as the liver, lungs, or peritoneum (inner lining of the abdomen [belly]) (M1).

"
"*The T categories are described in the table above, except for:
>TX: Main tumor cannot be assessed due to lack of information.
"
TX:
"Main tumor cannot be assessed due to lack of information.
"
"The N categories are described in the table above, except for:
>NX: Nearby lymph nodes cannot be assessed due to lack of information.
"
"NX: Nearby lymph nodes cannot be assessed due to lack of information.
"
"

After a person is diagnosed with perihilar (hilar) bile duct cancer, doctors will try to figure out if it has spread, and if so, how far."
This process is called staging .
The stage of a cancer describes how much cancer is in the body.
It helps determine how serious the cancer is and how best to treat it.
"Doctors also use a cancer's stage when talking about survival statistics.
"
"The earliest stage perihilar bile duct cancers are stage 0 , also called carcinoma in situ (CIS) or high-grade biliary intraepithelial neoplasia ."
Stages then range from stages I (1) through IV (4).
"As a rule, the lower the number, the less the cancer has spread."
"A higher number, such as stage IV, means cancer has spread more."
"And within a stage, an earlier letter means a lower stage.
"
"Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way."
"
The staging system most often used for perihilar bile duct cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:
>The extent (size) of the main
   tumor (T)
   : Has the cancer grown through the bile duct or reached nearby structures or organs?
>"
"The spread to nearby lymph
   nodes (N)
   : Has the cancer spread to nearby lymph nodes?
"
">The spread (
   metastasis
   ) to distant sites
   (M)
   :"
"Has the cancer spread to distant lymph nodes or distant organs such as the bones, lungs, or peritoneum (the lining of the abdomen [belly])?
"
"The system described below is the most recent AJCC system, effective January 2018."
"It's used only for perihilar bile duct cancers (those starting in the hilum, just outside the liver)."
"Staging systems for cancers starting in other parts of the bile ducts are described in:
>Intrahepatic Bile Duct Cancer Stages
   (for cancers starting in bile ducts within the liver)
>Distal Bile Duct Cancer Stages
   (for cancers starting farther down the bile duct)
Numbers or letters after T, N, and M provide more details about each of these factors."
"Higher numbers mean the cancer is more advanced.
"
"Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage."
"For more on this, see Cancer Staging .
"
"Perihilar bile duct cancer is typically given a clinical stage based on the results of a physical exam, biopsy, and imaging tests (described in Tests for Bile Duct Cancer )."
"If surgery is done, the pathologic stage (also called the surgical stage ) is determined by examining the tissue removed during the operation.
"
"Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand."
"
AJCC Stage
Stage grouping
Stage description*
0
Tis
N0
M0
The cancer is only in the mucosa (the innermost layer of cells in the bile duct)."
"It hasn't started growing into the deeper layers (Tis).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"I
T1
N0
M0
The cancer has grown into deeper layers of the bile duct wall, such as the muscle layer or fibrous tissue layer (T1).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"II
T2a or T2b
N0
M0
"
"The tumor has grown through the bile duct wall and into the nearby fatty tissue (T2a) or into the nearby liver tissue (T2b).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"IIIA
T3
N0
M0
The cancer is growing into branches of the main blood vessels of the liver (the portal vein and/or the hepatic artery) on one side (left or right) (T3).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).

"
"IIIB

T4
N0
M0
The cancer is growing into the main blood vessels of the liver (the portal vein and/or the common hepatic artery) or into branches of these vessels on both sides (left and right), OR the cancer is growing into other bile ducts on one side (left or right) and a main blood vessel on the other side (T4).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"IIIC
Any T
N1
M0
The cancer is any size and may or may not be growing outside the bile duct or into nearby blood vessels (Any T) and has spread to 1 to 3 nearby lymph nodes (N1).
"
"It has not spread to distant sites (M0).
"
"IVA
Any T
N2
M0
The cancer is any size and may or may not be growing outside the bile duct or into nearby blood vessels (Any T)."
"It has also spread to 4 or more nearby lymph nodes (N2).
"
"It has not spread to distant sites (M0).
"
"IVB
Any T
Any N
M1
"
The cancer is any size and may or may not be growing outside the bile duct or into nearby blood vessels (Any T).
"It may or may not have spread to nearby lymph nodes (Any N).
"
"It has spread to distant organs such as the bones, lungs, or distant parts of the liver (M1).
"
"*The T categories are described in the table above, except for:
>TX
    : Main tumor cannot be assessed due to lack of information.
"
TX :
"Main tumor cannot be assessed due to lack of information.
"
">T0
    : No sign of a primary tumor.
"
T0 :
"No sign of a primary tumor.
"
"The N categories are described in the table above, except for:
>NX:
    "
"Nearby lymph nodes cannot be assessed due to lack of information.
"
"NX: Nearby lymph nodes cannot be assessed due to lack of information.
"
"

After a person is diagnosed with intrahepatic bile duct cancer, doctors will try to figure out if it has spread, and if so, how far."
This process is called staging .
The stage of a cancer describes how much cancer is in the body.
It helps determine how serious the cancer is and how best to treat it.
"Doctors also use a cancer's stage when talking about survival statistics.
"
"The earliest stage intrahepatic bile duct cancers are stage 0 (also called carcinoma in situ, or CIS) ."
Stages then range from stages I (1) through IV (4).
"As a rule, the lower the number, the less the cancer has spread."
"A higher number, such as stage IV, means cancer has spread more."
"And within a stage, an earlier letter means a lower stage.
"
"Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way."
"
The staging system most often used for intrahepatic bile duct cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:
>The extent (size) of the main
   tumor
   (T)
   : How large has the cancer grown?"
"Has the cancer reached nearby structures or organs?
>The spread to nearby lymph
   nodes
   (N)
   : Has the cancer spread to nearby lymph nodes?
>"
"The spread (
   metastasis
   ) to distant sites
   (M)
   : Has the cancer spread to distant lymph nodes or distant organs such as the bones, lungs, or peritoneum (the lining of the abdomen [belly])?
"
"The system described below is the most recent AJCC system, effective January 2018."
It's used only for intrahepatic bile duct cancers (those starting within the liver).
"Staging systems for cancers starting in other parts of the bile ducts are described in:
>Perihilar Bile Duct Cancer Stages
   (for cancers starting in the hilum, just outside the liver)
>Distal Bile Duct Cancer Stages
   (for cancers starting farther down the bile duct)
Numbers or letters after T, N, and M provide more details about each of these factors."
"Higher numbers mean the cancer is more advanced.
"
"Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage."
"For more on this, see Cancer Staging .
"
"Intrahepatic bile duct cancer is typically given a clinical stage based on the results of a physical exam, biopsy, and imaging tests (described in Tests for Bile Duct Cancer )."
"If surgery is done, the pathologic stage (also called the surgical stage ) is determined by examining the tissue removed during the operation.
"
"Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand."
"
AJCC Stage
Stage grouping
Stage description*
0
Tis
N0
M0
The cancer is only in the mucosa (the innermost layer of cells in the bile duct)."
"It hasn't started growing into the deeper layers (Tis).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"IA
T1a
N0
M0
The tumor is no more than 5 cm (about 2 inches) across and has not invaded nearby blood vessels (T1a).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"IB
T1b
N0
M0
The tumor is more than 5 cm (about 2 inches) across but has not invaded nearby blood vessels (T1b).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"II
T2
N0
M0
The tumor has grown into nearby blood vessels, OR there are 2 or more tumors, which may or may not have grown into nearby blood vessels (T2).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).

"
"IIIA

T3
N0
M0
The cancer has grown through the visceral peritoneum (the outer lining of organs in the abdomen) (T3).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"IIIB
T4
N0
M0
The cancer has grown directly into nearby structures outside of the liver (T4).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"OR
Any T
N1
M0
The cancer is any size and might or might not be growing outside the bile duct (Any T) and has spread to nearby lymph nodes (N1).
"
"It has not spread to distant sites (M0).
"
"IV
Any T
Any N
M1
"
The cancer is any size and may or may not be growing outside the bile duct (Any T).
"It may or may not have spread to nearby lymph nodes (Any N).
"
"It has spread to distant organs such as the bones or lungs (M1).
"
"*The T categories are described in the table above, except for:
>TX:
   Main tumor cannot be assessed due to lack of information.
"
">T0:
   "
"No sign of a primary tumor.
"
"The N categories are described in the table above, except for:
>NX:
   "
"Nearby lymph nodes cannot be assessed due to lack of information.


"
"

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed."
"They can’t tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
"
"Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they can’t predict what will happen in any particular person’s case."
These statistics can be confusing and may lead you to have more questions.
Ask your doctor how these numbers might apply to you.
"
A relative survival rate compares people with the same type and stage of cancer to people in the overall population."
"For example, if the 5-year relative survival rate for a specific stage of bile duct cancer (cholangiocarcinoma) is 30%, it means that people who have that cancer are, on average, about 30% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed."
"
The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results (SEER) database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer.
"
"The SEER database tracks 5-year relative survival rates for bile duct cancer in the United States, based on how far the cancer has spread."
"The SEER database, however, does not group cancers by AJCC TNM stages (stage 1, stage 2, stage 3, etc.)."
"Instead, it groups cancers into localized, regional, and distant stages:
>Localized:
   There is no sign that the cancer has spread outside of the bile ducts.
"
">Regional:
   "
"The cancer has spread outside the bile ducts to nearby structures or lymph nodes.
"
">Distant:
   "
"The cancer has spread to distant parts of the body, such as the lungs."
"
These numbers are based on people diagnosed with cancers of the bile duct between 2012 and 2018. "
They are divided into intrahepatic and extrahepatic bile duct cancers.
"
SEER* stage
5-year relative survival rate
Localized
23%
Regional
9%
Distant
3%
All SEER stages combined
9%"
"
(This includes both perihilar and distal bile duct cancers.)
"
"SEER stage
5-year relative survival rate
Localized
18%
Regional
18%
Distant
2%
All SEER stages combined
11%
*SEER= Surveillance, Epidemiology, and End Results"
"
>These numbers apply only to the stage of the cancer when it is first diagnosed.
   "
"They do not apply later on if the cancer grows, spreads, or comes back after treatment.
"
">These numbers don’t take everything into account.
   "
Survival rates are grouped based on how far the cancer has spread.
"But other factors, such as your age and overall health, and how well the cancer responds to treatment, can also affect your outlook.
"
">People now being diagnosed with bile duct cancer may have a better outlook than these numbers show.
   "
"Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least five years earlier.
"
"
"
"
Cancer can start anywhere in the body."
Bile duct cancer starts when cells in the bile ducts start to grow out of control and crowd out normal cells.
"This makes it hard for the body to work the way it should.
"
Cancer cells can spread to other parts of the body.
Cancer cells in the bile ducts can sometimes travel to the lungs and grow there.
"When cancer cells do this, it’s called metastasis ."
"To doctors, the cancer cells in the new place look just like the ones from the bile ducts.
"
Cancer is always named for the place where it starts.
"So when bile duct cancer spreads to the lungs (or any other place), it’s still called bile duct cancer."
"It’s not called lung cancer unless it starts in the lungs.


"
Ask your doctor to use this picture to show you where the cancer is.
"
"
The bile ducts are thin tubes that connect the liver and the gallbladder to the small intestine.
They carry a fluid called bile.
Bile is made in the liver and gallbladder.
It helps you digest fats in food.
"
>Intrahepatic bile duct cancers start in the bile ducts that are inside the liver.
"
">Perihilar bile duct cancers are in the ducts where they come out of the liver.
"
>Distal bile duct cancers are close to where the ducts join with the small intestine.
"
>Why do you think I have cancer?
>Is there a chance I don’t have cancer?
"
">Would you please write down the kind of cancer you think I might have?
"
>What will happen next?
"
It's hard to find bile duct cancer early, when it's small and hasn't spread."
"Because the bile ducts are deep inside the body, the doctor can’t see or feel them during a physical exam."
"Most of the time, these cancers aren't found until they cause problems that make a person go to a doctor.
"
The doctor will ask questions about your health and perform a physical exam.
"If signs are pointing to bile duct cancer, more tests will be done."
"
Blood tests : Blood tests can be used to help find out how much bilirubin is in the blood."
Bilirubin is the chemical that gives the bile its yellow color.
"Problems in the gallbladder, bile ducts, or liver can cause a high bilirubin level."
"Other blood tests can show how well the liver is working.
"
"Ultrasound :For this test, a small wand is moved around on your skin."
It gives off sound waves and picks up the echoes as they bounce off tissues.
The echoes are made into a picture on a computer screen.
"This test is often the first test used to look at the liver and bile ducts.
"
Endoscopic ultrasound or EUS for short This test uses sound waves to make pictures of the inside of the body.
"To do this test, a small probe is placed on the tip of a thin tube that is passed down the throat into the stomach and then into the first part of the small intestine."
The probe can be pointed at the bile ducts.
"It can also be used to take out a little bit of tissue that can be checked for cancer.
"
CT or CAT scan : Uses x-rays to make pictures of your insides.
"This can show clear pictures of the bile ducts and the area around it to see if the cancer has spread.
"
MRI scan : Uses radio waves and strong magnets instead of x-rays to make clear pictures of the inside of the body.
This test may be used to learn more about the cancer’s size and spread.
"Special types of MRI scans can also be used to look at the organs and blood vessels around the bile ducts.
"
"Cholangiogram : This test looks at the bile ducts to see if they are blocked, narrowed, or widened."
It can be used to help plan surgery (SUR-jur-ee).
"There are many types of cholangiograms, and each has different pros and cons.
"
Laparoscopy :
"For this type of surgery, a thin, lighted tube is put into the belly through a small cut in the skin."
A tiny camera on the end of the tube lets the doctor look at the gallbladder and other nearby body parts.
This can help plan surgery or other treatments.
"A biopsy may be done with tools put into the tube.
"
Biopsy: The doctor takes out a little bit of tissue or some cells to check for cancer.
A biopsy is the only way to tell for sure if you have cancer.
Biopsies can be done in more than one way.
Ask your doctor which type of biopsy you will have.
Each type has pros and cons.
"
>What tests will I need to have?
>"
"Who will do these tests?
>Where will they be done?
"
>
"Who can explain them to me?
>"
"How and when will I get the results?
>Who will explain the results to me?
>What do I need to do next?"
"
If you have bile duct cancer, the doctor will want to find out how far it has spread."
This is called staging.
You may have heard other people say that their cancer was stage 2 or stage 3.
"Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.
"
"Your cancer can be staged 1, 2 ,3 or 4."
"The lower the number, the less the cancer has spread."
Be sure to ask the doctor about the cancer stage and what it means for you.
"
>Do you know the stage of the cancer?
>If not, how and when will you find out the stage of the cancer?
"
">Would you explain to me what the stage means in my case?
>Based on the stage of the cancer, how long do you think I’ll live?
"
>What will happen next?
"
Most people with bile duct cancer find out that it's a higher stage and hard to treat."
Treatment in many cases helps make symptoms better and slows down the cancer but may not cure it.
Talk with your doctor to find out your options.
"The main ways to treat bile duct cancer are surgery (SUR-jur-ee), radiation (RAY-dee-A-shun) therapy, and chemotherapy (KEY-mo-THAIR-uh-pee)."
"Ask your doctor what treatments can help you and what the goal is.
"
"The treatment plan that’s best for you will depend on:
>The stage of the cancer
>The chance that a type of treatment will cure the cancer or help in some way
>Your age
>Other health problems you have
>Your feelings about the treatment and the side effects that come with it"
"
Surgery is used to try to take out all of the cancer."
"If the cancer has spread, surgery may not be possible."
There's more than one way to do surgery.
"Ask your doctor what kind of surgery you will have, the goal of the surgery, and what you can expect."
"
Surgery for bile duct cancer is often a very big operation and can have risks and side effects."
Be sure to ask the doctor what you can expect.
"If you have problems, let your doctors know."
Even in the best cases you can have problems from surgery.
"They include:
>Leaking inside the body
>Infections
>Bleeding
>Trouble eating (may need to take medicine to help)
>Weight loss
>Liver failure"
"
Radiation uses high energy x-rays to kill cancer cells."
Radiation (along with chemotherapy) can be used when the cancer is too far along to be taken out by surgery.
It can also be used before surgery to try to shrink a tumor so it can be taken out.
"It might be used after surgery, also, to kill any cancer cells that may have been missed."
Radiation is often used to help make symptoms better – such as to ease pain or blockages caused by large tumors.
"
If your doctor suggests radiation treatment, talk about what side effects might happen."
"The most common side effects of radiation are:
>Skin changes where the radiation is given
>Feeling very tired
>Feeling sick to your stomach
>Losing weight
Most side effects get better after treatment ends."
Some might last longer.
Talk to your cancer care team about what you can expect.
"
Chemo (chemotherapy), the use of drugs to fight cancer."
These drugs go into the blood and spread through the body.
Chemo is given in cycles or rounds.
Each round of treatment is followed by a break to allow your body to get better from the side effects.
Your doctor can pick from more than one chemo drug.
Chemo might be used before or after surgery.
It also can be used to help shrink tumors and ease problems they're causing.
"
Common side effects are:
>Feeling very tired
>Feeling sick to your stomach
>Hair loss
>Mouth sores
>Low blood counts
There are ways to treat most chemo side effects."
"If you have side effects, be sure to talk to your cancer care team so they can help."
"
Clinical trials are research studies that test new drugs or other treatments in people."
"They compare standard treatments with others that may be better.
"
"If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials."
"See Clinical Trials to learn more.
"
Clinical trials are one way to get the newest cancer treatment.
They are the best way for doctors to find better ways to treat cancer.
"If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part."
"And if you do sign up for a clinical trial, you can always stop at any time."
"
"
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms.
These may not always be standard medical treatments.
"These treatments may be vitamins, herbs, special diets, and other things."
"You may wonder about these treatments.
"
"Some of these are known to help, but many have not been tested."
Some have been shown not to help.
A few have even been found to be harmful.
"Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else."
"
>What treatment do you think is best for me?
>What’s the goal of this treatment?"
"Do you think it could cure the cancer?
>Will treatment include surgery?"
"If so, who will do the surgery?
>What will the surgery be like?
"
">Will I need other types of treatment, too?
>"
"What’s the goal of these treatments?
>What side effects could I have from these treatments?
>What can I do about side effects that I might have?
"
">Is there a clinical trial that might be right for me?
>"
What about special vitamins or diets that friends tell me about?
"How will I know if they are safe?
>How soon do I need to start treatment?
"
">What should I do to be ready for treatment?
"
">Is there anything I can do to help the treatment work better?
>"
What’s the next step?
"
With bile duct cancer, treatments may not cure your cancer."
You may need to keep getting treatment and care.
"From time to time tests will be done to see how your treatment is working, and at other times tests will be done to see if your cancer has come back."
Ask your doctor what to expect.
"No matter what, your doctors will still want to watch you closely."
Be sure to go to all of these follow-up visits.
"During these visits, your doctors will ask about symptoms, do physical exams, and may order blood tests or tests that take pictures, such as CT scans.
"
"Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways."
"Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.
"
You can’t change the fact that you have cancer.
"What you can change is how you live the rest of your life.
"
"

The extent of bile duct cancer is an important factor in deciding on treatment options."
"Whenever possible, surgery is the main treatment for bile duct cancers."
It offers the only realistic chance for a cure.
"Because of this, doctors generally divide bile duct cancers into:
>Resectable cancers
    , those that doctors believe can be removed completely by surgery, based on the results of imaging tests and other tests.
"
">Unresectable cancers
    , those that have spread too far or are in too difficult a place to be removed entirely by surgery.
"
Most bile duct cancers are unresectable by the time they're found.
"
Most stage 0, I, and II cancers and possibly some stage III cancers are potentially resectable -- that is, it might be possible to remove them completely with surgery."
"But other factors can impact whether this is a good option, such as where the cancer is and whether the patient is healthy enough to have major surgery.
"
Surgery to remove the cancer completely is the preferred treatment if it's possible.
"If surgery is being considered, a staging laparoscopy may be done first."
This allows the doctor to look inside the abdomen (belly) for any spread of the cancer that could make it unresectable.
(Laparoscopy is described in Tests for Bile Duct Cancer )
"
The type of surgery done to remove the cancer depends on the location and extent of the cancer."
(See Surgery for bile duct cancer for more details.)
"
If a person has jaundice (yellowing of the skin and eyes) before surgery, a stent or catheter may be put in the bile duct first."
This allows the bile to flow the way it should.
"It can help relieve symptoms over a few days and might help make a person healthy enough to have the operation.
Radiation therapy and/or chemotherapy (chemo) may be given after surgery to try to lower the risk that the cancer will come back."
This is called adjuvant therapy.
Doctors aren’t sure how helpful adjuvant therapy is.
It's more likely to be used if there’s a higher chance that the cancer wasn’t removed completely (based on looking at and testing the tissue removed during surgery).
"If it's clear that some cancer was left behind, a second surgery to take out more tissue may also be an option in some cases.
"
Sometimes it isn’t clear from imaging or other tests whether the cancer can be removed completely.
These cancers may be called borderline resectable tumors.
Some doctors may recommend treatment with radiation and/or chemo before surgery to try to shrink the tumor.
(This is called neoadjuvant treatment.)
"Then, if the cancer shrinks, surgery can be done to try to remove all of it."
"
These cancers cannot be removed with surgery, which includes most stage III and IV cancers."
It may also include earlier stage cancers if a person isn’t healthy enough for surgery.
"
As noted above, in cases where it isn’t clear if a cancer is resectable, chemotherapy and/or radiation therapy may be used first to try to shrink the cancer and make it resectable."
"Surgery could then be done to try to remove the cancer.
"
"In some cases, the doctor might think that a cancer is resectable, but once the operation starts it becomes clear that it can’t be removed completely."
"For example, the cancer may turn out to have spread farther than was seen on the imaging tests done before surgery."
"It doesn't help to remove only part of the cancer, and surgery could still cause major side effects, so this part of the operation is stopped."
"But while the doctor can see the area, a biliary bypass may be done to relieve any bile duct blockage or to try to keep it from happening in the future."
Putting stents in the bile ducts to keep them open may also be an option.
"
For some unresectable intrahepatic or perihilar bile duct cancers, a liver transplant (after complete removal of the liver and bile ducts) may be an option."
Chemo and radiation may be given first.
"It's often hard to find a compatible liver donor, but a liver transplant can provide a chance for a cure."
"
For most bile duct cancers, it’s clear from imaging tests and/or laparoscopy when they're not resectable."
"For these cancers, treatment is aimed at trying to control the growth of the cancer for as long as possible and to relieve any symptoms it's causing.
"
Radiation and/or chemo: Radiation therapy and/or chemo may shrink or slow the growth of the cancer for a time.
When chemo is given alone (without radiation) the drugs cisplatin and gemcitabine are often used.
"When chemo is given with radiation, 5-FU is the drug most often used.
"
"Chemo plus immunotherapy: For advanced bile duct cancers that can’t be removed completely, another option might be chemo (cisplatin and gemcitabine) plus the immunotherapy drug pembrolizumab (Keytruda).
"
"Targeted therapy: For advanced bile duct cancers that have an FGFR2 or IDH1 gene mutation (change) and have grown after at least one other treatment, targeted therapy drugs might be an option.
"
Ablation:
"For bile duct cancers within the liver, ablation using extreme heat (radiofrequency ablation) or cold (cryotherapy) may help control the tumors."
"But almost all of these cancers will start to grow again in the future.
"
"Clinical trials: For people looking to continue to try to treat the cancer, taking part in clinical trials of newer treatments may be an option."
"This way patients can get the best treatment available now and may also get the treatments that are thought to be even better.
"
Much of the focus of treating people with unresectable cancers is on relieving symptoms from the cancer.
"Two of the most important problems are bile duct blockage (which can lead to jaundice, itching, and other symptoms) and pain."
"
"
This is supportive care.
It's aimed at preventing and treating symptoms or problems caused by the bile duct cancer.
Palliative care is used with every type of cancer treatment at every stage of bile duct cancer.
"It includes things like medicines to prevent nausea, pain control, and maintaining the flow of bile where a tumor may block it."
"Palliative care is focused on helping you feel better, it's not used to treat the cancer.
"
Maintaining your quality of life is an important goal.
"Please don’t hesitate to discuss pain, other symptoms, or any quality-of-life concerns with your cancer care team.
"
See Palliative Therapy for Bile Duct Cancer for details on some of these treatments.
"
Cancer is called recurrent when it come backs after treatment."
"Recurrence can be local (in or near the same place it started) or distant (it comes back in other parts of the body, like the lungs)."
"If the cancer comes back, further treatment depends on where the cancer recurs, the kind of treatment used in the past, and the patient’s overall health.
"
"In most cases if the cancer comes back after initial treatment, it will not be resectable."
"Treatment will be aimed at controlling the cancer growth and relieving symptoms, as described above for unresectable cancers and palliative care."
"In rare cases, if the cancer comes back where it started, surgery to try to remove the cancer (and possibly adjuvant therapy afterwards) may be an option."
"Because most of these cancers are not curable, people might want to consider taking part in a clinical trial of newer treatments.
"
"

Chemotherapy (chemo) is treatment with cancer-killing drugs that are usually given into a vein (IV) or taken by mouth."
"These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for some cancers that have spread to organs beyond the bile duct."
"Because the drugs reach all the areas of the body, this is known as a systemic treatment.
"
"Chemo can help some people with bile duct cancer, but so far it's not clear how useful it is for this type of cancer."
"Still, chemo might be used in these ways:
>After surgery to remove the cancer:
   Chemo may be given after surgery (often along with radiation therapy) to try to lower the risk that the cancer will come back."
"This is called
   adjuvant chemo
   .
"
">Before surgery:
   It may be given before surgery for cancers that might be able to be completely removed."
Chemo might shrink the tumor enough to improve the odds that surgery will be successful.
"This is called
   neoadjuvant treatment
   .
"
">As part of the liver transplant process:
   Chemo may be used to keep bile duct cancer under control while waiting for a
   liver transplant
   .
"
">As part of the main treatment for some advanced cancers:
   Chemo can be used (sometimes with radiation therapy) for more advanced cancers that cannot be removed or have spread to other parts of the body."
"Chemo does not cure these cancers, but it might help people live longer.
"
">As palliative therapy:
   Chemo can help shrink tumors or slow their growth for a time."
"This can help relieve symptoms from the cancer, for instance, by shrinking tumors that are pressing on nerves and causing pain.
"
"Doctors give chemo in cycles, with each period of treatment followed by a rest period to give the body time to recover."
Chemo cycles generally last about 3 to 4 weeks.
"Chemo usually isn't recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemotherapy."
"


Because giving chemo into a vein isn't always helpful for bile duct cancer, doctors have tried giving the drugs right into the main artery going into the liver, called the hepatic artery."
"The hepatic artery also supplies most bile duct tumors, so putting the chemo into this artery means more chemo goes to the tumor."
The healthy liver then removes most of the remaining drug before it can reach the rest of the body.
This can lessen chemo side effects.
"HAI may help some people whose cancer couldn't be removed by surgery live longer, but more research is needed."
"This technique often requires surgery to put a catheter into the hepatic artery, and many people with bile duct cancer are not well enough to have this surgery."
"
Embolization is a procedure where a substance is put into the blood vessels to help stop blood from getting to a tumor."
TACE uses tiny beads of chemo to do this.
"A catheter is used to put the beads into the artery that ""feeds"" the tumor."
The beads lodge there to block blood flow and give off the chemo.
TACE may be used for tumors that can't be removed or to treat bile duct cancer that comes back after surgery.
"
The drugs used most often to treat bile duct cancer include:
>5-fluorouracil (5-FU)
>Gemcitabine (Gemzar®)
>Cisplatin (Platinol®)
>Capecitabine (Xeloda®)
>Oxaliplatin (Eloxatin®)
"
"In some cases, 2 or more of these drugs may be combined to try to make them more effective."
"For example, combining gemcitabine and cisplatin may help people live longer than getting just gemcitabine alone."
"
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells."
"But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly."
"These cells can be affected by chemo, which can lead to side effects.
"
"The side effects of chemo depend on the type and dose of drugs given, how they're given, and the length of treatment."
"Side effects can include:
>Hair loss
>Mouth sores
>Loss of appetite
>Nausea and vomiting
>Diarrhea
>Nerve damage (neuropathy), which can lead to numbness, tingling, and even pain in the hands and feet
>Increased chance of infections (from having too few white blood cells)
>Easy bruising or bleeding (from having too few blood platelets)
>Fatigue (from having too few red blood cells)
Ask your cancer care team what you should watch for."
Most side effects are short-term and go away after treatment ends.
There are often ways to lessen these side effects.
"For example, drugs can be given to help prevent or reduce nausea and vomiting."
"Be sure to ask your doctor or nurse about medicines to help reduce side effects.
"
Report any side effects you notice to your medical team so that they can be treated right away.
Most side effects can be treated.
"In some cases, the doses of the chemo drugs may need to be reduced or treatment might need to be delayed or stopped to keep the effects from getting worse.
"
"

Immunotherapy is the use of medicines to help a person’s immune system better recognize and destroy cancer cells."
"Many types of immunotherapy are being tested in clinical trials , and some might now be used to treat bile duct cancer."
"
An important part of the immune system is its ability to keep itself from attacking the body's normal cells."
"To do this, it uses “checkpoint” proteins on immune cells, which act like switches that need to be turned on (or off) to start an immune response."
"Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system.
Drugs that target these checkpoints (called immune checkpoint inhibitors ) can be used to treat some bile duct cancers."
"
Pembrolizumab (Keytruda) is a drug that targets PD-1, a checkpoint protein on immune system cells called T cells ."
PD-1 normally helps keep T cells from attacking other cells in the body (including some cancer cells).
"By blocking PD-1, this drug boosts the immune response against cancer cells."
"This can shrink some tumors or slow their growth.
"
"Pembrolizumab can used along with the chemotherapy drugs gemcitabine and cisplatin to treat bile duct cancer that can’t be removed by surgery or that has spread to other parts of the body.
"
"Pembrolizumab can also be used by itself to treat some advanced bile duct cancers, typically after other treatments have been tried, if there are no other good treatment options, and if the cancer cells have any of the following:
>A
   high level of microsatellite instability (MSI-H)
   or a defect in a
   mismatch repair gene (dMMR)
>A
   high tumor mutational burden (TMB-H)
   , meaning the cells have many gene mutations
Tumor cells can be tested for these changes.
"
"This drug is given as an intravenous (IV) infusion, typically once every 3 or 6 weeks."
"
Side effects of PD-1 inhibitors can include:
>Feeling tired or weak
>Fever
>Cough
>Nausea
>Itching
>Skin rash
>Loss of appetite
>Muscle or joint pain
>Shortness of breath
>Constipation or diarrhea
Other, more serious side effects occur less often."
"These can include:
Infusion reactions: Some people might have an infusion reaction while getting this drug."
"This is like an allergic reaction, and can include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing."
"It’s important to tell your doctor or nurse right away if you have any of these symptoms while getting this drug.
"
Autoimmune reactions: This drug works by basically removing one of the safeguards on the body’s immune system.
"Sometimes this causes the immune system to attack other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, skin, or other organs.
"
It’s very important to report any new side effects to your health care team right away.
"If you do have a serious side effect, treatment may need to be delayed or stopped, and you may be given high doses of corticosteroids to suppress your immune system.
"
"

Palliative care is treatment used to help control or reduce symptoms caused by cancer."
"It's not meant to cure the cancer.
"
"If bile duct cancer has spread too far to be removed by surgery, doctors may focus on palliative treatments."
"For instance, pain medicines and drugs to control nausea or itching might be used to help you feel better."
Chemotherapy and radiation can also be used to relieve problems caused by the tumor(s).
"Sometimes, surgery or other treatments are used to help you feel better or to help prevent possible problems the cancer might cause."
"Because bile duct cancers tend to grow and spread quickly, doctors try to use palliative therapies that are less likely to have unpleasant short-term side effects, whenever possible."
"Your cancer care team will talk with you about the pros and cons of all the treatments that might help you.
"
Here are some examples of procedures that might be used as part of palliative care for bile duct cancer:
"
"
"If cancer is blocking a bile duct, it can lead to jaundice (yellowing of the skin and eyes) as well as other problems, like infection and liver failure."
"A small tube or a catheter can be put into the duct to help keep it open.
"
">A
   stent
   is a small metal or plastic tube that's put through the blockage in the duct."
"It keeps the duct open to allow bile to drain into the small intestine.
"
">A
   catheter
   is a thin, flexible tube that's put in through the skin over the abdomen (belly)."
One end of the tube is put into a bile duct and the other end is outside the body.
This allows the bile to drain into a bag.
The bag can be emptied when needed.
"If you have a catheter, your doctor or nurse will teach you how to care for it.
"
"These procedures can be done as part of a cholangiography procedure such as ERCP or PTC (see Tests for Bile Duct Cancer ) or, in some cases, during surgery."
"They're often done to help prevent or relieve symptoms from more advanced cancers, but they can also be done to help relieve jaundice before potentially curative surgery is done."
"This helps lower the risk of complications from the surgery.
"
The stent or catheter might need to be replaced every few months to help reduce the risk of infection and gallbladder inflammation.
It will also need to be replaced if it becomes clogged.
"
Another option to allow bile to go into the small intestine and not build up in the liver is a surgery called biliary bypass."
There are different biliary bypass operations.
The decision on which one to use depends on where the blockage is.
"In these procedures, the surgeon creates a bypass around the tumor blocking the bile duct by connecting part of the bile duct before the blockage with a part of the duct that lies past the blockage, or with the intestine itself.
"
"As mentioned in Surgery for Bile Duct Cancer , biliary bypass is more likely to be done if a patient is already having surgery to try to cure the cancer by taking it out, but it turns out the cancer cannot be totally removed."
"While a bypass is clearly more invasive than placing a stent or catheter, it has some advantages in that it may last longer and infection is less likely to be a problem."
"
Tumors in the liver that can’t be resected can sometimes be destroyed (ablated) by putting a long metal probe through a small hole in the skin and into the tumor."
A CT scan or ultrasound is used to guide it to the right place.
The tip of the probe is then heated (in radiofrequency ablation ) or frozen (in cryotherapy) to kill the cancer cells.
"
For PDT , a light-activated drug is injected into a vein."
"Over time, the drug tends to collect in cancer cells more than in normal cells."
"A few days later, an endoscope (a long, flexible tube that can be used to look inside the body) is passed down the throat, through the stomach and intestine, and into the bile ducts."
A special laser light on the end of the endoscope is aimed at the tumor.
"The light turns on the drug, causing the cells to die."
"The combination of PDT and stenting can be helpful for patients with bile duct cancer whose tumors can't be removed with surgery.
"
"The drugs used for PDT can also collect in normal cells in the body, making a person very sensitive to sunlight or strong indoor lights."
You'll need to stay out of any strong light for several weeks after the injection.
"
To relieve pain, doctors may deaden the nerves that carry pain signals from the bile duct and intestinal area to the brain by injecting these nerves with alcohol."
"This can be done during surgery or through a long, hollow needle that's guided into place with the help of a CT scan.
"
"

Radiation therapy uses high-energy rays or particles to destroy cancer cells."
"Radiation isn't often used to treat bile duct cancer, still, it might be used in these ways:
>After surgery to remove the cancer:
   "
"This is called
   adjuvant therapy
   ."
It's used to kill any tiny deposits of cancer cells that are left after surgery but are too small to see.
"Not all doctors agree that adjuvant radiation therapy is helpful.
"
">Before surgery for cancers that might be able to be taken out:
   Some doctors may use radiation therapy before surgery for certain cancers that are thought to be resectable (removable)."
This is done to try to shrink the cancer and make it easier to take it out.
"This is called
   neoadjuvant therapy
   ."
"It’s not clear how helpful this is.
"
">As part of the main therapy for some advanced cancers:
   Radiation therapy can also be used as a main therapy for some patients whose cancer has not spread widely throughout the body, but can't be removed with surgery."
"While treatment in this case does not offer a cure, it may help patients live longer.
"
">As palliative therapy:
   Radiation therapy is often used to ease symptoms when a cancer is too advanced to be cured."
"It can help relieve pain or other symptoms by shrinking tumors that block bile ducts or blood vessels, or press on nerves.
"
The 2 main types of radiation therapy are external beam radiation therapy (EBRT) and brachytherapy.
EBRT is the most common form of radiation for bile duct cancer.
"
In this type of radiation therapy, a machine sends x-rays to a specific part of the patient's body to kill cancer cells.
"
"Before your treatments start, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation."
"The treatment is much like getting an x-ray, but the radiation is much stronger."
The procedure itself is painless.
"Each treatment lasts only a few minutes, but the set-up time – getting you into place for treatment – usually takes longer."
"Most often, radiation treatments are given 5 days a week for many weeks."
"These are some of the ways EBRT might be given:
Three-dimensional conformal radiation therapy (3D-CRT) uses special computers to precisely map the location of the tumor(s)."
"Radiation beams are then shaped and aimed at the tumor(s) from several directions, which makes it less likely to damage normal tissues."
"It may be used to treat localized intrahepatic bile duct cancers that can't be removed with surgery.
"
Intensity-modulated radiation therapy (IMRT) is an advanced form of 3D-CRT.
It uses a computer-driven machine that moves around you as it delivers radiation.
"Along with shaping the beams and aiming them at the cancer from many angles, the intensity (strength) of the beams can be adjusted to limit the dose reaching the most sensitive normal tissues."
"This lets doctors deliver an even higher dose to the cancer.
"
"Stereotactic body radiotherapy (SBRT) uses the techniques of 3D-CRT and IMRT, but gives a high dose of radiation over fewer sessions."
"A course of SBRT may take a week or 2, while a course of radiation using these other techniques often takes 3 to 6 weeks.
"
Chemoradiation is when chemotherapy (chemo) is given along with EBRT to help it work better.
It may be tried in select patients with early stage perihilar bile duct cancer before a liver transplant is done.
The main drawback of this approach is that the side effects tend to be worse than giving radiation alone.
"
Some common side effects of ERBT to treat bile duct cancer include:
>Skin changes, ranging from redness to blistering and peeling (in the area being treated)
>"
"Nausea and vomiting
>Diarrhea
>Fatigue (tiredness)
>Hair loss (on the skin in the area being treated)
>Low blood cell counts
>Liver damage
Side effects from radiation often start a week or 2 into treatment, and usually get better over time once treatment is over."
"
This type of treatment uses small pellets of radioactive material that are put next to or right into the tumor."
"The radiation travels a very short distance, so it affects the cancer without causing much harm to nearby healthy body tissues."
"For bile duct cancer, brachytherapy is sometimes done with a thin radioactive wire that's put into the bile duct for a short time."
This may be called intrabiliary brachytherapy.
"Brachytherapy can be used alone, or it may be used along with EBRT."
"At this time it's mostly used as a palliative treatment.
"
"

There are 2 general types of surgery for bile duct cancer: potentially curative surgery (resectable and unresectable) and palliative surgery."
"
Resectable (potentially curative surgery) means imaging tests or the results of earlier surgeries show there’s a good chance that the surgeon can remove all of the cancer along with a rim (margin) of healthy tissue around it.
"
"Only a small percentage of bile duct cancers are resectable when they're first found.
"
"If potentially curative surgery is being considered, you may want to get a second opinion or even be referred to a large cancer center ."
Nearly all doctors agree that surgery offers the only realistic chance for curing people with bile duct cancer.
But there are differences of opinion about how advanced a bile duct cancer can be and still be treatable with surgery.
The surgery needed for bile duct cancer is often complex and requires an experienced surgeon.
"These operations are most often done at major cancer centers.
"
"If a tumor is unresectable, it means doctors think the cancer is too advanced, it has spread too far, or is in too difficult a place to be entirely removed by surgery."
"
If your surgical team is planning curative surgery, they first may do a laparoscopy (a type of minor surgery) to look for any spread of the cancer that could make curative surgery not an option."
This procedure is described in Tests for Bile Duct Cancer .
"During the laparoscopy, the surgeon can look for areas of cancer that did not show up on imaging tests."
"If the cancer is resectable, laparoscopy can also help plan the operation to remove it.
"
"Surgery to remove bile duct cancer can have serious side effects and, depending on how extensive it is, you may need many weeks to recover."
"If your cancer is very unlikely to be curable, be sure to carefully weigh the pros and cons of surgery or other treatments that will need a lot of recovery time."
"It’s very important to understand the goal of any surgery for bile duct cancer, what the possible benefits and risks are, and how the surgery is likely to affect your quality of life."
"
For resectable cancers, the type of operation depends on where the cancer is.
"
">Intrahepatic bile duct cancers
   are in bile ducts that are inside the liver."
"To treat these cancers, the surgeon cuts out the part of the liver containing the cancer."
"Removing part of the liver is called a
   partial hepatectomy
   ."
Sometimes this means that a whole lobe (right or left part) of the liver must be removed.
"This is called
   hepatic lobectomy
   and is a complicated operation that requires an experienced surgical team."
"If the amount of liver removed is not too great, the liver will still work normally because it has some ability to grow back.
"
">Perihilar bile duct cancer
   develops where the branches of the bile ducts first leave the liver."
Surgery for these cancers is complicated and requires great skill.
"Usually part of the liver is removed, along with the bile duct, gallbladder, nearby lymph nodes, and sometimes part of the pancreas and small intestine."
Then the surgeon connects the remaining ducts to the small intestine.
"This is a complex operation that can lead to life-threatening complications for some people.
"
">Distal bile duct cancers
   are further down the bile duct near the pancreas and small intestine."
"Along with the bile duct and nearby lymph nodes, the surgeon often has to remove part of the pancreas and small intestine."
"This operation is called a
   Whipple procedure
   ."
"Like the other operations, this is a complex procedure that requires an experienced surgical team."
"
Surgery is less likely to be done for unresectable cancers, but there are some instances where it might be helpful."
"
For some people with early stage, unresectable intrahepatic or perihilar bile duct cancers, removing the liver and bile ducts and then transplanting a donor liver may be an option."
In some cases it might even cure the cancer.
But getting a new liver may not be easy.
Not many centers accept patients with bile duct cancer into their transplant programs.
"Also, few livers are available for patients with cancer because they tend to be used for more curable diseases."
"People needing a transplant must wait until a liver is available, which can take too long for some people with bile duct cancer.
"
One option might be having a living donor (often a close relative) give a part of their liver for transplant.
"This can be successful, but it carries risks for the donor."
Another option might be to treat the cancer first with chemotherapy and radiation .
Then a transplant is done when a liver becomes available.
"Clinical trial results using this approach have been promising.
"
"Like other surgeries for bile duct cancer, a liver transplant is a major operation with potential risks (bleeding, infection, complications from anesthesia, etc.)."
But there are also some additional risks after this surgery.
"After liver transplant, drugs have to be taken to help suppress the patient's immune system to keep it from rejecting the new liver."
"These drugs have their own risks and side effects, especially the risk of getting serious infections."
"Some of the drugs used to prevent rejection can cause high blood pressure, high cholesterol, and diabetes."
They can also weaken the bones and kidneys and can lead to the development of another cancer.
"After a liver transplant, regular blood tests are needed to check for signs of rejection."
Sometimes liver biopsies are also done to see if rejection is occurring and if the anti-rejection medicines need to be changed.
"
Palliative surgery is done to relieve symptoms or treat (or even prevent) complications, such as blockage of the bile ducts."
This type of surgery is done when the cancer is too widespread to be removed completely.
"Palliative surgery is not expected to cure the cancer, but it can sometimes help a person feel better and sometimes can even help them live longer.
"
"In some cases the doctor might think the cancer can be removed (is resectable) based on the information available (imaging tests, laparoscopy, etc.), but then once surgery is started it becomes clear that the cancer is too advanced to be removed completely."
"In these cases, the surgeon might still try to prevent or relieve symptoms using a different approach."
"
The surgeon creates a bypass around the tumor blocking the bile duct by connecting part of the bile duct before the blockage with a part of the duct that lies past the blockage The bile duct may also be connected to the intestine itself."
"Often, the gallbladder is used to provide some of the bypass."
"Different types of biliary bypass operations may be done, based on where the blockage is."
The bypass allows the bile to flow into the intestines and can help reduce symptoms such as jaundice or itching.
"
If a bypass can’t be done, the surgeon may put a plastic or expandable metal tube (called a stent) inside the bile duct to keep it open and allow bile to flow.
"
Palliative surgery is described in more detail in the section Palliative Therapy for Bile Duct Cancer .
"
The risks and side effects of surgery depend on the extent of the operation and a person’s overall health before surgery."
Another key factor is how well the liver is working.
"All surgery carries some risk, including the possibility of bleeding, blood clots, infections, complications from anesthesia, pneumonia, and even death in rare cases.
"
"People will have some pain from the incision for some time after surgery, but this can usually be controlled with medicines.
"
Surgery for bile duct cancer is a major operation that might mean removing parts of other organs.
This can have a major effect on a person’s recovery and health after the surgery.
"Serious problems soon after surgery can include bile leakage into the abdomen, infections, and liver failure."
"Because most of the organs removed are involved in digestion, eating and nutrition problems may be a concern after surgery.
"
"

As researchers learn more about the changes in cells that cause cancer, they've developed drugs to target some of these changes."
These targeted drugs work differently from standard chemotherapy (chemo) drugs.
"They sometimes work when standard chemo drugs don’t, and they often have different side effects."
"
FGFRs (fibroblast growth factor receptors) are proteins on cells that help them grow and divide normally."
"A small number of people with bile duct cancer within the liver have changes in the genes that make FGFRs, which result in abnormal FGFR proteins that cause cells to grow out of control and turn into cancer.
"
Pemigatinib (Pemazyre) and futibatinib (Lytgobi) are FGFR2 inhibitors.
"They block the abnormal FGFR2 protein in bile duct cancer cells and keep them from growing and spreading to other places.
"
These drugs can be used to treat some advanced bile duct cancers that cannot be removed by surgery or have spread to distant areas after at least one previous chemotherapy treatment.
"For these drugs to work, your cancer must have an abnormal FGFR2 gene, so your cancer will be tested before starting any of these drugs.
"
"These medicines are taken by mouth as tablets, typically once a day."
"
The most common side effects of FGFR2 inhibitors include kidney problems, hair loss, diarrhea, constipation, nail problems, fatigue, taste changes, nausea, vomiting, dry mouth or mouth sores, loss of appetite, dry skin, dry eye or other eye problems, hand-foot syndrome, abdominal (belly) pain, and changes in blood mineral levels."
"
In some people with bile duct cancer, the cancer cells have a change (mutation) in the IDH1 gene, which normally helps cells make the IDH1 protein."
"Mutations in this gene can lead to an abnormal IDH1 protein, which can stop cells from maturing the way they normally would.
"
Ivosidenib (Tibsovo) is an IDH1 inhibitor.
"It blocks the abnormal IDH1 protein, which seems to help the cancer cells mature into more normal cells."
"This drug can be used in people with advanced, previously treated bile duct cancer, if the cancer cells are found to have an IDH1 mutation."
"Your doctor can test your cancer cells to see if they have an IDH1 mutation.
"
"This drug is taken by mouth, once a day."
"
Common side effects can include fatigue, nausea, vomiting, abdominal (belly) pain or swelling, diarrhea, loss of appetite, cough, low red blood cell counts (anemia), rash, and changes in lab tests showing the drug is affecting the liver.
"
"Less common but more serious side effects can include changes in heart rhythm, pneumonia, and jaundice (yellowing of the eyes and skin).
"
"

"
"Although the exact number isn’t known, about 8,000 carcinoid tumors and cancers that start in the gastrointestinal tract (the stomach, intestine, appendix, colon, or rectum) are diagnosed each year in the United States."
"These tumors can also start in the lungs and the pancreas , and a small number develop in other organs.
"
The number of carcinoid tumors diagnosed has been increasing for many years.
The reason for this is unknown.
Some think it may be the result of more medical tests being done to look for something else and finding carcinoid tumors.
"Since many carcinoids never cause any symptoms, there are probably many people with carcinoid tumors that are never diagnosed."
"These tumors might only be seen during an autopsy when a person dies of something else, or when someone has surgery or imaging tests for an unrelated condition.
"
The most common locations of gastrointestinal (GI) carcinoid tumors are the small intestine and the rectum.
"Other common sites include , the colon (large intestine), the appendix, and the stomach.
"
The average age of people diagnosed with GI carcinoid tumors is early 60s .
"Carcinoid tumors are more common in African Americans than in White people, and are slightly more common in women than men .
"
"

Gastrointestinal carcinoid tumors are a type of cancer that forms in the lining of the gastrointestinal (GI) tract."
Cancer starts when cells begin to grow out of control.
"To learn more about what cancer is and how it can grow and spread, see What Is Cancer?
To understand gastrointestinal carcinoid tumors, it helps to know about the gastrointestinal system, as well as the neuroendocrine system."
"
The gastrointestinal (GI) system, also known as the digestive system, processes food for energy and rids the body of solid waste."
"After food is chewed and swallowed, it enters the esophagus."
This tube carries food through the neck and chest to the stomach.
The esophagus joins the stomach just beneath the diaphragm (the breathing muscle under the lungs).
The stomach is a sac that holds food and begins the digestive process by secreting gastric juice.
"The food and gastric juices are mixed into a thick fluid, which then empties into the small intestine.


"
The small intestine keeps breaking down food and absorbs most of the nutrients.
"It is the longest section of the gastrointestinal (GI) tract, measuring more than 20 feet (6 meters)."
The small intestine then joins the colon.
"This is a wider, muscular tube about 5 feet (1.5 meters) long."
The appendix is near the junction of small intestine and colon.
"The colon absorbs water, minerals, and nutrients from food and serves as a storage place for waste."
The waste that is left after this process goes into the rectum.
"
The neuroendocrine system has cells that act like nerve cells in certain ways and like hormone-making endocrine cells in others."
These cells don’t form an actual organ like the adrenal or thyroid glands.
"Instead, they are scattered throughout organs like the esophagus, stomach, pancreas, intestines, appendix, and lungs."
The digestive system has more neuroendocrine cells than any other part of the body.
"This might be why carcinoid tumors most often start there.
"
Neuroendocrine cells help control the release of digestive juices and how fast food moves in the GI tract.
They may also help control the growth of other types of digestive system cells.
"Like most cells in the body, GI tract neuroendocrine cells sometimes go through certain changes that cause them to grow too much and form cancers."
"
Neuroendocrine tumors (NETs) are mostly slow growing, but some are not and can possibly spread to other parts of the body
They are classified by tumor grade which describes how quickly the cancer is likely to grow and spread..
>G
   rade
   1
   (low grade) NETs have cells that look more like normal cells and are not multiplying quickly.
"
">G
   rade
   2
   (intermediate grade) NETs have features in between those of low- and high-grade tumors.
"
">Grade
   3
   (high grade) NETs have cells that look very abnormal and are multiplying faster.
"
Cancers that are grade 1 or grade 2 are called GI neuroendocrine tumors.
"These cancers tend to grow slowly and can possibly spread to other parts of the body.
"
Cancers that are grade 3 are called GI neuroendocrine carcinomas (NECs).
"These cancers tend to grow and spread quickly and can spread to other parts of the body.
"
The term “carcinoid” is often used to describe grade 1 and grade 2 GI NETs.
The term carcinoid will be used here unless referring to NECs specifically.
"
Neuroendocrine (carcinoid) tumors are different from the more common tumors of the GI tract."
"Most GI tract tumors start from the glandular cells that produce mucus and make up the inner lining of the digestive system.
"
Pancreatic neuroendocrine tumors are not the same as carcinoid tumors.
They have a different prognosis (course of disease and outlook) and respond differently to treatment.
"Neuroendocrine tumors of the pancreas are not covered here (see Pancreatic Neuroendocrine Tumors ).
"
"These tumors differ quite a lot in their symptoms, their outlook, and their treatment."
"For these reasons, it is important to know what type of tumor you have."
"Information about other kinds of tumors of the GI tract can be found in Esophagus Cancer , Stomach Cancer , Small Intestine Cancer , and Colorectal Cancer .
"
"

For some people with gastrointestinal (GI) carcinoid tumor, treatment may remove or destroy the cancer."
Completing treatment can be both stressful and exciting.
"You may be relieved to finish treatment, but find it hard not to worry about cancer coming back."
"This is a very common if you have had cancer.
"
"For other people, the cancer may never go away completely."
"These people may stay on drug therapy or get regular treatments with chemotherapy, radiation therapy, or other therapies to try to help keep the cancer in check."
Learning to live with cancer that does not go away can be difficult and very stressful.
"
"
"When treatment ends, your doctors will still want to watch you closely."
It is very important to go to all of your follow-up appointments.
"During these visits, your doctors will ask if you are having any problems and will examine you and may order lab tests or x-rays and scans to look for signs of cancer or treatment side effects."
Almost any cancer treatment can have side effects .
"Some may last for a few weeks to months, but others might last a long time."
Some side effects might not even show up until years after you have finished treatment.
"It’s important for all GI carcinoid tumor survivors, to let their health care team know about any new symptoms or problems, because they could be caused by the cancer coming back or by a new disease or a second cancer.
"
"
Standard recommendations for doctor visits and follow-up tests have not yet been defined for GI carcinoid tumors."
"Initial guidelines suggest that for most people who have had their GI carcinoid tumors completely removed:
>Very small (less than 1cm) and low-grade (grade 1) GI carcinoids may require minimal or no follow-up due to a low risk of the cancer coming back
>GI carcinoids that are bigger (larger than 1 cm), grade 2 or grade 3, or have lymph nodes with cancer may require more frequent imaging tests (a CT scan yearly for 3 years, then every 1 to 2 years for then next 7 years) and doctor visits every 1 to 2 years for 10 years
>Blood and or urine tests (5-HIAA, Chromogranin A) may be helpful for some patients but are not always recommended for routine follow-up.
"
"For some rectal tumors, sigmoidoscopy is recommended 12 months after treatment and possibly annually thereafter."
"Your doctor may follow one of these schedules, but might have reasons to recommend a different schedule as well.
"
"Follow-up visits and imaging tests may be slightly more frequent for those patients whose cancers could not be completely removed with surgery, who have cancer that has spread to other organs like the liver, or have cancers that are growing very quickly."
"
Talk with your doctor about developing a survivorship care plan for you."
"This plan might include:
>A suggested schedule for follow-up exams and tests
>A list of potential late or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
>A schedule for other tests you might need, such as
   early detection (screening) tests
   for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
>Suggestions for things you can do that might improve your health, including possibly lowering your chances of the cancer coming back"
"
Even after treatment, it’s very important to keep health insurance ."
"Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
"
"At some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history."
It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment.
Learn more in Keeping Copies of Important Medical Records .
"
If you have (or have had) a GI carcinoid tumor, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements.
"
"Adopting healthy behaviors such as not smoking , eating well , getting regular physical activity , and staying at a healthy weight is important."
We know that these types of changes can have positive effects on your health that can extend beyond your risk of GI carcinoid tumors or other cancers.
"
If you smoke, quitting is important."
"Although most GI carcinoid tumors do not appear to be linked with smoking, more studies are needed."
"Of course, quitting smoking can have other health benefits such as improved healing, lowering your risk of some other cancers, as well as improving your outcome (prognosis) from the cancer."
"If you need help quitting, talk to your doctor or call the American Cancer Society at 1-800-227-2345."
"
So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of GI carcinoid tumors progressing or coming back."
"This doesn’t mean that no supplements will help, but it’s important to know that none have been proven to do so.
"
"Dietary supplements are not regulated like medicines in the United States – they do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do."
"If you’re thinking about taking any type of nutritional supplement, talk to your health care team."
They can help you decide which ones you can use safely while avoiding those that might be harmful.
"
"
"If cancer does come back at some point, your treatment options will depend on where the cancer is, what treatments you’ve had before, and your health.
"
"For more information on how recurrent cancer is treated, see Treatment of Gastrointestinal Carcinoid Tumor, by Extent of Disease .
"
"For more general information on recurrence, you may also want to see Understanding Recurrence ."
"
People who’ve had a GI carcinoid tumor can still get other cancers."
Learn more in Second Cancers After Gastrointestinal Carcinoid Tumor .
"
Some amount of feeling depressed, anxious, or worried is normal when GI carcinoid is a part of your life."
Some people are affected more than others.
"But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups, professional counselors, or others."
"Learn more in Life After Cancer .
"
"

Cancer survivors can be affected by a number of health problems, but often their greatest concern is facing another cancer."
"Sometimes people with a gastrointestinal (GI) carcinoid tumor develop a new, unrelated cancer later."
This is called a second cancer .
"No matter what type of cancer you have or had, it's still possible to get another (new) cancer."
"
Unfortunately, being treated for one cancer doesn’t mean you can’t get another."
People who have had cancer can still get the same types of cancers that other people get.
"In fact, certain types of cancer and cancer treatments can be linked to a higher risk of certain second cancers.
"
"People who have or had a GI carcinoid tumor can get any type of second cancer, but they have a higher risk than the general population of developing:
>Prostate cancer
>Melanoma
>Female breast cancer
>Colon and rectal cancer
>Lung cancer
>Bladder cancer"
"
Many people with a GI carcinoid tumor are treated with medicines that keep the disease in check without curing the disease, so they need to see their doctors regularly."
Let your doctor know if you have any new symptoms or problems.
"They could be from the carcinoid tumor getting worse or from a new disease or cancer.
"
All people with a GI carcinoid tumor should not use any type of tobacco and should avoid tobacco smoke.
"Tobacco is linked to an increased risk of many cancers and might further increase the risk of some of the second cancers seen in patients with GI carcinoid tumors.
"
"To help maintain good health , survivors should also:
>Get to and stay at a healthy weight
>Keep physically active and limit the time you spend sitting or lying down
>Follow a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and limits or avoids red and processed meats, sugary drinks, and highly processed foods
>Not drink
   alcohol
   ."
"If you do drink, have no more than 1 drink per day for women or 2 per day for men
These steps may also lower the risk of some cancers.
"
"See Second Cancers in Adults for more information about causes of second cancers.
"
"

At this time, there is no known way to prevent gastrointestinal carcinoid tumors."
"Since smoking might increase the risk of carcinoid tumors of the small intestine, not starting or quitting smoking may reduce the risk for this disease."
"More studies are needed to know for sure.
"
"

A risk factor is anything that increases your chance of getting a disease such as cancer."
Different cancers have different risk factors.
"Some risk factors, like smoking, can be changed."
"Others, like a person’s age or family history, can’t be changed.
"
"In some cases, there might be a factor that may decrease your risk of developing cancer."
"That is not considered a risk factor, but you may see them noted clearly on this page as well.
"
"But having a risk factor, or even many, does not mean that you will get cancer."
And some people who get cancer may not have any known risk factors.
Here are some of the risk factors known to increase your risk for GI carcinoid tumors.
"
"
This is a rare condition caused by inherited defects in the MEN1 gene.
"People with this syndrome have a very high risk of getting tumors of the pituitary, parathyroid, and pancreas."
They also have an increased risk of carcinoid tumors.
Some studies estimate that inherited mutations of the MEN1 gene are responsible for about 5% to 10% of carcinoid tumors.
Most of these are gastric (stomach) carcinoids.
"Children have a 50/50 chance of inheriting this syndrome from a parent.
"
"If you have family members with the MEN1 syndrome, you might want to talk to your doctor about the pros and cons of getting tested for it."
"Although the gene that causes tumors in people with the MEN1 syndrome has been found, the results of genetic testing are not always clear cut so it is important that the test is done along with genetic counseling to help you make sense of the results."
"
"
This disease often runs in families and is characterized by many neurofibromas (benign tumors that form in nerves under the skin and in other parts of the body).
It is caused by defects in the NF1 gene.
Some people with this condition also develop carcinoid tumors of the small intestines.
"
Carcinoid tumors are also more common among people with tuberous sclerosis complex, von Hippel Lindau disease and familial small intestinal neuroendocrine tumor.
"
">Tuberous sclerosis complex can be caused by a defect in the
    TSC1
    or
    TSC2
    gene."
"People with this condition can also develop tumors of the heart, eyes, brain, lungs, and skin.
"
">People with von Hippel Lindau disease have an inherited tendency to develop blood vessel tumors of the brain, spinal cord, or retina, as well as kidney cancer."
"It is caused by changes in the
    VHL
    gene.
"
">A newly discovered condition called familial small intestinal neuroendocrine tumor has been found which is caused by a change in the
    IPMK
    gene."
"People with this gene defect have a higher risk of developing carcinoid tumors in the small intestine (bowel).
"
"To find out more on being tested for genetic syndromes, see Genetic Testing: What You Need to Know ."
"
Carcinoid tumors are more common among African Americans than whites."
Outcomes are also not as good for African Americans.
Researchers do not yet know why.
Carcinoid tumors are also slightly more common in women than men.
"
People with certain diseases that damage the stomach and reduce the amount of acid it makes (such as atrophic gastritis or Zollinger-Ellison syndrome) have a greater risk of developing stomach carcinoid tumors, but their risk for carcinoid tumors of other organs is not affected."
"
Having a family history of any cancer, specifically in a first-degree relative (sibling, parent, or child), or a family history of a neuroendocrine tumor or carcinoid tumor seems to raise the risk of developing a carcinoid tumor."
"
It is not clear if smoking increases the risk of getting a carcinoid tumor."
"Further studies are needed.
"
"

Cancers can be caused by DNA mutations (changes) that turn on oncogenes or turn off tumor suppressor genes."
This leads to cells growing out of control.
"Changes in many different genes are usually needed to cause carcinoid tumors.
"
"For more about how genes changes can lead to cancer, see Genes and Cancer ."
"
Some DNA mutations can be passed on in families and are found in a person's cells."
These are inherited (or familial ) mutations.
"A small portion of carcinoid tumors are caused by inherited gene mutations.
"
"Changes in 4 tumor suppressor genes are responsible for many inherited cases of carcinoid tumors.
>MEN1
    (multiple neuroendocrine neoplasia 1)."
Changes in this gene account for most inherited cases.
"A smaller number are caused by inherited changes in the following genes:
>NF1
    (Neurofibromatosis type 1) gene
>VHL
    (Von Hippel–Lindau) gene
>TSC1 or TSC2
    (tuberous sclerosis complex 1 or 2) genes
Most carcinoid tumors are caused by sporadic changes (mutations) in oncogenes or tumor suppressor genes."
"Mutations are called sporadic if they occur after a person is born, rather than having been inherited.
"
"

Because carcinoid tumors usually start out very small and grow and spread slowly, about half of all gastrointestinal carcinoid tumors are found in an early or localized stage, often before they cause any problems.
"
Carcinoid tumors often are found by accident.
These tumors aren’t causing any symptoms but are found when tests are done for other reasons or diseases.
They may also be found when parts of the gastrointestinal system are removed to treat other diseases.
"When patients have parts of their stomach or small intestine removed to treat other diseases, taking a close look in the microscope often shows small groups of neuroendocrine cells that look like tiny carcinoid tumors."
"Researchers still do not know why some tumors stay small, but others grow large enough to cause symptoms.
"
"For example, a person with stomach pain or bleeding may have a test called an upper endoscopy to look for an ulcer."
"In this test, the doctor looks at the stomach lining through a flexible lighted tube."
"During this test, the doctor might notice a small bump in the stomach wall that turns out to be a carcinoid tumor.
"
"Sometimes during colorectal cancer screening, a routine sigmoidoscopy, or colonoscopy (looking at the large bowel through a flexible lighted tube) will incidentally find a small carcinoid tumor.
"
"Sometimes when the appendix is removed (to treat appendicitis or as part of a larger operation), a small carcinoid tumor is found at the tip."
This happens in about 1 of every 300 people who have appendix surgery.
"Most of these carcinoids were too small to have caused any symptoms.
"
"

Certain signs and symptoms might suggest that a person could have a gastrointestinal (GI) carcinoid tumor, but tests are needed to confirm the diagnosis."
"
You will be asked questions about your general health, lifestyle habits, symptoms, and risk factors."
"The doctor also will probably ask about symptoms that could be caused by carcinoid syndrome, as well as those that might be caused by a mass (tumor) in the stomach, intestines, or rectum.
"
"Some patients with carcinoid tumors also have cancers or benign tumors of other organs, so doctors may ask about symptoms that might suggest other tumors are present."
A thorough physical exam will provide information about signs of carcinoid tumors and other health problems.
"The doctor may pay special attention to the abdomen, looking for a tumor mass or enlarged liver.
"
"If your medical history and physical exam give the doctor reason to suspect you might have a GI carcinoid, some tests will be ordered to find out if the disease is present."
"These might include imaging tests, lab tests, and other procedures."
"
These tests use a barium-containing solution that coats the lining of the esophagus, stomach, and intestines."
The coating of barium helps show abnormalities of the lining of these organs.
Barium studies can be used to examine the upper or lower parts of the digestive system. 
"This type of study is often useful in diagnosing some GI carcinoid tumors, but is least effective in finding those in the small intestine.
"
Barium swallow: This test is used to examine the lining of the esophagus.
"The patient drinks a barium solution that coats the lining of the esophagus, then x-ray pictures are taken.
"
"Upper GI series with small bowel follow-through: This test is used to examine the lining of the stomach and the first part of the small intestine.
"
Enteroclysis:
This is another way to look at the small intestine.
A thin tube is passed through the mouth or nose down through the stomach to the start of the small intestine.
"Barium contrast is sent through the tube, along with a substance that creates more air in the intestines, causing them to expand."
X-rays of the intestines are then taken.
"This test may be quicker and give clearer images of the small intestine than a small bowel follow-through, but the use of a tube to give the barium makes it more uncomfortable.
"
"Barium enema: This test is used to look at the inner surface of the colon and rectum.
"
Barium x-rays are used less these days than in the past.
"In many cases, they are being replaced by endoscopy , where the doctor looks into the esophagus, stomach, or colon with a narrow fiber optic scope."
"
A CT scan is most often used to look at the chest and/or belly (abdomen) to see if GI neuroendocrine (carcinoid) tumors have spread to nearby lymph nodes or other organs such as the liver."
It can also be used to guide a biopsy needle into an area of concern..
"
MRI scans sometimes can see cancer spread to the liver better than a CT scan.
"
Sometimes MRI is used to look at blood vessels in the liver.
This requires IV contrast and is known as MR angiography (MRA).
"
Scans using small amounts of radioactivity and special cameras can be helpful in looking for GI carcinoid tumors."
"They can help find tumors or look for areas of cancer spread if doctors aren’t sure where it is in the body.
"
"Positron emission tomography (PET) scan: For most types of cancer, PET scans use a form of radioactive glucose (sugar) to find tumors."
"This type of PET scan is useful in finding high-grade (grade 3) carcinoid tumors, but a newer type of PET scan, called a Gallium-68 PET/CT Dotatate scan is being used for low (grade 1) or intermediate-grade (grade 2) GI carcinoid tumors."
"It uses the radioactive agent gallium-68 dotatate which attaches to the somatostatin protein on carcinoid cells.
"
A special camera can detect the radioactivity.
"The gallium-68 PET/CT scan is slowly becoming more widely available since it was approved by the FDA in 2016 and is able to find carcinoid tumors better than an Octreoscan (described below).
"
"Another radioactive agent, copper Cu-64 dotatate, also attaches to the somatostatin protein, and was approved in 2020 for use with a PET scan in people with a GI carcinoid tumor.
"
Octreoscan (somatostatin receptor scintigraphy):
This test uses a drug called octreotide joined to a radioactive drug .
Octreotide is a hormone-like substance that attaches to GI carcinoid cells .
A small amount is injected into a vein and it travels through the blood where it attaches to GI carcinoid tumors.
"A few hours after the injection, a special camera can be used to show where the radioactivity has collected in the body."
More scans may be done over the next few days as well.
"Along with showing where tumors are located, this test can help tell whether treatment with certain drugs such as octreotide and lanreotide is likely to be helpful."
"This test is most helpful for grade 1 and 2 GI carcinoid tumors.
"
I-131 MIBG scan:
This is test is used much less often to find GI carcinoid tumors.
It uses a chemical called MIBG that is attached to radioactive iodine (I-131).
"This substance is injected into a vein, and the body is scanned several hours or days later with a special camera to look for areas that picked up the radioactivity."
"These would most likely be GI carcinoid tumors, but other kinds of neuroendocrine tumors can also pick up this chemical."
"
Endoscopy tests use a flexible lighted tube (endoscope) with a video camera on the end."
"The camera is connected to a monitor, which lets the doctor see any abnormal areas in the lining of the digestive organs clearly."
"If needed, small pieces of the abnormal areas can be removed (biopsied) through the endoscope."
The biopsy samples can be looked at in the lab to find out if cancer is present and what kind of cancer it is.
"
This test is also known as esophagogastroduodenoscopy or EGD."
"An endoscope is passed down through the mouth to look at the esophagus, stomach, and first part of the small bowel.
"
"An upper endoscopy may be done in a hospital outpatient department, clinic, or doctor’s office."
"It usually takes 15 to 30 minutes, and most patients are given medicine in a vein to make them feel relaxed and sleepy."
"If you are sedated for the procedure, you will need someone to take you home."
"
A colonoscopy is also called lower endoscopy."
It uses a special endoscope known as a colonoscope which is inserted through the anus into the colon.
The doctor will be able to see the lining of the entire rectum and colon.
"For a clear view though, the colon must be completely cleaned out before the test."
"There are different ways to do this, but the most common is drinking a large amount of a laxative solution the night before and the morning of the exam.
"
You will be given intravenous medicine to make you feel relaxed and sleepy during the procedure.
"Colonoscopy can be done in a hospital outpatient department, clinic, or doctor's office."
"It usually takes 15 to 30 minutes, although it may take longer if a tumor is seen and/or a biopsy is taken."
"Because you will be sedated for the procedure, you will need someone you know to take you home afterward."
"
Flexible sigmoidoscopy is similar to a colonoscopy and can be used to look for a rectal tumor and some tumors in the lower part of the colon."
"This test uses a shorter, flexible, hollow tube, with a light on the end of it that is also inserted through the anus up into the colon."
"
Unfortunately, neither an upper nor lower endoscopy can reach all areas of the small intestine, where many NETs begin."
"A device known as a capsule endoscopy may help in some cases.
"
This test doesn’t really use an endoscope.
"Instead, the patient swallows a capsule (about the size of a large vitamin pill) that contains a light source and a tiny camera."
"Like any other pill, the capsule goes through the stomach and into the small intestine."
"As it travels (usually over about 8 hours), it takes thousands of pictures."
"These images are transmitted electronically to a device worn around the person’s waist, while they go on with normal daily activities."
"The pictures can then be downloaded onto a computer, where the doctor can watch them as a video."
The capsule passes out of the body during a normal bowel movement and is discarded.
"
"
This is another way to look at the small intestine.
The small intestine is very long (20 feet [6 meters]) and has too many curves to be examined well with regular endoscopy.
"This method gets around these problems by using a special endoscope that is made up of 2 tubes, one inside the other."
"First the inner tube, which is an endoscope, goes forward about a foot, and then a balloon at its end is inflated to anchor it."
Then the outer tube goes forward to near the end of the inner tube and it is then anchored in place with a balloon.
"This process is repeated over and over, letting the doctor see the intestine a foot (30 centimeters) at a time.
"
This procedure is done after the patient is given drugs to make them sleepy and may be even done under general anesthesia (where the patient is asleep).
The main advantage of this test over capsule endoscopy is that the doctor can take a biopsy if something abnormal is seen.
"As with other tests that are done under sedation, you will need someone to take you home after this procedure."
"
This test uses an endoscope with a small ultrasound probe on the end."
This probe releases sound waves and then uses the echoes that bounce back to create images of the digestive tract wall (or nearby lymph nodes).
Putting the ultrasound probe on the end of an endoscope lets it get very close to a tumor.
"Because the probe is close to the area being looked at, it can make very detailed pictures.
"
"EUS can be used to see how deeply a tumor has grown into the wall of the esophagus, stomach, intestine, or rectum."
"It can also help see if certain lymph nodes are enlarged and help a doctor guide a needle into a lymph node, tumor, or other suspicious area to do a biopsy."
"You will be sedated for this test, so you will need someone to take you home."
"
In many cases, the only way to know for sure if a person has some type of GI carcinoid tumor is to remove cells from the tumor and look at them in the lab."
"This procedure is called a biopsy .
"
There are several ways to take a sample from a GI tumor.
One way is through the endoscope.
"When a tumor is found, the doctor can use biopsy forceps (tweezers or tongs) through the tube to take a small sample of it."
"Another way to sample a tumor is with a CT-guided needle biopsy .
"
Bleeding after a biopsy of a GI carcinoid is a rare but potentially serious problem.
"If serious bleeding occurs, doctors can sometimes inject drugs into the tumor to constrict blood vessels and slow or stop bleeding.
"
"In rare cases, an endoscopic biopsy or a CT-guided needle biopsy will not be able to get enough tissue to identify the type of tumor."
This is sometimes the case with tumors in the small intestine.
"In such cases, surgery may be needed to remove a tissue sample.
"
You can read more about biopsies and how they are tested in Biopsy and Cytology Tests .
"
Blood and urine tests can be very helpful in diagnosing carcinoid syndrome in patients who have symptoms that might be caused by it.
"
"Many GI carcinoid tumors, especially those in the small intestine, make serotonin (also called 5-HT)."
It is probably the cause of at least some of the symptoms of carcinoid syndrome.
"The body breaks it down into 5-hydroxyindoleactic acid (5-HIAA), which is released into the urine."
A common test to look for carcinoid syndrome measures the levels of 5-HIAA in a urine sample collected over 24 hours.
These tests can help diagnose many (but not all) carcinoid tumors.
"Sometimes, the tumors are small and don’t release enough serotonin for a positive test result.
"
"Some foods, including bananas, plantains, kiwi fruit, certain nuts, avocado, tomatoes, and eggplant, contain a lot of serotonin and can raise 5-HIAA levels in the urine."
"Medicines, including cough syrup and acetaminophen (Tylenol), can also affect the results."
"Ask your doctor what you should avoid before having urine or blood tests for carcinoid syndrome.
"
Other common tests to look for carcinoids include blood tests for chromogranin A (CgA) and gastrin.
"Medicines that lower stomach acid called proton-pump inhibitors (such as omeprazole/Prilosec, lansoprazole/Prevacid, esomeprazole/Nexium, and many others) can make CgA and gastrin levels high even when carcinoid tumors aren’t present."
"If you take any of these medicines, talk to your doctor about what you need to avoid before having these blood tests."
"Depending on the tumor’s location and your symptoms, your doctor might do other blood tests as well.
"
"Some of these tests can also be used to show how well treatment is working, since the levels of these substances tend to go down as tumors shrink.
"
"

Most gastrointestinal (GI) carcinoids grow slowly."
"If they do cause symptoms, they tend to be vague."
"When trying to figure out what’s going on, doctors and patients are likely to explore other, more common possible causes first."
"This can delay a diagnosis, sometimes even for several years."
"But some do cause symptoms that lead to their diagnosis .

"
"
The symptoms a person can have from a GI carcinoid tumor often depend on where it is growing."
"
People with tumors in their appendix often don’t have symptoms."
"If the tumor is discovered, it is usually when the appendix is removed for some other problem."
"Sometimes, the tumor blocks the opening between the appendix and the rest of the intestine and causes appendicitis."
"This leads to symptoms like fever, nausea, vomiting, and abdominal (belly) pain."
"
If the tumor starts in the small intestine, it can cause the intestines to kink and be blocked for a while."
"This can cause cramps, belly pain, weight loss, fatigue, bloating, diarrhea, or nausea and vomiting, which might come and go."
These symptoms can sometimes go on for years before the carcinoid tumor is found.
"A tumor usually has to grow fairly large before it completely blocks (obstructs) the intestine and causes severe belly pain, nausea and vomiting, and a potentially life-threatening situation.
"
"Sometimes a carcinoid tumor can block the opening of the ampulla of Vater , which is where the common bile duct (from the liver) and the pancreatic duct (from the pancreas) empty into the intestine."
"When this is blocked, bile can back up, leading to yellowing of the skin and eyes (jaundice)."
"Pancreatic juices can also back up, leading to an inflamed pancreas (pancreatitis), which can cause belly pain, nausea, and vomiting.
"
A carcinoid tumor sometimes can cause intestinal bleeding.
This can lead to anemia (too few red blood cells) with fatigue and shortness of breath.
"
Rectal carcinoid tumors are often found during routine exams, even though they can cause pain and bleeding from the rectum and constipation."
"
Carcinoid tumors that develop in the stomach usually grow slowly and often do not cause symptoms."
They are sometimes found when the stomach is examined by an endoscopy looking for other things.
Some can cause symptoms such as the carcinoid syndrome.
"
Some carcinoid tumors can release hormones into the bloodstream."
This can cause different symptoms depending on which hormones are released.
"
About 1 out of 10 carcinoid tumors release enough hormone-like substances into the bloodstream to cause carcinoid syndrome symptoms."
"These include:
>Facial flushing (redness and warm feeling)
>Severe diarrhea
>Wheezing
>Fast heartbeat
Many people find that factors such as stress, heavy exercise, and drinking alcohol trigger these symptoms."
"Over a long time, these hormone-like substances can damage heart valves, causing shortness of breath, weakness, and a heart murmur (an abnormal heart sound).
"
Not all GI carcinoid tumors cause the carcinoid syndrome.
"For example, those in the rectum usually do not make the hormone-like substances that cause these symptoms.
"
Most cases of carcinoid syndrome occur only after the cancer has already spread to other parts of the body.
"Carcinoid tumors in the midgut (appendix, small intestine, cecum and ascending colon) that spread to the liver are most likely to cause carcinoid syndrome."
"
Some carcinoid tumors produce ACTH (adrenocorticotropic hormone), a substance that causes the adrenal glands to make too much cortisol (a steroid)."
"This can cause Cushing syndrome, with symptoms of:
>Weight gain
>Muscle weakness
>High blood sugar (even diabetes)
>High blood pressure
>Increased body and facial hair
>A bulge of fat on the back of the neck
>Skin changes like stretch marks (called striae)"
"
Carcinoid tumors can make a hormone called gastrin that signals the stomach to make acid."
"Too much gastrin can cause Zollinger-Ellison syndrome, in which the stomach makes too much acid."
"High acid levels can lead to irritation of the lining of the stomach and even stomach ulcers, which can cause pain, nausea, and loss of appetite.
"
Severe ulcers can start bleeding.
"If the bleeding is mild, it can lead to anemia (too few red blood cells), causing symptoms like feeling tired and being short of breath."
"If the bleeding is more severe, it can make stools black and tarry."
"Severe bleeding can be life threatening.
"
"If the stomach acid reaches the small intestine, it can damage the intestinal lining and break down digestive enzymes before they have a chance to digest food."
"This can cause diarrhea and weight loss.
"
"

After someone is diagnosed with a gastrointestinal (GI) carcinoid tumor, doctors will try to figure out if it has spread, and if so, how far."
This process is called staging .
The stage of cancer describes how much cancer is in the body.
It helps determine how serious the cancer is and how best to treat it.
Doctors also use a cancer's stage when talking about survival statistics.
"
GI carcinoid tumors are typically given a clinical stage based on the results of any exams, biopsies, and imaging tests that might have been done (as described in Tests for Gastrointestinal Carcinoid Tumors."
"If surgery has been done, the pathologic stage (also called the surgical stage ) can also be determined.
"
GI carcinoid tumors typically start in the inner lining of the wall of the GI tract.
"As they grow, they can spread into deeper layers of the GI tract."
"For most of the GI tract, these layers include:
>Mucosa:
    "
This is the innermost layer.
"It has 3 parts: the top layer of cells (the epithelium), a thin layer of connective tissue (the lamina propria), and a thin layer of muscle (the muscularis mucosa).
"
">Submucosa:
    "
"This is the fibrous tissue that lies beneath the mucosa.
"
">Thick muscle layer (muscularis propria):
    This layer of muscle contracts to force the food along the GI tract.
"
">Subserosa and serosa:
    "
These are the thin outermost layers of connective tissue that cover the GI tract.
"The serosa is also known as the visceral peritoneum.


"
"
Until recently there was no standard staging system for describing the spread of GI carcinoid tumors."
"Many doctors simply staged GI carcinoid tumors as localized, regional spread, and distant spread."
"This approach was fairly easy to understand and could be useful when determining treatment options.
>Localized:
   The cancer has not spread beyond the wall of the organ it started in (for example, the stomach, small intestine, or rectum).
"
">Regional spread:
   "
"The cancer has either spread to nearby lymph nodes, or it has grown through the wall of the organ where it started and into nearby tissues such as fat, ligaments, and muscle (or both).
"
">Distant spread:
   "
"The cancer has spread to tissues or organs that are not near where the cancer started (such as the liver, bones, or lungs)."
"
The staging system most often used for GI carcinoid tumors is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:
>The size and extent of the main
   tumor (T):
   Where is the tumor?"
"How far has it grown into the wall of the GI tract and nearby structures?
>"
"The spread to nearby lymph
   nodes (N):
   Has the cancer spread to nearby lymph nodes?
>The spread (
   metastasis
   ) to distant sites
   (M):
   "
Has the cancer spread to distant parts of the body?
"(The most common sites of spread are lymph nodes far away from the tumor, the liver, the lungs, and the bones.)
"
"Numbers or letters after T, N, and M provide more details about each of these factors."
"Higher numbers mean the cancer is more advanced.
"
"Once the T, N, and M categories of the cancer have been determined, this information is combined in a process called stage grouping to assign an overall stage."
"For more information, see Cancer Staging .
"
The main stages of GI carcinoid tumors in the TNM system range from I (1) through IV (4).
"Some stages might be divided further with letters (A, B, etc.)."
"As a rule, the lower the number, the less the cancer has spread."
"A higher number, such as stage IV, means cancer has spread more."
"And within a stage, an earlier letter means a lower stage."
"Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.
"
"The system described below is the most recent AJCC system, effective January 2018."
"It includes lower-grade carcinoid tumors that start in the GI tract, but not other types of cancers that can start there."
"(For example, it doesn't include high-grade neuroendocrine carcinomas, or the more common types of stomach cancer or colorectal cancer , which have their own staging systems.)
"
"The stages of GI carcinoid tumors are slightly different, based on which part of the GI tract the cancer starts in:
>The
   stomach
>The
   small intestine (jejunum or ileum)*
>The
   appendix
>The
   colon or rectum
*Carcinoid tumors starting in the duodenum or ampulla of Vater are uncommon and have their own staging system, which is not included here.
"
GI carcinoid tumor staging with the TNM system can be complex.
"If you have any questions about your cancer's stage or what it means, ask your doctor to explain it to you in a way you understand."
"
AJCC stage
Stage grouping
Stage description*
I
T1 N0 M0
The tumor is no more than 1 centimeter (cm) across and has grown from the top layer of cells and into deeper layers, such as the lamina propria or the submucosa (T1).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).


"
"II
T2 N0 M0
The tumor has grown into the lamina propria or submucosa (or both) and is greater than 1 cm across; OR the tumor has grown into the main muscle layer of the stomach (the muscularis propria) (T2).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"OR
T3 N0 M0
The tumor has grown through the muscularis propria and into the subserosa (T3).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).


"
"III
T4"
"N0 M0
The tumor has grown into the outer layer of tissue covering the stomach (the serosa or visceral peritoneum) or into nearby organs or structures (T4).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"OR
"
"Any T N1 M0
The tumor can be any size and might or might not have grown into nearby structures (any T).
"
"It has spread to nearby lymph nodes (N1), but not to distant parts of the body (M0).
"
"IV
Any T Any N M1
"
"The tumor can be any size and might or might not have grown into nearby structures (any T).
"
"It might or might not have spread to nearby lymph nodes (any N).
"
"The cancer has spread to distant parts of the body (M1).
"
"*The following additional categories are not listed in the table above:
>TX:"
"Main tumor cannot be assessed due to lack of information.
"
>T0:
"No evidence of a main tumor.
"
>NX: Nearby lymph nodes cannot be assessed due to lack of information.
"
AJCC stage
Stage grouping
Stage description*
I
T1 N0 M0
The tumor is no more than 1 centimeter (cm) across and has grown from the top layer of cells and into deeper layers, such as the lamina propria or the submucosa (T1).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).


"
"II
T2 N0 M0
The tumor has grown into the lamina propria or submucosa (or both) and is greater than 1 cm across; OR the tumor has grown into the main muscle layer of the intestine (the muscularis propria) (T2).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"OR
T3 N0 M0
The tumor has grown through the muscularis propria and into the subserosa (T3).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).


"
"III
T4"
"N0 M0
The tumor has grown into the outer layer of tissue covering the intestine (the serosa or visceral peritoneum) or into nearby organs or structures (T4).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"OR
"
"Any T N1 or N2 M0
"
"The tumor can be any size and might or might not have grown into nearby structures (any T).
"
"It has spread to nearby lymph nodes (N1 or N2), but not to distant parts of the body (M0).
"
"IV
Any T Any N M1
"
"The tumor can be any size and might or might not have grown into nearby structures (any T).
"
It might or might not have spread to nearby lymph nodes (any N).
"The cancer has spread to distant parts of the body (M1).
"
"*The following additional categories are not listed in the table above:
>TX:"
"Main tumor cannot be assessed due to lack of information.
"
>T0:
"No evidence of a main tumor.
"
>NX: Nearby lymph nodes cannot be assessed due to lack of information.
"
AJCC stage
Stage grouping
Stage description*
I
T1 N0 M0
The tumor is no more than 2 centimeters (cm) across (T1).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).


"
"II
T2 N0 M0
The tumor is more than 2 cm but no more than 4 cm across (T2).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"OR
T3 N0 M0
The tumor is more than 4 cm across, OR it has grown into the subserosa or the mesoappendix (T3).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).


"
"III
T4"
"N0 M0
The tumor has grown into the outer layer of tissue covering the appendix (the peritoneum) or into nearby organs or structures (T4).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"OR
"
"Any T N1 M0
The tumor can be any size and might or might not have grown into nearby structures (any T).
"
"It has spread to nearby lymph nodes (N1), but not to distant parts of the body (M0).
"
"IV
Any T Any N M1
"
"The tumor can be any size and might or might not have grown into nearby structures (any T).
"
It might or might not have spread to nearby lymph nodes (any N).
"The cancer has spread to distant parts of the body (M1).
"
"*The following additional categories are not listed in the table above:
>TX:"
"Main tumor cannot be assessed due to lack of information.
"
>T0:
"No evidence of a main tumor.
"
>NX: Nearby lymph nodes cannot be assessed due to lack of information.
"
AJCC stage
Stage grouping
Stage description*
I
T1 N0 M0
The tumor is no more than 2 centimeters (cm) across and has grown from the top layer of cells and into deeper layers, such as the lamina propria or the submucosa (T1).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"IIA
T2 N0 M0
The tumor has grown into the lamina propria or submucosa (or both) and is greater than 2 cm across; OR the tumor has grown into the main muscle layer (the muscularis propria) (T2).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"IIB
T3 N0 M0
The tumor has grown through the muscularis propria and into the subserosa (T3).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"IIIA
T4"
"N0 M0
The tumor has grown into the outer layer of tissue covering the intestine (the serosa or visceral peritoneum) or into nearby organs or structures (T4).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"IIIB
"
"Any T N1 M0
The tumor can be any size and might or might not have grown into nearby structures (any T).
"
"It has spread to nearby lymph nodes (N1), but not to distant parts of the body (M0).
"
"IV
Any T Any N M1
"
"The tumor can be any size and might or might not have grown into nearby structures (any T).
"
It might or might not have spread to nearby lymph nodes (any N).
"The cancer has spread to distant parts of the body (M1).
"
"*The following additional categories are not listed in the table above:
>TX:"
"Main tumor cannot be assessed due to lack of information.
"
>T0:
"No evidence of a main tumor.
"
">NX: Nearby lymph nodes cannot be assessed due to lack of information.





"
"

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed."
"They can’t tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
"
"Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they can’t predict what will happen in any particular person’s case."
These statistics can be confusing and may lead you to have more questions.
Ask y our doctor how these numbers might apply to you .
"
A relative survival rate compares people with the same type and stage of gastrointestinal (GI) carcinoid tumor to people in the overall population."
"For example, if the 5-year relative survival rate for a specific stage of GI carcinoid tumor is 90%, it means that people who have that cancer are, on average, about 90% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed."
"
The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results (SEER) database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer.
"
"The SEER database tracks 5-year relative survival rates for GI carcinoid tumors in the United States, based on how far the cancer has spread."
"The SEER database, however, does not group cancers by AJCC TNM stages (stage 1, stage 2, stage 3, etc.)."
"Instead, it groups cancers into localized, regional, and distant stages:
>Localized:
   The cancer has not spread beyond the wall of the organ it started in (for example, the stomach, small intestine, or rectum).
"
">Regional:
   "
"The cancer has either spread to nearby lymph nodes, or it has grown through the wall of the organ where it started and into nearby tissues such as fat, ligaments, and muscle (or both).
"
">Distant:
   "
"The cancer has spread to distant parts of the body such as the lungs, liver or bones.
"
"
(These numbers are based on people diagnosed with grade 1 or 2 GI carcinoid tumors [stomach, small intestine, colon, appendix, cecum and rectum] between 2012 and 2018.)
"
"*SEER= Surveillance, Epidemiology, and End Results"
"
>These numbers apply only to the stage of the cancer when it is first diagnosed.
   "
"They do not apply later on if the cancer grows, spreads, or comes back after treatment.
"
">These numbers don’t take everything into account.
   "
"Survival rates are grouped based on how far the cancer has spread, but your age,
   organ the tumor started in
   , overall health, how well the cancer responds to treatment, and other factors can also affect your outlook.
"
">People now being diagnosed with a GI carcinoid tumor may have a better outlook than these numbers show.
   "
"Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least five years earlier.
"
"

It is important to have honest, open discussions with your cancer care team."
"They want to answer all of your questions, so that you can make informed treatment and life decisions."
"For instance, consider these questions:"
"
>Where is the cancer located?
>Has the cancer spread beyond where it started?
"
">What is the cancer’s
    stage
    (extent), and what does that mean?
"
">Will I need other
    tests
    before we can decide on treatment?
>Will I need to see any other doctors or health professionals?
>"
"If I’m concerned about the costs and insurance coverage for my diagnosis and treatment, who can help me?"
"
>What are my
    treatment options
    ?
>"
"What do you recommend and why?
"
">How much experience do you have treating this type of cancer?
"
">Should I get a
    second opinion
    ?"
How do I do that?
"Can you recommend someone?
>"
"What would the goal of the treatment be?
>How quickly do we need to decide on treatment?
"
">What should I do to be ready for treatment?
>How long will treatment last?"
What will it be like?
"Where will it be done?
>What risks or side effects are there to the treatments you suggest?"
"Are there things I can do to reduce these side effects?
>How might treatment affect my daily activities?"
"Can I still work full time?
>"
"What are the chances the cancer will recur (come back) with these treatment plans?
>What will we do if the treatment doesn’t work or if the cancer recurs?
"
>What if I have transportation problems getting to and from treatment?
"
Once treatment begins, you’ll need to know what to expect and what to look for."
"Not all of these questions may apply to you, but asking the ones that do may be helpful.
"
">How will we know if the treatment is working?
>Is there anything I can do to help manage
    side effects
    ?
>"
"What symptoms or side effects should I tell you about right away?
>How can I reach you on nights, holidays, or weekends?
"
">Do I need to change what I eat during treatment?
>Are there any limits on what I can do?
>"
Can I exercise during treatment?
"If so, what kind should I do, and how often?
"
>
"Can you suggest a mental health professional I can see if I start to feel overwhelmed, depressed, or distressed?
>"
What if I need social support during treatment because my family lives far away?
"
>Do I need a special diet after treatment?
>Are there any limits on what I can do?
>"
"What other symptoms should I watch for?
>What kind of exercise should I do now?
"
">What type of follow-up will I need after treatment?
>How often will I need to have follow-up exams and imaging tests?
"
">Will I need any blood tests?
"
">How will we know if the cancer has
    come back
    ?"
"What should I watch for?
"
"What will my options be if the cancer comes back?
"
"Along with these sample questions, you might write down some of your own."
"For instance, you might want more information about recovery times."
"Or you might want to ask if you qualify for any clinical trials .
"
Keep in mind that doctors aren’t the only ones who can give you information.
"Other health care professionals, such as nurses and social workers, can answer some of your questions."
"To find out more about speaking with your health care team, see The Doctor-Patient Relationship .
"
"
"
"
Gastrointestinal carcinoid tumors are a type of cancer in the lining of the digestive tract (the gut)."
Cancer starts when cells begin to grow out of control.
Cells in nearly any part of the body can become cancer.
"To learn more about what cancer is and how it can grow and spread, see What Is Cancer?
To understand gastrointestinal carcinoid tumors, it helps to know about the digestive system, as well as the neuroendocrine system."
"
The gastrointestinal (GI) system, also known as the digestive system, turns food into energy and rids the body of solid waste."
"After food is chewed and swallowed, it enters the esophagus."
This tube carries food through the neck and chest to the stomach.
The esophagus joins the stomach (a sac that holds food and begins the digestive process by secreting gastric juice).
"The food and gastric juices are mixed into a thick fluid, which then empties into the small intestine.


"
The small intestine continues breaking down food and absorbs most of the nutrients.
"It is the longest section of the gut, measuring more than 20 feet."
The small intestine then joins the colon.
This is a wider tube about 5 feet long.
The appendix is found near the corner of the small intestine and colon.
The colon absorbs water and nutrients from food and stores the waste.
The waste that is left goes into the rectum.
From there it passes out of the body through the anus as stool (feces).
"
"
This system is made up of cells that are like nerve cells in certain ways and like hormone-making cells in other ways.
These cells do not form an actual organ like the adrenal or thyroid glands.
"Instead, they are scattered throughout the body in organs like the lungs, stomach, and intestines."
"Carcinoid tumors start from cells of the neuroendocrine system.
"
Neuroendocrine cells help control the release of digestive juices and how fast food moves in the gut.
They may also help control the growth of other types of digestive system cells.
"
Like most cells in the body, neuroendocrine cells in the gut sometimes go through certain changes that cause them to grow too much and form tumors.
"
>Neuroendocrine tumors are growths that look benign but can possibly spread to other parts of the body.
"Low
     -
     grade
     (grade 1) tumors have cells that do not look very abnormal and grow slowly."
"Intermediate
     -
     grade
     (grade 2) tumors look in between those of low and high-grade tumors.
"
">Low
     -
     grade
     (grade 1) tumors have cells that do not look very abnormal and grow slowly.
"
">Intermediate
     -
     grade
     (grade 2) tumors look in between those of low and high-grade tumors.
"
">Neuroendocrine cancers
   can spread to other parts of the body.  "
"They are called
   high
   -
   grade
   (grade 3) cancers because the cells look very abnormal and are growing quickly."
"
>Would you please write down the kind of cancer you think I might have?
"
">Why do you think I might have a GI carcinoid tumor?
>Could my symptoms be caused by something else?
>What will happen next?"
"
The symptoms a person can have from a GI carcinoid tumor often depend on where it is growing."
"
People with tumors in their appendix often don’t have symptoms."
"If a tumor is found, it is usually when a person has their appendix removed during an operation for some other problem."
"Sometimes, the tumor blocks the opening between the appendix and the rest of the intestine and causes appendicitis."
"This leads to symptoms like fever, nausea, vomiting, and belly pain."
"
If the tumor starts in the small intestine, it can cause the intestines (bowel) to kink and be blocked for a while."
"This can cause cramps, belly pain, weight loss, fatigue, bloating, diarrhea, or nausea and vomiting, which might come and go."
This can sometimes go on for years before the tumor is found.
"A tumor usually needs to grow fairly large before it completely blocks the bowel causing severe belly pain, nausea and vomiting and a possible life-threatening condition."
"
Rectal carcinoid tumors are often found during routine exams, even though they can cause pain and bleeding from the rectum and constipation."
"
Carcinoid tumors that start in the stomach usually grow slowly and often do not cause symptoms."
They are sometimes found during an exam of the stomach looking for other things.
"
Some carcinoid tumors can release enough hormone-like substances into the blood to cause the symptoms of carcinoid syndrome."
"These include:
>Facial flushing (redness and warm feeling)
>Severe diarrhea
>Wheezing
>Fast heartbeat
Many people find that stress, heavy exercise, and drinking alcohol can also trigger these symptoms."
"Over a long time, these hormone-like substances can damage the heart, causing shortness of breath, weakness, and a heart murmur (an abnormal heart sound).
"
Not all GI carcinoid tumors cause the carcinoid syndrome.
Most cases of carcinoid syndrome occur only after the cancer has spread to other parts of the body like the liver.
"
Barium x-ray : These tests use barium (a chalky white liquid) to coat the lining of the esophagus, stomach, and intestines."
"The coating helps show abnormal areas in these organs.
"
CT or CT scan: Uses x-rays to make pictures of your insides.
This can show clear pictures of the gut and the area around it to see if the cancer has spread.
"CT scans can also be used to do a biopsy (see below).
"
Magnetic resonance imaging (MRI) scan:
Uses radio waves and strong magnets instead of x-rays to make clear pictures of the inside of the body.
"MRI scans are helpful in looking at the liver.
"
PET scan: PET scans use a kind of sugar that can be seen inside your body with a special camera.
"If there is cancer, the sugar shows up as “hot spots” where the cancer is found."
"This test is useful when your doctor thinks the cancer has spread, but doesn’t know where."
"For GI carcinoid tumors, a different substance is used instead of sugar to find the cancer cells.
"
Octreotide scan:
Octreotide is a hormone-like substance that attaches to carcinoid cells.
A small amount of octreotide with a radioactive substance is injected into your veins.
It travels through the blood and attaches to carcinoid tumors.
"A few hours after the injection, a special camera will show where the radioactivity has collected in the body showing where the tumors are located.
"
"Biopsy : For a biopsy, the doctor takes out a small piece of the tumor."
It’s sent to the lab to see if there are cancer cells in it.
"This is the best way to know for sure if you have cancer.
"
"Blood/urine tests: Blood/urine tests are not used to find GI carcinoid tumors, but they are done to tell the doctor more about your health. ."
"
>What tests will I need to have?
>"
"Who will do these tests?
>Where will they be done?
"
>
"Who can explain them to me?
>"
"How and when will I get the results?
>Who will explain the results to me?
>What do I need to do next?"
"
If you have a GI carcinoid tumor, the doctor will want to find out how far it has spread ."
This is called staging.
"Knowing the stage of the cancer helps your doctor decide what treatment is best for you.
"
"For most GI carcinoid tumors, the stage describes the growth of the cancer through the layers of the wall of the digestive system."
"It also tells if the cancer has spread to nearby lymph nodes or to organs like the liver.
"
Be sure to ask your doctor about the stage of your cancer and what it might mean for you.
"
>Do you know the stage of the cancer?
>If not, how and when will you find out the stage of the cancer?
"
">Would you explain to me what the stage means in my case?
>Based on the stage of the cancer, how long do you think I’ll live?
"
">Can my cancer be removed with surgery?
>What will happen next?"
"
The treatment plan that is best for you depends on the stage of your cancer, your age and overall health, the possibility the cancer can be removed with surgery, and other factors."
"Often, treatment helps make symptoms better and slows down the cancer but may not cure it."
Talk with your doctor to find out your options.
"
Surgery is the main treatment for GI carcinoid tumors."
"If the tumor hasn’t spread, it can often be cured by surgery alone."
"Sometimes, part of the organ (like the stomach or intestine) must be removed along with nearby lymph nodes."
"
Any type of surgery can have risks and side effects ."
Ask the doctor what you can expect.
"If you have problems, let your doctors know."
"
Tumor ablation destroys the tumor without taking it out."
"There are a number of ways to do this, such as heating the tumor, freezing the tumor, or killing the tumor by putting alcohol in it."
Talk to the doctor about the planned treatment and what you can expect.
"
Radiation uses high-energy rays (such as x-rays) to kill cancer cells."
It may be an option for those who can’t have surgery and it may also be given after surgery in some cases if there’s a chance some of the tumor was not removed.
Radiation can also be used to ease some problems caused by the cancer.
It’s given in small doses every day for many weeks.
"
If your doctor suggests radiation as your treatment, ask what side effects might happen."
"They can include:
>Skin changes where the radiation is given
>Feeling very tired (fatigue)
>Feeling sick to your stomach
>Diarrhea
Most side effects get better after treatment ends."
Some might last longer.
"Talk to your doctor about what you can expect.
"
"
Chemo (the short word for chemotherapy) is the use of drugs to fight cancer."
"Chemo drugs can be used together or alone, and often with other types of medicines."
"Treatment often lasts for many months.
"
Most carcinoid tumors are not treated with chemo.
"It is mainly used for tumors that have spread to other organs, are causing severe symptoms, have not gotten smaller with other medicines, or tumors that are growing quickly.
"
The drugs may be given through a needle into a vein or taken as pills.
"These drugs go into the blood and spread through the body.
"
Chemo is given in cycles or rounds.
There’s often a rest period after each treatment.
This gives the body time to get better from any side effects.
"
>Hair loss
>Mouth sores
>Not feeling like eating
>Diarrhea
>Feeling sick to your stomach
>More risk of infections
>Bruising and bleeding easily
>Tiredness
These problems tend to go away after treatment ends, but there are ways to treat most side effects."
Be sure to talk to your cancer care team so they can help.
"
Drugs containing radioactive particles may be useful in treating some carcinoid tumors."
"This type of treatment lets doctors deliver high doses of radiation directly to the tumors.
"
"The most common side effects are nausea, kidney and liver problems, low white blood counts, and vomiting."
"
Targeted therapy drugs are newer treatments that may be used for certain types of GI carcinoid tumors."
These drugs affect mainly cancer cells and not normal cells in the body.
They may work even if other treatment doesn’t.
They come as pills that you take at home.
These drugs have different side effects than chemo.
"
Drugs like octreotide and lanreotide are used to treat the symptoms of carcinoid syndrome and help shrink carcinoid tumors."
They are given as injections (shots) just under the skin.
"
Clinical trials are research studies that test new drugs or other treatments in people."
"They compare standard treatments with others that might be better.
"
Clinical trials are one way to get the newest cancer treatment.
They often are the best way for doctors to find better ways to treat cancer.
"If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part."
"And if you do sign up for a clinical trial, you can always stop at any time.
"
"If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials."
See Clinical Trials to learn more.
"
"
When you have cancer you might hear about other ways to treat your cancer or treat your symptoms.
These may not always be standard medical treatments.
"These treatments may be vitamins, herbs, diets, and other things.
"
"Some of these are known to help, but many have not been tested."
Some have been shown not to be helpful.
A few have even been found to be harmful.
You might feel you want to know more about these treatments.
"Talk to your doctor about anything you are thinking about using, whether it’s a vitamin, a diet, or anything else."
"
>What treatment do you think is best for me?
>"
What is the goal of this treatment?
"Do you think it could cure the cancer?
>Will treatment include surgery?"
"If so, what will the surgery be like?
>Will I need other types of treatment, too?
>What’s the goal of these treatments?
>What side effects could I have from these treatments?
>"
"What can I do about side effects that I might have?
"
">Is there a clinical trial that might be right for me?
>"
What about vitamins or diets that friends tell me about?
"How will I know if they are safe?
>How soon do I need to start treatment?
"
">What should I do to be ready for treatment?
"
">Is there anything I can do to help the treatment work better?
>"
What’s the next step?
"
You’ll be glad when treatment is over."
But it’s hard not to worry about cancer coming back .
"Even when cancer never comes back, people still worry about this.
"
"For years after treatment ends, you will see your cancer doctor."
Be sure to go to all follow-up visits.
"You will have exams, blood tests, and maybe other tests like CT scans or octreotide scans, to tell if the cancer has come back.
"
"For the first year after treatment, your visits may be every 6 months."
You may have CT scans and blood tests.
"After the first few years, your visits might be every 6 to 12 months."
"After 5 years, they may be once a year.
"
"Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways."
You might be thinking about ways to improve your health. 
"Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.
"
You can’t change the fact that you have cancer.
"What you can change is how you live the rest of your life – making healthy choices and feeling as well as you can.
"
"

Treatment of GI carcinoid tumors is based mostly on their size or how far they have grown into the wall of the organ where they started, as well as if they have spread."
"
A tumor is localized when it has not spread outside the organ where it started."
"
Carcinoid) tumors of the stomach are generally grouped by:
>The level of a hormone called
    gastrin
    and
>The amount of acid in the stomach (measured before
    surgery
    ).
"
"The levels of these substances determine the type of stomach carcinoid tumor.
"
Type 1: Patients with this type have high gastrin levels but low levels of stomach acid.
"These carcinoid tumors tend to be small, but there may be many of them."
"The tumors don’t tend to grow into the deeper layers of the stomach or spread to other organs or tissues, and are often treated by removing them completely through an endoscope."
"The other option is to watch the tumors closely (by endoscopy), and only removing them if they start growing.
"
Type 2: Patients with this type have high gastrin levels and high stomach acid levels.
"Like type 1, these tumors are often small and there may be more than one at a time."
"Type 2 tumors also don’t tend to grow into deeper layers of the stomach or spread to other organs.
"
"Small tumors can be watched closely without treatment, removed with endoscopy, or treated with a medicine like octreotide or lanreotide that will lower levels of both gastrin and stomach acid."
"High doses of proton pump inhibitors, such as omeprazole or lansoprazole, may also be used to control the stomach acid. "
"For tumors larger than 2 cm (slightly less than an inch), just watching the tumor closely isn’t usually an option."
"These tumors need to be removed, either through an endoscope or in a regular operation through an incision in the abdomen that removes the tumor and some surrounding stomach tissue.
"
Type 3: Patients with type 3 tumors have normal levels of gastrin and stomach acid.
"There is usually only one tumor, and the tumor tends to grow into deeper layers of the stomach or even spread to nearby lymph nodes or other organs (like the liver)."
"If the tumor is small, endoscopic surgery may still be an option."
"More, often, though, more extensive surgery  with a partial gastrectomy (a piece of the stomach is removed) and removal of nearby lymph nodes is needed."
"
Some small tumors in the duodenum (the first part of the small intestine) can often be removed through the endoscope (endoscopic resection)."
"Depending on the size of the tumor and whether it is growing into nearby tissues, other options include surgery to remove the tumor (local excision), removing all or part of the duodenum with nearby lymph nodes, and removing the duodenum and part of the pancreas (a pancreatoduodenectomy).
"
"For tumors in other parts of the small intestine, treatment is either local excision for small tumors or small bowel resection (removal of a piece of intestine as well as some surrounding blood vessels and lymph nodes) for larger tumors."
"
The usual treatment is hemicolectomy (removal of a section of colon along with nearby lymph nodes and blood vessels)."
"Because many patients have more than one carcinoid tumor, the surgeon will often check the rest of the colon for other tumors during surgery."
"For very small tumors, sometimes the tumor can be removed without surgery using a colonoscope."
"
Most often, an appendectomy (surgical removal of the appendix) is the only treatment needed for carcinoid tumors that are 2 cm (a little less than an inch) across or smaller."
"Still, other factors, such as the way the tumor cells look, the patient's age, general health, and the patient's degree of worry about the possibility of the cancer coming back, might also be used to determine whether more treatment is needed.
"
"Tumors larger than 2 cm are more likely to have already spread to nearby tissues and lymph nodes, so more extensive surgery is usually recommended."
"This means removal of about a third of the colon next to the appendix (a hemicolectomy), along with nearby blood vessels and lymph nodes."
"This procedure might not be recommended for people who are older or have other serious health problems (especially if these problems make surgery more risky), because the benefit might not outweigh the risks."
"
Most rectal carcinoid tumors that are smaller than 1 cm (slightly less than half an inch) can be removed by an endoscope or local excision through the anus .
"
"The best approach for rectal carcinoid tumors between 1 and 2 cm, depends on how deeply the tumor has grown into the wall of the rectum, as well as if it has invaded the nearby lymph nodes."
Doctors can check for this before surgery by using an endoscopic ultrasound.
"If the tumor has grown into the thick muscle layer of the rectum (the muscularis propria) or deeper or if local lymph nodes have tumor cells, it needs to be treated the same as a larger tumor."
"If not, it may still be able to be removed by endoscope or local excision through the anus.
"
"Tumors larger than 2 cm (and those that have grown deep into the wall of the rectum) have a higher risk of growing and spreading, so they are removed by the same operations used for adenocarcinomas (the usual type of rectal cancer)."
This operation is a low anterior resection if the tumor is in the upper part of the rectum.
"If the lower part is involved, abdominoperineal (AP) resection and colostomy are used."
"
Regional spread means that the cancer has either spread to nearby lymph nodes or it has grown through the wall of the organ where it started and has invaded nearby tissues such as fat, ligaments, and muscle.
"
"If possible, the primary (main) tumor and any areas of cancer spread should all be removed by surgery."
Nearby lymph nodes should be removed and checked for signs of cancer spread.
This provides the best chance of cure.
"If this can't be done, surgery should remove as much cancer as possible without causing severe side effects."
"Surgery should also be done to relieve symptoms such as intestinal blockage caused by the local growth of the tumor.
"
"If all of the tumor cannot be removed at the time of surgery, treatment with somatostatin drugs, like octreotide or lanreotide, or targeted drugs, like everolimus, can be considered because they may control the remaining cancer."
"
At this stage, the cancer has spread to other organs such as the liver and a cure is not usually possible."
"Treatment is not always needed right away, depending on how quickly the tumors are growing."
The goal of surgery in this situation is usually to relieve symptoms and slow the course of the disease.
"For example, removing or bypassing areas blocked by cancer growth can relieve some symptoms."
"If distant metastases are not causing symptoms, treatment may not be needed."
"If the cancer has spread to the liver, even when it isn’t causing symptoms, some doctors recommend treatment with octreotide or lanreotide, chemotherapy, or targeted therapy because it may slow tumor growth.
"
"If carcinoid syndrome is causing bothersome symptoms, treatment options include chemotherapy, targeted therapy, treatment with octreotide or lanreotide, or surgery to remove the metastatic tumors."
"If metastatic tumors in the liver cannot be removed by surgery without causing severe side effects, ablation or embolization can be used to destroy as much of the tumors as possible."
"Patients should also be advised to avoid alcoholic drinks, stress, strenuous exercise, spicy foods, and certain medicines that can make the symptoms of carcinoid syndrome worse."
"
"
When cancer comes back after treatment it is called a recurrence.
Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs or bone).
Patients with recurrent carcinoid tumors are treated sometimes with surgery to remove all signs of tumor if possible.
This provides the best chance for a good long-term outcome.
"If surgery is not possible, the treatments used for distant spread may be helpful."
"For more information, see Understanding Recurrence ."
"
Gastrointestinal neuroendocrine carcinomas (NECs) are high-grade (grade 3) tumors that grow very quickly."
There are also some low- (grade 1) and intermediate-grade (grade 2) carcinoid tumors that act like neuroendocrine carcinomas because they grow fast.
These cancers are treated differently from most carcinoid tumors (grade 1 and 2) because they are treated with chemotherapy first.
"
The substances released into the blood by some carcinoid tumors can damage the heart."
Early symptoms are fatigue and shortness of breath.
"Eventually, patients get fluid in their legs and even their abdomen."
The major cause is damage to the valves of the heart.
"Doctors can usually make the diagnosis by listening to the heart and by an ultrasound of the heart called an echocardiogram.
"
The main treatment is with a somatostatin analog like octreotide or lanreotide to block the tumor’s secretion of the toxic substances.
Drugs (diuretics) to get rid of extra fluid can also help.
"In some instances, heart surgery may be needed to replace the damaged valves.
"
"

Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or a muscle or taken by mouth to kill cancer cells."
"These drugs enter the blood and reach almost all areas of the body, making this treatment useful for some types of cancers that have spread.
"
"Unfortunately, gastrointestinal (GI) carcinoid tumors often do not respond well to chemo."
"Because of this, chemo generally is used only for tumors that have spread to other organs, are causing severe symptoms, have not responded to other medicines or are high grade (grade 3).
"
"Some of the chemo drugs used to treat GI carcinoid tumors include:
>Capecitabine (Xeloda)
>5-fluorouracil (5-FU)
>Doxorubicin (Adriamycin)
>Etoposide (VP-16)
>Dacarbazine (DTIC)
>Streptozocin
>Temozolomide
>Oxaliplatin
Some tumors, especially high-grade tumors, may be treated with more than one drug."
"For these, combinations of 5-FU plus streptozocin, 5-FU plus doxorubicin or oxaliplatin plus capecitabine may be used.
"
"Doctors give chemo in cycles, with each period of treatment followed by a rest period to allow the body time to recover."
"Chemo cycles generally last about 3 to 4 weeks, and initial treatment is typically 4 to 6 cycles."
"
Chemo drugs damage cells that are dividing quickly, which is why they can work against cancer cells."
"But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly."
"These cells are also likely to be affected by chemo, which can lead to side effects.
"
The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken.
"Common side effects can include:
>Nausea and vomiting
>Loss of appetite
>Hair loss
>Mouth sores
>Diarrhea or constipation
>Increased chance of
   infections
   (from having too few white blood cells)
>Easy bruising or bleeding (from having too few blood platelets
>Fatigue
   (from having too few red blood cells)
"
Most side effects go away a short time after treatment is finished.
Often medicines can help prevent or minimize many of the side effects.
"For example, your doctor can prescribe drugs to help prevent or reduce nausea and vomiting.
"
"You should tell your medical team about any side effects or changes you notice while getting chemotherapy, so that they can be treated promptly."
"In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to keep the effects from worsening.
"
"For more information on chemo, see Chemotherapy ."
"
For people with metastatic GI carcinoid tumors, several medicines can help control symptoms and tumor growth."
"
"
"These drugs are related to somatostatin, a natural hormone that seems to help slow the growth of neuroendocrine cells."
"They are especially useful in people who have carcinoid syndrome (facial flushing, diarrhea, wheezing, rapid heart rate) and in people whose tumors show up on a somatostatin receptor scintigraphy (SRS) scan or gallium-68 Dotatate scans .
"
Octreotide: This drug is helpful in treating the symptoms of carcinoid syndrome.
"Sometimes octreotide can temporarily shrink carcinoid tumors, but it does not cure them.
"
The original version of octreotide (Sandostatin®) is injected under the skin (subcutaneously) at least twice daily.
Some people learn to give this injection themselves at home.
A long-acting version of the drug (Sandostatin LAR®) is injected into a muscle once a month by your doctor or nurse.
"Depending on the severity of symptoms, some people are given injections every day when first starting treatment."
"Once the doctor finds the correct dose, the longer-acting monthly injection may then be used.
"
"Side effects can include pain or burning at the injection site, stomach cramps, nausea, vomiting, headaches, dizziness, and fatigue.
"
Lanreotide (Somatuline®) :
This drug is similar to octreotide.
It is injected under the skin once a month.
"It may be given by your doctor or nurse, or you may learn how to give the injection at home."
"Side effects are similar to those of octreotide, although pain at the injection site is less common.
"
Telotristat (Xermelo™): This drug is used along with a somatostatin analog (octreotide or lanreotide) to help control carcinoid syndrome diarrhea.
"It is given by mouth as a pill and common side effects can include fever, poor appetite, headache, nausea, and swelling of the hands or feet"
"
Anti-cancer drugs that work differently from standard chemotherapy drugs have been developed for some types of cancer."
These drugs target specific parts of cancer cells.
They are sometimes helpful when chemotherapy is not.
"They often have different side effects.
"
"The targeted drug, everolimus (Afinitor®), has been shown to help treat advanced GI carcinoid tumors."
"It can be used with or without somatostatin drugs, such as octreotide."
"Common side effects include diarrhea, fatigue, rash, mouth sores and swelling of the legs or arms."
"
Interferons are natural substances that normally activate the body's immune system."
They also slow the growth of some tumor cells.
Interferon-alfa is sometimes helpful in shrinking or slowing the growth of metastatic GI carcinoid tumors and improving symptoms of carcinoid syndrome.
"Often, the drug's usefulness is limited by its flu-like side effects, which may be severe."
"The drug is given by injection.
"
"

Radiation therapy is the use of high-energy rays (such as x-rays) or radioactive particles to kill cancer cells.
"
"Although surgery is the main treatment for most carcinoid tumors, radiation therapy may be an option for those who can’t have surgery for some reason."
It may also be given after surgery in some cases if there’s a chance some of the tumor was not removed.
Radiation therapy can also be used to help relieve symptoms such as pain if the cancer has spread to the bones or other areas.
"
External beam radiation therapy uses a machine to deliver a beam of radiation to a specific part of the body."
This type of radiation is used most often to treat cancer.
"
The main side effects of GI radiation therapy are:
>Tiredness (fatigue)
"
">Nausea and vomiting
>Diarrhea (if the belly or pelvis is treated)
"
">Skin changes, which can range from mild redness to blistering and peeling
>Hair loss in the area being treated"
"
This technique combines embolization with radiation therapy and is used to treat liver metastases.
"
Embolization is a procedure that injects substances to try to block or reduce the blood flow to cancer cells in the liver.
The liver is unusual in that it has 2 blood supplies.
"Most normal liver cells are fed by the portal vein, whereas cancer cells in the liver are usually fed by the hepatic artery ."
"Blocking the branch of the hepatic artery feeding the tumor helps kill off the cancer cells, but it leaves most of the healthy liver cells unharmed because they get their blood supply from the portal vein.
"
"In this procedure, a catheter (a thin, flexible tube) is put into an artery through a small cut in the inner thigh and eased up into the hepatic artery in the liver."
"A dye is injected into the blood at the same time to allow the doctor to monitor the path of the catheter via angiography, a special type of x-ray."
"Once the catheter is in place, small particles called microspheres are injected into the artery to plug it up.
"
"In radioembolization, microspheres (small beads) that are attached to a radioactive element called yttrium-90 (or 90Y) are used."
"After they are injected, the beads travel in the liver blood vessels until they get stuck in small blood vessels near the tumor."
"There they give off radioactivity for a short while, killing nearby tumor cells."
"The radiation travels a very short distance, so its effects are limited mainly to the tumor."
"
In this form of radiation therapy, a drug is linked to a radioactive element."
"The drug travels throughout the body, attaches to the cancer cells, and gives off radiation to kill them."
"It is given through a vein and not directly into the liver like radioembolization.
"
One option is to use somatostatin analog drugs like octreotide or lanreotide linked with a radioactive form of the element yttrium-90.
"Another option uses a different radioactive element, called lutetium (Lu-177), that is carried to the cancer cells by dotatate where it attaches to carcinoid tumor cells."
"These injectable therapies let doctors deliver high doses of radiation directly to the tumors.
"
"For adults with somatostatin (a type of hormone) receptor-positive GI carcinoid tumors, that are no longer responding to octreotide or lanreotide, a radioactive drug, called Lutathera (lutetium Lu- 177 dotatate), can be used for treatment."
"Lu-177 dotatate, also called a radiopharmaceutical , works by attaching to the somatostatin receptor (protein), which is part of the cancer cell, allowing radiation to enter the cell and cause damage."
"If you are taking octreotide or lanreotide, you will most likely be asked to stop taking these medicines before Lu-177 dotatate is given.
"
"Common side effects of Lu-177 dotatate include low levels of white blood cells, high levels of enzymes in certain organs, nausea and vomiting, high levels of blood sugar, and low levels of potassium in the blood.
"
"Serious side effects of Lu-177 dotatate include low levels of blood cells, development of certain blood or bone marrow cancers, kidney damage, liver damage, abnormal levels of hormones in the body, and infertility."
"Women who are pregnant or might become pregnant should be advised that Lu-177 dotatate can cause harm to a developing fetus.
"
Lu-177 dotatate is given intravenously and does expose those taking it and possibly others around them to radiation.
"Family members should know how to protect themselves from being exposed to the radiation.
"
"

Many gastrointestinal (GI) carcinoid)"
tumors can be cured by surgery alone.
"The type of operation will depend on a number of factors, including the size and location of the tumor, whether the person has any other serious diseases, and whether the tumor is causing the carcinoid syndrome.
"
"Surgeons often try to cure localized carcinoid tumors by removing them completely, which is usually successful.
"
The options for GI carcinoid tumors that have spread to nearby tissues or to distant parts of the body are more complex.
"Because most carcinoid tumors grow slowly and some do not cause any symptoms, completely removing all metastatic carcinoid tumors may not always be needed."
"But in some patients, surgery to remove all visible cancer is the best option."
"This is particularly true if removing most of the cancer will reduce the level of hormone-like substances causing symptoms.
"
Several types of operations can be used to treat GI carcinoid tumors.
"Some of these remove the primary tumor (where the cancer started), while others remove or destroy cancer that has spread (metastasized) to other organs."
"
In this procedure, the cancer is removed through an endoscope."
This is most often used to treat small carcinoid tumors of the stomach and duodenum (the first part of the small intestine) and it also can be used to remove small carcinoid tumors of the rectum.
"
This operation removes the primary tumor and some normal tissue around it."
The edges of the defect are then sewn together.
This usually doesn’t cause any prolonged problems with eating or bowel movements.
"This operation may be done for small carcinoid tumors (no larger than 2 cm, or a little less than an inch).
"
Carcinoid tumors are sometimes removed during an operation being done for some other reason.
This often happens with carcinoid tumors of the appendix.
"When the appendix is removed (for some other reason), it is examined after surgery, and sometimes a carcinoid tumor is found."
Most doctors believe that if the tumor is small — 2 cm or less — removing the appendix (appendectomy) is curative and no other surgery is needed.
"If the tumor is larger than 2 cm, more surgery may be needed.
"
"Rectal carcinoid tumors may be taken out through the anus, without cutting the skin."
Other GI carcinoid tumors can sometimes be locally excised through an endoscope but usually it is done through an incision (cut) in the skin.
"
A larger incision (cut) is needed to remove a larger tumor along with nearby tissues."
This also gives the surgeon the chance to see if the tumor has grown into other tissues in the abdomen (belly).
"If it has, the surgeon may be able to remove the areas of cancer spread.
"
"Partial gastrectomy: In this operation, part of the stomach is removed."
"If the upper part is removed, sometimes part of the esophagus is removed as well."
"If the lower part of the stomach is removed, sometimes the first part of the small intestine (the duodenum) is also taken."
Nearby lymph nodes are also removed.
"This operation is also known as a subtotal gastrectomy .
"
Small bowel (intestine) resection:
This is an operation to remove a piece of the small intestine (also called the small bowel).
"When it is used to treat a small bowel carcinoid, this surgery includes removing the tumor and some of the small bowel around it (called a wide margin resection )."
It will also remove nearby (regional) lymph nodes and the supporting connective tissue (called the mesentery) that contains lymph nodes and vessels that carry blood to and from the intestine.
"Tumors in the terminal ileum (the last part of the small bowel) may require removing the right side of the colon ( hemicolectomy ).
"
Pancreaticoduodenectomy (Whipple procedure) :
"This operation is most often used to treat pancreatic cancer, but it is also used to treat cancers of the duodenum (the first part of the small intestine)."
"It removes the duodenum, part of the pancreas, nearby lymph nodes and part of the stomach."
The gallbladder and part of the common bile duct are removed and the remaining bile duct is attached to the small intestine so that bile from the liver can continue to enter the small intestine.
This is a complex operation that requires a lot of skill and experience.
"It carries a relatively high risk of complications that could even be fatal.
"
"Segmental colon resection or hemicolectomy: This operation removes between one-third and one-half of the colon, as well as the nearby layers of tissue that hold and connect the intestines ( the mesentery), which includes blood vessels and lymph nodes.
"
Low anterior resection:
This operation can be used for some tumors in the upper part of the rectum.
It removes some of the rectum and the remaining ends are sewn together.
"This does not have much effect on digestive function.
"
Abdominoperineal (AP) resection:
This surgery is done for large or very invasive cancers in the lower part of the rectum.
"It removes the anus, rectum, and lower part of the colon."
"After this operation, the end of the colon is connected to an opening on the skin on the abdomen (called a colostomy)."
A bag attached over this opening collects stool (feces) as it leaves the body.
"(For more information, see Colostomy Guide )."
"
If the cancer spreads to the liver, treating the tumors in the liver may help with symptoms."
"When there are only 1 or 2 tumors in the liver, they may be removed with surgery."
"If there are more than just a few liver tumors (or if a person is too sick for surgery), other techniques may be used."
"
In this operation, one or more pieces of the liver that contain areas of cancer are removed."
"If it isn’t possible to remove all areas of cancer, surgery may still be done to remove as much tumor as possible to help reduce symptoms of carcinoid syndrome."
This is sometimes called cytoreductive surgery.
"Removing liver metastases may help some people with carcinoid tumors live longer, but most people who have this surgery will eventually develop new liver metastases."
"
Ablation techniques destroy tumors without removing them."
"They are generally best for tumors no more than about 2 cm (a little less than an inch) across.
"
Radiofrequency ablation (RFA) uses high-energy radio waves for treatment.
"A thin, needle-like probe is placed through the skin and into the tumor."
Placement of the probe is guided by ultrasound or CT scans.
"The tip of the probe releases a high-frequency current that heats the tumor and destroys the cancer cells.
"
Ethanol (alcohol) ablation (also known as percutaneous ethanol injection) kills the cancer cells by injecting concentrated alcohol directly into the tumor.
This is usually done through the skin using a needle guided by ultrasound or CT scans.
"
Uses microwaves to heat and destroy the cancer cells."
"
Cryotherapy destroys a tumor by freezing it with a metal probe."
The probe is guided through the skin and into the tumor using ultrasound.
"Then very cold gasses are passed through the probe to freeze the tumor, killing the cancer cells."
"This method may be used to treat larger tumors compared to the other ablation techniques, but it sometimes requires general anesthesia (where you are asleep)."
"
Intra-arterial therapy and chemoembolization (also known as transarterial embolization or TAE):"
This is another option for tumors that can’t be removed completely.
It can be used for larger tumors (up to about 5 cm or 2 inches across).
This technique reduces the blood flow to the cancer cells by blocking the branch of the hepatic artery feeding the area of the liver containing the tumor.
Blood flow is blocked (or reduced) by injecting materials that plug up the artery.
"Most of the healthy liver cells will not be affected because they get their blood supply from a different blood vessel, the portal vein.
"
"In this procedure a thin, flexible catheter is put into an artery in the inner thigh and threaded up into the liver."
"A dye is then injected into the bloodstream to allow the doctor to monitor the path of the catheter via angiography, a special type of x-ray."
"Once the catheter is in place, small particles are injected into the artery to plug it up.
"
Chemoem bolization (also known as trans-arterial chemoembolization or TACE):
This procedure combines embolization with chemotherapy.
"Most often, this is done by using tiny beads that release a chemotherapy drug during the embolization."
"TACE can also be done by giving chemotherapy through a thin catheter directly into the artery, then plugging up the artery.
"
Radioembolization:
"In the United States, this is done by injecting small radioactive beads into the hepatic artery."
"The beads travel to the tumor and give off small amounts of radiation only at the tumor sites.

"
"

Gastrointestinal stromal tumors (GISTs) are not common, and the exact number of people diagnosed with these tumors each year is not known."
"Until the late 1990s, not much was known about these tumors (and doctors didn’t have good ways of identifying them with lab tests), so many of them ended up being classified as other kinds of cancers.
"
"Current estimates for the total number of GIST cases diagnosed each year in the United States range from about 4,000 to about 6,000.
"
"These tumors can start anywhere in the GI tract, but they occur most often in the stomach (about 60%) or the small intestine (about 35%)."
"Most of the rest are found in the esophagus, colon, and rectum."
"A small number develop in the abdomen outside the GI tract.
"
GISTs are most commonly found in people over the age of 50.
"These tumors are rare in people younger than 40, but they can develop in people of any age.
"
"Survival statistics for people with GIST tumors are discussed in Survival Rates for Gastrointestinal Stromal Tumors .
"
"

Cancer starts when cells in the body begin to grow out of control."
"Cells in nearly any part of the body can become cancer, and then can spread to other areas of the body."
"To learn more about cancer and how it starts and spreads, see What Is Cancer?
"
"Gastrointestinal stromal tumors (GISTs) are uncommon cancers that start in special cells in the wall of the gastrointestinal (GI) tract, also known as the digestive tract."
"
The GI tract processes food for energy and rids the body of solid waste."
"After food is chewed and swallowed, it goes through the esophagus, a tube that carries food down the throat and chest to the stomach."
"The esophagus joins the stomach just beneath the diaphragm (the thin band of muscle below the lungs).
"
The stomach is a sac-like organ that helps the digestive process by mixing the food with gastric juices.
The food and gastric juices are then emptied into the small intestine.
"The small intestine, which is about 20 feet long, continues breaking down the food and absorbs most of the nutrients into the bloodstream.
"
"The small intestine joins the large intestine, the first part of which is the colon, a muscular tube about 5 feet long."
The colon absorbs water and mineral nutrients from the remaining food matter.
"The waste left after this process (stool) goes into the rectum, where it is stored until it passes out of the body through the anus.

"
"
Gastrointestinal stromal tumors (GISTs) start in very early forms of special cells in the wall of the GI tract called the interstitial cells of Cajal (ICCs)."
"ICCs are sometimes called the “pacemakers” of the GI tract because they signal the muscles in the GI tract to contract to move food and liquid along.
"
More than half of GISTs start in the stomach.
"Most of the others start in the small intestine, but GISTs can start anywhere along the GI tract."
"A small number of GISTs start outside the GI tract in nearby areas such as the omentum (an apron-like layer of fatty tissue that hangs over the organs in the abdomen) or the peritoneum (the thin lining over the organs and walls inside the abdomen).
"
Some GISTs seem to be much more likely than others to grow into other areas or spread to other parts of the body.
"Doctors look at certain factors to help tell whether a GIST is likely to grow and spread quickly, such as:
>The size of the tumor
>Where it's located in the GI tract
>How fast the tumor cells are dividing (its
   mitotic rate
   , described in
   Tests for Gastrointestinal Stromal Tumors
   )"
"
GISTs are not the same as other, more common types of GI tract cancers that develop from other types of cells.
"
Cancers can occur anywhere in the GI tract − from the esophagus to the anus.
"Most cancers that start in the GI tract, including most esophagus cancers, stomach cancers, and colon and rectum cancers, start in the gland cells that line almost all of the GI tract."
"The cancers that develop in these cells are called adenocarcinomas .
"
"Cancers can also start in squamous cells, which are flat cells that line some parts of the GI tract, like the upper part of the esophagus and the end of the anus."
"Cancers starting in these cells are called squamous cell carcinomas .
"
The GI tract also has neuroendocrine cells.
These cells have some features in common with nerve cells but also have other features in common with hormone-producing (endocrine) cells.
Cancers that develop from these cells are called neuroendocrine tumors (NETs) .
These cancers are rare in the GI tract.
"Carcinoid tumors are an example of a neuroendocrine tumor found in the GI tract.
"
"Other rare types of cancer in the GI tract include different types of soft tissue sarcomas , such as:
>Leiomyosarcomas:
   cancers of smooth muscle cells
>Angiosarcomas:
   cancers of blood vessel cells
>Malignant peripheral nerve sheath tumors (MPNSTs):
   cancers of cells that support and protect nerves
GISTs are different from these other types of GI tract cancers."
"They start in different types of cells, need different types of treatment, and have a different prognosis (outlook)."
"This is why doctors need to figure out whether a person with a tumor in the GI tract has a GIST, some other type of cancer, or a non-cancerous condition.
"
"

For some people with a gastrointestinal stromal tumor (GIST), treatment can remove or destroy the cancer."
Completing treatment can be both stressful and exciting.
"You may be relieved to finish treatment, but find it hard not to worry about cancer coming back."
"(When cancer comes back after treatment, it’s called a recurrence. )"
"This is a very common concern if you've had cancer.
"
"For some people, the GIST may never go away completely."
These people may get regular treatments with targeted therapy drugs or other therapies to help keep the cancer in check and to help relieve symptoms.
Learning to live with cancer that doesn't go away can be difficult and very stressful.
It has its own type of uncertainty.
"
Whether you have completed treatment or are still being treated, your doctors will still want to watch you closely."
"It's very important to go to all of your follow-up appointments, as GISTs can sometimes come back after treatment.
"
Some treatment side effects might last a long time or might not even show up until years after you have finished treatment.
Your doctor visits are a good time to ask questions and talk about any changes or problems you notice or concerns you have.
"
During your follow-up visits, your doctors will ask about symptoms, examine you, and may order imaging tests like CT scans. "
"Because of the risk that a GIST may come back after treatment, doctors often recommend follow-up visits every 3 to 6 months for at least several years after treatment, and then possibly less frequently afterward."
"
Talk with your doctor about developing a survivorship care plan for you."
"This plan might include:
>A suggested schedule for follow-up
   exams and tests
>A schedule for other tests you might need in the future, such as
   early detection (screening) tests
   for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
>A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
>Diet and physical activity suggestions"
"
Even after treatment, it’s very important to keep health insurance ."
"Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
"
"At some point after your treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history."
It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment.
Learn more in Keeping Copies of Important Medical Records .
"
If you have (or have had) a GIST, you probably want to know if there are things you can do that might lower your risk of the tumor growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements."
"Unfortunately, it’s not yet clear if there are things you can do that will help.
"
"Adopting healthy behaviors such as not smoking, eating well, getting regular physical activity, and staying at a healthy weight might help, but no one knows for sure."
"However, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of GIST or other cancers."
"
So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of cancers such as GISTs progressing or coming back."
"This doesn’t mean that no supplements will help, but it’s important to know that none have been proven to do so.
"
"Dietary supplements are not regulated like medicines in the United States – they do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do."
"If you’re thinking about taking any type of nutritional supplement, talk to your health care team."
They can help you decide which ones you can use safely while avoiding those that might be harmful.
"
"
"If cancer does recur, your treatment options will depend on the location of the cancer, and what treatments you’ve had before, and your current health and preferences."
"For more information on how recurrent cancer is treated, see Typical Treatment Options for Gastrointestinal Stromal Tumors ."
"For more general information on dealing with a recurrence, see Coping With Cancer Recurrence ."
"
Some amount of feeling depressed, anxious, or worried is normal when cancer is a part of your life."
Some people are affected more than others.
"But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups , professional counselors, or others.
"
"

The risk of many types of cancer can be reduced with certain lifestyle changes (such as getting to and staying at a healthy weight, or quitting smoking).
"
"But the only known risk factors for gastrointestinal stromal tumors (GISTs) − older age and certain rare, inherited genetic syndromes – cannot be changed."
"There are no known lifestyle-related or environmental causes of GISTs, so at this time we do not know of any way to protect against these cancers.
"
"

A risk factor is anything that increases a person’s chances of getting a disease like cancer."
Different cancers have different risk factors.
"Some risk factors, like smoking, can be changed."
"Others, like a person’s age or family history, can’t be changed.
"
"But having a risk factor, or even several, does not mean that a person will get the disease."
"And many people who get the disease may have few or no known risk factors.
"
"Currently, there are very few known risk factors for gastrointestinal stromal tumors (GISTs)."
"
"
"These tumors can occur in people of any age, but they are rare in people younger than 40 and are most common in people older than 50."
Most GISTs are sporadic (not inherited) and have no clear cause.
"In rare cases, though, GISTs have been found in several members of the same family."
"These family members have inherited a gene mutation (change) that can lead to GISTs.
"
"Primary familial GIST syndrome: This is a rare, inherited condition that leads to an increased risk of developing GISTs."
People with this syndrome tend to develop GISTs at a younger age than when they usually occur.
"They are also more likely to have more than one GIST.
"
"Most often, this syndrome is caused by an abnormal KIT gene that is passed from parent to child."
This is the same gene that is mutated (changed) in most sporadic GISTs.
(See What Causes Gastrointestinal Stromal Tumors? )
"People who inherited this abnormal gene from a parent have it in all their cells, while people with sporadic GISTs only have it in the cancer cells.
"
"Less often, a change in the PDGFRA gene causes this genetic syndrome."
"(Defects in the PDGFRA gene are also found in a small percentage of sporadic GISTs.)
"
Sometimes people with familial GIST syndrome also have skin spots like those seen in patients with neurofibromatosis (discussed below).
"Before tests for the KIT and PDGFRA genes became available, some of these people mistakenly were thought to have neurofibromatosis.
"
Neurofibromatosis type 1 (von Recklinghausen disease):
This condition is caused by a defect in the NF1 gene.
"This gene change may be inherited from a parent, but in some cases the change occurs before birth, without being inherited.
"
"People affected by this syndrome often have many benign (non-cancerous) nerve tumors, called neurofibromas , starting when they are young."
These tumors form under the skin and in other parts of the body.
"These people also typically have tan or brown spots on the skin (called café au lait spots).
"
"People with NF1 have a higher risk of GISTs (most often in the small intestine), as well as some other types of cancer.
"
"Carney-Stratakis syndrome: People with this rare inherited condition have an increased risk of GISTs (most often in the stomach), as well as nerve tumors called paragangliomas ."
GISTs often develop when these people are in their teens or 20s.
"They are also more likely to have more than one GIST.
"
"This syndrome is caused by a change in one of the SDH (succinate dehydrogenase) genes, which is passed from parent to child.
"
"

Researchers do not know exactly what causes most gastrointestinal stromal tumors (GISTs)."
"But great progress has been made in learning how certain changes in DNA can cause normal cells to become cancer cells.
"
"DNA is the chemical in our cells that makes up our genes , which control how our cells function."
We usually look like our parents because they are the source of our DNA.
"But DNA affects more than just how we look.
"
"Some genes control when cells grow and divide into new cells:
>Certain genes that help cells grow, divide, and stay alive are called
   oncogenes
   .
"
">Genes that normally keep cell growth under control, repair mistakes in DNA, or cause cells to die at the right time are called
   tumor suppressor genes
   .
"
"Cancers can be caused by DNA changes that keep oncogenes turned on, or that turn off tumor suppressor genes. "
These types of gene changes can lead to cells growing out of control.
"
The gene changes that lead to most GISTs are now understood, but it’s still not clear why these changes occur."
There are no known lifestyle-related or environmental risk factors for GIST .
"Some of the gene changes that lead to GISTs might have causes that haven’t been found yet, but many of these changes may just be random events that sometimes happen inside cells that unfortunately lead to cancer.
"
A small number of families have GISTs that are caused by a gene mutation passed down from parent to child.
(See Gastrointestinal Stromal Tumor Risk Factors .)
But most gene mutations related to GISTs are not inherited.
"These changes occur for no apparent reason, and are called acquired or sporadic ."
"
In most people with GISTs, the cancer cells have a change in the KIT oncogene."
"This gene directs cells to make the KIT protein (also known as CD117), which causes the cells to grow and divide.
"
"Usually the KIT gene is inactive in interstitial cells of Cajal (ICCs) , which are the cells in the walls of the GI tract from which GISTs develop."
The KIT gene is only active if there is a need for more ICCs.
But in most GISTs the KIT gene is mutated.
"It is always active, so the cells are always growing and dividing.
"
"In about 5% to 10% of GISTs, the cancer cells have a mutation in the PDGFRA gene, which causes the cells to make too much of the PDGFRA protein."
"This has the same effect on the cells as does KIT.
"
"Most GISTs have changes in either the KIT or the PDGFRA gene, but not both."
"
A small number of GISTs, especially those in children, do not have changes in either of these genes."
Many of these tumors have changes in one of the SDH genes.
"Researchers are still trying to determine what other gene changes can lead to these cancers.
"
"As doctors have learned more about the gene and protein changes in GIST cells, they have been able to use this information to help diagnose and treat these cancers."
"(See Targeted Therapy for Gastrointestinal Stromal Tumors .)
"
"

Screening is testing for diseases like cancer in people who do not have any symptoms."
"Screening tests can find some types of cancer early, when treatment is most likely to be effective."
"But at this time, there are no effective screening tests for gastrointestinal stromal tumors (GISTs), so routine testing of people without any symptoms is not recommended.
"
"Many GISTs are found because of symptoms a person is having, but some GISTs may be found early by chance."
"Sometimes they are seen on an exam for another problem, like during a colonoscopy to look for colorectal cancer."
"Rarely, a GIST may be seen on an imaging test, like a computed tomography (CT) scan, that is done for another reason."
"Some GISTs may also be found incidentally (unexpectedly) during abdominal surgery for another problem.
"
"

Gastrointestinal stromal tumors (GISTs) are often found because a person is having signs or symptoms ."
Others are found during exams or tests for other problems.
But these symptoms or initial tests aren’t usually enough to know for sure if a person has a GIST or another type of gastrointestinal (GI) tumor. 
"If a GI tumor is suspected, you will need to have further tests to confirm what it is."
"
"
"The doctor will ask you questions about your medical history , including your symptoms, possible risk factors , family history, and other medical conditions.
"
"Your doctor will physically examine you to get more information about the possible signs of a GI tumor, like a mass in the abdomen, or other health problems.
"
"If there is a reason to suspect that you may have a GIST (or other type of GI tumor), the doctor will do imaging tests or endoscopy exams to help find out if it is cancer or something else."
"If you’re seeing your primary care doctor, you might be referred to a specialist, such as a gastroenterologist (a doctor who treats diseases of the digestive system).
"
"If a GIST is found, you will likely have further tests to help determine the stage (extent) of the cancer."
"
Imaging tests use x-rays, magnetic fields, or radioactive substances to create pictures of the inside of the body."
"Imaging tests are done for a number of reasons, including:
>To help find out if a suspicious area might be cancer
>To learn how far cancer has spread
>To help determine if treatment has been effective
>To look for signs that the cancer has come back
Most people thought to have a GI tumor will get one or more of these tests."
"
A CT scan uses x-rays to make detailed, cross-sectional images of your body."
"Unlike a regular x-ray, a CT scan creates detailed images of the soft tissues in the body.
"
"CT scans can be useful in patients who have (or might have) GISTs to find the location and size of a tumor, as well as to see if it has spread to other parts of the body.
"
"In some cases, CT scans can also be used to guide a biopsy needle precisely into a suspected cancer."
"However, this can be risky if the tumor might be a GIST (because of the risk of bleeding and a possible increased risk of tumor spread), so these types of biopsies are usually done only if the result might affect the decision on treatment."
(See the biopsy information below.)
"
Like CT scans, MRI scans show detailed images of soft tissues in the body."
"But MRI scans use radio waves and strong magnets instead of x-rays.
"
"MRI scans can sometimes be useful in people with GISTs to help find the extent of the cancer in the abdomen, but usually CT scans are enough."
"MRIs can also be used to look for cancer that might have come back (recurred) or spread (metastasized) to distant organs, particularly in the brain or spine."
"
Barium x-rays are not used as much as they were in the past."
"They have largely been replaced by CT/MRI and by endoscopy (where the doctor actually looks inside your esophagus, stomach, and intestines with a narrow fiberoptic scope - see below).
"
"For these types of x-rays, a chalky liquid containing barium is used to coat the inner lining of the esophagus, stomach, and intestines."
This makes abnormal areas of the lining easier to see on x-ray.
"These tests are sometimes used to diagnose GI tumors, but they can miss some small intestine tumors.
"
You will probably have to fast starting the night before the test.
"If your colon is being examined, you might need to take laxatives and/or enemas to clean out the bowel the night before or the morning of the exam.
"
Barium swallow: This is often the first test done if someone is having a problem swallowing.
"For this test, you drink a liquid containing barium to coat the inner lining of the esophagus."
"A series of x-rays is then taken over the next few minutes.
"
"Upper GI series: This test is similar to the barium swallow, except that x-rays are taken after the barium has had time to coat the stomach and the first part of the small intestine."
"To look for problems in the rest of the small intestine, more x-rays can be taken over the next few hours as the barium passes through."
"This is called a small bowel follow-through .
"
"Enteroclysis: A thin tube is passed through your mouth or nose, down your esophagus, and through your stomach into the start of the small intestine."
"Barium is sent through the tube, along with a substance that creates more air in the intestines, causing them to expand."
Then x-rays are taken of the intestines.
"This test can give better images of the small intestine than a small bowel follow-through, but it is also more uncomfortable.
"
Barium enema: This test (also known as a lower GI series ) is used to look at the inner surface of the large intestine (colon and rectum).
"For this test, the barium solution is given through a small, flexible tube inserted in the anus while you are lying on the x-ray table."
"Often, air is blown in through the tube as well to help push the barium toward the wall of the colon and better coat the inner surface."
This is called an air-contrast barium enema or double-contrast barium enema .
"You may be asked to change positions to help spread the barium, as well as to get different views of the colon."
Then one or more sets of x-rays are taken.
"
For a PET scan , you are injected with a slightly radioactive form of sugar, which collects mainly in cancer cells."
A special camera is then used to create a picture of areas of radioactivity in the body.
"The picture is not detailed like a CT or MRI scan, but a PET scan can look for possible cancer spread in all areas of the body at once.
"
Many centers now have machines that can do both a PET and CT scan at the same time (PET/CT scan).
"This lets the doctor see areas that “light up” on the PET scan in more detail.
"
"PET scans can be useful for looking at GISTs, especially if the results of CT or MRI scans aren’t clear."
"This test can also be used to look for possible areas where cancer might have spread to help determine if surgery is an option.
"
"PET scans can also be helpful in finding out if a drug treatment is working, as they can often give an answer quicker than CT or MRI scans."
The scan is usually done several weeks after starting the drug.
"If the drug is working, the tumor will stop taking up the radioactive sugar."
"If the tumor still takes up the sugar, your doctor may decide to change your drug treatment."
"
For an endoscopy , the doctor puts an endoscope (a flexible lighted tube with a tiny video camera on the end) into the body to see the inner lining of the gastrointestinal (GI) tract."
"If abnormal areas are found, small pieces can be biopsied (removed) through the endoscope."
"The biopsy samples will be looked at under the microscope to find out if they contain cancer and if so, what kind of cancer it is.
"
GISTs are often below the surface (mucosa) of the inner lining of the GI tract.
"This can make them harder to see with endoscopy than more common GI tract tumors, which typically start in the mucosa."
The doctor may see only a bulge under the normally smooth surface if a GIST is present.
GISTs that are below the mucosa are also harder to biopsy through the endoscope.
"This is one reason that many GISTs are not diagnosed before surgery.
"
"If the tumor has broken through the inner lining of the GI tract and is easy to see on endoscopy, there is a greater chance that the GIST might spread to other parts of the body."
"
For this procedure, an endoscope is passed through the mouth and down the throat to look at the inner lining of the esophagus, stomach, and first part of the small intestine."
"Biopsy samples may be taken from any abnormal areas.
"
"Upper endoscopy can be done in a hospital, in an outpatient surgery center, or in a doctor’s office."
You are typically given medicine through an intravenous (IV) line to make you sleepy before the exam.
"The exam itself usually takes 10 to 20 minutes, but it might take longer if a tumor is seen or if biopsy samples are taken."
"If medicine is given to make you sleepy, you will likely need someone you know to drive you home (not just a cab or rideshare service).
"
This test is also known as an EGD (short for esophagogastroduodenoscopy).
"
For colonoscopy , a type of endoscope known as a colonoscope is inserted through the anus and up into the colon."
"This lets the doctor look at the inner lining of the rectum and colon and to take biopsy samples from any abnormal areas.
"
"To get a good look at the inside of the colon, it must be cleaned out before the test."
Your doctor will give you specific instructions.
You might need to follow a special diet for a day or more before the test.
"You might also have to drink a large amount of a liquid laxative the evening before, which means you will spend a lot of time in the bathroom.
"
"A colonoscopy can be done in a hospital, in an outpatient surgery center, or in a doctor’s office."
You will likely be given intravenous (IV) medicine to make you feel relaxed and sleepy during the procedure.
"Less often, you might be given general anesthesia to put you into a deep sleep."
"The exam typically takes 15 to 30 minutes, but it can take longer if a tumor is seen and/or a biopsy taken."
"Because medicine is given to make you sleepy, you will likely need someone you know to drive you home (not just a cab or rideshare service)."
"
Neither upper endoscopy nor colonoscopy can reach all areas of the small intestine."
"Capsule endoscopy is one way to look at the small intestine.
"
This procedure does not actually use an endoscope.
"Instead, you swallow a capsule (about the size of a large vitamin pill) that contains a light source and a very small camera."
"Like any other pill, the capsule goes through the stomach and into the small intestine."
"As it travels through the intestine (usually over about 8 hours), it takes thousands of pictures."
These images are transmitted electronically to a device worn around your waist.
"The pictures can then be downloaded onto a computer, where the doctor can view them as a video."
"The capsule passes out of the body during a normal bowel movement and is discarded.
"
This test requires no sedation – you can just continue normal daily activities as the capsule travels through the GI tract.
"This technique is still fairly new, and the best ways to use it are still being studied."
One disadvantage is that any abnormal areas seen can’t be biopsied during the test.
"
"
This is another way to look at the small intestine.
The small intestine is too long and has too many curves to be examined well with regular endoscopy.
"But this method gets around these problems by using a special endoscope that is made of 2 tubes, one inside the other.
"
"You are given intravenous (IV) medicine to help you relax, or even general anesthesia (so that you are asleep)."
"The endoscope is then inserted either through the mouth or the anus, depending on if there is a specific part of the small intestine to be examined.
"
"Once inside the small intestine, the inner tube, which has the camera on the end, is advanced forward about a foot as the doctor looks at the lining of the intestine."
Then a balloon on the end of the endoscope is inflated to anchor it.
The outer tube is then pushed forward to near the end of the inner tube and is anchored in place with a second balloon.
The first balloon is deflated and the endoscope is advanced again.
"This process is repeated over and over, letting the doctor see the intestine a foot at a time."
"The test can take hours to complete.
"
This test may be done along with capsule endoscopy.
The main advantage of this test over capsule endoscopy is that the doctor can take a biopsy if something abnormal is seen.
"Like other forms of endoscopy, because you are given medicine to make you sleepy for the procedure, someone you know will likely need to drive you home (not just a cab or rideshare service)."
"
"
This is a type of imaging test that uses an endoscope.
Ultrasound uses sound waves to take pictures of parts of the body.
"For most ultrasound exams, a wand-like probe (called a transducer ) is placed on the skin."
"The probe gives off sound waves and detects the pattern of echoes that come back.
"
"For an EUS, the ultrasound probe is on the tip of an endoscope."
This allows the probe to be placed very close to (or on top of) a tumor in the wall of the GI tract.
"Like a regular ultrasound, the probe gives off sound waves and then detects the echoes that bounce back."
"A computer then translates the echoes into an image of the area being looked at.
"
EUS can be used to find the precise location of the GIST and to determine its size.
It is useful in finding out how deeply a tumor has grown into the wall of the GI tract (or beyond it and into a nearby organ).
The test can also help show if the tumor has spread to nearby lymph nodes.
It can also be used to help guide a needle biopsy (see below).You are typically given medicine before this procedure to make you sleepy.
"(Less often, you might be given general anesthesia to put you into a deep sleep.)"
"Because of this, you will probably need to have someone you know drive you home (not just a cab or rideshare service)."
"
Even if something abnormal is seen on an imaging test such as a barium x-ray or CT scan, these tests often can't tell for sure if the abnormal area is a GIST, some other type of tumor (benign or cancer), or some other condition (like an infection)."
The only way to know what it is for sure is to remove cells from the area.
This procedure is called a biopsy.
"The cells are then sent to a lab, where a doctor called a pathologist looks at them under a microscope and might do other tests on them.
"
Not everyone who has a tumor that might be a GIST needs a biopsy before treatment. 
"If the doctor suspects a tumor is a GIST, a biopsy is usually done only if it will help determine treatment options."
GISTs are often fragile tumors that tend to break apart and bleed easily.
"Any biopsy must be done very carefully, because of the risk that the biopsy might cause bleeding or possibly increase the risk of cancer spreading.
"
There are several ways to biopsy a GI tract tumor.
"
Biopsy samples can be obtained through an endoscope."
"When a tumor is found, the doctor can insert biopsy forceps (pincers or tongs) through the tube to take a small sample of the tumor.
"
"Even though the sample will be very small, doctors can often make an accurate diagnosis."
"However, with GISTs, sometimes the biopsy forceps can’t go deep enough to reach the tumor because it's underneath the inner lining of the stomach or intestine.
"
"Bleeding from a GIST after a biopsy is rare, but it can be a serious problem."
"If this occurs, doctors can sometimes inject drugs into the tumor through an endoscope to constrict blood vessels and stop the bleeding."
"
A biopsy can also be done using a thin, hollow needle to remove small samples of the area."
The most common way to do this is during an endoscopic ultrasound (described above).
The doctor uses the ultrasound image to guide a needle on the tip of the endoscope into the tumor.
"This is known as an endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) .
"
"Less often, the doctor may place a needle through the skin and into the tumor while guided by an imaging test such as a CT scan."
This is known as a percutaneous biopsy .
"
If a sample can’t be obtained from an endoscopic or needle biopsy, or if the result of a biopsy wouldn’t affect treatment options, the doctor might recommend waiting until surgery to remove the tumor to get a sample of it.
"
"If the surgery is done through a large cut (incision) in the abdomen, it is called a laparotomy ."
"Sometimes the tumor can be sampled (or small tumors can be removed) using a thin, lighted tube called a laparoscope, which lets the surgeon see inside the belly through a small incision."
"The surgeon can then sample (or remove) the tumor using long, thin surgical tools that are passed through other small incisions in the abdomen."
This is known as laparoscopic or keyhole surgery .
"
Once tumor samples are obtained, a pathologist might be able to tell that a tumor is most likely a GIST just by looking at the cells with a microscope."
"But sometimes further lab tests might be needed to be sure.
"
Immunohistochemistry:
"For this test, a part of the sample is treated with man-made antibodies that will attach only to a certain protein in the cells."
"The antibodies cause color changes if the protein is present, which can be seen under a microscope.
"
"If GIST is suspected, some of the proteins most often tested for are KIT (also known as CD117) and DOG1.  "
"Most GIST cells have these proteins, but cells of most other types of cancer do not, so tests for these proteins can help tell whether a GI tumor is a GIST or not."
"Other proteins, such as CD34, might be tested for as well.
"
"Molecular genetic testing: Testing might also be done to look for mutations in the KIT or PDGFRA genes, as most GIST cells have mutations in one or the other."
"Testing for mutations in these genes can also help tell if certain targeted therapy drugs are likely to be helpful in treating the cancer.
"
"Less often, tests might be done to look for changes in other genes, such as the SDH genes.
"
"Mitotic rate: If a GIST is diagnosed, the doctor will also look at the cancer cells in the sample to see how many of them are actively dividing into new cells."
This is known as the mitotic rate (or mitotic index) .
"A low mitotic rate means the cancer cells are growing and dividing slowly, while a high rate means they are growing quickly."
The mitotic rate is an important part of determining the stage of the cancer.
(See Gastrointestinal Stromal Tumor Stages. )
"
Your doctor may order some blood tests if they think you may have a GIST.
"
There are no blood tests that can tell for sure if a person has a GIST.
But blood tests can sometimes point to a possible tumor (or to its spread).
"For example:
>A
   complete blood count (CBC)
   can show if you have a low red blood cell count (that is, if you are anemic)."
"Some people with GISTs may become
   anemic
   because of bleeding from the tumor.
"
">Abnormal
   liver function tests
   may mean that the GIST has spread to your liver.
"
"Blood tests are also done to check your overall health before you have surgery or while you get other treatments such as targeted therapy .
"
"

Most gastrointestinal stromal tumors (GISTs) develop  within the wall of the stomach or small intestine."
"These tumors often grow into the empty space inside the gastrointestinal (GI) tract, so they might not cause symptoms right away unless they are in a certain location or reach a certain size.
"
Small tumors might not cause any symptoms and can be found accidentally when the doctor is checking out some other problem.
These small tumors often grow slowly.
"
GISTs tend to be fragile tumors that can bleed easily."
"In fact, they are often found because they cause bleeding into the GI tract ."
"Signs and symptoms of this bleeding depend on how fast it occurs and where the tumor is located.
"
">Brisk bleeding into the esophagus or stomach might cause the person to
   throw up blood
   ."
"When the blood is thrown up it may be partially digested, so it might look like coffee grounds.
"
">Brisk bleeding into the stomach or small intestine can make
   bowel movements (stools) black and tarry
   .
"
">Brisk bleeding into the large intestine is likely to
   turn the stool red with visible blood
   .
"
>
"If the bleeding is slow, it often doesn’t cause the person to throw up blood or have a change in their stool."
"Over time, though, slow bleeding can lead to a low red blood cell count (
   anemia
   ), which can make a person feel
   tired and weak
   .
"
Bleeding from the GI tract can be very serious.
"If you have any of these signs or symptoms, see a doctor right away."
"
Other symptoms of GISTs can include:
>Abdominal (belly) pain
>A mass or swelling in the abdomen
>Nausea and vomiting
>Feeling full after eating only a small amount of food
>Loss of appetite
>Weight loss
>Problems swallowing (for tumors in the esophagus)
"
Some tumors grow large enough to block the passage of food through the stomach or intestine.
"This is called an obstruction , and it can cause severe abdominal pain and vomiting.
"
"Because GISTs are often fragile, they can sometimes rupture, which can lead to a hole ( perforation ) in the wall of the GI tract."
This can also result in severe abdominal pain.
"Emergency surgery might be needed in these situations.
"
"Although many of the possible symptoms of GISTs (like belly pain and nausea) can be caused by things other than cancer, if you have these symptoms, especially if they last for more than a few days, it's important to see a doctor.
"
"

After someone is diagnosed with cancer, doctors will try to figure out if it has spread, and if so, how far."
"This process, called staging , is based on the results of physical exams and other tests, which are described in Tests for Gastrointestinal Stromal Tumors .
"
The stage of a cancer describes how much cancer is in the body.
It helps determine how serious the cancer is and how best to treat it.
"Doctors also use a cancer's stage when talking about survival statistics .
"
The stages for gastrointestinal stromal tumors (GIST) range from I (1) through IV (4).
"As a rule, the lower the number, the less the cancer has spread."
"A higher number, such as stage IV, means cancer has spread more."
"And within a stage, an earlier letter means a lower stage."
"Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way."
"
The staging system most often used for GIST tumors is the American Joint Committee on Cancer (AJCC) TNM system; the most recent version is effective as of 2018."
"This staging system is based on 4 key pieces of information:
>The extent of the main (primary)
   tumor (T):
   How large is the cancer?
"
">The spread to nearby lymph
   nodes
   (N):
   Has the cancer spread to nearby lymph nodes?"
"(This is uncommon in GISTs.)
"
">The spread (
   metastasis
   ) to distant sites
   (M):
   Has the cancer spread to distant parts of the body?"
"(The most common sites of spread are the liver, bones, lungs, and the tissue layers lining the inside of the abdomen.)
"
">The
   mitotic rate:
   "
"This is a
   lab test
   measurement of how fast the cancer cells are growing and dividing."
It is described as either low or high.
"A low mitotic rate predicts a better outcome.
"
"Numbers or letters after T, N, and M provide more details about each of these factors."
Higher numbers mean the cancer is more advanced.
"Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage."
"Although the T, N, and M categories are the same for all GISTs, there are 2 different stage grouping schemes, depending on where the cancer starts:
>The stomach or the omentum (an apron-like layer of fatty tissue that hangs over the organs in the abdomen)
"
">The small intestine, esophagus, colon, rectum, or peritoneum (a layer of tissue that lines the organs and walls of the abdomen.)
"
"This is because GISTs that start in the stomach or omentum are typically less likely to grow and spread to other parts of the body than GISTs starting in other locations.

"
"Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand."
"
AJCC stage
TNM
Mitotic rate
Stage description*
(2 cm = almost 1 inch; 5 cm = about 2 inches; 10 cm = about 4 inches)
IA
T1 or T2
N0
M0
Low
"
"The tumor is:
>No more than 2 cm across (T1)
       OR
>Larger than 2 cm but not more than 5 cm across (T2).
"
The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"The mitotic rate is low.
"
"IB
T3
N0
M0
Low
"
"The tumor is larger than 5 cm but not more than 10 cm across (T3).
"
The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"The mitotic rate is low.

"
"II
T1
N0
M0
High
"
"The tumor is no more than 2 cm across (T1).
"
The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"The mitotic rate is high.
"
"OR
T2
N0
M0
High
"
"The tumor is larger than 2 cm, but not more than 5 cm across (T2).
"
The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"The mitotic rate is high.
"
"OR
T4
N0
M0
Low
"
"The tumor is larger than 10 cm across (T4).
"
The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"The mitotic rate is low.
"
"IIIA

T3
N0
M0
High
"
"The tumor is larger than 5 cm but not more than 10 cm across (T3).
"
The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"The mitotic rate is high.
"
"IIIB
T4
N0
M0
High
"
"The tumor is larger than 10 cm across (T4).
"
The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"The mitotic rate is high.
"
"IV
Any T
N1
M0
Any rate
The tumor is any size (Any T) AND it has spread to nearby lymph nodes (N1).
"
The cancer has not spread to distant sites (M0).
"The mitotic rate can be low or high.
"
"OR
Any T
Any N
M1
"
"Any rate
The tumor is any size (Any T) AND it might or might not have spread to nearby lymph nodes (Any N).
"
The cancer has spread to distant parts of the body (M1).
"The mitotic rate can be low or high.
"
"*The following additional categories are not listed in the table above:
>TX:
   Main (primary) tumor cannot be assessed due to lack of information.
"
">T0:
   "
"No evidence of a main (primary) tumor.
"
">NX:
   Regional lymph nodes cannot be assessed due to lack of information."
"
AJCC s tage
TNM
Mitotic rate
Stage description*
(2 cm = almost 1 inch; 5 cm = about 2 inches; 10 cm = about 4 inches)
"
"I
T1 or T2
N0
M0
Low
"
"The tumor is:
>No more than 2 cm across (T1)
       OR
>Larger than 2 cm but not more than 5 cm across (T2).
"
The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"The mitotic rate is low.

"
"II
T3
N0
M0
Low
"
"The tumor is larger than 5 cm but not more than 10 cm across (T3).
"
The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"The mitotic rate is low.
"
"IIIA
T1
N0
M0
High
"
"The tumor is no more than 2 cm across (T1).
"
The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"The mitotic rate is high.
"
"OR
T4
N0
M0
Low
"
"The tumor is larger than 10 cm across (T4).
"
The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"The mitotic rate is low.
"
"IIIB
T2
N0
M0
High
"
"The tumor is larger than 2 cm but not more than 5 cm across (T2).
"
The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"The mitotic rate is high.
"
"OR
T3
N0
M0
High
"
"The tumor is larger than 5 cm but not more than 10 cm across (T3).
"
The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"The mitotic rate is high.
"
"OR
T4
N0
M0
High
"
"The tumor is larger than 10 cm across (T4).
"
The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"The mitotic rate is high.
"
"IV
Any T
N1
M0
Any rate
The tumor is any size (Any T) AND it has spread to nearby lymph nodes (N1).
"
The cancer has not spread to distant sites (M0).
"The mitotic rate can be low or high.
"
"OR
Any T
Any N
M1
"
"Any rate
The tumor is any size (Any T) AND it might or might not have spread to nearby lymph nodes (Any N).
"
The cancer has spread to distant parts of the body (M1).
"The mitotic rate can be low or high.
"
"*The following additional categories are not listed in the table above:
>TX:
   Main (primary) tumor cannot be assessed due to lack of information.
"
">T0:
   "
"No evidence of a main (primary) tumor.
"
">NX:
   Regional lymph nodes cannot be assessed due to lack of information.
"
The TNM staging system is not meant to be used for GISTs in children (pediatric GIST) or GISTS that are the result of inherited genetic syndromes .
"
The AJCC staging system gives a detailed summary of how far a GIST has spread."
"But for treatment purposes, doctors are often more concerned about whether the tumor can be removed (resected) completely with surgery .
"
"Whether or not a tumor is resectable depends on its size and location, if it has spread to other parts of the body, and if a person is healthy enough for surgery:
>Tumors that can clearly be removed without causing major health problems are defined as
   resectable
   .
"
">Tumors that can’t be removed completely (because they have spread or for other reasons) are described as
   unresectable
   .
>"
"In some cases, doctors may describe a tumor as
   marginally resectable
   or
   borderline resectable
   if it’s not clear if it can be removed completely.
"
"If a tumor is considered unresectable or marginally resectable when it is first found, treatments such as targeted therapy may be used first to try to shrink the tumor enough to make it resectable."
"
Along with the stage and resectability of the cancer, other factors can also affect treatment options and outlook (prognosis).
"
"For example, some GISTs are much more likely to grow and spread than others."
Doctors are looking at ways to determine which tumors are potentially more dangerous (and therefore might need more aggressive treatment).
Prediction tools have been developed to help with this.
"Doctors and patients can now get a reasonable idea of how likely a GIST is to grow and spread to other parts of the body, or to return (recur) after surgery, based on factors such as:
>Where the tumor starts
>"
"The size of the tumor
>The mitotic rate
>Whether or not the tumor has ruptured
Doctors are also looking at how mutations in the KIT or PDGFR2A genes , which often drive the growth of GIST cells, might affect how well the cancer responds to treatment with targeted therapy drugs ."
"Testing for these mutations is now becoming more common.
"
"

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed."
"They can’t tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
"
"Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they can’t predict what will happen in any particular person’s case."
These statistics can be confusing and may lead you to have more questions.
Ask your doctor how these numbers might apply to you.
"
A relative survival rate compares people with the same type and stage of gastrointestinal stromal tumor (GIST) to people in the overall population."
"For example, if the 5-year relative survival rate for a specific stage of GIST is 90%, it means that people who have that cancer are, on average, about 90% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed."
"
The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results (SEER) database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer.
"
"The SEER database tracks 5-year relative survival rates for GIST in the United States, based on how far the cancer has spread."
"The SEER database, however, does not group cancers by AJCC TNM stages (stage 1, stage 2, stage 3, etc.)."
"Instead, it groups cancers into localized, regional, and distant stages:
>Localized:
   The cancer is limited to the organ where it started (for example, the small intestine, esophagus, or stomach).
"
">Regional:
   "
"The cancer has grown into nearby structures or spread to nearby lymph nodes.
"
">Distant:
   "
The cancer has spread to distant parts of the body such as the liver.
"
These numbers are based on people diagnosed with GIST [small intestine, esophagus, colon, rectum, peritoneum, stomach, omentum] between 2012 and 2018.
"
SEER*
"Stage
5-Year Relative Survival Rate
Localized
95%
Regional
84%
Distant
52%
All SEER stages combined
85%
*SEER= Surveillance, Epidemiology, and End Results"
"
>These numbers apply only to the stage of the cancer when it is first diagnosed.
   "
"They do not apply later on if the cancer grows, spreads, or comes back after treatment.
"
">These numbers don’t take everything into account.
   "
"Survival rates are grouped based on how far the cancer has spread, but
   other factors
   , such as your age and overall health, whether the cancer can be resected (removed), and how well the cancer responds to treatment, can also affect your outlook.
"
">People now being diagnosed with GIST may have a better outlook than these numbers show.
   "
"Treatments have improved over time, and these numbers are based on people who were diagnosed and treated at least five years earlier.
"
"

It’s important to have honest, open discussions with your cancer care team."
"You should feel free to ask any question, no matter how small it might seem."
Some questions to consider:
"
>How sure are you that my tumor is a GIST?
>Where is my tumor located?"
"How big is it?
>How likely is this tumor to grow or spread quickly?
>Has my tumor spread beyond where it started?
"
>
"What is my cancer's
   stage
   , and what does that mean?
"
">Will I need any other
   tests
   before we can decide on treatment?
>Will I need to see any other doctors?
>"
"If I'm concerned about costs and insurance coverage for my diagnosis and treatment, who can help me?"
"
>How much experience do you have treating these tumors?
>"
"What are my
   treatment options
   ?
>"
What do you recommend?
"Why?
>What’s the goal of the treatment?
>Should I get a
   second opinion
   ?"
"If so, how do I do that?"
"Can you recommend a doctor or cancer center?
>"
"What are the chances my cancer can be cured?
>How quickly do we need to decide on treatment?
"
">What should I do to be ready for treatment?
>How long will treatment last?"
What will it be like?
"Where will it be done?
>What risks or side effects I should expect?"
"How long are they likely to last?
>Will treatment affect my daily activities?
>How likely is it that the cancer will come back after treatment?"
Is there anything I can do to lower this risk?
"
Once treatment begins, you’ll need to know what to expect and what to look for."
"Not all of these questions may apply to you, but getting answers to the ones that do may be helpful.
"
">How will we know if the treatment is working?
>Is there anything I can do to help manage
   side effects
   ?
>"
"What symptoms or side effects should I tell you about right away?
>How can I reach you or someone on your team on nights, holidays, or weekends?
"
">Do I need to change what I eat or my level of physical activity?
>Are there any limits on what I can do?
>Do you know of any local or online support groups where I can talk to others who have been through this?
>"
"Can you suggest a
   mental health professional
   I can see if I start to feel overwhelmed, depressed, or distressed?"
"
>Are there any limits on what I can do?
>"
"What symptoms should I watch for?
"
">Should I be exercising or following a special diet?
>"
What are the chances of my cancer coming back?
"Is there anything I can do to help lower my risk?
>What type of
   follow-up
   will I need after treatment?
"
How will we know if the cancer has come back?
"What should I watch for?
"
"What will my options be if the cancer comes back?
"
"Along with these sample questions, be sure to write down some of your own."
"For instance, you might want more information about clinical trials for which you may qualify.
"
Keep in mind that doctors aren’t the only ones who can give you information.
"Other health care professionals, such as nurses and social workers, can answer some of your questions."
"To find more about speaking with your health care team, see The Doctor-Patient Relationship .
"
"
"
"
Cancer can start any place in the body."
"A GIST (pronounced “jist”) is an uncommon type of cancer that starts in the digestive tract, also known as the gastrointestinal (GI) tract."
This is the path inside our body that food passes through.
"Most GISTs start in the stomach or small intestine, but they can also start in the esophagus (the tube that connects the throat to the stomach), colon, rectum, or other places.


"
"GISTs are not the same as more common types of cancer that start in the GI tract, such as colon cancer and stomach cancer ."
"GISTs are not treated the same way as these cancers.
"
GISTs start when certain cells that help move food through the GI tract begin to grow out of control.
"They can crowd out normal cells, which makes it hard for the body to work the way it should.
"
GIST cells can sometimes spread to other parts of the body.
"For instance, GIST cells in the stomach might travel to the liver and grow there."
"When cancer cells do this, it’s called metastasis ."
"To doctors, the cancer cells in the new place look just like the ones from the stomach.
"
Cancer is always named based on the place where it starts.
"So when a GIST spreads to the liver (or any other place), it’s still called a GIST."
It’s not called liver cancer unless it starts from cells in the liver.
"
Not all GISTs are the same."
Some are likely to grow and spread slowly.
Others are more likely to grow and spread quickly.
Your doctor has ways to help tell what’s most likely to happen with your tumor.
"
>Why do you think I have cancer?
>Is there a chance I don’t have cancer?
"
">Would you please write down the kind of cancer you think I might have?
"
">Where is the cancer?
>What will happen next?"
"
Many GISTs don’t cause symptoms right away."
"Sometimes they are found when a person has an exam or test done for another problem.
"
"If a GIST does cause symptoms , they might include throwing up blood, or having bloody or dark colored stools."
"They might also cause belly pain, loss of appetite, or weight loss."
Some people with GISTs feel tired because they’ve lost blood from the tumor into their stool.
Your doctor will ask questions about your symptoms and do a physical exam.
"
If your doctor thinks you might have a GIST (or some other type of GI tumor), more tests will be done ."
"Here are some of the tests you might need:
CT or CAT scan: This test uses x-rays to make detailed pictures of the inside of your body."
"CT scans can often show the size, shape, and place of tumors in the GI tract."
"This test may also be done to see if cancer has spread.
"
MRI scan: MRIs use radio waves and strong magnets instead of x-rays to make very detailed pictures of the inside of your body.
"MRIs can make it easier to see the size and shape of the tumor.
"
Barium x-ray tests: Different types of x-ray tests can be used to look at the inside of your GI tract.
"For these tests, you either swallow a chalky liquid, or it is put in through your rectum."
The barium in the liquid outlines the inner lining of the GI tract on x-rays.
"These types of tests aren’t used as much as they were in the past.
"
"PET scan: In this test, you are given a special type of sugar that can be seen inside your body with a special camera."
"If there is cancer, this sugar shows up as “hot spots” where the cancer is found."
"This test can help show where a GIST has spread.
"
"Endoscopy: For these tests, the doctor puts a flexible lighted tube with a tiny video camera on the end into the body to see the inner lining of the GI tract."
"Depending on where the tumor is thought to be, the tube can be put down the throat (for an upper endoscopy ) or put into the rectum (for a colonoscopy )."
"If abnormal areas are seen, small samples can be taken out for a biopsy (see below).
"
Endoscopy can also be used to do a kind of ultrasound test called endoscopic ultrasound (EUS).
Ultrasound uses sound waves to make pictures of the inside of the body.
"For EUS, a small ultrasound probe is on the end of the scope, which allows it to get very close to a tumor."
This test can show how far a tumor has grown into the wall of the GI tract.
It can also help show if the tumor has reached nearby lymph nodes.
"
In a biopsy, the doctor takes out small pieces of an abnormal area to check for cancer cells."
"If cancer is found, lab tests will also be done to find out what type of cancer it is."
"But not everyone who has a tumor that might be a GIST needs to have a biopsy before treatment.
"
There are different ways to do a biopsy.
"It can be done during endoscopy or surgery, or sometimes using a thin, hollow needle to get biopsy samples."
The type used will depend on the size of the tumor and where it is in your body.
"Ask your doctor what kind you will need.
"
"If a GIST is found, tests can be done on the biopsy samples to help tell how quickly the tumor is likely to grow and spread."
This might affect your treatment.
"
>What tests will I need to have?
>"
"Who will do these tests?
>Where will they be done?
"
>
"Who can explain them to me?
>"
"How and when will I get the results?
>Who will explain the results to me?
>What do I need to do next?"
"
If you have a GIST, the doctor will want to find out if it has spread and if so, how far it has spread."
This is called staging the cancer .
"Your doctor will want to find out the stage to help decide what type of treatment is best for you.
"
The stage is based on how much the cancer has grown in the place where it started or spread to other parts of your body.
"It’s also based on where the tumor is in the GI tract, and how quickly it’s likely to grow and spread (based on lab tests of biopsy samples).
"
"Your cancer can be stage 1, 2, 3, or 4."
"The lower the number, the less the cancer has spread."
"A higher number, like stage 4, means a more serious cancer that has spread from where it first started."
"Ask the doctor about the cancer stage and what it means for you.
"
"When trying to decide on treatment, doctors often use a simpler system that divides GISTs into 2 main groups:
>Resectable tumors:
   those that can be removed safely with surgery
>Unresectable tumors:
   those that can’t be removed safely"
"
>Do you know the stage of the cancer?
>If not, how and when will you find out the stage of the cancer?
"
">Would you explain to me what my cancer's stage means?
"
">How does the stage of the cancer affect my treatment options?
>"
What will happen next?
"
Not all GISTs need to be treated right away."
Some small tumors that are likely to grow slowly can just be watched carefully.
"But if treatment is needed, surgery is usually the main treatment, if it can be done."
Targeted drugs are more likely to be used if the tumor has spread.
"Other types of treatment are used less often.
"
"The treatment plan that’s best for you will depend on:
>The stage of the tumor and where it is
>"
"If the tumor can be removed safely with surgery
>"
"The chances of the tumor coming back after treatment
>Your age and overall health
>Your feelings about the treatment and the side effects that can come with it"
"
Surgery is used to take out the tumor and a margin or edge of the healthy tissue around it."
"This is the main treatment for GISTs, if it can be done."
The type of surgery depends on where the tumor is.
Ask your doctor what kind of surgery you will need and what to expect.
"
Any type of surgery can have risks and side effects."
Ask the doctor what you can expect.
"If you have problems, let your doctors and nurses know."
They can help you with any problems that come up.
"
Targeted drugs attack some of the changes in cancer cells that help them grow."
These drugs affect mainly cancer cells and not normal cells in the body.
They are often the main treatment for GISTs if surgery is not an option.
"They can also be used before or after surgery for some tumors.
"
These drugs are pills that you take at home.
They tend to have different side effects from chemo drugs.
"
Side effects depend on which drug is used."
"Some of these drugs might cause stomach upset, loose stools, muscle pain, skin changes, and might make a person feel tired."
"Worse side effects are also possible.
"
There are ways to treat many of the side effects caused by targeted drugs.
"If you have side effects, talk to your cancer care team so they can help."
"
Chemotherapy , or chemo for short, is the use of certain types of drugs to fight cancer."
Chemo is given in cycles or rounds.
Each round of treatment is followed by a break.
The drugs are often given through a needle into a vein.
"These drugs go into the blood and spread through the body.
"
"Chemo is not often helpful in treating GISTs, so it is not used much."
"
Chemo can make you feel very tired, sick to your stomach, and can sometimes make your hair fall out."
"But these problems tend to go away after treatment ends.
"
There are ways to treat most chemo side effects.
"If you have side effects, talk to your cancer care team so they can help."
"
Radiation uses high-energy rays (like x-rays) to kill cancer cells."
"Radiation is not very helpful in treating GISTs, so it is not used often."
"But sometimes it can be used to relieve symptoms like bone pain.
"
Radiation for GISTs is aimed at the tumor from a machine outside the body.
This is called external beam radiation.
"
If your doctor suggests radiation treatment, ask what side effects might happen."
Side effects depend on the area being treated.
"Some common side effects of radiation are:
>Skin changes where the radiation is given
>Feeling tired
Most side effects get better after treatment ends."
Ask your cancer care team what you can expect during and after treatment.
"
Clinical trials are research studies that test new drugs or other treatments in people."
"They compare standard treatments with others that may be better.
"
"If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials."
"See Clinical Trials to learn more.
"
Clinical trials are one way to get the newest cancer treatment.
They are the best way for doctors to find better ways to treat cancer.
But they might not be for everyone.
"If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part."
"And if you do sign up for a clinical trial, you can always stop at any time."
"
"
"When you have a GIST, you might hear about other ways to treat it or to treat your symptoms."
These may not always be standard medical treatments.
"These treatments may be vitamins, herbs, diets, and other things ."
"You may wonder about these treatments.
"
"Some of these might help, but many have not been tested."
Some have been shown not to help.
A few have even been found to be harmful.
"Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else."
"
>Will I need to see other doctors?
>"
"What treatment do you think is best for me?
>What’s the goal of this treatment?"
"Do you think it could cure the cancer?
>Will treatment include surgery?"
"If so, who will do the surgery?
>What will the surgery be like?
"
">How will my body look and work after surgery?
"
">Will I need other types of treatment, too?
>"
"What will these treatments be like?
>"
"What’s the goal of these treatments?
>What side effects could I have from these treatments?
>What can I do about side effects that I might have?
"
">Is there a clinical trial that might be right for me?
>"
What about vitamins or diets that friends tell me about?
"How will I know if they are safe?
>How soon do I need to start treatment?
"
">What should I do to be ready for treatment?
"
">Is there anything I can do to help the treatment work better?
>"
What’s the next step?
"
You’ll be glad when treatment is over."
But it’s hard not to worry about cancer coming back .
"Even when cancer never comes back, people still worry about it."
"For years after treatment ends , you will see your cancer doctor."
"At first, your visits may be every few months."
"Then, the longer you’re cancer-free, the less often the visits are needed.
"
Be sure to go to all of your follow-up visits.
"Your doctors will ask about your symptoms, examine you, and may order tests to see if the cancer has come back.
"
"Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways."
You might be thinking about how to improve your health.
"Call us at 1-800-227-2345 or talk to your doctor to find out what you can do to feel better.
"
You can’t change the fact that you have had cancer.
"What you can change is how you live the rest of your life – making healthy choices and feeling as good as you can.
"
"

If a gastrointestinal stromal tumor (GIST) has spread to the liver, treatments such as ablation and embolization might be used, especially if surgery can't be done to remove the tumors."
"
Ablation is the destruction of tumors using extreme heat or cold, or using chemicals."
It can sometimes be used to destroy GISTs that have spread as no more than a few small tumors in the liver.
"Because ablation often destroys some of the normal tissue around the tumor, it might not be a good choice for treating tumors near important structures like major blood vessels, the diaphragm (the thin breathing muscle above the liver), or major ducts in the liver.
"
"There are several types of ablation:
>Radiofrequency ablation (RFA)
   , which uses high-energy radio waves to heat the tumor and destroy cancer cells
>Ethanol (alcohol) ablation
   , where concentrated alcohol is injected directly into the tumor to kill cancer cells
>Microwave thermotherapy
   , where microwaves transmitted through a probe placed in the tumor are used to heat and destroy the cancer cells
>Cryosurgery (cryotherapy)
   , which destroys a tumor by freezing it using a thin metal probe."
This method sometimes requires general anesthesia (you are in a deep sleep and not able to feel pain)
"
Usually, you don't need to stay overnight in the hospital for this type of treatment."
Ablation can often can be done without surgery by inserting a needle or probe into the tumor through the skin.
The needle or probe is guided into place with ultrasound or CT scanning.
This might be done with general anesthesia (you are in a deep sleep) or with conscious sedation (you are awake but sleepy and should not feel any pain).
"Sometimes, though, to be sure the treatment is aimed at the right place, it is done during surgery."
"
Possible side effects after ablation therapy include abdominal (belly) pain, infection in the liver, and bleeding into the chest cavity or abdomen."
"Serious complications are uncommon, but they can happen."
"
Embolization is a procedure in which the doctor injects substances to try to block or reduce the blood flow to cancer cells in the liver.
"
The liver is unusual in that it has 2 blood supplies.
"Most normal liver cells are fed by branches of the portal vein, whereas cancer cells in the liver are usually fed by branches of the hepatic artery."
"Blocking the branch of the hepatic artery feeding the tumor helps kill off the cancer cells, but it leaves most of the healthy liver cells unharmed because they get their blood supply from the portal vein.
"
"Embolization does reduce some of the blood supply to the normal liver tissue, so it might not be a good option for some patients whose liver has already been damaged by diseases such as hepatitis or cirrhosis."
"
The main type of embolization used to treat GISTs that have spread to the liver is arterial embolization (also known as trans-arterial embolization or TAE )."
"In this procedure, a catheter (a thin, flexible tube) is put into an artery through a small cut in the inner thigh and threaded up into the hepatic artery in the liver."
"A dye is usually injected into the bloodstream at this time to help the doctor see the path of the catheter via angiography, a special type of x-ray."
"Once the catheter is in place, small particles are injected into the artery to plug it up.
"
"Embolization can also be done by injecting tiny radioactive spheres into the hepatic artery ( radioembolization ), or by giving chemo directly into the artery just before plugging it up ( chemoembolization )."
"But it’s not clear that either of these techniques is better than TAE.
"
This procedure might be done with general anesthesia (where you are in a deep sleep) or with conscious sedation (where you are awake but sleepy and should not feel any pain).
"Typically, you won't have to stay overnight in the hospital for an embolization procedure."
"
Possible complications after embolization include abdominal (belly) pain, fever, nausea, infection in the liver, gallbladder inflammation, and blood clots in the main blood vessels of the liver."
"Because healthy liver tissue can be affected, there is a risk that liver function will get worse after treatment."
This risk is higher if a large branch of the hepatic artery is embolized.
"Serious complications are not common, but they are possible.
"
"

Treatment for gastrointestinal stromal tumors (GISTs) depends mainly on factors such as:
>If the tumor can be
   resected
   (removed) with surgery, which is based on the size of the tumor, where it is, and how far it has spread
>How quickly the tumor is growing (its
   mitotic rate
   )
>"
"If the tumor cells have certain
   gene mutations
>The risk of the tumor coming back after treatment
Other factors, such as a person’s age and overall health, can be important as well."
"
Most small GISTs need to be treated."
But some very small tumors (less than 2 centimeters across) that are not causing any symptoms might never grow enough to cause any problems.
"One option for such a tumor might be to just watch it carefully, checking it with endoscopy at regular intervals, such as once or twice a year."
"As long as it is not growing, you might not need further treatment.
"
Surgery is the main treatment for most other small tumors.
"The need for further treatment after surgery depends on the risk of the GIST coming back.
"
"Tumors that are small and are not growing quickly typically have a low risk of coming back, so often no further treatment is needed.
"
"The risk of a GIST coming back after surgery is higher if:
>"
"The tumor is larger
>It did not start in the stomach
>"
"The cancer cells are dividing quickly (have a high mitotic rate)
"
"If the doctor thinks that the cancer has an intermediate or high risk of coming back based on these factors, adjuvant treatment with the targeted drug imatinib (Gleevec) is typically recommended for at least a year after surgery."
"For tumors that are highly likely to come back, many doctors now recommend at least 3 years of imatinib.
"
The doctor will likely test the tumor cells for certain changes in the KIT and PDGFRA genes before prescribing imatinib.
This is because imatinib isn’t likely to be helpful for tumors that don’t have one of these gene changes​.
"
Tumors that are larger or in places that make them harder to remove (resect) completely might require more extensive surgery , which could cause health problems both in the short term and later on."
"Because of this, surgery is not typically the first treatment.
"
Treatment with the targeted drug imatinib (Gleevec) is usually done first to try to shrink the tumor.
"But before starting treatment, it’s important to be sure that the tumor is in fact a GIST, so a biopsy is needed."
"As part of the testing of the biopsy sample, the tumor cells are typically checked for certain changes in the KIT and PDGFRA genes."
This is because imatinib isn’t likely to be helpful for tumors that don’t have one of these gene changes.
"If imatinib is given, it is continued at least until the tumor stops shrinking.
"
"If the tumor shrinks enough, surgery might be done if the doctor thinks it can be removed safely."
"Imatinib will likely be continued after surgery to help lower the chance that the cancer will come back.
"
"If the tumor doesn’t shrink enough to make surgery possible, imatinib is often continued for as long as it seems to help."
"If it's no longer working, sometimes upping the dose can be helpful."
"If not, or if the side effects are too severe, another targeted drug, sunitinib (Sutent), may be tried instead."
"If sunitinib is no longer working, regorafenib (Stivarga) may help some people."
"If this drug is no longer working, ripretinib (Qinlock) may be helpful."
"
Treatment options for unresectable GISTs depend on why they are unresectable and, if they have spread, how extensive the spread is.
"
"Surgery is not typically the first treatment for these tumors, so before starting treatment, it’s important to confirm that the tumor is in fact a GIST with a biopsy .
"
The targeted drug imatinib (Gleevec) is typically the preferred first treatment for most advanced GISTs.
(The targeted drug avapritinib (Ayvakit) might be used instead if the cancer cells have certain changes in the PDGFRA gene.)
"As part of the testing of the biopsy sample, the tumor cells might be checked for certain changes in the KIT and PDGFRA genes."
"This can give an idea of how likely it is that imatinib (or avapritinib) will be helpful.
"
"If imatinib is used, it is continued for as long as the tumor doesn’t grow (and the side effects are tolerable)."
"If the tumor starts to grow again, it may respond to increasing the dose of imatinib."
"If not, or if the side effects from imatinib are too severe, a switch to sunitinib (Sutent) may be helpful."
"If sunitinib is no longer working, regorafenib (Stivarga) may help some people."
"If regorafenib is no longer helpful, ripretinib (Qinlock) may be an option.
"
"If the tumor shrinks enough with targeted therapy, surgery may then be an option for some people."
"This might be followed by more targeted therapy if it is still effective.
"
"If the cancer has spread to only 1 or 2 sites in the abdomen (such as the liver), the doctor may advise removing the main tumor and trying to remove these other tumors as well."
"If this is the case, be sure to talk with your doctor about what the goals of treatment are (whether it is to try to cure the cancer, to help you live longer, or to prevent or reduce symptoms), as well as its possible benefits and risks.
"
"Other options to treat cancers that have spread to the liver include ablation and embolization to try to destroy these tumors.
"
Cancers that are no longer responding to the targeted drugs discussed above can be hard to treat.
"Some doctors may recommend trying other targeted drugs, such as sorafenib (Nexavar), dasatinib (Sprycel), nilotinib (Tasigna), or pazopanib (Votrient), although it’s not yet clear how helpful these drugs are.
"
Standard chemotherapy drugs are usually not very effective.
Taking part in a clinical trial of a newer treatment may be a good option for some people.
"
When a cancer comes back after treatment, it is called a recurrence ."
"If the cancer comes back (recurs) in or near the place it started, it is called a local recurrence ."
"If it recurs at other sites (like the lungs or liver), it is called a distant recurrence ."
"Treatment options for recurrent GISTs depend on the location and extent of the recurrence.
"
"For most recurrences, treatment with the targeted drug imatinib (Gleevec) is often the first option to try to shrink any tumors, as long as it is still effective and the patient can tolerate taking it."
"If the starting dose of imatinib doesn't work, the dose can be increased."
"Another option is to try other targeted drugs, such as sunitinib (Sutent), regorafenib (Stivarga), or ripretinib (Qinlock).
"
"If the cancer comes back as one or more well-defined tumors, removing or destroying the tumor may be an option."
"Doctors are still not certain if removing GISTs that come back after treatment helps people live longer, so it's important to discuss the risks and benefits of this treatment with your doctor and family.
"
"Radiation therapy might also be an option to help treat symptoms such as pain, especially in tumors in the bones.
"
"If the targeted drugs mentioned above are no longer helpful, some doctors may recommend trying other targeted drugs, such as sorafenib (Nexavar), dasatinib (Sprycel), nilotinib (Tasigna), or pazopanib (Votrient), although it’s not yet clear how helpful these drugs are.
"
"Because these cancers are often hard to treat, you may want to consider taking part in clinical trials of newer treatments as well.
"
"

Chemotherapy (chemo) is the use of drugs to treat cancer."
"Often, these drugs are injected into a vein (IV) or given by mouth."
"They enter the bloodstream and reach throughout the body, making this treatment potentially useful for cancers that have spread beyond the organ they started in.
"
"Any drug used to treat cancer can be considered chemo, even the targeted therapy drugs like imatinib (Gleevec) that are now commonly used to treat gastrointestinal stromal tumors (GISTs)."
"But the term chemo is generally used to describe certain drugs that work by attacking quickly growing cells anywhere in the body, which includes cancer cells.
"
"Before targeted therapy drugs were found to be helpful in treating GISTs, traditional chemo drugs were often tried."
"But GISTs rarely shrink in response to these drugs, so traditional chemo is rarely used today."
People considering chemo may want to think about taking part in a clinical trial .
"
Chemo drugs can cause side effects ."
"These depend on the specific drugs used, their doses, and how long they are taken."
"Common side effects of chemo include:
>Nausea and vomiting
>Loss of appetite
>Mouth sores
>Diarrhea
>Hair loss
>An increased chance of infection (from a shortage of white blood cells)
>"
"Problems with bleeding or bruising (from a shortage of blood platelets)
>Fatigue or shortness of breath (from a shortage of red blood cells)
"
"Along with the risks above, some chemo drugs can cause other side effects.
"
Ask your health care team what side effects you can expect based on the specific drugs you will get.
"Be sure to tell your doctor or nurse if you do have side effects, as there are often ways to help with them."
"For example, drugs can be given to help prevent or reduce nausea and vomiting.
"
"

Radiation therapy is the use of high-energy x-rays (or particles) to kill cancer cells."
"Radiation is not very helpful in treating gastrointestinal stromal tumors (GISTs), so it is not used often."
"But sometimes it can be used to relieve symptoms like bone pain.
"
"Before your treatment starts, the radiation team will take careful measurements to find the correct angles for aiming the radiation beams and the proper dose of radiation."
"This planning session, called simulation , usually includes getting imaging tests such as CT or MRI scans.
"
"Radiation therapy is much like getting an x-ray, but the radiation is much stronger."
The treatment itself is painless.
"It lasts only a few minutes, although the setup time – getting you into place for treatment – usually takes longer."
You might get radiation treatment for several days in a row.
"
Depending on where the radiation is aimed, side effects may include:
>Skin changes in areas getting radiation, ranging from redness to blistering and peeling
>Nausea and vomiting
>Diarrhea
>Fatigue
>Low blood counts
Most side effects go away a short while after treatment ends, although fatigue and skin changes may last longer."
"Talk with your doctor about the possible side effects and the ways to reduce or relieve them.
"
"

Surgery is usually the main treatment for gastrointestinal stromal tumors (GISTs) that haven’t spread."
"The goal of the surgery is to remove all of the cancer.
"
The type of surgery needed depends on the location and size of the tumor.
"
If the tumor is small, it often can be removed along with a small area of normal tissue around it."
This is done through a cut (incision) in the skin.
"Unlike many other cancers, GISTs almost never spread to the lymph nodes, so removing nearby lymph nodes is usually not needed.
"
"For some small cancers, “keyhole” (laparoscopic) surgery is an option."
"Instead of making a large incision in the skin to remove the tumor, several small ones are used."
"The surgeon inserts a thin, lighted tube with a tiny video camera on the end (a laparoscope) through one of them."
This lets them see inside the belly.
"Long, thin surgical tools are then used through the other incisions to remove the tumor."
"Because the incisions are small, patients usually recover more quickly from this type of surgery than from traditional surgery that requires a longer incision."
"
If the tumor is large or growing into other organs, the surgeon might still be able to remove it entirely."
"To do this, parts of organs (such as a section of the intestines) might need to be removed."
"The surgeon might also remove tumors that have spread elsewhere in the abdomen, such as the liver.
"
"Another option for tumors that are large or have grown into nearby areas might be to take the targeted drug imatinib (Gleevec) first, typically for at least several months."
"This is called neoadjuvant treatment and can often shrink the tumor, making it easier to remove with surgery."
"
Surgery is not a common treatment for a GIST that has spread (metastasized) to other parts of the body."
Targeted therapy drugs are usually the first option for metastatic GISTs.
"But if there are no more than a few metastatic tumors and they respond well to targeted therapy, some doctors might advise surgery to remove them."
"No large studies have been done to show how helpful this is, but it might be an option."
"If your doctor offers this surgery, be sure you understand the goals and possible side effects.
"
"If the tumors are in the liver and would be hard to remove, other options might include different types of local treatments, such as ablation or embolization ."
"
No matter what type of surgery is done, it's very important that it is done by a surgeon experienced in treating GISTs."
"GISTs are often delicate tumors, and surgeons must be careful not to open the outer lining that surrounds them (known as the capsule ), because it might increase the risk of spreading the cancer."
"GISTs also tend to have a lot of blood vessels, so your surgeon has to be careful to control any bleeding from the tumor.
"
"For more information about finding a surgeon, see Where to Find Cancer Care .
"
"

Some drugs can target certain proteins in gastrointestinal stromal tumor (GIST) cells that help them divide and grow."
These targeted drugs (sometimes called precision drugs) are often very helpful in treating GISTs.
"They work differently from standard chemotherapy (chemo) drugs, which are usually not helpful.
"
"The targeted drugs used to treat GISTs are called tyrosine kinase inhibitors (TKIs) , because they target proteins that are tyrosine kinases, such as KIT and PDGFRA.
"
"All of these targeted drugs are taken as pills, typically once a day."
"
"
This drug is used to treat most people with GISTs at some point.
"Tumors can be tested for certain mutations in the KIT and PDGFRA genes before treatment, which can help tell how likely it is that imatinib will be helpful."
"This drug targets both the KIT and PDGFRA proteins, blocking their ability to help tumor cells grow and divide."
"In most GISTs, the cells have too much of one of these proteins.
"
Most GISTs shrink when treated with imatinib.
Some other tumors at least stop growing for a time.
"A small number of tumors are not helped by this treatment.
"
"Imatinib can be helpful in different situations:
>"
"If a GIST has been removed completely by
   surgery
   , doctors typically recommend taking imatinib for at least a year afterward (unless the risk of the cancer coming back is low)."
"This is known as
   adjuvant therapy
   ."
"Many doctors now recommend at least 3 years of imatinib after surgery for patients who have a higher risk of their tumors returning (based on the tumor’s size, location, and mitotic rate).
"
">For larger tumors that may be hard to remove, imatinib may be used first to try to shrink the tumor and make surgery easier."
"This is known as
   neoadjuvant therapy
   ."
"Imatinib is often given again after surgery as well, typically for at least 2 years.
"
">Imatinib is usually the treatment of choice for
   advanced GISTs
   that have spread too far to be removed by surgery."
"While it's unlikely to cure these tumors, it can often shrink or slow their growth for several years, helping people live longer and feel better."
"If the drug stops working and the tumor starts growing again, raising the dose of imatinib may help slow the growth for some time, but higher doses can also have more side effects.
"
"Side effects of imatinib can include mild stomach upset, diarrhea, muscle pain, and skin rashes."
The stomach upset is lessened if the drug is taken with food.
Imatinib can also make people retain fluid.
Often this causes some swelling in the face (around the eyes) or in the ankles.
"The drug rarely can cause more severe problems, such as fluid building up in the lungs or in the abdomen."
"It can also affect heart function in some people.
"
One other concern when using this drug to treat large GISTs is that these tumors often have a lot of fragile blood vessels.
"If imatinib causes the tumor to shrink quickly, it could lead to internal bleeding."
"For this reason, doctors watch patients carefully when they first start taking this drug."
"
"
"This drug can be useful in treating GISTs if imatinib is no longer working or if a person can’t take imatinib for some reason.
"
"Sunitinib targets the KIT and PDGFRA proteins, as well as several other proteins that imatinib does not target.
"
"Sunitinib helps some people, usually by shrinking or slowing the growth of the tumor."
"This may help some people live longer.
"
"Common side effects of sunitinib include fatigue, nausea, diarrhea, mouth irritation, and skin and hair color changes."
"More serious side effects can include high blood pressure, increased risk of bleeding, swelling, heart problems, and serious liver problems."
"
Regorafenib can be used to treat advanced GISTs if imatinib and sunitinib stop working, or if a person can’t take these drugs for some reason."
"This drug targets many proteins, including KIT and PDGFRA.
"
"Regorafenib can slow tumor growth and even shrink some tumors, although it’s not clear if it can help people live longer.
"
"Common side effects of regorafenib include belly pain, diarrhea, feeling tired or weak, mouth or throat irritation, fever, loss of appetite, and weight loss."
"Less common but more serious side effects can include infections, high blood pressure, heart problems, serious bleeding, trouble with wound healing, holes forming in the wall of the stomach or intestines, severe rashes, and problems with redness, pain, or even blistering of the palms of the hands and soles of the feet (called hand-foot syndrome )."
"
Ripretinib is typically used to treat advanced GISTs if other TKIs such as imatinib, sunitinib, and regorafenib are no longer helpful, or if a person can’t take these drugs for some reason."
"This drug targets many kinase proteins, including KIT and PDGFRA.
"
"Ripretinib can slow tumor growth and even shrink some tumors, although it’s not yet clear if it can help people live longer.
"
"Common side effects of ripretinib can include hair loss, nausea and vomiting, loss of appetite, diarrhea or constipation, feeling tired, and muscle or belly pain."
"Less common but more serious side effects can include high blood pressure, an increased risk of new skin cancers, heart problems, trouble with wound healing, and problems with redness, pain, or even blistering of the palms of the hands and soles of the feet (called hand-foot syndrome )."
"
"
"This is another TKI that targets PDGFRA and KIT, as well as several other proteins.
"
Avapritinib is used mainly to treat advanced GISTs whose cells have a change in the PDGFRA gene known as an exon 18 mutation .
"These cancers typically don’t respond well to treatment with the TKIs above.
"
"Common side effects of avapritinib can include swelling or fluid retention, fatigue, nausea and vomiting, loss of appetite, diarrhea or constipation, increased tears in the eyes, hair color changes, belly pain, rash, and dizziness.
"
"More serious side effects can include bleeding in the brain, as well as central nervous system (CNS) effects, such as:
>Forgetfulness
>Confusion
>Trouble thinking
>Drowsiness
>Trouble sleeping
>Hallucinations
>Changes in mood or behavior"
"
Several other TKIs are now being studied for use against GISTs as well."
"While there is limited evidence on how useful they are, some of the TKIs that might be options if those listed above are no longer working include:
>Sorafenib (Nexavar)
>Nilotinib (Tasigna)
>Dasatinib (Sprycel)
>Pazopanib (Votrient)
"
"Because it’s not exactly clear how well these and other TKIs work against GISTs, taking part in a clinical trial studying them might be a good option.
"
"

The American Cancer Society’s estimates for primary liver cancer and intrahepatic bile duct cancer in the United States for 2023 are:
>About 41,210 new cases (27,980 in men and 13,230 in women) will be diagnosed
>About 29,380 people (19,000 men and 10,380 women) will die of these cancers
Liver cancer incidence rates have more than tripled since 1980, while the death rates have more than doubled during this time."
"
Liver cancer is much more common in countries in sub-Saharan Africa and Southeast Asia than in the US."
In many of these countries it is the most common type of cancer.
"More than 800,000 people are diagnosed with this cancer each year throughout the world."
"Liver cancer is also a leading cause of cancer deaths worldwide, accounting for more than 700,000 deaths each year.
"
"Visit the American Cancer Society’s Cancer Statistics Center for more key statistics.
"
"

Liver cancer is a type of cancer that starts in the liver."
Cancer starts when cells in the body begin to grow out of control.
"To learn more about how cancers start and spread, see What Is Cancer?
To understand liver cancer, it helps to know about the normal structure and function of the liver."
"
The liver is the largest internal organ."
It lies under your right ribs just beneath your right lung.
"It has two lobes (sections).


"
The liver is made up mainly of cells called hepatocytes .
"It also has other types of cells, including cells that line its blood vessels and cells that line small tubes in the liver called bile ducts ."
"The bile ducts carry bile from the liver to the gallbladder or directly to the intestines.
"
You cannot live without your liver.
"It has many important functions:
>It breaks down and stores many of the nutrients absorbed from the intestine that your body needs to function."
"Some nutrients must be changed (metabolized) in the liver before they can be used for energy or to build and repair body tissues.
"
">It makes most of the clotting factors that keep you from bleeding too much when you are cut or injured.
"
">It delivers bile into the intestines to help absorb nutrients (especially fats).
"
">It breaks down alcohol, drugs, and toxic wastes in the blood, which then pass from the body through urine and stool
The different types of cells in the liver can form several types of malignant (cancerous) and benign (non-cancerous) tumors."
"These tumors have different causes, are treated differently, and have a different prognosis (outlook)."
"
A cancer that starts in the liver is called primary liver cancer."
There is more than one kind of primary liver cancer.
"
"
"This is the most common form of liver cancer in adults.
"
"Hepatocellular cancers can have different growth patterns:
>Some begin as a single tumor that grows larger."
"Only late in the disease does it spread to other parts of the liver.
"
">A second type seems to start as many small cancer nodules throughout the liver, not just a single tumor."
"This is seen most often in people with cirrhosis (chronic liver damage) and is the most common pattern seen in the United States.
"
Doctors can classify several subtypes of HCC.
Most often these subtypes do not affect treatment or prognosis (outlook).
"But one of these subtypes, fibrolamellar, is important to recognize."
"It is rare, making up less than 1% of HCCs and is most often seen in women younger than age 35."
Often the rest of the liver is not diseased.
"This subtype tends to have a better outlook than other forms of HCC.
"
Most of the rest of th is content refers only to hepatocellular carcinoma and is called liver cancer.
"
About 10% to 20% of cancers that start in the liver are intrahepatic cholangiocarcinomas."
These cancers start in the cells that line the small bile ducts (tubes that carry bile to the gallbladder) within the liver.
"Most cholangiocarcinomas, however, actually start in the bile ducts outside the liver.
"
"Although the rest of this information is mainly about hepatocellular cancers, cholangiocarcinomas are often treated the same way."
"For more detailed information on this type of cancer, see Bile Duct Cancer ."
"
These are rare cancers that begin in cells lining the blood vessels of the liver."
People who have been exposed to vinyl chloride or to thorium dioxide (Thorotrast) are more likely to develop these cancers (see Liver cancer risk factors).
"Some other cases are thought to be caused by exposure to arsenic or radium, or to an inherited condition known as hereditary hemochromatosis ."
"In about half of all cases, no likely cause can be identified.
"
These tumors grow quickly and are usually too widespread to be removed surgically by the time they are found.
"Chemotherapy and radiation therapy may help slow the disease, but these cancers are usually very hard to treat."
These cancers are treated like other sarcomas.
"For more information, see Soft Tissue Sarcoma ."
"
"
"This is a very rare kind of cancer that develops in children, usually in those younger than 4 years old."
The cells of hepatoblastoma are similar to fetal liver cells.
"About 2 out of 3 children with these tumors are treated successfully with surgery and chemotherapy, although the tumors are harder to treat if they have spread outside the liver."
"
Most of the time when cancer is found in the liver it did not start there but has spread (metastasized) from somewhere else in the body, such as the pancreas, colon, stomach, breast, or lung."
"Because this cancer has spread from its original (primary) site, it is called a secondary liver cancer."
These tumors are named and treated based on their primary site (where they started).
"For example, cancer that started in the lung and spread to the liver is called lung cancer with spread to the liver , not liver cancer."
"It is also treated as lung cancer.
"
"In the United States and Europe, secondary (metastatic) liver tumors are more common than primary liver cancer."
"The opposite is true for many areas of Asia and Africa.
"
"For more information on liver metastases from different types of cancer, see specific cancer types, as well as Advanced Cancer."
"
Benign tumors sometimes grow large enough to cause problems, but they do not grow into nearby tissues or spread to distant parts of the body."
"If they need to be treated, the patient can usually be cured with surgery."
"
The most common type of benign liver tumor, hemangiomas, start in blood vessels."
Most hemangiomas of the liver cause no symptoms and do not need treatment.
But some may bleed and need to be removed with surgery.
"
Hepatic adenoma is a benign tumor that starts from hepatocytes (the main type of liver cell)."
Most cause no symptoms and do not need treatment.
"But some eventually cause symptoms, such as pain or a lump in the abdomen (stomach area) or blood loss."
"Because there is a risk that the tumor could rupture (leading to severe blood loss) and a small risk that it could eventually develop into liver cancer, most experts will usually advise surgery to remove the tumor if possible.
"
Using certain drugs may increase the risk of getting these tumors.
"Women have a higher chance of having one of these tumors if they take birth control pills, although this is rare."
Men who use anabolic steroids may also develop these tumors.
Adenomas may shrink when these drugs are stopped.
"
Focal nodular hyperplasia (FNH) is a tumor-like growth made up of several cell types (hepatocytes, bile duct cells, and connective tissue cells)."
"Although FNH tumors are benign, they might cause symptoms. "
"It can be hard to tell them apart from true liver cancers and doctors sometimes remove them when the diagnosis is unclear.
"
"Both hepatic adenomas and FNH tumors are more common in women than in men.
"
"

For some people with liver cancer, treatment can remove or destroy the cancer."
Completing treatment can be both stressful and exciting.
"You may be relieved to finish treatment, but find it hard not to worry about cancer coming back."
"This is a very common concern if you have had cancer.
"
"For many people with liver cancer, the cancer may never go away completely, or it might come back in another part of the body."
"These people may still get regular treatments with chemotherapy, radiation therapy, or other therapies to help keep the cancer under control for as long as possible."
Learning to live with cancer that does not go away can be difficult and very stressful.
"
Even if you have completed treatment, your doctors will still want to watch you closely."
It is very important to go to all your follow-up appointments.
"During these visits, your doctors will ask questions about any problems you are having and might do exams and blood tests, such as alpha-fetoprotein (AFP), liver function tests (LFTs)."
"Imaging tests, such as ultrasound, CT, or MRI scans might also be done."
"These tests will help look for signs of cancer or side effects of treatment.
"
Some treatment side effects might last a long time or might not even show up until years after you have finished treatment.
"Your doctor visits are a good time to ask questions and talk about any changes or problems you notice or concerns you have.
"
"It’s important for all liver cancer survivors, to tell their health care team about any new symptoms or problems, because they could be caused by the cancer coming back, by a new disease, or a second cancer ."
"
If you have been treated with surgery, a liver transplant, or ablation/embolization and have no signs of cancer remaining, most doctors recommend follow-up with imaging tests and blood tests every 3 to 6 months for the first 2 years, then every 6 to 12 months."
"Follow-up is needed to check for cancer recurrence or spread, as well as possible side effects of certain treatments.
"
Follow-up after liver transplant:
A liver transplant can be very effective at treating the cancer and replacing a damaged liver.
But this is a major procedure that requires very close follow-up after treatment.
"Along with monitoring your recovery from surgery and looking for possible signs of cancer, your medical team will watch you carefully to make sure your body is not rejecting the new liver.
"
You will need to take strong medicines to help prevent rejection.
"These medicines can have their own side effects, including weakening your immune system, which can make you more likely to get infections .
"
Your transplant team should tell you what to watch for in terms of symptoms and side effects and when you need to contact them.
"It is very important to follow their instructions closely.
"
"Anti-viral treatment: If you have hepatitis B or C that may have contributed to your liver cancer, your doctor may want to put you on medicines to treat or help control the infection."
"
Talk with your doctor about developing a survivorship care plan for you."
"This plan might include:
>A suggested schedule for follow-up exams and tests
>A schedule for other tests you might need, such as tests to look for long-term health effects from your cancer or its treatment
>A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
>Suggestions for things you can do that might improve your health, including possibly lowering your chances of the cancer coming back"
"
Even if you've finished treatment, it’s very important to keep health insurance ."
"Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
"
"At some point after your cancer treatment, you might find yourself seeing a new doctor who does not know about your medical history."
It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment.
"
If you have (or have had) liver cancer, you probably want to know if there are things you can do that might lower your risk of the cancer coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements."
"Unfortunately, it’s not yet clear if there are things you can do that will help.
"
Getting treatment for hepatitis B or hepatitis C may help reduce damage to your liver that can increase liver cancer risk.
"Tobacco and alcohol use has clearly been linked to liver cancer, so not smoking and avoiding alcohol may help reduce your risk."
"We don’t know for certain if this will help, but we do know that it can help improve your appetite and overall health."
It can also reduce the chance of developing other types of cancer.
"If you want to quit smoking and need help, call the American Cancer Society at 1-800-227-2345.
"
"Other healthy behaviors such as eating well, being active, and staying at a healthy weight might help as well, but no one knows for sure."
"However, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of liver or other cancers."
"
So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of liver cancer progressing or coming back."
"This doesn’t mean that no supplements can help, but it’s important to know that so far none have been proven to do so.
"
"Dietary supplements are not regulated like medicines in the United States – they do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do."
"If you’re thinking about taking any type of nutritional supplement, talk to your health care team."
They can help you decide which ones you can use safely while avoiding those that might be harmful.
"
If your cancer does come back at some point (called a recurrence), your treatment options will depend on the where the cancer is, what treatments you’ve had before, and your health."
"Treatment options might include ablation, embolization, radiation therapy, chemotherapy, targeted therapy, or some combination of these."
"See Treatment of Liver Cancer, By Stage .
"
"For more general information on cancer recurrence, see Understanding Recurrence ."
"
People who’ve had liver cancer can still get other cancers."
Learn more in Second Cancers After Liver Cancer .
"
It is normal to feel depressed, anxious, or worried when liver cancer is a part of your life."
Some people are affected more than others.
"But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups, professional counselors, or others."
"Learn more in Life After Cancer .



"
"

Liver cancer survivors can be affected by a number of health problems, but often a major concern is facing cancer again."
Cancer that comes back after treatment is called a recurrence.
"But some cancer survivors develop a new, unrelated cancer later."
"This is called a second cancer .
"
"Unfortunately, being treated for liver cancer doesn’t mean you can’t get another cancer."
People who have had liver cancer can still get the same types of cancers that other people get.
"In fact, they might be at higher risk for certain types of cancer.
"
"Studies looking at the second cancers liver cancer survivors can get are not easy to do, mainly because of the poor outcomes related to liver cancer."
"The little information that is known shows that there is an increased risk of:
>Oral cavity cancer
>Ovarian cancer
>Kidney cancer
>Thyroid cancer
For people diagnosed with liver cancer before age 50, there appears to be an increased risk of these second cancers:
>"
"Colon cancer
>Ovarian cancer
>Bladder cancer
>Acute Myeloid Leukemia (AML)
"
Exactly how high the risk is of developing these second cancers is not known at this time.
"
After completing treatment, you should still see your doctor regularly."
"Report any new symptoms or problems, because they could be caused by the cancer spreading or coming back, or by a new disease or second cancer.
"
"Liver cancer survivors should also follow the American Cancer Society guidelines for the early detection of cancer , such as those for colorectal, breast, cervical, and prostate cancer."
"Screening tests can find some cancers early, when they are likely to be treated more successfully."
"For people who have had liver cancer, most experts don’t recommend any additional testing to look for second cancers unless you have symptoms or if you or your family have an inherited disease ."
"
There are steps you can take to lower your risk and stay as healthy as possible."
"For example, people who have had liver cancer should stay away from tobacco products ."
"Not smoking lowers the chance of developing most lung cancers, and may help decrease the possibility of a new liver cancer forming.
"
"To help maintain good health , liver cancer survivors should also:
>Get to and stay at a healthy weight
>Keep physically active and limit the time you spend sitting or lying down
>Follow a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and limits or avoids red and processed meats, sugary drinks, and highly processed foods
>Not drink alcohol."
"If you do drink, have no more than 1 drink per day for women or 2 per day for men
These steps may also lower the risk of some other health problems.
"
"See Second Cancers in Adults for more information about causes of second cancers.
"
"

Many liver cancers could be prevented by reducing exposure to known risk factors for this disease."
"
Worldwide, the most significant risk factor for liver cancer is chronic infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) ."
"These viruses can spread from person to person through sharing contaminated needles (such as in drug use), through unprotected sex, and through childbirth, so some liver cancers could be avoided by not sharing needles and by using safer sex practices (such as always using condoms).
"
Blood transfusions were once a major source of hepatitis infection as well.
"But because blood banks in the United States test donated blood to look for these viruses, the risk of getting a hepatitis infection from a blood transfusion is extremely low."
"
The US Centers for Disease Control and Prevention (CDC) recommends that all children and adults up to age 59, as well as older adults at risk for HBV, get the HBV vaccine to reduce their risk of chronic hepatitis B and liver cancer.
"
There is no vaccine for HCV.
"Preventing HCV infection, as well as HBV infection in people who have not been immunized, is based on understanding and avoiding some of the ways in which these infections occur."
"
Some people might have a chronic HBV or HCV infection without even knowing it."
"To help find these infections, the CDC recommends that all people 18 years of age or older get tested for HBV and HCV at least once during their lifetime, and that some groups of people get tested at a younger age and/or more often."
"(For detailed lists of who should get tested for HBV and HCV and how often, visit the CDC website at https://www.cdc.gov/hepatitis/hbv/bfaq.htm and https://www.cdc.gov/hepatitis/hcv/cfaq.htm .)"
"
If a person is found to have a chronic HBV or HCV infection, treatment and preventive measures can help slow liver damage and reduce cancer risk.
"
"Medicines to treat chronic HCV infection can eliminate the virus in many people and may lower their risk of liver cancer.
"
A number of medicines can be used to treat chronic HBV.
They can reduce the number of viruses in the blood and lessen liver damage.
"Although these drugs don't cure the disease, they lower the risk of cirrhosis, and they may lower the risk of liver cancer as well."
"
Drinking alcohol can lead to cirrhosis, which in turn, can lead to liver cancer."
"Not drinking alcohol or drinking in moderation could help prevent liver cancer.
"
"Since smoking also increases the risk of liver cancer, not smoking will also prevent some of these cancers."
"If you smoke, quitting will help lower your risk of this cancer, as well as many other cancers and life-threatening diseases."
"
Avoiding obesity might be another way to help protect against liver cancer."
"People who are obese are more likely to have fatty liver disease and diabetes, both of which have been linked to liver cancer."
"
Changing the way certain grains are stored in tropical and subtropical countries could reduce exposure to cancer-causing substances such as aflatoxins ."
Many developed countries already have regulations to prevent and monitor grain contamination.
"
Certain inherited diseases can cause cirrhosis of the liver, increasing a person’s risk for liver cancer."
Finding and treating these diseases early in life could lower this risk.
"For example, all children in families with hemochromatosis should be screened for the disease and treated if they have it."
"Treatment regularly removes small amounts of blood to lower the amount of excess iron in the body.
"
"

A risk factor is anything that increases your chance of getting a disease, such as cancer."
Different cancers have different risk factors.
"Some risk factors, like smoking, can be changed."
"Others, like a person's age or family history, can't be changed.
"
"But having a risk factor, or even several risk factors, does not mean that you will get the disease."
And some people who get the disease may have few or no known risk factors.
"
"
Several factors can increase a person's chance of getting a hepatocellular carcinoma (HCC).
"
Hepatocellular carcinoma is much more common in men than in women."
Much of this is probably because of behaviors affecting some of the risk factors described below.
The fibrolamellar subtype of HCC is more common in women.
"
In the United States, Asian Americans and Pacific Islanders have the highest rates of liver cancer, followed by Hispanic and Latino, American Indians, Alaska Natives, African Americans, and White individuals."
"
Worldwide, the most common risk factor for liver cancer is chronic (long-term) infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) ."
"These infections lead to cirrhosis of the liver and are responsible for making liver cancer the most common cancer in many parts of the world.
"
"In the US, infection with hepatitis C is the more common cause of HCC, while in Asia and developing countries, hepatitis B is more common."
"People infected with both viruses have a high risk of developing chronic hepatitis, cirrhosis, and liver cancer."
"The risk is even higher if they are heavy drinkers (at least 6 alcoholic drinks a day).
"
"HBV and HCV can spread from person to person through sharing contaminated needles (such as in drug use), unprotected sex, or childbirth."
"They can also be passed on through blood transfusions, although this is very rare in the United States since blood products are tested for these viruses."
"In developing countries, children sometimes contract hepatitis B infection from prolonged contact with family members who are infected.
"
"HBV is more likely to cause symptoms, such as a flu-like illness and jaundice (a yellowing of the eyes and skin)."
But most people recover completely from HBV infection within a few months.
Only a very small percentage of adults become chronic carriers (and have a higher risk for liver cancer).
"Infants and small children who become infected have a higher risk of becoming chronic carriers.
"
"HCV, on the other hand, is less likely to cause symptoms."
"But most people with HCV develop chronic infections, which are more likely to lead to liver damage or even cancer.
"
"Other viruses, such as the hepatitis A virus and hepatitis E virus, can also cause hepatitis."
"But people infected with these viruses do not develop chronic hepatitis or cirrhosis, and do not have an increased risk of liver cancer."
"
Cirrhosis is a disease in which liver cells become damaged and are replaced by scar tissue."
People with cirrhosis have an increased risk of liver cancer.
"Most (but not all) people who develop liver cancer already have some evidence of cirrhosis.
"
There are several possible causes of cirrhosis.
Most cases in the United States occur in people who abuse alcohol or have chronic HBV or HCV infections.
"
Non-alcoholic fatty liver disease is a common condition in obese people."
"People with a subtype of this disease, known as non-alcoholic steatohepatitis (NASH), might go on to develop cirrhosis."
"
Some types of autoimmune diseases that affect the liver can also cause cirrhosis."
"For example, in primary biliary cirrhosis (PBC) the bile ducts in the liver are damaged and even destroyed which can lead to cirrhosis."
People with advanced PBC have a high risk of liver cancer.
"
Certain inherited metabolic diseases can lead to cirrhosis.
"
People with hereditary hemochromatosis absorb too much iron from their food.
"The iron settles in tissues throughout the body, including the liver."
"If enough iron builds up in the liver, it can lead to cirrhosis and liver cancer."
"
Alcohol abuse is a leading cause of cirrhosis in the US, which in turn is linked with an increased risk of liver cancer."
"
Smoking increases the risk of liver cancer."
"People who smoked and stopped have a lower risk than those who still smoke, but both groups have a higher risk than those who never smoked."
"
Being obese (very overweight) increases the risk of developing liver cancer."
This is probably because it can result in fatty liver disease and cirrhosis.
"
Type 2 diabetes has been linked with an increased risk of liver cancer, usually in patients who also have other risk factors such as heavy alcohol use and/or chronic viral hepatitis."
"This risk may also be increased because people with type 2 diabetes tend to be overweight or obese, which in turn can cause liver problems."
"
Diseases that increase the risk of liver cancer include:
>Tyrosinemia
>Alpha1-antitrypsin deficiency
>Porphyria cutanea tarda
>Glycogen storage diseases
>Wilson disease"
"
These cancer-causing substances are made by a fungus that contaminates peanuts, wheat, soybeans, ground nuts, corn, and rice."
"Storage in a moist, warm environment can lead to the growth of this fungus."
"Although this can occur almost anywhere in the world, it is more common in warmer and tropical countries."
"Developed countries, such as the US and those in Europe, test foods for levels of aflatoxins.
"
Long-term exposure to these substances is a major risk factor for liver cancer.
The risk is increased even more in people with hepatitis B or C infections.
"
Exposure to these chemicals raises the risk of angiosarcoma of the liver (see What is liver cancer? )."
"It also increases the risk of developing cholangiocarcinoma and hepatocellular cancer, but to a far lesser degree."
Vinyl chloride is a chemical used in making some kinds of plastics.
Thorotrast is a chemical that in the past was injected into some patients as part of certain x-ray tests.
"When the cancer-causing properties of these chemicals were recognized, steps were taken to eliminate them or minimize exposure to them."
"Thorotrast is no longer used, and exposure of workers to vinyl chloride is strictly regulated."
"
Anabolic steroids are male hormones used by some athletes to increase their strength and muscle mass."
Long-term anabolic steroid use can slightly increase the risk of hepatocellular cancer.
"Cortisone-like steroids, such as hydrocortisone, prednisone, and dexamethasone, do not carry this same risk."
"
Since chronic hepatitis B infection can lead to cirrhosis and then liver cancer, getting vaccinated against the hepatitis B virus may protect people from liver cancer caused by the hepatitis B virus."
"
It is known that chronic infections with hepatitis B or even hepatitis C can lead to cirrhosis and liver cancer."
Getting treatment for either infection can lower one's risk of liver cancer.
"
Aspirin has been shown to reduce the risk of a few cancers."
"Some studies have shown a reduced risk of liver cancer with regular use of aspirin, but more research is needed.
"
"

Although several risk factors for liver cancer are known (see Liver Cancer Risk Factors ), exactly how these may lead normal liver cells to become cancerous is only partially understood."
"Some of these risk factors affect the DNA of cells in the liver, which can result in abnormal cell growth and may cause cancers to form.
"
DNA is the chemical in our cells that carries our genes which control how our cells function.
We look like our parents because they are the source of our DNA.
"But DNA affects more than just how we look.
"
"Some genes control when cells grow, divide into new cells, and die.
"
">Genes that help cells to grow and divide and stay alive are called
    oncogenes
    .
"
">Genes that keep cell division under control, repair mistakes in DNA, or cause cells to die at the right time are called
    tumor suppressor genes
    .
"
Cancers can be caused by DNA changes (mutations) that turn on oncogenes or turn off tumor suppressor genes.
"Several different genes usually need to have changes for a cell to become cancerous.
"
"Certain chemicals that cause liver cancer, such as aflatoxins, are known to damage the DNA in liver cells."
"For example, studies have shown that aflatoxins can damage the TP53 tumor suppressor gene, which normally works to prevent cells from growing too much."
"Damage to the TP53 gene can lead to increased growth of abnormal cells and formation of cancers.
"
Hepatitis viruses can also change DNA when they infect liver cells.
"In some patients, the virus's DNA can insert itself into a liver cell's DNA, where it may turn on the cell's oncogenes.
"
"Liver cancer clearly has many different causes, and there are undoubtedly many different genes involved in its development."
"It is hoped that a more complete understanding of how liver cancers develop will help doctors find ways to better prevent and treat them.
"
"

It is often hard to find liver cancer early because signs and symptoms often do not appear until it is in its later stages."
Small liver tumors are hard to detect on a physical exam because most of the liver is covered by the right rib cage.
"By the time a tumor can be felt, it might already be quite large.
"
"At this time, there are no widely recommended screening tests for liver cancer in people who are at average risk."
(Screening means testing for cancer in people who have no symptoms or history of cancer.)
"
Many patients who develop liver cancer have long-standing cirrhosis (scar tissue formation from liver damage)."
"Doctors may do tests to look for liver cancer if a patient with cirrhosis gets worse for no apparent reason.
"
"For people at higher risk of liver cancer because they have cirrhosis (from any cause), hereditary hemochromatosis, or chronic hepatitis B infection (even without cirrhosis), some experts recommend screening for liver cancer with alpha-fetoprotein (AFP) blood tests and ultrasound exams every 6 months."
"In some studies, screening was linked to improved survival from liver cancer.
"
AFP is a protein that can be measured in the blood of patients with liver cancer.
But looking for high AFP levels isn’t a perfect test for liver cancer.
Many patients with early liver cancer have normal AFP levels.
"Also, AFP levels can be increased from other kinds of cancer as well as some non-cancerous conditions.
"
"

Some liver cancers can be found by testing people at high risk who don't have symptoms ( screening ), but most liver cancers are found because they are causing symptoms."
"If you have possible signs or symptoms of liver cancer, see your doctor, who will examine you and may order some tests."
"
Your doctor will ask about your medical history to learn more about your symptoms and possible risk factors ."
"Your doctor will also examine you to look for signs of liver cancer and other health problems, probably paying special attention to your abdomen and checking your skin and the whites of your eyes looking for jaundice (a yellowish color).
"
"If symptoms and/or the results of the physical exam suggest you might have liver cancer, more tests will probably be done."
"These might include imaging tests, lab tests, and/or biopsies of liver tissue."
"
Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body."
"Imaging tests maybe done for a number of reasons both before and after a diagnosis of liver cancer, including:
>To help find suspicious areas that might be cancer
>To help a doctor guide a biopsy needle into a suspicious area to take a sample
>To learn how far cancer might have spread
>To help guide certain treatments in the liver
>To help determine if treatment is working
>To look for possible signs of cancer coming back after treatment"
"
Ultrasound is often the first test used to look at the liver."
It uses sound waves to create an image on a computer screen.
"This test can show tumors growing in the liver, which then can be tested for cancer, if needed."
"
The CT scan is an x-ray test that makes detailed images of your body."
A CT scan of the abdomen can help find many types of liver tumors.
"It can give specific information about the size, shape, and location of any tumors in the liver or elsewhere in the abdomen, as well as nearby blood vessels."
CT scans can also be used to guide a biopsy needle precisely into a suspected tumor (called a CT-guided needle biopsy ).
"If you are found to have liver cancer, a CT of your chest may also be done to look for possible cancer spread to the lungs."
"
Like CT scans, MRI scans provide detailed images of soft tissues in the body."
But MRI scans use radio waves and strong magnets instead of x-rays.
MRI scans can be very helpful in looking at liver tumors.
Sometimes they can tell a benign tumor from a malignant one.
"They can also be used to look at blood vessels in and around the liver to see any blockages, and can help show if liver cancer has spread to other parts of the body."
"
An angiogram is an x-ray test that looks at blood vessels."
"Contrast medium, or dye, is injected into an artery to outline blood vessels while x-ray images are taken.
"
"Angiography can be used to show the arteries that supply blood to a liver cancer, which can help doctors decide if a cancer can be removed and to help plan the operation."
"It can also be used to help guide some types of non-surgical treatment, such as embolization (see Embolization Therapy for Liver Cancer ).
"
Angiography can be uncomfortable because a small catheter (a flexible hollow tube) must be put into the artery leading to the liver to inject the dye.
Usually the catheter is put into an artery in your groin and eased up into the liver artery.
You have to stay very still while the catheter is in place.
A local anesthetic is often used to numb the area before inserting the catheter.
"Then the dye is injected quickly to outline all the vessels while the x-rays are being taken.
"
Angiography can also be done with a CT scanner (CT angiography) or an MRI scanner (MR angiography).
These techniques are often used instead of x-ray angiography because they can give information about the blood vessels in the liver without the need for a catheter in the groin.
You will still need an IV line in your arm so that a contrast dye can be injected into the blood during the test.
"
A bone scan can help look for cancer that has spread (metastasized) to bones."
"Doctors don't usually order this test for people with liver cancer unless you have symptoms such as bone pain, or if there's a chance you may qualify for a liver transplant to treat your cancer."
"
Other types of tests may be done if your doctor thinks you might have liver cancer but the imaging results aren’t certain."
"
A biopsy is the removal of a sample of tissue to see if it is cancer."
"Sometimes, the only way to be sure that liver cancer is present is to take a biopsy and look at it in the pathology lab."
"But in some cases, doctors can be fairly certain that a person has liver cancer based on the results of imaging tests such as CT and MRI scans."
"In these cases, a biopsy may not be needed.
"
Doctors are often concerned that sticking a needle into the tumor or otherwise disturbing it without completely removing it might help cancer cells spread along the needle's path.
"This is a major concern if surgery or a liver transplant might be an option to try to cure the cancer, as any spread of the cancer might make the person ineligible for a transplant."
"That is why some experts recommend that patients who could be transplant candidates only have biopsies done at the center where the transplant will be done.
"
"If a biopsy is needed, it can be done in several ways.
"
Needle biopsy:
A hollow needle is placed through the skin in the abdomen and into the liver.
The skin is first numbed with local anesthesia before the needle is placed. 
"This type of biopsy is typically done with the help of an ultrasound or CT scan to guide the needle.
"
Laparoscopic biopsy:
Biopsy specimens can also be taken during laparoscopy .
"This lets the doctor see the surface of the liver and take samples of abnormal-appearing areas.
"
Surgical biopsy:
"An incisional biopsy (removing a piece of the tumor) or an excisional biopsy (removing the entire tumor and some surrounding normal liver tissue) can be done with surgery.
"
"For more information about biopsies and how they are tested, see Testing Biopsy and Cytology Specimens for Cancer ."
"
Your doctor could order lab tests for a number of reasons:
>To help diagnose liver cancer
>To help determine what might have caused your liver cancer
>To learn how well your liver is working, which can affect what treatments you can have
>To get an idea of your general health and how well your other organs are working, which also could affect what treatments you can have
>To see how well treatment is working
>To look for signs that the cancer has come back after treatment"
"
AFP is a protein that can be found in high levels in adults with liver disease, liver cancer, who are pregnant, or other cancers.
"
"If AFP levels are very high in someone with a liver tumor, it can be a sign that liver cancer is present."
But liver cancer isn’t the only reason for high AFP levels.
"Many patients with early liver cancer have normal levels of AFP, so high AFP levels aren’t very helpful in determining if a liver mass might be cancer.
"
"This test, however, is sometimes useful in people already diagnosed with liver cancer."
The AFP level can help determine treatment options.
"During treatment, the test can be used to give an idea of how well it is working, as the AFP level should go down if treatment is effective."
"The test can also be used after treatment, to look for possible signs that the cancer has come back (recurred)."
"
Tests for viral hepatitis: Your doctor might order blood tests to check for hepatitis B and C.
Liver function tests (LFTs): Because liver cancer often develops in livers already damaged by hepatitis and/or cirrhosis, doctors need to know the condition of your liver before starting your treatment."
"If the part of your liver not affected by cancer isn’t working well, you might not be able to have surgery to try to cure the cancer, as the surgery might require removal of a large part of your liver."
"Other treatment options such as certain targeted therapy or chemotherapy may also not be good choices if your liver is not working well.
"
Blood clotting tests: The liver also makes proteins that help blood clot when you bleed.
"A damaged liver might not make enough of these clotting factors, which could increase your risk of bleeding."
"Your doctor may order blood tests to help measure this risk.
"
"Kidney function tests: Tests of blood urea nitrogen (BUN) and creatinine levels are often done to assess how well your kidneys are working.
"
Complete blood count (CBC):
"This test measures levels of red blood cells (which carry oxygen throughout your body), white blood cells (which fight infections), and platelets (which help the blood clot)."
"It gives an idea of how well the bone marrow (where new blood cells are made) is functioning.
"
"Blood chemistry tests and other tests: Blood chemistry tests check the levels of a number of substances in the blood, some of which might be affected by liver cancer."
"For example, liver cancer can raise blood levels of calcium, while blood glucose levels may fall."
"Liver cancer can also sometimes raise cholesterol levels, so this may be checked as well.
"
"For more information about tests see Exams and Tests for Cancer .
"
"

Having one or more of the symptoms below does not mean you have liver cancer."
"In fact, many of these symptoms are more likely to be caused by other conditions."
"Still, if you have any of these symptoms, it’s important to have them checked by a doctor so that the cause can be found and treated, if needed."
"Signs and symptoms of liver cancer often do not show up until the later stages of the disease, but sometimes they may show up sooner."
"If you go to your doctor when you first notice symptoms, your cancer might be diagnosed earlier, when treatment is most likely to be helpful."
"Some of the most common symptoms of liver cancer are:
>Weight loss (without trying)
>Loss of appetite
>Feeling very full after a small meal
>Nausea or vomiting
>An enlarged liver, felt as fullness under the ribs on the right side
>An enlarged spleen, felt as fullness under the ribs on the left side
>Pain in the abdomen (belly) or near the right shoulder blade
>Swelling or fluid build-up in the abdomen (belly)
>Itching
>Yellowing of the skin and eyes (jaundice)
"
"Other symptoms can include fever, enlarged veins on the belly that can be seen through the skin, and abnormal bruising or bleeding.
"
"People who have chronic hepatitis or cirrhosis might feel worse than usual or might just have changes in lab test results, such as liver function tests or alpha-fetoprotein (AFP) levels.
"
Some liver tumors make hormones that act on organs other than the liver.
"These hormones may cause:
>High blood calcium levels (hypercalcemia), which can cause nausea, confusion, constipation, weakness, or muscle problems
>Low blood sugar levels (hypoglycemia), which can cause fatigue or fainting
>Breast enlargement (gynecomastia) and/or shrinkage of the testicles in men
>High counts of red blood cells (erythrocytosis) which can cause someone to look red and flushed
>High cholesterol levels
"
"


















After someone is diagnosed with liver cancer, doctors will try to figure out if it has spread, and if so, how far."
This process is called staging .
The stage of a cancer describes how much cancer is in the body.
It helps determine how serious the cancer is and how best to treat it.
"Doctors also use a cancer's stage when talking about survival statistics.
"
Liver cancer stages range from stage I (1) through IV (4).
"As a rule, the lower the number, the less the cancer has spread."
"A higher number, such as stage IV, means cancer has spread more."
"Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way."
"
There are several staging systems for liver cancer, and not all doctors use the same system."
"The staging system most often used in the United States for liver cancer is the AJCC (American Joint Committee on Cancer) TNM system, which is based on 3 key pieces of information:
"
>
"The extent (size) of the
   t
   umor
   (T):
   How large has the cancer grown?"
Is there more than one tumor in the liver?
"Has the cancer reached nearby structures like the veins in the liver?
>The spread to nearby lymph
   n
   odes
   (N):
   Has the cancer spread to nearby lymph nodes?
>"
"The spread (
   m
   etastasis) to distant sites
   (M):
   Has the cancer spread to distant lymph nodes or distant organs such as the bones or lungs?
"
"The system described below is the most recent AJCC system, effective January 2018.
"
"Numbers or letters after T, N, and M provide more details about each of these factors."
Higher numbers mean the cancer is more advanced.
"Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage."
"For more information see Cancer Staging .
"
"Liver cancer is usually staged based on the results of the physical exam, biopsies , and imaging tests (ultrasound, CT or MRI scan, etc.), also called a clinical stage."
"If surgery is done, the pathologic stage (also called the surgical stage ) is determined by examining tissue removed during an operation.
"
"Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.
"
"AJCC Stage
Stage grouping
Stage description*
IA
T1a
N0
M0
A single tumor 2 cm (4/5 inch) or smaller that hasn't grown into blood vessels (T1a).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"IB
T1b
N0
M0
A single tumor larger than 2cm (4/5 inch) that hasn't grown into blood vessels (T1b).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"II
T2
N0
M0
Either a single tumor larger than 2 cm (4/5 inch) that has grown into blood vessels, OR more than one tumor but none larger than 5 cm (about 2 inches) across (T2).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

"
"IIIA


T3
N0
M0
More than one tumor, with at least one tumor larger than 5 cm across (T3).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"IIIB
T4
N0
M0
At least one tumor (any size) that has grown into a major branch of a large vein of the liver (the portal or hepatic vein) (T4).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"IVA
Any T
N1
M0
A single tumor or multiple tumors of any size (Any T) that has spread to nearby lymph nodes (N1) but not to distant sites (M0).
"
"IVB
Any T
Any N
M1
"
"A single tumor or multiple tumors of any size (any T).
"
"It might or might not have spread to nearby lymph nodes (any N).
"
"It has spread to distant organs such as the bones or lungs (M1).

"
*
"The following additional categories are not listed on the table above:
>TX:"
"Main tumor cannot be assessed due to lack of information.
"
>T0:
"No evidence of a primary tumor.
"
>NX: Regional lymph nodes cannot be assessed due to lack of information.
"
The staging systems for most types of cancer depend only on the extent of the cancer, but liver cancer is complicated by the fact that most patients have damage to the rest of their liver along with the cancer."
"This also affects treatment options and survival outlook.
"
"Although the TNM system defines the extent of liver cancer in some detail, it does not take liver function into account."
"Several other staging systems have been developed that include both of these factors:
>The Barcelona Clinic Liver Cancer (BCLC) system
>The Cancer of the Liver Italian Program (CLIP) system
>"
"The Okuda system
These staging systems have not been compared against each other."
"Some are used more than others in different parts of the world, but at this time there is no single staging system that all doctors use."
"If you have questions about the stage of your cancer or which system your doctor uses, be sure to ask."
"
The Child-Pugh score measures liver function, especially in people with cirrhosis."
"Many people with liver cancer also have cirrhosis, and in order to treat the cancer, doctors need to know how well the liver is working."
"This system looks at 5 factors, the first 3 of which are results of blood tests:
>Blood levels of bilirubin (the substance that can cause yellowing of the skin and eyes)
>Blood levels of albumin (a major protein normally made by the liver)
>"
"The prothrombin time (measures how well the liver is making blood clotting factors)
>Whether there is fluid (ascites) in the abdomen
>Whether the liver disease is affecting brain function
Based on these factors, there are 3 classes of liver function."
"If all these factors are normal, then liver function is called class A. Mild abnormalities are class B, and severe abnormalities are class C. People with liver cancer and class C cirrhosis are often too sick for surgery or other major cancer treatments.
"
The Child-Pugh score is actually part of the BCLC and CLIP staging systems mentioned previously.
"
Formal staging systems (such as those described before) can often help doctors determine a patient's prognosis (outlook)."
"But for treatment purposes, doctors often classify liver cancers more simply, based on whether or not they can be cut out (resected) completely."
Resectable means able to be removed by surgery.
"
"
"If the patient is healthy enough for surgery, these cancers can be completely removed by surgery or treated with a liver transplant."
"This would include most stage I and some stage II cancers in the TNM system, in patients who do not have cirrhosis or other serious medical problems."
Only a small number of patients with liver cancer have this type of tumor.
"
Cancers that have not spread to the lymph nodes or distant organs but cannot be completely removed by surgery are classified as unresectable."
"This includes cancers that have spread throughout the liver or can’t be removed safely because they are close to the area where the liver meets the main arteries, veins, and bile ducts."
"
The cancer is small enough and in the right place to be removed but you aren’t healthy enough for surgery."
"Often this is because the non-cancerous part of your liver is not healthy (because of cirrhosis, for example), and if the cancer is removed, there might not be enough healthy liver tissue left for it to function properly."
It could also mean that you have serious medical problems that make surgery unsafe.
"
Cancers that have spread to lymph nodes or other organs are classified as advanced."
These would include stages IVA and IVB cancers in the TNM system.
"Most advanced liver cancers cannot be treated with surgery.
"
"

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain length of time (usually 5 years) after they were diagnosed."
"They can’t tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
"
"Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they can’t predict what will happen in any particular person’s case."
These statistics can be confusing and may lead you to have more questions.
Ask your doctor how these numbers might apply to you.
"
A relative survival rate compares people with the same type and stage of cancer to people in the overall population."
"For example, if the 5-year relative survival rate for a specific stage of liver cancer is 30%, it means that people who have that cancer are, on average, about 30% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed."
"
The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results (SEER) database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer.
"
"The SEER database tracks 5-year relative survival rates for liver cancer in the United States, based on how far the cancer has spread."
"The SEER database, however, does not group cancers by AJCC TNM stages (stage 1, stage 2, stage 3, etc.)."
"Instead, it groups cancers into localized, regional, and distant stages:
>Localized:
    There is no sign that the cancer has spread outside of the liver.
"
">Regional:
    "
"The cancer has spread outside the liver to nearby structures or lymph nodes.
"
">Distant:
    "
"The cancer has spread to distant parts of the body, such as the lungs or bones."
"
These numbers are based on people diagnosed with cancers of the liver (or intrahepatic bile ducts) between 2012 and 2018.
"
"SEER* stage
5-year relative survival rate
Localized
36%
Regional
13%
Distant
3%
All SEER stages combined
21%
*SEER = Surveillance, Epidemiology, and End Results
In general, survival rates are higher for people who can have surgery to remove their cancer, regardless of the stage."
"For example, studies have shown that patients with small, resectable (removable) tumors who do not have cirrhosis or other serious health problems are likely to do well if their cancers are removed."
"For people with early-stage liver cancers who have a liver transplant, the 5-year survival rate is in the range of 60% to 70%."
"
>People now being diagnosed with liver cancer may have a better outlook than these numbers show.
    "
"Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least five years earlier.
"
">These numbers apply only to the stage of the cancer when it is first diagnosed.
    "
"They do not apply later on if the cancer grows, spreads, or comes back after treatment.
"
">These numbers don’t take everything into account.
    "
"Survival rates are grouped based on how far the cancer has spread, but your age, overall health, how well the cancer responds to treatment, and other factors will also affect your outlook.
"
"

It’s important to have honest, open discussions with your cancer care team."
"They want to answer all of your questions, so that you can make informed treatment and life decisions."
Here are some questions to consider:
"
>What
   kind
   of liver cancer do I have?
"
">Has the cancer spread beyond my liver?
>"
"What is the
   stage
   of my cancer?
>How well is my liver working?
>Will I need other
   tests
   before we can decide on treatment?
>Will I need to see other doctors or health professionals?
"
">If I’m concerned about the costs and insurance coverage for my diagnosis and treatment, who can help me?"
"
>What are my
   treatment
   choices?
>"
"What do you recommend and why?
"
">How much experience do you have treating this type of cancer?
>"
"What is the goal of the treatment?
>Can the cancer be removed with
   surgery
   ?
"
">Will I need a
   liver transplant
   ?
"
">Should I get a
   second opinion
   ?"
How do I do that?
"Can you recommend a doctor or cancer center?
>What risks or side effects should I expect?"
"How long are they likely to last?
>How quickly do we need to decide on treatment?
>Should I think about taking part in a
   clinical trial
   ?
>How soon do I need to start treatment?
"
">What should I do to be ready for treatment?
>How long will treatment last?"
What will it be like?
"Where will it be done?
"
">Will treatment affect my daily activities?
>"
"What will we do if the treatment doesn’t work or if the cancer
   comes back
   ?"
"
Once treatment begins, you’ll need to know what to expect and what to look for."
"Not all of these questions may apply to you, but asking the ones that do may be helpful.
"
">How will we know if the treatment is working?
>Is there anything I can do to help manage
   side effects
   ?
>"
"What symptoms or side effects should I tell you about right away?
>How can I reach you on nights, holidays, or weekends?
"
">Do I need to change what I eat during treatment?
>Are there any limits on what I can do?
>Will my treatment affect my daily activities?
>Can I exercise during treatment?"
"If so, what can I do, and how often?
"
>
"Can you suggest a mental health professional I can see if I start to feel
   overwhelmed, depressed, or distressed
   ?
>"
What if I need social support during treatment because my family lives far away?
"
>Will I need a special diet after treatment?
>Are there limits on what I can do?
>"
"What symptoms should I watch for?
>What kind of exercise can I do now?
"
">How often will I need to have follow-up exams and tests?
"
>How will we know if the cancer has come back?
"What should I watch for?
"
"What will my options be if the cancer comes back?
>What type of
   follow-up
   will I need after treatment?
"
"In addition to these examples, you might want to write down some of your own."
"For instance, you might want more information about recovery times.
"
"
"
"
Liver cancer is a cancer that starts in the liver."
"It happens when cells in the liver start to change and grow out of control, crowding out normal cells."
This makes it hard for the body to work the way it should.
The liver makes bile to help the body use food.
"It also cleans the blood and helps the blood clot when you are cut.
"
Liver cancer cells can spread to other parts of the body.
"When cancer does this, it's called metastasis ."
"But even if a liver cancer spreads to your bones, it is still called and treated like a liver cancer, not bone cancer.


"
Ask your doctor to use this picture to show you where the cancer is .
"
If a cancer starts in the liver, it is called primary liver cancer. "
There are many types of liver cancer.
Some are very rare.
"Your doctor can tell you more about the type you have.
"
The most common type of liver cancer is called hepatocellular carcinoma.
Also known as HCC.
"It starts in the cells that make up the liver.
"
"Some rare types of liver cancer are:
>Angiosarcoma
>Hemangiosarcoma
These cancers start in the cells lining the blood vessels of the liver."
They often grow quickly.
"
Most of the time when cancer is found in the liver it didn’t start there."
It spread there (metastasized) from somewhere else in the body.
"Because the cancer has spread from where it started, it’s called a secondary liver cancer."
"So, cancer that started in the lung and spreads to the liver is called lung cancer with spread to the liver, not liver cancer."
And this cancer is treated like lung cancer.
"
>Why do you think I have cancer?
>Is there a chance I don’t have cancer?
"
">Would you please write down the kind of cancer you think I might have?
"
>What will happen next?
"
Liver cancer often doesn’t cause signs and symptoms until it has grown very large or spread.
"
"Some symptoms of liver cancer are unplanned weight loss, don’t feel like eating, feeling full after a small meal, belly pain and swelling, and itchy, yellow skin."
The doctor will ask you questions about your health and do a physical exam.
"
"
"If signs are pointing to liver cancer, more tests may be done."
"Here are some of the tests you may need:
Ultrasound : For this test, a small wand is moved around on your skin."
It gives off sound waves and picks up the echoes as they bounce off tissues.
The echoes are made into a picture on a computer screen.
"This test is often the first test used to look at the liver.
"
CT or CAT scan :
This scan uses x-rays to make detailed pictures of your body.
"It can show the size, shape, and place of any tumors in or near the liver.
"
MRI : This scan uses radio waves and strong magnets instead of x-rays to make detailed pictures.
MRI scans can help tell if tumors in the liver are cancer.
They can also be used to look at blood vessels in and around the liver.
"They can help find out if liver cancer has spread.
"
Lab tests: Blood tests can check a protein called AFP (alpha-fetoprotein).
AFP is often very high in people with liver cancer.
"Other blood tests can also help find out how well the liver is working.
"
Liver biopsy:
"In a biopsy, the doctor takes out a small piece of tissue where the cancer seems to be."
"The tissue is checked for cancer.
"
There are many types of biopsies.
Ask your doctor what kind you will need.
Each type has risks and benefits.
"The choice of which type to use depends on your own case.
"
"Sometimes MRI or CT scans clearly show liver cancer and a biopsy isn’t needed.
"
"
>What tests will I need to have?
>"
"Who will do these tests?
"
">Where will the tests be done?
>Who can explain the tests to me?
>"
"How and when will I get the test results?
>Who will explain the test results to me?
>What do I need to do next?"
"
If you have liver cancer, the doctor will want to find out how far it has spread."
This is called staging .
The stage describes the growth or spread of the cancer through the liver.
It also tells if the cancer has spread to other organs of your body that are close by or far away.
Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.
"
Your cancer can be stage 1, 2, 3, or 4."
"The lower the number, the less the cancer has spread."
"A higher number, like stage 4, means the cancer has spread outside the liver.
"
"Doctors may also group liver cancers more simply, based on whether or not they can be entirely cut out (resected)."
"Resectable means can be removed by surgery.
"
Be sure to ask about your cancer stage and what it means.
"
>Do you know the stage of the cancer?
>If not, how and when will you find out the stage of the cancer?
"
">Would you explain to me what the stage means in my case?
>Based on the stage of the cancer, how long do you think I’ll live?
"
>What will happen next?
"
There are many ways to treat liver cancer , but the main types of treatment are:
>Surgery
>Tumor ablation
>Embolization
>Radiation
>Immunotherapy
>Targeted therapy
>Chemotherapy
Many times more than one kind of treatment is used.
"
"The treatment plan that’s best for you will depend on:
>The stage of the cancer
>How well your liver is working
>"
"The chance that a type of treatment will cure the cancer or help in some way
>Your age
>Other health problems you have
>Your feelings about the treatment and the side effects that come with it"
"
Surgery is the only way to try to cure liver cancer."
Surgery can be done to take out the part of the liver with the tumor or to do a liver transplant.
"Talk to the doctor about the kind of surgery planned and what you can expect.
"
Side effects of surgery : Any type of surgery can have risks and side effects.
Be sure to ask your cancer care team what you can expect.
"If you have problems, let your doctors know."
Doctors who treat liver cancer should be able to help you with any problems that come up.
"
Ablation is a treatment that destroys small liver tumors without taking them out."
"There are a number of ways to do this, such as heating the tumor with radio waves or microwaves, freezing the tumor, or killing the tumor by putting alcohol in it."
Talk to the doctor about the planned treatment and what you can expect.
"
Some patients with tumors that cannot be removed by surgery can have embolization."
It can be used for tumors that are too large to be treated with ablation.
Embolization can also be used with ablation.
"Substances are injected into the tumor or nearby blood vessels, to try to block or reduce some of the blood supply to the cancer."
"This causes the cancer cells to die.
"
"There are different types of embolization procedures (arterial embolization, chemoembolization, and radioembolization).  "
"But this treatment may not be a good choice for some patients whose liver has been damaged by diseases like hepatitis or cirrhosis.
"
"Side effects of embolization : Possible side effects after embolization include abdominal (belly) pain, fever, nausea, infection in the liver, gallbladder inflammation, and blood clots in the main blood vessels of the liver.  "
"Serious complications are not common, but they are possible."
"
Radiation uses high-energy rays (like x-rays) to kill cancer cells."
"There are different kinds of radiation.
"
"One kind, called external beam radiation can be aimed at the liver from a machine outside the body.
"
Another type of radiation treatment uses radiation and embolization (called radioembolization ).
"It's done by using a needle to put small radioactive beads into the hepatic artery, a large blood vessel in the liver, so the radiation is very close to the cancer .
"
"Side effects of radiation treatments: If your doctor suggests radiation treatment, ask what side effects might happen."
Side effects depend on the type of radiation that’s used.
The most common side effects of radiation are skin changes where the radiation is given and feeling very tired.
Most side effects get better after treatment ends.
Some might last longer.
Talk to your doctor about what you can expect.
"
Chemo is the short word for chemotherapy – the use of drugs to fight cancer."
The drugs may be given into a vein.
These drugs go into the blood and spread through the body.
Chemo is given in cycles or rounds.
Each round of treatment is followed by a break.
"Chemo may be used to treat liver cancer, but it doesn’t work as well as other treatments for liver cancer.
"
A type of embolization that uses chemotherapy is known as chemoembolization . 
"Tiny beads carrying chemo drugs are put into an artery to reduce blood flow to the tumor and also to put the chemo very close to the cancer.
"
"Side effects of chemo: Chemo can make you feel very tired, sick to your stomach, and may cause your hair to fall out."
But these problems go away after treatment ends.
There are ways to treat most chemo side effects.
"If you have side effects, talk to your cancer care team so they can help."
"
Targeted therapy uses drugs, different from chemotherapy, to treat certain types of liver cancer."
These drugs affect mainly cancer cells and not normal cells in the body.
They may work even if other treatment doesn’t.
They come as pills that you can take at home.
These drugs have different side effects from chemo.
"
Immunotherapy is the use of medicines that help a person’s own immune system find and destroy cancer cells. "
"One type of immunotherapy that is used to treat liver cancer is given into a vein.
"
"Side effects of immunotherapy : Immunotherapy can make you feel tired, sick to your stomach, or cause fever, chills, and rashes."
"Most of these problems go away after treatment ends.
"
Some side effects though are more serious than others.  
Talk to your doctor about what you can expect.
"
Clinical trials are research studies that test new drugs or other treatments in people."
"They compare standard treatments with others that may be better.
"
"If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials."
"See Clinical Trials to learn more.
"
Clinical trials are one way to get the newest cancer treatment.
They are the best way for doctors to find better ways to treat cancer.
"If your doctor can find one that’s studying the kind of cancer you have, it’s up to you if you want to take part."
"And if you do sign up for a clinical trial, you can always stop at any time."
"
"
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms.
"These treatments may be vitamins, herbs, special diets, and other things."
"You may want to know more about them.
"
"Some of these are known to help, but many have not been tested."
Some have been shown not to help.
A few have even been found to be harmful.
"Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else."
"
>What treatment do you think is best for me?
>What’s the goal of this treatment?"
"Do you think it could cure the cancer?
>Will treatment include surgery?"
"If so, who will do the surgery?
>What will the surgery be like?
"
">Will I need other types of treatment, too?"
"What’s the goal of these treatments?
>What side effects could I have from these treatments?
>What can I do about side effects that I might have?
"
">Is there a clinical trial that might be right for me?
>"
What about special vitamins or diets that friends tell me about?
"How will I know if they are safe?
>How soon do I need to start treatment?
"
">What should I do to be ready for treatment?
"
">Is there anything I can do to help the treatment work better?
>"
What’s the next step?
"
You’ll be glad when treatment is over."
"For years after treatment ends, you still will need to see your cancer doctor."
Be sure to go to all of these follow-up visits.
"Your doctor will ask about any symptoms that you might have and you will have exams, blood tests, and maybe other tests done to see if the cancer has come back.
"
"At first, your visits may be every 3 to 6 months for the first 2 years, then every 6 to 12 months."
"The longer you’re cancer-free, the less often the visits are needed.
"
Some treatments may not cure your cancer.
You might need to keep getting treatment and care.
"From time to time tests will be done to see how your treatment is working.
"
"Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways."
You might be thinking about how to improve your health.
"Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.
"
You can’t change the fact that you have cancer.
"What you can change is how you live the rest of your life .
"
"

Although the AJCC (TNM) staging system (see Liver Cancer Stages ) is often used to describe the spread of a liver cancer, doctors use a more practical system to determine treatment options."
"Liver cancers are often categorized as:
>Potentially resectable or transplantable cancer
>Unresectable (inoperable) cancer that has not spread
>Advanced cancer"
"
If your cancer is early stage and the rest of your liver is healthy, surgery (partial hepatectomy) may cure you."
Only a small number of people with liver cancer are in this category.
Important factors that may influence the outcome are the size of the tumor(s) and if nearby blood vessels are affected.
Larger tumors or those that invade blood vessels are more likely to come back in the liver or spread elsewhere after surgery.
How well your liver is working and your general health are also important.
"For some people with early-stage liver cancer, a liver transplant could be another option.
"
Clinical trials are now looking at whether patients who have a partial hepatectomy will be helped by getting other treatments in addition to surgery.
Some studies have found that using chemoembolization or other treatments along with surgery may help some patients live longer.
More research is needed to know the value (if any) of adding other treatments to surgery.
"
If your cancer is at an early stage, but the rest of your liver isn’t healthy, you may be able to be treated with a liver transplant."
A transplant may also be an option if the tumor is in a part of the liver that makes it hard to remove (such as very close to a large blood vessel).
Candidates for liver transplant might have to wait a long time for a liver to become available.
"While they are waiting, they are often given other treatments, such as ablation or embolization , to keep the cancer under control."
"
Unresectable cancers include cancers that haven’t yet spread to lymph nodes or distant parts of the body, but that can’t be removed safely by partial hepatectomy."
"This might be because:
>"
"The tumor is too large to be removed safely.
"
">The tumor is in a part of the liver that makes it hard to remove (such as very close to a large blood vessel).
"
">There are several tumors or the cancer has spread throughout the liver.
"
">The person isn't healthy enough for liver surgery.
"
"Treatment options might include ablation , embolization , or both for the liver tumor(s)."
"Other options may include targeted therapy , immunotherapy , chemotherapy (either systemic or by hepatic artery infusion), and/or radiation therapy ."
"For some of these cancers, treatment may shrink the tumor(s) enough so that surgery (partial hepatectomy or transplant) may become possible.
"
"These treatments are very unlikely to cure the cancer, but they can reduce symptoms and may even help a person live longer."
"Because these cancers can be hard to treat, clinical trials of newer treatments may offer a good option in many cases."
"
Advanced liver cancer has spread either to the lymph nodes or to other organs."
"Because these cancers are widespread, they cannot be removed with surgery.
"
"For people whose liver is functioning well enough (Child-Pugh class A or B), initial treatment options might include:
>The
    immunotherapy
    drug atezolizumab (Tecentriq) plus the
    targeted drug
    bevacizumab (Avastin)
>"
"Either of the targeted drugs sorafenib (Nexavar) or lenvatinib (Lenvima)
"
"If these drugs are no longer working, other targeted drugs, such as regorafenib (Stivarga), cabozantinib (Cabometyx), or ramucirumab (Cyramza) are possible options."
"Immunotherapy drugs such as pembrolizumab (Keytruda), or nivolumab (Opdivo) combined with ipilimumab (Yervoy), might also be helpful.
"
"As with unresectable liver cancer that has not spread, clinical trials of newer targeted therapies, immunotherapy, new approaches to chemotherapy (new drugs and ways to deliver chemotherapy), new forms of radiation therapy, and other new treatments may be helpful."
"These clinical trials are also important for improving the outcome for future patients.
"
Treatments such as radiation might also be used to help relieve pain and other symptoms.
"Please be sure to discuss any symptoms you have with your cancer team, so they can treat them effectively."
"
Cancer that comes back after treatment is called recurrent ."
Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs or bone).
"Treatment of liver cancer that returns after initial therapy depends on many factors, including where it comes back, the type of initial treatment, and how well the liver is functioning.
"
"People with resectable cancer that recurs in the liver might be eligible for further surgery or local treatments like ablation or embolization .
"
"If the cancer is widespread, targeted therapy , immunotherapy , or chemotherapy drugs may be options."
"Patients may also wish to ask their doctor whether a clinical trial may be right for them.
"
Treatment can also be given to relieve pain and other side effects .
"Please be sure to discuss any symptoms you have with your cancer care team, so they may be treated effectively.
"
"

Chemotherapy (chemo) is treatment with drugs to destroy cancer cells."
"Chemo may be an option for people whose liver cancer cannot be treated with surgery, has not responded to local therapies such as ablation or embolization, or when targeted therapy is no longer helpful."
"
Unfortunately, most chemo drugs do not have a great effect on liver cancer."
Recent advances have shown that a combination of drugs may be more helpful than using just a single chemo drug.
"But even these combinations of drugs shrink only a small number of tumors, and the responses often do not last long."
"And most studies show systemic chemo has not helped patients live longer.
"
"The most common chemotherapy drugs for treating liver cancer include:
>Gemcitabine (Gemzar)
>Oxaliplatin (Eloxatin)
>Cisplatin
>Doxorubicin (pegylated liposomal doxorubicin)
>5-fluorouracil (5-FU)
>Capecitabine (Xeloda)
>Mitoxantrone (Novantrone)
"
"Sometimes, combinations of 2 or 3 of these drugs are used."
GEMOX (gemcitabine plus oxaliplatin) is one option for people who are fairly healthy and may tolerate more than one drug.
"5-FU based chemotherapy, for example with FOLFOX (5-FU, oxaliplatin and leucovorin), is another option for people with bad liver disease."
"
You can get chemotherapy in different ways."
"
Drugs are injected right into a vein (IV) or taken by mouth."
"These drugs enter the bloodstream and reach almost all areas of the body, possibly making this treatment useful for cancers that have spread to other parts of the body.
"
"For IV chemo, a slightly larger and sturdier catheter is required in the vein system to administer chemo."
"They are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines."
"They are used to put medicines, blood products, nutrients, or fluids right into your blood."
They can also be used to take out blood for testing.
Many different kinds of CVCs are available.
"The 2 most common types are the port and the PICC line.
"
"Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs."
Cycles are most often 2 or 3 weeks long.
The schedule varies depending on the drugs used.
"For example, with some drugs, the chemo is given only on the first day of the cycle."
"With others, it is given for a few days in a row, or once a week."
"Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
"
Treatment for advanced liver cancer is based on how well it is working and what side effects you have.
"
Drugs are put right into an artery that leads to the part of the body with the tumor."
This focuses the chemo on the cancer cells in that area.
It reduces side effects by limiting the amount of drug reaching the rest of the body.
"Hepatic artery infusion, or chemo given directly into the hepatic artery, is regional chemotherapy that can be used for liver cancer.

"
"
Doctors have studied putting chemo drugs directly into the hepatic artery at a constant rate to see if it might be more effective than systemic chemo."
This technique is known as hepatic artery infusion (HAI).
It is slightly different from chemoembolization because surgery is needed to put an infusion pump under the skin of the abdomen (belly).
The pump is attached to a catheter that connects to the hepatic artery.
This is done while the patient is under general anesthesia.
"The chemo is injected with a needle through the skin into the pump' reservoir and it is released slowly and steadily into the hepatic artery.
"
The healthy liver cells break down most of the drug before it can reach the rest of the body.
This method gets a higher dose of chemo to the tumor than systemic chemo but doesn’t increase side effects.
"The drugs most commonly used for HAI include floxuridine (FUDR), cisplatin, and oxaliplatin.
"
HAI may be used for people with very large liver cancers that cannot be removed with surgery or cannot be treated entirely with TACE .
"This technique may not be useful in all patients because it requires surgery to insert the pump and catheter, an operation that many liver cancer patients may not be able to tolerate.
"
"Early studies have found that HAI is often effective in shrinking tumors, but more research is still needed."
"
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells."
"But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly."
"These cells are also likely to be affected by chemo, which can lead to side effects.
"
The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken.
"Common side effects include:
>Hair loss
>Mouth sores
>Loss of appetite
>Nausea and vomiting
>Diarrhea
>Increased chance of infections (from low white blood cell counts)
>Easy bruising or bleeding (from low blood platelet counts)
>Fatigue (from low red blood cell counts)
"
These side effects usually don’t last long and go away after treatment is finished.
There are often ways to lessen them.
"For example, drugs can be given to help prevent or reduce nausea and vomiting."
"Be sure to ask your doctor or nurse about drugs to help reduce side effects.
"
"Along with the possible side effects in the list above, some drugs may have their own specific side effects."
"Ask your health care team what you can expect.
"
You should report any side effects you notice while getting chemotherapy to your medical team so that you can be treated promptly.
"In some cases, the doses of the chemotherapy drugs may need to be reduced or treatment may need to be delayed or stopped to prevent side effects from getting worse.
"
"

Embolization is a procedure that injects substances directly into an artery in the liver to block or reduce the blood flow to a tumor in the liver.
"
The liver is special in that it has 2 blood supplies.
"Most normal liver cells are fed by the portal vein , whereas a cancer in the liver is mainly fed by the hepatic artery ."
"Blocking the part of the hepatic artery that feeds the tumor helps kill off the cancer cells, but it leaves most of the healthy liver cells unharmed because they get their blood supply from the portal vein.


"
Embolization is an option for some patients with tumors that cannot be removed by surgery.
It can be used for people with tumors that are too large to be treated with ablation (usually larger than 5 cm across) and who also have adequate liver function.
It can also be used with ablation.
"Embolization can reduce some of the blood supply to the normal liver tissue, so it may not be a good option for some patients whose liver has been damaged by diseases such as hepatitis or cirrhosis."
"It isn’t yet clear which type of embolization has a better long-term outcome.
"
People getting this type of treatment typically do not stay in the hospital overnight.
"
During trans-arterial embolization a catheter (a thin, flexible tube) is put into an artery in the inner thigh through a small cut and eased up into the hepatic artery in the liver."
A dye is usually injected into the bloodstream to help the doctor watch the path of the catheter.
"Once the catheter is in place, small particles are injected into the artery to plug it up, blocking oxygen and key nutrients from the tumor."
"
Trans-arterial chemoembolization is usually the first type of embolization used for large liver cancers that cannot be treated with surgery or ablation."
It combines embolization with chemotherapy (chemo).
"Most often, this is done by giving chemotherapy through the catheter directly into the artery, then plugging up the artery, so the chemo can stay close to the tumor."
"
Drug-eluting bead chemoembolization combines TACE embolization with drug-eluting beads (tiny beads that contain a chemotherapy drug)."
The procedure is essentially the same as TACE except that the artery is blocked after drug-eluting beads are injected.
"Because the chemo is physically close to the cancer and because the drug-eluting beads slowly release the chemo, the cancer cells are more likely to be damaged and die."
"The most common chemo drugs used for TACE or DEB-TACE are mitomycin C, cisplatin, and doxorubicin."
"
Radioembolization combines embolization with radiation therapy."
This is done by injecting small beads (called microspheres ) that have a radioactive isotope (yttrium-90 or Y-90) attached to them into the hepatic artery.
"Once infused, the beads lodge in the blood vessels near the tumor, where they give off small amounts of radiation to the tumor site for several days."
"The radiation travels a very short distance, so its effects are limited mainly to the tumor."
"
Possible complications after embolization include:
>Abdominal pain
>Fever
>Nausea
>Infection in the liver
>Blood clots in the main blood vessels of the liver
Sometimes, it can take 4-6 weeks to fully recover from the procedure."
"Because healthy liver tissue can be affected, there is a risk that liver function will get worse after embolization."
This risk is higher if a large branch of the hepatic artery is embolized.
"Serious complications are not common, but they are possible.
"
"

Immunotherapy is the use of medicines that help a person’s own immune system find and destroy cancer cells."
It can be used to treat some people with liver cancer.
"
An important part of the immune system is its ability to keep itself from attacking normal cells in the body."
"To do this, it uses “checkpoints” – proteins on immune cells that need to be turned on (or off) to start an immune response."
Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system.
Newer drugs that target these checkpoints hold a lot of promise as liver cancer treatments.
"
PD-1 is a checkpoint protein on immune cells called T cells ."
"When PD-1 attaches to PD-L1, a protein on other cells in the body, it acts as a type of “off switch” that basically tells the T cell to leave the other cell alone."
"Some cancer cells have large amounts of PD-L1, which helps them hide from an immune attack."
"Drugs that target either PD-1 or PD-L1 can block this binding and boost the immune response against cancer cells.
"
Atezolizumab (Tecentriq) and durvalumab (Imfinzi) target the PD-L1 protein.
Blocking this protein can help boost the immune response against cancer cells.
"This can shrink some tumors or slow their growth.
"
"Atezolizumab can be used along with the targeted drug bevacizumab (Avastin) as the first treatment for liver cancer that cannot be treated by surgery or that has spread to other organs.
"
"Durvalumab can be used with another immunotherapy drug tremelimumab (Imjudo) as the first treatment for liver cancer that cannot be removed with surgery.
"
"These drugs are given as an infusion into a vein (IV), typically once every 2, 3, or 4 weeks.
"
"Pembrolizumab (Keytruda) and n ivolumab (Opdivo) are drugs that target PD-1, which can help boost the immune response against cancer cells."
"This can shrink some tumors or slow their growth.
"
These drugs can be used in people with advanced liver cancer who have previously been treated (such as with the targeted drug sorafenib [Nexavar]).
"Pembrolizumab can be used by itself, while nivolumab is typically used along with ipilimumab (see below).
"
"These drugs are given as an intravenous (IV) infusion, typically every 2, 3, 4, or 6 weeks."
"
Ipilimumab (Yervoy) and tremelimumab (Imjudo) are other types of drugs that boost the immune response, but they have a different target."
"They block CTLA-4, another protein on T cells that normally helps keep them in check.
"
Tremelimumab (Imjudo) can be used with another immunotherapy drug durvalumab as the first treatment for liver cancer that cannot be removed with surgery.
"It is given as an intravenous (IV) infusion once every 4 weeks.
"
Ipilimumab can be used in combination with nivolumab to treat liver cancer that has previously been treated (such as with the targeted drug sorafenib).
"This drug is given as an intravenous (IV) infusion, usually once every 3 weeks for 4 treatments."
"
Side effects of these drugs can include:
>Feeling tired or weak
>Fever
>Cough
>Nausea
>Itching
>Skin rash
>Loss of appetite
>Muscle or joint pain
>Constipation or diarrhea
Other, more serious side effects occur less often:
Infusion reactions: Some people might have an infusion reaction while getting these drugs."
"This is like an allergic reaction, and can include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing."
"It’s important to tell your doctor or nurse right away if you have any of these symptoms while getting these drugs.
"
Autoimmune reactions: These drugs work by basically removing one of the safeguards on the body’s immune system.
"Sometimes the immune system starts attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, skin, or other organs.
"
"Serious side effects seem to occur more often with ipilimumab than with the PD-1 and PD-L1 inhibitors.
"
It’s very important to report any new side effects to your health care team promptly.
"If serious side effects do occur, treatment may need to be stopped and you may get high doses of corticosteroids to suppress your immune system.
"
"

Radiation therapy uses high-energy rays (or particles) to kill cancer cells. "
"It may not be a good option for some patients whose liver has been greatly damaged by diseases such as hepatitis or cirrhosis.
"
"Radiation can be helpful in treating:
>Liver cancer that cannot be removed by surgery
>Liver cancer that cannot be treated with ablation or embolization or did not respond well to those treatments
>Liver cancer that has spread to other areas such as the brain or bones
>People with pain because of large liver cancers
>People with a tumor thrombus (a collection of liver cancer cells) blocking the portal vein."
"
External beam radiation therapy (EBRT) focuses radiation from a source outside of the body on the cancer."
"Getting radiation therapy is much like getting an x-ray, but the radiation is stronger."
The procedure itself is painless.
"Each treatment lasts only a few minutes, although the setup time – getting you into place for treatment – usually takes longer."
"Most often, EBRT treatments are small doses of radiation given 5 days a week for several weeks.
"
"Although liver cancer cells are sensitive to radiation, much care is taken when planning the treatment to avoid damaging normal liver tissue as much as possible."
"Newer radiation techniques, such as s tereotactic body radiation therapy (SBRT) , help doctors target liver tumors while reducing the radiation to nearby healthy tissues."
This makes it more effective and reduces side effects.
SBRT allows treatment to be completed in a short-time compared to EBRT.
It uses very focused beams of high-dose radiation given on one or a few days.
Beams are aimed at the tumor from many different angles.
"To focus the radiation precisely, the person is put in a specially designed body frame for each treatment."
This type of radiation may be used in people with small cancers who are waiting for a liver transplant.
"
As mentioned in Embolization Therapy for Liver Cancer , tumors in the liver can be treated by injecting small radioactive beads into the hepatic artery."
The beads then lodge in the liver near the tumor and give off small amounts of radiation that travel only a short distance.
"
Some of the more common side effects of radiation therapy include:
>Skin changes in areas getting radiation, ranging from redness to blistering and peeling
>Nausea and vomiting
>Fatigue
>Diarrhea
>Loss of appetite
These effects typically go away within a few weeks after treatment ends.
"
A more serious side effect of radiation therapy to the liver is radiation-induced liver disease (RILD) .
"It commonly happens 3 to 4 months after treatment and usually only lasts a set time, but can be fatal in some instances."
"Signs and symptoms seen with RILD can include abnormal blood liver tests, an enlarged liver and spleen, ascites (fluid build up in the abdomen), and jaundice."
"Ask your doctor what side effects to expect and how to prevent or relieve them.
"
"

The best option to cure liver cancer is with either surgical resection (removal of the tumor with surgery) or a liver transplant."
"If all cancer in the liver is completely removed, you will have the best outlook."
Small liver cancers may also be cured with other types of treatment such as ablation or radiation.
"
Partial hepatectomy is surgery to remove part of the liver."
"Only people with good liver function who are healthy enough for surgery and who have a single tumor that has not grown into blood vessels can have this operation.
"
"Imaging tests , such as CT or MRI with angiography are done first to see if the cancer can be removed completely."
"Still, sometimes during surgery the cancer is found to be too large or has spread too far to be removed, and the surgery that has been planned cannot be done.
"
Most patients with liver cancer in the United States also have cirrhosis .
"In someone with severe cirrhosis, removing even a small amount of liver tissue at the edges of a cancer might not leave enough liver behind to perform important functions.
"
People with cirrhosis are typically eligible for surgery if there is only one tumor (that has not grown into blood vessels) and they will still have a reasonable amount (at least 30%) of liver function left once the tumor is removed.
"Doctors often assess this function by assigning a Child-Pugh score (see Liver Cancer Stages ), which is a measure of cirrhosis based on certain lab tests and symptoms.
"
Patients in Child-Pugh class A are most likely to have enough liver function to have surgery.
Patients in class B are less likely to be able to have surgery.
Surgery is not typically an option for patients in class C.
"
Liver resection is a major, serious operation that should only be done by skilled and experienced surgeons."
"Because people with liver cancer usually have other liver problems besides the cancer, surgeons have to remove enough of the liver to try to get all of the cancer, but also leave enough behind for the liver to function.
"
">Bleeding: A lot of blood passes through the liver, and bleeding after surgery is a major concern."
"Also, the liver normally makes substances that help the blood clot."
"Damage to the liver (both before the surgery and during the surgery) can add to potential bleeding problems.
"
">Infection
>Complications from anesthesia
>Blood clots
>Pneumonia
>New liver cancer: Because the remaining liver still has the underlying disease that led to the cancer, sometimes a new liver cancer can develop afterward."
"
"
"When it is available, a liver transplant may be the best option for some people with liver cancer."
"Liver transplants can be an option for those with tumors that cannot be removed with surgery, either because of the location of the tumors or because the liver has too much disease for the patient to tolerate removing part of it."
"In general, a transplant is used to treat patients with small tumors (either 1 tumor smaller than 5 cm across or 2 to 3 tumors no larger than 3 cm) that have not grown into nearby blood vessels."
It can also rarely be an option for patients with resectable cancers (cancers that can be removed completely).
"With a transplant, not only is the risk of a second new liver cancer greatly reduced, but the new liver will function normally.
"
"According to the Organ Procurement and Transplantation Network, about 1,000 liver transplants were done in people with liver cancer in the United States in 2016, the last year for which numbers are available."
"Unfortunately, the opportunities for liver transplants are limited."
"Only about 8,400 livers are available for transplant each year, and most of these are used for patients with diseases other than liver cancer."
"Increasing awareness about the importance of organ donation is an essential public health goal that could make this treatment available to more patients with liver cancer and other serious liver diseases.
"
Most livers used for transplants come from people who have just died.
But some patients receive part of a liver from a living donor (usually a close relative) for transplant.
The liver can regenerate some of its lost function over time if part of it is removed.
"Still, the surgery does carry some risks for the donor."
About 370 living donor liver transplants are done in the United States each year.
"Only a small number of them are for patients with liver cancer.
"
"People needing a transplant must wait until a liver is available, which can take too long for some people with liver cancer."
"In many cases a person may get other treatments, such as embolization or ablation , while waiting for a liver transplant."
Or doctors may suggest surgery or other treatments first and then a transplant if the cancer comes back.
"
Like partial hepatectomy, a liver transplant is a major operation with serious risks and should only be done by skilled and experienced surgeons."
"Possible risks include:
>Bleeding
>Infection: People who get a liver transplant are given drugs to help suppress their immune systems to prevent their bodies from rejecting the new organ."
"These drugs have their own risks and side effects, especially the risk of getting serious
   infections
   ."
"By suppressing the immune system, these drugs might also allow any liver cancer that had spread outside of the liver to grow even faster than before."
"Some of the drugs used to prevent rejection can also cause high blood pressure, high cholesterol, and diabetes; can weaken the bones and kidneys; and can even lead to a
   new cancer
   .
"
">Blood clots
>Complications from anesthesia
>Rejection of new liver: After a liver transplant, regular blood tests are done to check for signs of the body rejecting the new liver."
"Sometimes liver biopsies are also taken to see if rejection is happening and if changes are needed in the drugs that prevent rejection.
"
"

As researchers learn more about the changes in cells that cause cancer, they have been able to develop newer drugs that specifically target these changes."
"Targeted drugs work differently from standard chemotherapy drugs (which are described in Chemotherapy for Liver Cancer ) and often have different side effects.
"
"Like chemotherapy, these drugs enter the bloodstream and reach almost all areas of the body, which makes them potentially useful against cancers that have spread to distant parts of the body."
"Because standard chemo is not very effective in most patients with liver cancer, doctors are focusing more on using targeted therapies."
"
Kinases are proteins on or near the surface of a cell that carry important signals to the cell’s control center."
Many of the targeted drugs used to treat liver cancer are kinase inhibitors .
"These drugs block several kinase proteins, which normally help tumor cells grow in one of two ways:
>Some kinases help tumor cells grow directly.
"
">Some kinases help tumors form the new blood vessels they need in order to get bigger (a process called
   angiogenesis
   ).
"
Blocking these proteins can often help stop the growth of the cancer.
"
One of these drugs can be used as the first treatment for liver cancer if it cannot be treated by surgery or if it has spread to other organs.
"
Sorafenib is a pill taken twice daily.
"Lenvatinib is a pill that is taken once a day.
"
Sorafenib may work better in people with liver cancer caused by hepatitis C.
"
These drugs can be used to treat advanced liver cancer, typically if other treatments are no longer helpful.
"
"Regorafenib is a pill, typically taken once a day for 3 weeks, followed by a week off."
Cabozantinib is a pill taken once a day.
"
Common side effects of these drugs can include fatigue, loss of appetite, hand-foot syndrome (redness and irritation of the hands and feet), high blood pressure, weight loss, diarrhea, and abdominal (belly) pain.
"
"Less common but more serious side effects can include problems with blood flow to the heart, bleeding, abnormal thyroid tests, and perforations (holes) in the stomach or intestines."
"
Monoclonal antibodies are man-made versions of immune system proteins (antibodies) that are designed to attach to a specific target."
"The monoclonal antibodies used to treat liver cancer affect a tumor’s ability to form new blood vessels, which it needs to grow beyond a certain size."
"This new blood vessel growth is called angiogenesis , so these drugs are often referred to angiogenesis inhibitors ."
"
Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor (VEGF), a protein that helps new blood vessels to form."
"This drug can be used along with the immunotherapy drug atezolizumab (Tecentriq) as the first treatment for liver cancer that cannot be treated by surgery or that has spread to other organs.
"
"This drug is given as an infusion into a vein (IV), typically once every 3 weeks."
"
Ramucirumab is a monoclonal antibody that targets a VEGF receptor (VEGFR) protein on cells, which can help stop the formation of new blood vessels."
"This drug can be used to treat advanced liver cancer, typically after another treatment stops working.
"
"This drug is given as an infusion into a vein (IV), usually once every 2 weeks."
"
Common side effects of these drugs can include:
>High blood pressure
>Tiredness (fatigue)
>Bleeding
>Low white blood cell counts (with increased risk of infections)
"
"Headaches
>Mouth sores
>Loss of appetite
>Diarrhea
Rare but possibly serious side effects can include blood clots, severe bleeding, holes (called perforations) in the stomach or intestines, heart problems, and slow wound healing.
"
"

Ablation is treatment that destroys liver tumors without removing them."
These techniques can be used in patients with a few small tumors and when surgery is not a good option (often because of poor health or reduced liver function).
"They are less likely to cure the cancer than surgery, but they can still be very helpful for some people."
"These treatments are also sometimes used in patients waiting for a liver transplant.
"
Ablation is best used for tumors no larger than 3 cm across (a little over an inch).
"For slightly larger tumors (1 to 2 inches, or 3 to 5 cm across), it may be used along with embolization."
"Because ablation often destroys some of the normal tissue around the tumor, it might not be a good choice for treating tumors near major blood vessels, the diaphragm, or major bile ducts.
"
People getting this type of treatment typically do not need to stay in a hospital.
"Often, ablation can be done without surgery by inserting a needle or probe into the tumor through the skin."
The needle or probe is guided into place with ultrasound or CT scan.
"Sometimes, though, to be sure the treatment is aimed at the right place, the ablation may be done in the operating room under general anesthesia (you are asleep) and may need an incision (cut) like the one for a partial hepatectomy ."
"
Radiofrequency ablation is one of the most common ablation methods for small tumors. "
It uses high-energy radio waves.
"The doctor inserts a thin, needle-like probe into the tumor through the skin."
"A high-frequency current is then passed through the tip of the probe, which heats the tumor and destroys the cancer cells."
"
Microwave ablation uses the energy from electromagnetic waves to heat and destroy the tumor using a probe."
"
Cryoablation destroys a tumor by freezing it using a thin metal probe."
The probe is guided into the tumor and then very cold gasses are passed through the probe to freeze the tumor which causes the cancer cells to die.
"
"
This is also known as percutaneous ethanol injection (PEI) .
"In this procedure, concentrated alcohol is injected directly into the tumor to damage cancer cells."
Sometimes multiple treatments of alcohol ablation may be needed.
"
Possible side effects after ablation therapy include abdominal pain, infection in the liver, fever and abnormal liver tests."
"Serious complications are uncommon, but they are possible.
"
"Newer ablation techniques in liver cancer are also being studied.
"
"
"
"
The American Cancer Society’s estimates for pancreatic cancer in the United States for 2023 are:
>About 64,050 people (33,130 men and 30,920 women) will be diagnosed with pancreatic cancer.
"
">About 50,550 people (26,620 men and 23,930 women) will die of pancreatic cancer.
"
"Pancreatic cancer accounts for about 3% of all cancers in the US and about 7% of all cancer deaths.
"
It is slightly more common in men than in women.
"
The average lifetime risk of pancreatic cancer is about 1 in 64."
"But each person’s chances of getting this cancer can be affected by certain risk factors .
"
"For statistics related to survival, see Pancreatic Cancer Survival Rates by Stage .
"
"Visit our Cancer Statistics Center for more key statistics.
"
"

Pancreatic cancer is a type of cancer that starts in the pancreas."
(Cancer starts when cells in the body begin to grow out of control.
"To learn more about how cancers start and spread, see What Is Cancer? )
"
Pancreatic adenocarcinoma is the most common type of pancreatic cancer.
"
The pancreas is an organ that sits behind the stomach."
"It's shaped a bit like a fish with a wide head, a tapering body, and a narrow, pointed tail."
"In adults it's about 6 inches (15 centimeters) long but less than 2 inches (5 centimeters) wide.
"
">The head of the pancreas is on the right side of the abdomen (belly), behind where the stomach meets the duodenum (the first part of the small intestine).
"
"The head of the pancreas is on the right side of the abdomen (belly), behind where the stomach meets the duodenum (the first part of the small intestine).
"
">The body of the pancreas is behind the stomach.
"
"The body of the pancreas is behind the stomach.
"
">The tail of the pancreas is on the left side of the abdomen next to the spleen.
"
"The tail of the pancreas is on the left side of the abdomen next to the spleen.


"
"The most common type of pancreatic cancer, adenocarcinoma of the pancreas, starts when exocrine cells in the pancreas start to grow out of control."
Most of the pancreas is made up of exocrine cells which form the exocrine glands and ducts.
The exocrine glands make pancreatic enzymes that are released into the intestines to help you digest foods (especially fats).
The enzymes are released into tiny tubes called ducts which eventually empty into the pancreatic duct.
"The pancreatic duct merges with the common bile duct (the duct that carries bile from the liver), and empties into the duodenum (the first part of the small intestine) at the ampulla of Vater.
"
Endocrine cells make up a smaller percentage of the cells in the pancreas.
"These cells make important hormones like insulin and glucagon (which help control blood sugar levels), and release them directly into the blood."
Pancreatic neuroendocrine tumors start in the endocrine cells.
"See Pancreatic Neuroendocrine Tumor for more about this type.
"
"If you are diagnosed with pancreatic cancer, it’s very important to know if it's an endocrine cancer (see Pancreatic Neuroendocrine Tumor) or exocrine cancer (discussed here)."
"
Exocrine cancers are by far the most common type of pancreas cancer."
"If you are told you have pancreatic cancer, it's most likely an exocrine pancreatic cancer.
"
Pancreatic adenocarcinoma: About 95% of cancers of the exocrine pancreas are adenocarcinomas .
These cancers usually start in the ducts of the pancreas.
"Less often, they develop from the cells that make the pancreatic enzymes, in which case they are called acinar cell carcinomas .
"
"Less common types of exocrine cancer: Other, less common exocrine cancers include adenosquamous carcinomas, squamous cell carcinomas, signet ring cell carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with giant cells.
"
Ampullary cancer (carcinoma of the ampulla of Vater):
"This cancer starts in the ampulla of Vater, which is where the bile duct and pancreatic duct come together and empty into the small intestine."
"Ampullary cancers aren’t technically pancreatic cancers, but they are included here because they are treated much the same.
"
Ampullary cancers often block the bile duct while they're still small and have not spread far.
"This blockage causes bile to build up in the body, which leads to yellowing of the skin and eyes (jaundice)."
"
Some growths in the pancreas are simply benign (not cancer), while others might become cancer over time if left untreated (known as precancers )."
"Because people are getting imaging tests such as CT scans more often than in the past (for a number of reasons), these types of pancreatic growths are now being found more often.
"
Serous cystic neoplasms (SCNs) (also known as serous cystadenomas ) are tumors that have sacs (cysts) filled with fluid.
"SCNs are almost always benign, and most don’t need to be treated unless they grow large or cause symptoms.
"
Mucinous cystic neoplasms (MCNs) (also known as mucinous cystadenomas ) are slow-growing tumors that have cysts filled with a jelly-like substance called mucin .
These tumors almost always occur in women.
"While they are not cancer, some of them can progress to cancer over time if not treated, so these tumors are typically removed with surgery.
"
Intraductal papillary mucinous neoplasms (IPMNs) are benign tumors that grow in the pancreatic ducts.
"Like MCNs, these tumors make mucin, and over time they sometimes become cancer if not treated."
"Some IPMNs can just be followed closely over time, but some might need to be removed with surgery if they have certain features, such as if they are in the main pancreatic duct.
"
"Solid pseudopapillary neoplasms (SPNs) are rare, slow-growing tumors that almost always develop in young women."
"Even though these tumors tend to grow slowly, they can sometimes spread to other parts of the body, so they are best treated with surgery."
"The outlook for people with these tumors is usually very good.
"
"

For some people with pancreatic cancer, treatment can remove or destroy the cancer."
Completing treatment can be both stressful and exciting.
"You may be relieved to finish treatment, but find it hard not to worry about cancer coming back."
"This is very common if you’ve had cancer.
"
"For many people with pancreatic cancer, the cancer might never go away completely, or it might come back in another part of the body."
"These people may get regular treatments with chemotherapy, radiation therapy, or other therapies to help keep the cancer under control for as long as possible."
Learning to live with cancer that does not go away can be difficult and very stressful.
"
If you have completed treatment, your doctors will still want to watch you closely."
It’s very important to go to all of your follow-up appointments.
"During these visits, your doctors will ask questions about any problems you are having and may do exams and lab or imaging tests to look for signs of cancer or treatment side effects.
"
Some treatment side effects might last a long time or might not even show up until years after you have finished treatment.
"Your doctor visits are a good time to ask questions and talk about any changes or problems you notice or concerns you have.
"
"It’s important for all pancreatic cancer survivors, to let their health care team know about any new symptoms or problems, because they could be caused by the cancer coming back or by a new disease or second cancer."
"
Your schedule of doctor visits, exams, and tests will depend on the original extent of your cancer, how it was treated, and other factors."
"Most often, for people with no signs of cancer remaining, many doctors recommend follow-up visits (which may include CT scans and blood tests) about every 3 months for the first couple of years after treatment and then about every 6 months for the next several years. "
Be sure to follow your doctor’s advice about follow-up tests.
"
Talk with your doctor about developing a survivorship care plan for you."
"This plan might include:
>A suggested schedule for follow-up exams and tests
>A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
>A schedule for other tests you might need, such as tests to look for long-term health effects from your cancer or its treatment
>Suggestions for things you can do that might improve your health, including possibly lowering your chances of the cancer coming back"
"
Even if you’ve finished treatment, it’s very important to keep health insurance ."
"Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
"
"At some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history."
It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment.
Learn more in Keeping Copies of Important Medical Records .
"
Pancreatic cancer often causes weight loss and weakness from poor nutrition."
These symptoms might be caused by treatment or by the cancer itself.
A team of doctors and nutritionists can work with you to provide nutritional supplements and information about your individual nutritional needs.
This can help you keep up your weight and nutritional intake.
Many patients need to take pancreatic enzymes in pill form to help digest food so that it can be absorbed.
"For serious nutrition problems, the doctor might need to put a feeding tube into the stomach to improve nutrition and energy levels."
This is usually temporary.
"For more information and nutrition tips for during and after cancer treatment, see Nutrition for the Person With Cancer .
"
There are many ways to control pain caused by pancreatic cancer .
"If you have pain, tell your cancer care team right away, so they can give you prompt and effective pain management.."
"
If you have (or have had) pancreatic cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements."
"Unfortunately, it’s not yet clear if there are things you can do that will help.
"
"Tobacco use has clearly been linked to pancreatic cancer, so not smoking may help reduce your risk."
"We don’t know for certain if this will help, but we do know that it can help improve your appetite and overall health."
It can also reduce the chance of developing other types of cancer.
"If you want to quit smoking and need help, call the American Cancer Society at 1-800-227-2345.
"
"Other healthy behaviors such as eating well, getting regular physical activity , and staying at a healthy weight might help as well, but no one knows for sure."
"However, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of cancer."
"
So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of pancreatic cancer progressing or coming back."
"This doesn’t mean that no supplements will help, but it’s important to know that none have been proven to do so.
"
"Dietary supplements are not regulated like medicines in the United States – they do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do."
"If you’re thinking about taking any type of nutritional supplement, talk to your health care team."
They can help you decide which ones you can use safely while avoiding those that might be harmful.
"
If your cancer does come back at some point, your treatment options will depend on the where the cancer is, what treatments you’ve had before, and your health."
"Treatment options might include surgery, radiation therapy, chemotherapy, or some combination of these."
"See Treatment of Pancreatic Cancer, Based on Extent of the Cancer .
"
"For more general information on recurrence, see Understanding Recurrence ."
"
People who’ve had pancreatic cancer can still get other cancers."
Learn more in Second Cancers After Pancreatic Cancer .
"
Some amount of feeling depressed, anxious, or worried is normal when pancreatic cancer is a part of your life."
Some people are affected more than others.
"But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups, professional counselors, or others."
"Learn more in Life After Cancer .
"
"

Pancreatic cancer survivors can be affected by a number of health problems, but often a major concern is facing cancer again."
Cancer that comes back after treatment is called a recurrence .
"But some cancer survivors develop a new, unrelated cancer later."
"This is called a second cancer .
"
"Unfortunately, being treated for pancreatic cancer doesn’t mean you can’t get another cancer."
People who have had pancreatic cancer can still get the same types of cancers that other people get.
"In fact, they might be at higher risk for certain types of cancer.
"
"Studies looking at the second cancers pancreatic cancer survivors can get are not easy to do, mainly because of the poor outcomes related to pancreatic cancer."
"The little information that is known shows that there is an increased risk of:
>Thyroid cancer
>Small Intestine Cancer
For people diagnosed with pancreatic cancer younger than 50 years of age, there appears to be an increased risk of lung cancer ."
"This is believed to be related to smoking.
"
Exactly how high the risk is of these second cancers is not known at this time.
"
After completing treatment, you should still see your doctor regularly."
"Report any new symptoms or problems, because they could be caused by the cancer spreading or coming back, or by a new disease or second cancer.
"
"Pancreatic cancer survivors should also follow the American Cancer Society guidelines for the early detection of cancer , such as those for colorectal, breast, cervical, and prostate cancer."
"Screening tests can find some cancers early, when they are likely to be treated more successfully."
"For people who have had pancreatic cancer, most experts don’t recommend any additional testing to look for second cancers unless you have symptoms or if you or your family have an inherited genetic syndrome ."
"
There are steps you can take to lower your risk and stay as healthy as possible."
"For example, people who have had pancreatic cancer should do their best to stay away from tobacco products ."
"Not smoking lowers the chance of developing most lung cancers, and may help decrease the possibility of a new pancreatic cancer from forming.
"
"To help maintain good health , pancreatic cancer survivors should also:
>Get to and stay at a healthy weight
>Keep physically active and limit the time you spend sitting or lying down
>Follow a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and limits or avoids red and processed meats, sugary drinks, and highly processed foods
>Not drink
   alcohol
   ."
"If you do drink, have no more than 1 drink per day for women or 2 per day for men
These steps may also lower the risk of some other health problems.
"
"See Second Cancers in Adults for more information about causes of second cancers.
"
"

There is no sure way to prevent pancreatic cancer."
"Some risk factors such as age, sex, race, and family history can’t be controlled."
But there are things you can do that might lower your risk.
"
Smoking is the most important avoidable risk factor for pancreatic cancer."
Quitting smoking helps lower risk.
"If you smoke and want help quitting, please talk to your health care provider or call us at 1-800-227-2345."
"
Getting to and staying at a healthy weight might help lower your risk."
"Getting regular physical activity can help you stay at a healthy weight and may also reduce your risk of pancreatic cancer risk.
"
"Processed and red meats and sugary drinks may also increase the risk of pancreatic cancer.
"
"The American Cancer Society recommends following a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and that limits or avoids red and processed meats, sugary drinks, and highly processed foods."
"For more, see the American Cancer Society Guidelines for Diet and Physical Activity for Cancer Prevention ."
"
Heavy alcohol use has been tied to pancreatic cancer in some studies."
"Heavy alcohol use can also lead to conditions such as chronic pancreatitis, which is known to increase pancreatic cancer risk."
It’s best not to drink alcohol .
"If you do drink, you should have no more than 1 drink per day for women or 2 drinks per day for men ."
"
Avoiding workplace exposure to certain chemicals may reduce your risk for pancreatic cancer.
"
"

A risk factor is anything that increases your chance of getting a disease such as cancer."
Different cancers have different risk factors.
"Some risk factors, like smoking, can be changed."
"Others, like a person’s age or family history, can’t be changed.
"
"In some cases, there might be a factor that may decrease your risk of developing cancer or has an unclear effect."
"That is not considered a risk factor, but you may see them noted clearly on this page as well.
"
"Having a risk factor, or even many, does not mean that you will get cancer."
"And some people who get cancer may have few or no known risk factors.
"
Here are some of the risk factors known to increase your risk for pancreatic cancer.
"
Smoking is one of the most important risk factors for pancreatic cancer."
The risk of getting pancreatic cancer is about twice as high among people who smoke compared to those who have never smoked.
About 25% of pancreatic cancers are thought to be caused by cigarette smoking.
Cigar smoking and the use of smokeless tobacco products also increase the risk.
"However, the risk of pancreatic cancer starts to drop once a person stops smoking ."
See Can Pancreatic Cancer Be Prevented?
"
Being very overweight (obese) is a risk factor for pancreatic cancer."
Obese people (body mass index [BMI] of 30 or more) are about 20% more likely to develop pancreatic cancer.
"Gaining weight as an adult can also increase risk.
"
Carrying extra weight around the waistline may be a risk factor even in people who are not very overweight.
"
Pancreatic cancer is more common in people with diabetes."
The reason for this is not known.
Most of the risk is found in people with type 2 diabetes.
This type of diabetes is increasing in children and adolescents as obesity in these age groups also rises.
Type 2 diabetes in adults is also often related to being overweight or obese.
It’s not clear if people with type 1 (juvenile) diabetes have a higher risk.
"
Chronic pancreatitis, a long-term inflammation of the pancreas, is linked with an increased risk of pancreatic cancer.  "
Chronic pancreatitis is often seen with heavy alcohol use and smoking.
"
Heavy exposure at work to certain chemicals used in the dry cleaning and metal working industries may raise a person’s risk of pancreatic cancer."
"
The risk of developing pancreatic cancer goes up as people age."
Almost all patients are older than 45.
About two-thirds are at least 65 years old.
The average age at the time of diagnosis is 70.
"
Men are slightly more likely to develop pancreatic cancer than women."
"This may be due, at least in part, to higher tobacco use in men, which raises pancreatic cancer risk (see above)."
"
African Americans are slightly more likely to develop pancreatic cancer than whites."
"The reasons for this aren’t clear, but it may be due in part to having higher rates of some other risk factors for pancreatic cancer, such as diabetes, smoking , and being overweight."
"
Pancreatic cancer seems to run in some families."
"In some of these families, the high risk is due to an inherited syndrome (explained below)."
"In other families, the gene causing the increased risk is not known."
"Although family history is a risk factor, most people who get pancreatic cancer do not have a family history of it."
"
Inherited gene changes (mutations) can be passed from parent to child."
These gene changes may cause as many as 10% of pancreatic cancers.
Sometimes these changes result in syndromes that include increased risks of other cancers (or other health problems).
"Examples of genetic syndromes that can cause pancreatic cancer include:
>Hereditary breast and ovarian cancer syndrome
   , caused by mutations in the
   BRCA1
   or
   BRCA2
   genes
>Hereditary breast cancer
   , caused by mutations in the PALB2 gene
>Familial atypical multiple mole melanoma (FAMMM) syndrome
   , caused by mutations in the
   p16/CDKN2A
   gene and associated with skin and eye melanomas
>Familial pancreatitis
   , usually caused by mutations in the
   PRSS1
   gene
>Lynch syndrome
   , also known as
   hereditary non-polyposis colorectal cancer
   (HNPCC), most often caused by a defect in the
   MLH1
   or
   MSH2
   genes
>Peutz-Jeghers syndrome
   , caused by defects in the
   STK11
   gene."
"This syndrome is also linked with polyps in the digestive tract and several other cancers.

"
Changes in the genes that cause some of these syndromes can be found by genetic testing.
"For more information on genetic testing, see Can Pancreatic Cancer Be Found Early?"
"
Chronic pancreatitis is sometimes due to an inherited gene mutation ."
People with this inherited (familial) form of pancreatitis have a high lifetime risk of pancreatic cancer.
"
Diets with red and processed meats (such as sausage and bacon) and saturated fats may increase the risk of pancreatic cancer."
Sugary drinks may also increase this risk.
More research is needed in this area.
"
Some research has suggested that lack of physical activity might increase pancreatic cancer risk."
But not all studies have found this .
Regular physical activity may help reduce the risk of pancreatic cancer.
"
Some older studies have suggested that drinking coffee might increase the risk of pancreatic cancer, but more recent studies have not confirmed this."
"
Some studies have shown a link between heavy alcohol use and pancreatic cancer."
"Heavy alcohol use can also lead to conditions such as chronic pancreatitis, which is known to increase pancreatic cancer risk."
"
Some research suggests that infection of the stomach with the ulcer-causing bacteria Helicobacter pylori (H. pylori) or infection with Hepatitis B may increase the risk of getting pancreatic cancer. "
"More studies are needed.
"
"

We don’t know what causes pancreatic cancer."
"But we do know many of the risk factors for this cancer (see Pancreatic Cancer Risk Factors ) and how some of them cause cells to become cancerous.
"
"Some genes control when cells grow, divide into new cells, and die:
"
">Genes that help cells grow, divide, and stay alive are called
   oncogenes
   .
"
">Genes that help keep cell division under control or cause cells to die at the right time are called
   tumor suppressor genes
   .
"
Cancers can be caused by DNA changes that turn on oncogenes or turn off tumor suppressor genes.
"
Some people inherit gene changes from their parents that raise their risk of pancreatic cancer."
Sometimes these gene changes are part of syndromes that include increased risks of other health problems as well.
"These syndromes, which cause a small portion of all pancreatic cancers, are discussed in Risk Factors for Pancreatic Cancer ."
"
Most gene mutations related to cancers of the pancreas occur after a person is born, rather than having been inherited."
These acquired gene mutations sometimes result from exposure to cancer-causing chemicals (like those found in tobacco smoke ).
But often what causes these changes is not known.
"Many gene changes are probably just random events that sometimes happen inside a cell, without having an outside cause.
"
"Some of the DNA changes often seen in sporadic (non-inherited) cases of pancreatic cancer are the same as those seen in inherited cases, while others are different."
"For example, many sporadic cases of pancreatic cancer have changes in the p16 and TP53 genes, which can also be seen in some genetic syndromes."
"But many pancreatic cancers also have changes in genes such as KRAS , BRAF , and DPC4 ( SMAD4 ), which are not part of inherited syndromes."
"Other gene changes can also be found in pancreatic cancers, although often it’s not clear what has caused these changes.
"
"

Pancreatic cancer is hard to find early."
"The pancreas is deep inside the body, so early tumors can’t be seen or felt by health care providers during routine physical exams."
"People usually have no symptoms until the cancer has become very large or has already spread to other organs.
"
"For certain types of cancer, screening tests or exams are used to look for cancer in people who have no symptoms (and who have not had that cancer before)."
"But for pancreatic cancer, no major professional groups currently recommend routine screening in people who are at average risk."
"
Some people might be at increased risk of pancreatic cancer because of a family history of the disease (or a family history of certain other cancers)."
"Sometimes this increased risk is due to a specific genetic syndrome .
"
Genetic testing looks for the gene changes that cause these inherited conditions and increase pancreatic cancer risk.
"The tests look for these inherited conditions, not pancreatic cancer itself."
"Your risk may be increased if you have one of these conditions, but it doesn’t mean that you have (or definitely will get) pancreatic cancer.
"
"Knowing if you are at increased risk can help you and your doctor decide if you should have tests to look for pancreatic cancer early, when it might be easier to treat."
But determining whether you might be at increased risk is not simple.
"The American Cancer Society strongly recommends that anyone thinking about genetic testing talk with a genetic counselor, nurse, or doctor (qualified to interpret and explain the test results) before getting tested."
"
For people in families at high risk of pancreatic cancer, newer tests for detecting pancreatic cancer early may help."
The two most common tests used are an endoscopic ultrasound or MRI.
(See Tests for Pancreatic Cancer .)
"These tests are not used to screen the general public, but might be used for someone with a strong family history of pancreatic cancer or with a known genetic syndrome that increases their risk."
"Doctors have been able to find early, treatable pancreatic cancers in some members of high-risk families with these tests.
"
Doctors are also studying other new tests to try to find pancreatic cancer early.
(See What's New in Pancreatic Cancer Research? )
"Interested families at high risk may wish to take part in studies of these new screening tests.
"
"

If a person has signs and symptoms that might be caused by pancreatic cancer, certain exams and tests will be done to find the cause."
"If cancer is found, more tests will be done to help determine the extent (stage) of the cancer."
"
Your doctor will ask about your medical history to learn more about your symptoms."
"The doctor might also ask about possible risk factors, including smoking and your family history.
"
Your doctor will also examine you to look for signs of pancreatic cancer or other health problems.
"Pancreatic cancers can sometimes cause the liver or gallbladder to swell, which the doctor might be able to feel during the exam."
"Your skin and the whites of your eyes will also be checked for jaundice (yellowing).
"
"If the results of the exam are abnormal, your doctor will probably order tests to help find the problem."
You might also be referred to a gastroenterologist (a doctor who treats digestive system diseases) for further tests and treatment.
"
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body."
"Imaging tests might be done for a number of reasons both before and after a diagnosis of pancreatic cancer, including:
>To look for suspicious areas that might be cancer
>To learn how far cancer may have spread
>To help determine if treatment is working
>To look for signs of cancer coming back after treatment"
"
The CT scan makes detailed cross-sectional images of your body."
CT scans are often used to diagnose pancreatic cancer because they can show the pancreas fairly clearly.
"They can also help show if cancer has spread to organs near the pancreas, as well as to lymph nodes and distant organs."
"A CT scan can help determine if surgery might be a good treatment option.
"
"If your doctor thinks you might have pancreatic cancer, you might get a special type of CT known as a multiphase CT scan or a pancreatic protocol CT scan ."
"During this test, different sets of CT scans are taken over several minutes after you get an injection of an intravenous (IV) contrast.
"
CT-guided needle biopsy:
CT scans can also be used to guide a biopsy needle into a suspected pancreatic tumor.
"But if a needle biopsy is needed, most doctors prefer to use endoscopic ultrasound (described below) to guide the needle into place."
"
MRI scans use radio waves and strong magnets instead of x-rays to make detailed images of parts of your body."
"Most doctors prefer to look at the pancreas with CT scans, but an MRI might also be done.
"
"Special types of MRI scans can also be used in people who might have pancreatic cancer or are at high risk:
>MR cholangiopancreatography (MRCP)
   , which can be used to look at the pancreatic and bile ducts, is described below in the section on cholangiopancreatography.
"
">MR angiography (MRA)
   , which looks at blood vessels, is mentioned below in the section on angiography."
"
Ultrasound (US) tests use sound waves to create images of organs such as the pancreas."
"The two most commonly used types for pancreatic cancer are:
>Abdominal ultrasound:
   "
"If it’s not clear what might be causing a person’s abdominal symptoms, this might be the first test done because it is easy to do and it doesn’t expose a person to radiation."
"But if signs and symptoms are more likely to be caused by pancreatic cancer, a CT scan is often more useful.
"
">Endoscopic ultrasound (EUS):
   This test is more accurate than abdominal US and can be very helpful in diagnosing pancreatic cancer."
"This test is done with a small US probe on the tip of an endoscope, which is a thin, flexible tube that doctors use to look inside the digestive tract and to get biopsy samples of a tumor."
"
"
"This is an imaging test that looks at the pancreatic ducts and bile ducts to see if they are blocked, narrowed, or dilated."
These tests can help show if someone might have a pancreatic tumor that is blocking a duct.
They can also be used to help plan surgery.
"The test can be done in different ways, each of which has pros and cons.
"
Endoscopic retrograde cholangiopancreatography (ERCP):
"For this test, an endoscope (a thin, flexible tube with a tiny video camera on the end) is passed down the throat, through the esophagus and stomach, and into the first part of the small intestine."
"The doctor can see through the endoscope to find the ampulla of Vater (where the common bile duct empties into the small intestine).
"
X-rays taken at this time can show narrowing or blockage in these ducts that might be due to pancreatic cancer.
"The doctor doing this test can put a small brush through the tube to remove cells for a biopsy or place a stent (small tube) into a bile or pancreatic duct to keep it open if a nearby tumor is pressing on it.
"
Magnetic resonance cholangiopancreatography (MRCP):
This is a non-invasive way to look at the pancreatic and bile ducts using the same type of machine used for standard MRI scans.
"Unlike ERCP, it does not require an infusion of a contrast dye."
"Because this test is non-invasive, doctors often use MRCP if the purpose is just to look at the pancreatic and bile ducts."
"But this test can’t be used to get biopsy samples of tumors or to place stents in ducts.
"
"Percutaneous transhepatic cholangiography (PTC): In this procedure, the doctor puts a thin, hollow needle through the skin of the belly and into a bile duct within the liver."
"A contrast dye is then injected through the needle, and x-rays are taken as it passes through the bile and pancreatic ducts."
"As with ERCP, this approach can also be used to take fluid or tissue samples or to place a stent into a duct to help keep it open."
"Because it is more invasive (and might cause more pain), PTC is not usually used unless ERCP has already been tried or can’t be done for some reason."
"
For a PET scan , you are injected with a slightly radioactive form of sugar, which collects mainly in cancer cells."
"A special camera is then used to create a picture of areas of radioactivity in the body.
"
"This test is sometimes used to look for spread from exocrine pancreatic cancers.
"
PET/CT scan: Special machines can do both a PET and CT scan at the same time.
This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed appearance of that area on the CT scan.
This test can help determine the stage (extent) of the cancer .
It might be especially useful for spotting cancer that has spread beyond the pancreas and wouldn’t be treatable by surgery.
"
"
This is an x-ray test that looks at blood vessels.
"A small amount of contrast dye is injected into an artery to outline the blood vessels, and then x-rays are taken.
"
An angiogram can show if blood flow in a particular area is blocked by a tumor.
It can also show abnormal blood vessels (feeding the cancer) in the area.
This test can be useful in finding out if a pancreatic cancer has grown through the walls of certain blood vessels.
"Mainly, it helps surgeons decide if the cancer can be removed completely without damaging vital blood vessels, and it can also help them plan the operation.
"
X-ray angiography can be uncomfortable because the doctor has to put a small catheter into the artery leading to the pancreas.
Usually the catheter is put into an artery in your inner thigh and threaded up to the pancreas.
A local anesthetic is often used to numb the area before inserting the catheter.
"Once the catheter is in place, the dye is injected to outline all the vessels while the x-rays are being taken.
"
Angiography can also be done with a CT scanner (CT angiography) or an MRI scanner (MR angiography).
These techniques are now used more often because they can give the same information without the need for a catheter in the artery.
You might still need an IV line so that a contrast dye can be injected into the bloodstream during the imaging.
"
Several types of blood tests can be used to help diagnose pancreatic cancer or to help determine treatment options if it is found.
"
Liver function tests: Jaundice (yellowing of the skin and eyes) is often one of the first signs of pancreatic cancer.
Doctors often get blood tests to assess liver function in people with jaundice to help determine its cause.
"Certain blood tests can look at levels of different kinds of bilirubin (a chemical made by the liver) and can help tell whether a patient’s jaundice is caused by disease in the liver itself or by a blockage of bile flow (from a gallstone, a tumor, or other disease).
"
Tumor markers: Tumor markers are substances that can sometimes be found in the blood when a person has cancer.
"Tumor markers that may be helpful in pancreatic cancer are:
>CA 19-9
>Carcinoembryonic antigen (CEA)
   , which is not used as often as CA 19-9
Neither of these tumor marker tests is accurate enough to tell for sure if someone has pancreatic cancer."
"Levels of these tumor markers are not high in all people with pancreatic cancer, and some people who don’t have pancreatic cancer might have high levels of these markers for other reasons."
"Still, these tests can sometimes be helpful, along with other tests, in figuring out if someone has cancer.
"
"In people already known to have pancreatic cancer and who have high CA19-9 or CEA levels, these levels can be measured over time to help tell how well treatment is working."
"If all of the cancer has been removed, these tests can also be done to look for signs the cancer may be coming back.
"
"Other blood tests: Other tests, like a CBC or chemistry panel , can help evaluate a person’s general health (such as kidney and bone marrow function)."
These tests can help determine if they’ll be able to withstand the stress of a major operation.
"
A person’s medical history, physical exam, and imaging test results may strongly suggest pancreatic cancer, but usually the only way to be sure is to remove a small sample of tumor and look at it under the microscope."
This procedure is called a biopsy .
"Biopsies can be done in different ways.
"
Percutaneous (through the skin) biopsy:
"For this test, a doctor inserts a thin, hollow needle through the skin over the abdomen and into the pancreas to remove a small piece of a tumor."
This is known as a fine needle aspiration (FNA).
"The doctor guides the needle into place using images from ultrasound or CT scans.
"
Endoscopic biopsy:
Doctors can also biopsy a tumor during an endoscopy.
"The doctor passes an endoscope (a thin, flexible, tube with a small video camera on the end) down the throat and into the small intestine near the pancreas."
"At this point, the doctor can either use endoscopic ultrasound (EUS) to pass a needle into the tumor or endoscopic retrograde cholangiopancreatography (ERCP) to place a brush to remove cells from the bile or pancreatic ducts.
"
Surgical biopsy: Surgical biopsies are now done less often than in the past.
They can be useful if the surgeon is concerned the cancer has spread beyond the pancreas and wants to look at (and possibly biopsy) other organs in the abdomen.
The most common way to do a surgical biopsy is to use laparoscopy (sometimes called keyhole surgery ).
The surgeon can look at the pancreas and other organs for tumors and take biopsy samples of abnormal areas.
"
Rarely, the doctor might not do a biopsy on someone who has a tumor in the pancreas if imaging tests show the tumor is very likely to be cancer and if it looks like surgery can remove all of it."
"Instead, the doctor will proceed with surgery, at which time the tumor cells can be looked at in the lab to confirm the diagnosis."
"During surgery, if the doctor finds that the cancer has spread too far to be removed completely, only a sample of the cancer may be removed to confirm the diagnosis, and the rest of the planned operation will be stopped.
"
"If treatment (such as chemotherapy or radiation) is planned before surgery, a biopsy is needed first to be sure of the diagnosis."
"
The samples obtained during a biopsy (or during surgery) are sent to a lab, where they are looked at under a microscope to see if they contain cancer cells.
"
"If cancer is found, other tests might be done as well."
"For example, tests might be done to see if the cancer cells have mutations (changes) in certain genes, such as the BRCA genes ( BRCA1 or BRCA2 ) or NTRK genes."
"This might affect whether certain targeted therapy drugs might be helpful as part of treatment.
"
"See Testing Biopsy and Cytology Specimens for Cancer to learn more about different types of biopsies, how the biopsy samples are tested in the lab, and what the results will tell you."
"
If you’ve been diagnosed with pancreatic cancer, your doctor might suggest speaking with a genetic counselor to determine if you could benefit from genetic testing.
"
"Some people with pancreatic cancer have gene mutations (such as BRCA mutations) in all the cells of their body, which put them at increased risk for pancreatic cancer (and possibly other cancers)."
Testing for these gene mutations can sometimes affect which treatments might be helpful.
"It might also affect whether other family members should consider genetic counseling and testing as well.
"
"For more information on genetic testing, see Genetics and Cancer .
"
"

Early pancreatic cancers often do not cause any signs or symptoms."
"By the time they do cause symptoms, they have often grown very large or already spread outside the pancreas.
"
Having one or more of the symptoms below does not mean you have pancreatic cancer.
"In fact, many of these symptoms are more likely to be caused by other conditions."
"Still, if you have any of these symptoms, it’s important to have them checked by a doctor so that the cause can be found and treated, if needed."
"
Jaundice is yellowing of the eyes and skin."
"Most people with pancreatic cancer (and nearly all people with ampullary cancer) will have jaundice as one of their first symptoms.
"
"Jaundice is caused by the buildup of bilirubin, a dark yellow-brown substance made in the liver."
"Normally, the liver releases a liquid called bile that contains bilirubin."
"Bile goes through the common bile duct into the intestines, where it helps break down fats."
It eventually leaves the body in the stool.
"When the common bile duct becomes blocked, bile can’t reach the intestines, and the amount of bilirubin in the body builds up.
"
Cancers that start in the head of the pancreas are near the common bile duct.
"These cancers can press on the duct and cause jaundice while they are still fairly small, which can sometimes lead to these tumors being found at an early stage."
But cancers that start in the body or tail of the pancreas don’t press on the duct until they have spread through the pancreas.
"By this time, the cancer has often spread beyond the pancreas.
"
"When pancreatic cancer spreads, it often goes to the liver."
"This can also cause jaundice.
"
"There are other signs of jaundice as well as the yellowing of the eyes and skin:
>Dark urine:
   "
"Sometimes, the first sign of jaundice is darker urine."
"As bilirubin levels in the blood increase, the urine becomes brown in color.
"
">Light-colored or greasy stools:
   Bilirubin normally helps give stools their brown color."
"If the bile duct is blocked, stools might be light-colored or gray."
"Also, if bile and pancreatic enzymes can’t get through to the intestines to help break down fats, the stools can become greasy and might float in the toilet.
"
">Itchy skin:
   When bilirubin builds up in the skin, it can start to itch as well as turn yellow.
"
Pancreatic cancer is not the most common cause of jaundice.
"Other causes, such as gallstones, hepatitis, and other liver and bile duct diseases, are much more common."
"
Pain in the abdomen (belly) or back is common in pancreatic cancer."
"Cancers that start in the body or tail of the pancreas can grow fairly large and start to press on other nearby organs, causing pain."
"The cancer may also spread to the nerves surrounding the pancreas, which often causes back pain."
Pain in the abdomen or back is fairly common and is most often caused by something other than pancreatic cancer.
"
Unintended weight loss is very common in people with pancreatic cancer."
These people often have little or no appetite.
"
If the cancer presses on the far end of the stomach it can partly block it, making it hard for food to get through."
"This can cause nausea, vomiting, and pain that tend to be worse after eating."
"
If the cancer blocks the bile duct, bile can build up in the gallbladder, making it larger."
Sometimes a doctor can feel this (as a large lump under the right side of the ribcage) during a physical exam.
"It can also be seen on imaging tests .
"
"Pancreatic cancer can also sometimes enlarge the liver, especially if the cancer has spread there."
"The doctor might be able to feel the edge of the liver below the right ribcage on an exam, or the large liver might be seen on imaging tests."
"
Sometimes, the first clue that someone has pancreatic cancer is a blood clot in a large vein, often in the leg."
This is called a deep vein thrombosis or DVT.
"Symptoms can include pain, swelling, redness, and warmth in the affected leg."
"Sometimes a piece of the clot can break off and travel to the lungs, which might make it hard to breathe or cause chest pain."
"A blood clot in the lungs is called a pulmonary embolism or PE.
"
"Still, having a blood clot does not usually mean that you have cancer."
Most blood clots are caused by other things.
"
Rarely, pancreatic cancers cause diabetes (high blood sugar) because they destroy the insulin-making cells."
"Symptoms can include feeling thirsty and hungry, and having to urinate often."
"More often, cancer can lead to small changes in blood sugar levels that don’t cause symptoms of diabetes but can still be detected with blood tests.
"
"












After someone is diagnosed with pancreatic cancer, doctors will try to figure out if it has spread, and if so, how far."
This process is called staging .
The stage of a cancer describes how much cancer is in the body.
It helps determine how serious the cancer is and how best to treat it.
"Doctors also use a cancer's stage when talking about survival statistics.
"
"The earliest stage pancreas cancers are stage 0 (carcinoma in situ), and then range from stages I (1) through IV (4)."
"As a rule, the lower the number, the less the cancer has spread."
"A higher number, such as stage IV, means a more advanced cancer."
Cancers with similar stages tend to have a similar outlook and are often treated in much the same way.
"
The staging system used most often for pancreatic cancer is the AJCC (American Joint Committee on Cancer) TNM system, which is based on 3 key pieces of information:
>The extent of the
   tumor (T):
   How large is the tumor and has it grown outside the pancreas into nearby blood vessels?
>The spread to nearby lymph
   nodes
   (N)
   : Has the cancer spread to nearby lymph nodes?"
"If so, how many of the lymph nodes have cancer?
>"
"The spread (
   metastasized
   ) to distant sites
   (M)
   : Has the cancer spread to distant lymph nodes or distant organs such as the liver, peritoneum (the lining of the abdominal cavity), lungs or bones?
"
"The system described below is the most recent AJCC system, effective January 2018."
"It is used to stage most pancreatic cancers except for well-differentiated pancreatic neuroendocrine tumors (NETs), which have their own staging system.
"
The staging system in the table uses the pathologic stage .
It is determined by examining tissue removed during an operation.
This is also known as the surgical stage .
"Sometimes, if the doctor's physical exam, imaging, or other tests show the tumor is too large or has spread to nearby organs and cannot be removed by surgery right away or at all, radiation or chemotherapy might be given first."
"In this case, the cancer will have a clinical stage ."
"It is based on the results of physical exam, biopsy, and imaging tests (see Tests for Pancreatic Cancer )."
The clinical stage can be used to help plan treatment.
"Sometimes, though, the cancer has spread further than the clinical stage estimates, and may not predict the patient’s outlook as accurately as a pathologic stage."
"For more information, see Cancer Staging .
Numbers or letters after T, N, and M provide more details about each of these factors."
Higher numbers mean the cancer is more advanced.
"Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage.
"
Cancer staging can be complex.
"If you have any questions about your stage, please ask your doctor to explain it to you in a way you understand."
(Additional information of the TNM system also follows the stage table below.)
"
AJCC Stage
Stage grouping
Stage description*
0
Tis
N0
M0
The cancer is confined to the top layers of pancreatic duct cells and has not invaded deeper tissues."
It has not spread outside of the pancreas.
"These tumors are sometimes referred to as carcinoma in situ (Tis).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"IA
T1
N0
M0
The cancer is confined to the pancreas and is no bigger than 2 cm (0.8 inch) across (T1).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"IB
T2
N0
M0
The cancer is confined to the pancreas and is larger than 2 cm (0.8 inch) but no more than 4cm (1.6 inches) across (T2).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
"
"IIA
T3
N0
M0
The cancer is confined to the pancreas and is bigger than 4 cm (1.6 inches) across (T3).
"
"It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

"
"IIB

T1
N1
M0
The cancer is confined to the pancreas and is no bigger than 2 cm (0.8 inch) across (T1) AND it has spread to no more than 3 nearby lymph nodes (N1).
"
"It has not spread to distant sites (M0).
"
"T2
N1
M0
The cancer is confined to the pancreas and is larger than 2 cm (0.8 inch) but no more than 4cm (1.6 inches) across (T2) AND it has spread to no more than 3 nearby lymph nodes (N1).
"
"It has not spread to distant sites (M0).
"
"T3
N1
M0
The cancer is confined to the pancreas and is bigger than 4 cm (1.6 inches) across (T3) AND it has spread to no more than 3 nearby lymph nodes (N1).
"
"It has not spread to distant sites (M0).
"
"III
T1
N2
M0
The cancer is confined to the pancreas and is no bigger than 2 cm (0.8 inch) across (T1) AND it has spread to 4 or more nearby lymph nodes (N2).
"
"It has not spread to distant sites (M0).
"
"OR
T2
N2
M0
The cancer is confined to the pancreas and is larger than 2 cm (0.8 inch)"
"but no more than 4cm (1.6 inches) across (T2) AND it has spread to 4 or more nearby lymph nodes (N2).
"
"It has not spread to distant sites (M0).
"
"OR
T3
N2
M0
The cancer is confined to the pancreas and is bigger than 4 cm (1.6 inches) across (T3) AND it has spread to 4 or more nearby lymph nodes (N2).
"
"It has not spread to distant sites (M0).
"
"OR
T4
Any N
M0
The cancer is growing outside the pancreas and into nearby major blood vessels (T4)."
"The cancer may or may not have spread to nearby lymph nodes (Any N).
"
"It has not spread to distant sites (M0).
"
"IV
Any T
Any N
M1
"
"The cancer has spread to distant sites such as the liver, peritoneum (the lining of the abdominal cavity), lungs or bones (M1)."
"It can be any size (Any T) and might or might not have spread to nearby lymph nodes (Any N).
"
*
"The following additional categories are not listed on the table above:
>TX:"
"Main tumor cannot be assessed due to lack of information.
"
>T0:
"No evidence of a primary tumor.
"
>NX: Regional lymph nodes cannot be assessed due to lack of information.
"
Although not formally part of the TNM system, other factors are also important in determining a person’s prognosis (outlook)."
"
The grade describes how closely the cancer looks like normal tissue under a microscope.
"
">Grade 1 (G1) means the cancer looks much like normal pancreas tissue.
"
">Grade 3 (G3) means the cancer looks very abnormal.
"
">Grade 2 (G2) falls somewhere in between.
Low-grade cancers (G1) tend to grow and spread more slowly than high-grade (G3) cancers."
"Most of the time, Grade 3 pancreas cancers tend to have a poor prognosis (outlook) compared to Grade 1 or 2 cancers."
"
For patients who have surgery, another important factor is the extent of the resection — whether or not all of the tumor is removed:
>R0:
   All of the cancer is thought to have been removed."
"(There are no visible or microscopic signs suggesting that cancer was left behind.)
"
">R1:
   All visible tumor was removed, but lab tests of the removed tissue show that some small areas of cancer were probably left behind.
"
">R2:
   Some visible tumor could not be removed."
"
The AJCC staging system gives a detailed summary of how far the cancer has spread."
"But for treatment purposes, doctors use a simpler staging system, which divides cancers into groups based on whether or not they can be removed (resected) with surgery:
>Resectable
>Borderline resectable
>Unresectable (either locally advanced or metastatic)"
"
If the cancer is only in the pancreas (or has spread just beyond it) and the surgeon believes the entire tumor can be removed, it is called resectable."
"(In general, this would include most stage IA, IB, and IIA cancers in the TNM system.)
"
"It’s important to note that some cancers might appear to be resectable based on imaging tests , but once surgery is started it might become clear that not all of the cancer can be removed."
"If this happens, only some of the cancer may be removed to confirm the diagnosis (if a biopsy hasn’t been done already), and the rest of the planned operation will be stopped to help avoid the risk of major side effects."
"
This term is used to describe some cancers that might have just reached nearby blood vessels, but which the doctors feel might still be removed completely with surgery."
"
These cancers can’t be removed entirely by surgery.
"
"Locally advanced: If the cancer has not yet spread to distant organs but it still can’t be removed completely with surgery, it is called locally advanced ."
Often the reason the cancer can’t be removed is because it has grown into or surrounded nearby major blood vessels.
"(This would include some stage III cancers in the TNM system.)
"
Surgery to try to remove these tumors would be very unlikely to be helpful and could still have major side effects.
"Some type of surgery might still be done, but it would be a less extensive operation with the goal of preventing or relieving symptoms or problems like a blocked bile duct or intestinal tract, instead of trying to cure the cancer.
"
Metastatic:
"If the cancer has spread to distant organs, it is called metastatic (Stage IV ) ."
These cancers can’t be removed completely.
"Surgery might still be done, but the goal would be to prevent or relieve symptoms, not to try to cure the cancer."
"
Tumor markers are substances that can sometimes be found in the blood when a person has cancer."
CA 19-9 is a tumor marker that may be helpful in pancreatic cancer.
"A drop in the CA 19-9 level after surgery (compared to the level before surgery) and low levels of CA 19-9 after pancreas surgery tend to predict a better prognosis (outlook).
"
"

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed."
"They can’t tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
"
"Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they can’t predict what will happen in any particular person’s case."
These statistics can be confusing and may lead you to have more questions.
Ask your doctor how these numbers might apply to you.
"
A relative survival rate compares people with the same type and stage of pancreatic cancer to people in the overall population."
"For example, if the 5-year relative survival rate for a specific stage of pancreatic cancer is 50%, it means that people who have that cancer are, on average, about 50% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed."
"
The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results (SEER) database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer.
"
"The SEER database tracks 5-year relative survival rates for pancreatic cancer in the United States, based on how far the cancer has spread."
"The SEER database, however, does not group cancers by AJCC TNM stages (stage 1, stage 2, stage 3, etc.)."
"Instead, it groups cancers into localized, regional, and distant stages:
>Localized:
   There is no sign that the cancer has spread outside of the pancreas.
"
">Regional:
   "
"The cancer has spread from the pancreas to nearby structures or lymph nodes.
"
">Distant:
   "
"The cancer has spread to distant parts of the body such as the lungs, liver or bones."
"
Based on people diagnosed with pancreatic cancer between 2012 and 2018.
"
SEER*
"Stage
5-year Relative Survival Rate
Localized
44%
Regional
15%
Distant
3%
"
"All SEER stages combined
12%
*"
"SEER = Surveillance, Epidemiology, and End Results"
"
>These numbers apply only to the stage of the cancer when it is first diagnosed.
   "
"They do not apply later on if the cancer grows, spreads, or comes back after treatment.
"
">These numbers don’t take everything into account.
   "
"Survival rates are grouped based on how far the cancer has spread, but your age, overall health, how well the cancer responds to treatment,
   tumor grade, extent of resection, level of tumor marker (CA 19-9)
   and other factors will also affect your outlook.
"
">People now being diagnosed with pancreatic cancer may have a better outlook than these numbers show.
   "
"Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least five years earlier.
"
"

It’s important to have honest, open discussions with your cancer care team."
"They want to answer all of your questions, so that you can make informed treatment and life decisions."
Here are some questions to consider:
"
>What
   kind of pancreatic cancer
   do I have?
>Has my cancer spread beyond the pancreas?
"
">What is the
   stage
   of my cancer?"
"Is it resectable (removable by surgery)?
"
">Will I need any other
   tests
   before we can decide on treatment?
>Do I need to see any other doctors or health professionals?
"
>
"If I’m concerned about the costs and insurance coverage for my diagnosis and treatment, who can help me?"
"
>What are my
   treatment options
   ?
>"
"What do you recommend and why?
"
">How much experience do you have treating this type of cancer?
>"
"What is the goal of each treatment?
>Should I get a
   second opinion
   ?"
How do I do that?
"Can you recommend a doctor or cancer center?
>How is treatment likely to help me?
>How quickly do we need to decide on treatment?
"
">Should I think about taking part in a
   clinical trial
   ?
>How soon do I need to start treatment?
"
>
"What should I do to be ready for treatment?
>How long will treatment last?"
What will it be like?
"Where will it be done?
>What risks or side effects should I expect?"
"How long are they likely to last?
>Will treatment affect how I eat?
>Will treatment affect my daily activities?
"
">What will we do if the treatment doesn’t work or if the cancer
   comes back
   ?"
"
Once treatment begins, you’ll need to know what to expect and what to look for."
"Not all of these questions may apply to you, but asking the ones that do may be helpful.
"
">How will we know if the treatment is working?
>Is there anything I can do to help manage
   side effects
   ?
>"
"What symptoms or side effects should I tell you about right away?
>How can I reach you on nights, holidays, or weekends?
"
">Do I need to change what I eat during treatment?
>Are there any limits on what I can do?
>"
Can I exercise during treatment?
"If so, what kind should I do, and how often?
"
>
"Can you suggest a mental health professional I can see if I start to feel
   overwhelmed, depressed, or distressed
   ?
>"
What if I need social support during treatment because my family lives far away?
"
>Are there any limits on what I can do?
"
Do
"I need a special diet after treatment?
>What symptoms should I watch for?
>"
"What kind of exercise should I do now?
>What type of
   follow-up
   will I need after treatment?
"
">How often will I need to have follow-up exams and tests?
"
>How will we know if the cancer has come back?
"What should I watch for?
"
"What will my options be if the cancer comes back?
"
"Along with these sample questions, be sure to write down some of your own."
"For instance, you might want more information about recovery times."
"You may also want to ask about clinical trials for which you may qualify.
"
"
"
"
Pancreatic cancer is a type of cancer that starts in the pancreas."
"It happens when exocrine cells (a type of cell found in the pancreas) start to change and grow out of control, crowding out normal cells.
"
"Your pancreas has 2 jobs:
>It makes a substance that helps break down (digest) the food you eat.
"
">it makes hormones that help control the levels of sugar, insulin, and other substances in your blood.
"
Pancreatic cancer starts in the type of cells that help break down food ( exocrine cells ).
"But there's another, less common type of pancreatic cancer that starts from the cells that make hormones ( endocrine cells )."
"If you've been diagnosed with pancreatic cancer, ask your doctor which type you have."
"The two types of pancreatic cancer are treated differently and have different outlooks.


"
"Ask your doctor to use this picture to show you where your cancer is located .
"
Pancreatic cancer can spread to other parts of the body.
"When cancer does this, it's called metastasis ."
But the type of cancer is based on the type of cells it started from.
"So even if a pancreatic cancer spreads to your liver, for example, it is still called a pancreatic cancer, not liver cancer.


"
"
>Why do you think I have cancer?
>Is there a chance I don’t have cancer?
"
">Would you please write down the kind of cancer you think I might have?
"
>What will happen next?
"
Most of the time, early pancreatic cancers don’t cause any signs or symptoms ."
They are often not found until they cause problems that make a person seek help from a doctor.
"
"
The doctor will ask questions about your health and do a physical exam.
"It can be hard to find pancreatic cancer early because the pancreas is deep inside the body, making it hard for the doctor to feel something wrong if the cancer is still small. "
"If signs are pointing to pancreatic cancer, more tests will be done."
"Here are some of the tests you may need :
Biopsy: The doctor takes out a little bit of tissue or some cells to check for cancer."
A biopsy is the only way to tell for sure if you have cancer.
"There are different ways to do biopsies so ask your doctor which type of biopsy you will have.
"
CT or CAT scan:
This test uses x-rays to make pictures of your insides.
"This can show clear pictures of the pancreas and the area around it to see if the cancer has spread.
"
MRI scan: This test uses radio waves and strong magnets instead of x-rays to make clear pictures of the inside of the body.
This test may be used to learn more about the cancer’s size and spread.
"Special types of MRI scans can also be used to look at ducts and blood vessels in and around the pancreas.
"
Endoscopic ultrasound (EUS): This test uses sound waves to make pictures of the inside of the body.
"A small ultrasound on the tip of a thin tube is passed down the throat, into the stomach, and then into the first part of the small intestine."
The ultrasound can be pointed to look at the pancreas.
"It can also be used to take out a little bit of tissue that can be checked for cancer.
"
"Endoscopic retrograde cholangiopancreatography (ERCP): A small camera on the tip of a thin tube is passed down the throat, into the stomach, and into the first part of the small intestine."
This test can check if the ducts are blocked due to pancreatic cancer.
"It can also be used to help open a blocked duct or take out some cells.
"
"Liver function tests: These are blood tests to see how well the liver is working.
"
Tumor markers: Some pancreatic cancer cells can make certain proteins that show up in the blood.
"This test can be used along with other tests that make pictures and a biopsy to help your doctor find out the kind of pancreatic cancer that you have.
"
Other blood tests: You might have other tests to help find out if you have any other health problems such as kidney disease and bone marrow problems.
"
>What tests will I need to have?
>"
"Who will do these tests?
>Where will they be done?
"
>
"Who can explain the tests to me?
>"
"How and when will I get the results?
>Who will explain the results to me?
>What do I need to do next?"
"
If you have pancreatic cancer, the doctor will want to find out how far it has spread ."
This is called staging .
Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.
"Your cancer can be staged 1, 2 ,3 or 4."
"The lower the number, the less the cancer has spread."
"
Grading means checking the cancer cells from your biopsy test to see how much they look like normal cells. "
This helps doctors tell how fast the cancer is likely to grow and spread.
Your tumor will be given a grade between 1 and 3. 
"The lower the number, the more the cancer cells look like normal cells and the slower they tend to grow."
"The tumor grade helps the doctor decide which treatment is best for you, so ask the doctor to explain the grade of your cancer and what it means for your treatment."
"
>Do you know the stage of the cancer?
>If not, how and when will you find out the stage of the cancer?
"
">Would you explain to me what the stage means in my case?
>Based on the stage of the cancer, how long do you think I’ll live?
"
">What is the grade of the cancer and what will that mean for treatment?
>What will happen next?"
"
The main ways to treat pancreatic cancer are surgery, chemotherapy, and radiation therapy."
Ask your doctor what treatments can help you.
"Even for cancers that are more advanced and harder to treat, treatment can often make symptoms better and slow down the cancer's growth."
"Talk with your doctor to find out your options.
"
"The treatment plan that’s best for you will depend on:
>The stage and grade of the cancer
>The chance that a type of treatment will cure the cancer or help in some way
>Your age
>Other health problems you have
>Your feelings about the treatment and the side effects that come with it"
"
Surgery is used to try to take out all of the cancer if it’s small and has not spread."
"Sometimes, surgery can be done to take out only the cancer, and leave the rest of the pancreas alone."
"But often, depending on how large the cancer is, parts, or even all, of your pancreas and other organs might need to be removed, also."
"If your cancer is too large or has spread too far, surgery may not be possible and other treatments might be done instead."
Ask your doctor what kind of surgery you will have.
"
Surgery for pancreatic cancer can be a very big operation and can have risks and side effects."
Be sure to ask the doctor what to expect and let your doctors know if you have any problems after surgery.
"Possible problems from surgery are:
>Leaking inside the body
>Infections
>Bleeding
>Trouble eating
>Weight loss
>Changes in bathroom habits
>Diabetes"
"
Tumor ablation or embolization can help if a pancreatic cancer has spread to the liver."
It destroys the tumor without taking it out by surgery.
It may be done if you are too sick to have surgery.
"There are many ways to do this, such as heating the tumor with radio waves or microwaves, freezing the tumor, or killing the tumor by blocking the blood supply that feeds the liver."
Talk to your doctor about what to expect.
"
Chemo is the short word for chemotherapy , the use of drugs to fight cancer."
"These drugs are mainly used for pancreatic cancers that are large, have spread, are growing fast, or are causing bad symptoms.
"
"Some chemo drugs are given through a needle into a vein (called an infusion ), and others are taken as pills."
These drugs go into the blood and spread through the body.
Chemo is given in cycles or rounds.
Each round of treatment is followed by a break to allow your body to get better from the side effects.
"Different kinds of chemo drugs can be used together or alone, and often with other types of drugs, too."
Treatment often lasts for many months.
"
Common side effects are:
>Hair loss
>Mouth sores
>Not feeling like eating
>Diarrhea
>Feeling sick to your stomach
>Infections
>Bruising and bleeding easily
>Tiredness
These problems usually go away after treatment ends, and there are ways to treat most chemo side effects. "
"If you have side effects, be sure to talk to your cancer care team so they can help."
"
Targeted therapy drugs work differently from chemo drugs."
These drugs affect mainly cancer cells and not normal cells in the body.
They may work even if other treatments don't.
The type of targeted therapy drug that is used for pancreatic cancer is taken as a pill.
Talk to your doctor what side effects to expect.
"Often, the side effects are different than the side effects from chemo."
"
Immunotherapy is treatment that either boosts your own immune system or uses man-made versions of parts of the immune system that attack the pancreatic cancer cells."
One type of immunotherapy that is used to treat pancreatic cancer is given into a vein.
"This drugs may make you feel tired, sick to your stomach, or cause fever, chills, and rashes."
Most of these problems go away after treatment ends.
"If you have side effects, talk to your cancer care team so they can help."
"
Radiation uses high energy x-rays to kill cancer cells."
Radiation (along with chemotherapy) can also be used when the cancer is too far along to be taken out by surgery.
It can also be used to help make symptoms better – such as pain caused by an advanced cancer.
"
If your doctor suggests radiation, ask about what side effects might happen."
"The most common side effects of radiation are:
>Skin changes where the radiation is given
>Feeling very tired
>Feeling sick to your stomach
>Losing weight"
"
Pain is a common problem with pancreatic cancer."
You should not be afraid to use the pain medicines offered.
"Pain medicines work best when they are taken at set times, not just when the pain gets bad."
Ask your doctor which ones you will get and what to expect.
"
Clinical trials are research studies that test new drugs or other treatments in people."
"They compare standard treatments with others that may be better.
"
Clinical trials are one way to get the newest cancer treatment.
They are the best way for doctors to find better ways to treat cancer.
"If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part."
"And if you do sign up for a clinical trial, you can always stop at any time.
"
"If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials."
See Clinical Trials to learn more.
"
"
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms.
These may not always be standard medical treatments.
"These treatments may be vitamins, herbs, special diets, and other things ."
"Some of these are known to help, but many have not been tested."
Some have been shown not to help.
A few have even been found to be harmful.
"Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else."
"
>What treatment do you think is best for me?
>What’s the goal of this treatment?"
"Do you think it could cure the cancer?
>Will treatment include surgery?"
"If so, who will do the surgery?
>What will the surgery be like?
"
">Will I need other types of treatment, too?"
"What’s the goal of these treatments?
>What side effects could I have from these treatments?
>What can I do about side effects that I might have?
"
">Is there a clinical trial that might be right for me?
>"
What about special vitamins or diets that friends tell me about?
"How will I know if they are safe?
>How soon do I need to start treatment?
"
">What should I do to be ready for treatment?
"
">Is there anything I can do to help the treatment work better?
>"
What’s the next step?
"
You’ll be glad when treatment is over ."
"For years after treatment ends, you will see your cancer doctor."
Be sure to go to all of these follow-up visits.
"You will have exams, blood tests, and maybe other tests to see if the cancer has come back."
"At first, your visits may be every 3 to 6 months."
"Then, the longer you’re cancer-free, the less often the visits are needed.
"
Some treatments may not cure your cancer.
You many need to keep getting treatment and care.
"From time to time tests will be done to see how your treatment is working.
"
"Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways."
Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.
You can’t change the fact that you have cancer.
"What you can change is how you live the rest of your life.
"
"

Ablation and embolization treatments are different ways of destroying tumors, rather than removing them with surgery."
"They are used much less often for pancreatic cancers but can sometimes be used to help treat pancreatic cancer that has spread to other organs, especially the liver.
"
These treatments are very unlikely to cure cancers on their own.
"They are more likely to be used to help prevent or relieve symptoms, when there are only a few areas of spread, and are often used along with other types of treatment."
"
Ablation refers to treatments that destroy tumors, usually with extreme heat or cold."
They are generally best for tumors no more than about 2 cm (a little less than an inch) across. 
"Typically, with this type of treatment you will not need to stay in the hospital."
"There are different kinds of ablative treatments:
Radiofrequency ablation (RFA) uses high-energy radio waves for treatment."
"A thin, needle-like probe is put through the skin and into the tumor."
Placement of the probe is guided by ultrasound or CT scans.
"The tip of the probe releases a high-frequency electric current which heats the tumor and destroys the cancer cells.
"
"Microwave thermotherapy is similar to RFA, except it uses microwaves to heat and destroy the cancer cells.
"
Ethanol (alcohol) ablation (also known as percutaneous ethanol injection ) kills the cancer cells by injecting concentrated alcohol directly into the tumor.
"This is usually done through the skin using a needle guided by ultrasound or CT scans.
"
Cryosurgery (also known as cryotherapy or cryoablation) destroys a tumor by freezing it with a thin metal probe.
"The probe is guided through the skin and into the tumor, using ultrasound."
"Then very cold gasses are passed through the probe to freeze the tumor, killing the cancer cells."
"This method may be used to treat larger tumors than the other ablation techniques, but it sometimes requires general anesthesia (where you are put into a deep sleep)."
"
Possible side effects after ablation therapy include abdominal pain, infection, and bleeding inside the body."
"Serious complications are uncommon, but they are possible."
"
During embolization, substances are injected into an artery to try to block the blood flow to cancer cells, causing them to die."
"This may be used for larger tumors (up to about 5 cm or 2 inches across) in the liver.
"
"There are 3 main types of embolization:
Arterial embolization (also known as trans-arterial embolization or TAE ) involves putting a catheter (a thin, flexible tube) into an artery through a small cut in the inner thigh and threaded up into the hepatic artery feeding the tumor."
Blood flow is blocked (or reduced) by injecting materials that plug up that artery.
"Most of the healthy liver cells will not be affected because they get their blood supply from a different blood vessel, the portal vein.
"
Chemoembolization (also known as trans-arterial chemoembolization or TACE ) combines embolization with chemotherapy .
"Most often, this is done by using tiny beads that give off a chemotherapy drug during the embolization."
"TACE can also be done by giving chemotherapy through the catheter directly into the artery, then plugging up the artery.
"
Radioembolization combines embolization with radiation therapy .
"In the United States, this is done by injecting small radioactive beads (called microspheres ) into the hepatic artery."
"The beads lodge in the blood vessels near the tumor, where they give off small amounts of radiation to the tumor site."
"Since the radiation travels a very short distance, its effects are limited mainly to the tumor."
"
Possible side effects after embolization include abdominal pain, fever, nausea, infection, and blood clots in nearby blood vessels."
"Serious complications are not common, but they can happen.
"
"

This information is about treating exocrine pancreatic cancer, the most common type of pancreatic cancer."
"See Pancreatic Neuroendocrine Tumor (NET) for information about how that type is typically treated.
"
"Most of the time, pancreatic cancer is treated based on its stage – how far it has spread in the body."
"But other factors, such as your overall health, can also affect treatment options."
"Talk to your doctor if you have any questions about the treatment plan they recommend.
"
It can be hard to stage pancreatic cancer accurately using imaging tests .
"Doctors do their best to figure out before treatment if there is a good chance the cancer is resectable – that is, if it can be removed completely."
"But sometimes cancers turn out to have spread farther than was first thought.
"
"
Surgeons usually consider pancreatic cancer to be resectable if it looks like it is still just in the pancreas or doesn’t extend far beyond the pancreas, and has not grown into nearby large blood vessels."
"A person must also be healthy enough to withstand surgery to remove the cancer, which is a major operation.
"
"If imaging tests show a reasonable chance of removing the cancer completely, surgery is the preferred treatment if possible, as it offers the only realistic chance for cure."
"Based on where the cancer started, usually either a Whipple procedure (pancreaticoduodenectomy) or a distal pancreatectomy is used.
"
"Sometimes even when a cancer is thought to be resectable, it becomes clear during the surgery that not all of it can be removed."
"If this happens, continuing the operation might do more harm than good."
"The surgery might be stopped, or the surgeon might continue with a smaller operation with a goal of relieving or preventing problems such as bile duct blockage."
"
Even when the surgeon thinks all of the cancer has been removed, the cancer might still come back."
"Giving chemotherapy (chemo), either alone or with radiation therapy (chemoradiation), after surgery (known as adjuvant treatment ) might help some patients live longer."
The chemo drugs most often used are gemcitabine (Gemzar) or 5-FU.
"
Sometimes, if the tumor is thought to be resectable but is very large, has many nearby large lymph nodes, or is causing significant pain, chemotherapy or chemoradiation may be given before surgery to shrink the tumor (known as neoadjuvant treatment) ."
This may make it easier to remove all the cancer at the time of surgery.
Additional chemo may still be recommended after surgery.
"
A small number of pancreatic cancers have reached nearby blood vessels but have not grown deeply into them or surrounded them."
"These cancers might still be removable by surgery, but the odds of removing all of the cancer are lower, so they are considered borderline resectable .
"
These cancers are often treated first with neoadjuvant chemotherapy (sometimes along with radiation therapy ) to try to shrink the cancer and make it easier to remove.
Imaging tests (and sometimes laparoscopy) are then done to make sure the cancer hasn’t grown too much to be removed.
"As long as it hasn’t, surgery is then done to remove it."
"This might be followed by more chemotherapy.
"
"Another option might be to have surgery first, followed by adjuvant chemotherapy (and possibly radiation)."
"If, during the surgery, it becomes clear that not all of the cancer can be removed, continuing the operation might do more harm than good."
"The surgery might be stopped, or the surgeon might continue with a smaller operation with a goal of relieving or preventing problems such as bile duct blockage."
"
Locally advanced cancers have grown too far into nearby blood vessels or other tissues to be removed completely by surgery, but have not spread to the liver or distant organs and tissues."
Surgery to try to remove these cancers does not help people live longer.
"Therefore, if surgery is done, it is to relieve bile duct blockage or to bypass a blocked intestine caused by the cancer pressing on other organs.
"
"Chemotherapy , sometimes followed by chemoradiation, is the standard treatment option for locally advanced cancers."
This may help some people live longer even if the cancer doesn’t shrink.
"Giving chemo and radiation therapy together may work better to shrink the cancer, but this combination has more side effects and can be harder on patients than either treatment alone."
"Sometimes, targeted therapy may be added to chemotherapy before chemoradiation is given.
"
"Other times, immunotherapy given alone may also be an option.
"
"Surgery might be done after chemo or chemoradiation, if imaging shows the cancer has become smaller and can be removed completely by surgery."
"
Pancreatic cancers often first spread within the abdomen (belly) and to the liver."
"They can also spread to the lungs, bone, brain, and other organs.
"
These cancers have spread too much to be removed by surgery.
"Even when imaging tests show that the spread is only to one other part of the body, it is often assumed that small groups of cancer cells (too small to be seen on imaging tests) have already reached other organs of the body.
"
Chemotherapy is typically the main treatment for these cancers.
"It can sometimes shrink or slow the growth of these cancers for a time and might help people live longer, but it is not expected to cure the cancer.
"
Gemcitabine is one of the drugs used most often.
"It can be used alone (especially for people in poor health), or it can be combined with other drugs like albumin-bound paclitaxel (Abraxane), capecitabine (Xeloda), or the targeted drug erlotinib (Tarceva).
"
"Another option, especially for people who are otherwise in good health, is a combination of chemo drugs called FOLFIRINOX."
"This consists of 4 drugs: 5-FU, leucovorin, irinotecan (Camptosar), and oxaliplatin (Eloxatin)."
"This treatment might help people live longer than getting gemcitabine alone, but it can also have more severe side effects.
"
"In certain cases, immunotherapy or targeted therapy may be options for people whose cancer cells have certain gene changes.
"
Other treatments might also be used to help prevent or relieve symptoms from these cancers.
"For example, radiation therapy or some type of nerve block might be used to help relieve cancer pain, or a stent might be placed during an endoscopy to help keep the bile duct open.
"
"Because the treatments now available don’t work well for many people, you may want to think about taking part in a clinical trial of new drugs or combinations of drugs."
"
"
"If cancer continues to grow during treatment (progresses) or comes back (recurs), your treatment options will depend on:
>Where and how much the cancer has spread
>What treatments you have already had
>Your health and desire for more treatment
"
"It’s important that you understand the goal of any further treatment, as well as the likelihood of benefits and risks.
"
"When pancreatic cancer recurs, it most often shows up first in the liver, but it may also spread to the lungs, bone, or other organs."
This is usually treated with chemotherapy if you are healthy enough to get it.
"If you have had chemo before and it kept the cancer away for some time, the same chemo might be helpful again."
"Otherwise, different chemo drugs might be tried, sometimes along with targeted therapy ."
Immunotherapy may also be helpful in some cases of recurrent pancreatic cancer.
"Other treatments such as radiation therapy or stent placement might be used to help prevent or relieve symptoms from the cancer.
"
"If the cancer progresses while you are getting chemotherapy, another type of chemotherapy might be tried if you are healthy enough.
"
"At some point, it might become clear that standard treatments are no longer controlling the cancer."
"If you want to continue getting treatment, you might think about taking part in a clinical trial of a newer pancreatic cancer treatment."
"While these are not always the best option for every person, they may benefit you, as well as future patients."
"
The ampulla of Vater is the area where the pancreatic duct and the common bile duct empty into the duodenum (the first part of the small intestine)."
"Cancer at this site (known as ampullary cancer ) can start in the pancreatic duct, the duodenum, or the common bile duct."
"In many patients, ampullary cancer can’t be distinguished from pancreatic cancer until surgery has been done.
"
"These cancers often cause early symptoms such as jaundice, so they are often found while they are still resectable."
Surgery with the Whipple procedure is often successful in treating these early stage cancers.
"Adjuvant chemoradiotherapy is often recommended after surgery.
"
"More advanced ampullary cancers are treated like pancreatic cancer.
"
"

Chemotherapy (chemo) is an anti-cancer drug injected into a vein or taken by mouth."
"These drugs enter the bloodstream and reach almost all areas of the body, making this treatment potentially useful for cancers whether or not they have spread."
"
Chemo is often part of the treatment for pancreatic cancer and may be used at any stage:
>Before surgery (neoadjuvant chemotherapy):
   Chemo can be given
   before
   surgery
   (sometimes along with radiation) to try to shrink the tumor so it can be removed with less extensive surgery."
"Neoadjuvant chemo is often used to treat cancers that are too big to be removed by surgery at the time of diagnosis (called
   locally advanced cancers
   ).
"
">After surgery (adjuvant chemotherapy):
   Chemo can be used
   after
   surgery (sometimes along with radiation) to try to kill any cancer cells that have been left behind or have spread but can’t be seen, even on imaging tests."
"If these cells were allowed to grow, they could form new tumors in other places in the body. "
"This type of treatment might lower the chance that the cancer will come back later.
"
">For advanced pancreatic cancer:
   Chemo can be used when the cancer is advanced and can’t be removed completely with surgery, or if surgery isn’t an option, or if the cancer has spread to other organs.
"
"When chemo is given along with radiation, it is known as chemoradiation ."
"It helps the radiation work better, but can also have more side effects."
"
In most cases (especially as adjuvant or neoadjuvant treatment), chemo is most effective when 2 or more drugs are given together."
"For people who are not healthy enough for combined treatments, a single drug (usually gemcitabine, 5-FU, or capecitabine) can be used."
"
>Gemcitabine
>5-fluorouracil (5-FU)
>Oxaliplatin
>Albumin-bound paclitaxel (Abraxane)
>Capecitabine (an oral 5-FU drug)
>Cisplatin
>Irinotecan"
"
>Gemcitabine
>5-fluorouracil (5-FU) or capecitabine (an oral 5-FU drug)
>Irinotecan or liposomal irinotecan (Onivyde)
>Platinum drugs: cisplatin or oxaliplatin
>Taxanes: paclitaxel, docetaxel, or albumin-bound paclitaxel (Abraxane)"
"
Chemo drugs for pancreatic cancer can be given into a vein (IV) or by mouth as a pill."
"The infusion can be done in a doctor’s office, chemotherapy clinic, or in a hospital.
"
"Often, slightly larger and sturdier IV lines are required to give chemo."
"These are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines."
"They are used to put medicines, blood products, nutrients, or fluids into your blood."
"They can also be used to take out blood for testing.
"
"Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs."
Cycles are most often 2 or 3 weeks long.
The schedule varies depending on the drugs used.
"For example, with some drugs, the chemo is given only on the first day of the cycle."
"With others, it is given for a few days in a row, or once a week."
"Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
"
"Adjuvant and neoadjuvant chemo is often given for a total of 3 to 6 months, depending on the drugs used."
The length of treatment for advanced pancreatic cancer is based on how well it is working and what side effects you have.
"
Chemo drugs can cause side effects."
These depend on the type and dose of drugs given and how long treatment lasts.
"Common possible side effects include:
>Nausea and vomiting
>Loss of appetite
>Hair loss
>Mouth sores
>Diarrhea or constipation
Chemo can also affect the blood-forming cells of the bone marrow, which can lead to:
>Increased chance of infection (from a shortage of white blood cells)
>Bleeding or bruising (from a shortage of platelets)
>Fatigue or shortness of breath (from having too few red blood cells)
"
These side effects usually go away after treatment.
There are often ways to lessen these side effects.
"For example, drugs can be given to help prevent or reduce nausea and vomiting.
"
Some chemo drugs can cause other side effects.
"For example:
>Drugs such as cisplatin, oxaliplatin, and paclitaxel can damage nerves, which can lead to symptoms of numbness, tingling, or even pain in the hands and feet (called
   peripheral neuropathy
   )."
"For a day or so after treatment, oxaliplatin can cause nerve pain that gets worse with exposure to cold, including when swallowing cold foods or liquids.
"
">Cisplatin can damage the
   kidneys
   ."
"Doctors try to prevent this by giving the patient lots of intravenous (IV) fluids before and after the drug is given.
"
">Cisplatin can affect
   hearing
   ."
"Your doctor may ask if you have any ringing in the ears or hearing loss during treatment.
"
"

Immunotherapy is the use of medicines to stimulate a person’s own immune system to recognize and destroy cancer cells more effectively."
Certain types of immunotherapy can be used to treat pancreatic cancer.
"
An important part of the immune system is its ability to keep itself from attacking the body's normal cells."
"To do this, it uses “checkpoint” proteins on immune cells, which act like switches that need to be turned on (or off) to start an immune response."
Cancer cells sometimes use these checkpoints to keep the immune system from attacking them.
"But drugs that target these checkpoints hold a lot of promise as cancer treatments.
"
"Drugs called checkpoint inhibitors can be used for people whose pancreatic cancer cells have tested positive for specific gene changes, such as a high level of microsatellite instability (MSI-H) , or changes in one of the mismatch repair (MMR) genes."
"Changes in MSI or in MMR genes (or both) are often seen in people with Lynch syndrome .
"
The drugs are used for people whose cancer starts growing again after chemotherapy.
"They might also be used to treat people whose cancer can't be removed with surgery, has come back (recurred) after treatment, or has spread to other parts of the body (metastasized)."
"
Pembrolizumab (Keytruda) is a drug that targets PD-1, a checkpoint protein on immune system cells called T cells, that normally helps keep these cells from attacking normal cells in the body."
"By blocking PD-1, this drug boosts the immune response against pancreatic cancer cells and can often shrink tumors.
"
"This drug is given as an intravenous (IV) infusion every 2 or 3 weeks.
"
"Side effects can include fatigue, cough, nausea, itching, skin rash, decreased appetite, constipation, joint pain, and diarrhea.
"
"Other, more serious side effects occur less often."
This drug works by basically removing the brakes from the body’s immune system.
"Sometimes the immune system starts attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, or other organs.
"
It’s very important to report any new side effects to your health care team promptly.
"If serious side effects do occur, treatment may need to be stopped and you may get high doses of corticosteroids to suppress your immune system.
"
"

Pain can be a major problem for people with pancreatic cancer."
"These cancers can invade and press on nerves near the pancreas, which can cause pain in the abdomen (belly) or back.
"
Treatment is available to help relieve this pain.
"If you are having any pain, please be sure to tell your doctor or nurse."
Pain is easier to control if the treatment is started when you first have it.
You and your doctor or nurse can talk about the best ways to treat your pain.
"A pain specialist can also help develop a treatment plan.
"
Some proven ways to relieve pain from pancreatic cancer include:
"
For most patients, morphine or similar drugs (opioids) can help control the pain."
"Many people are worried about these drugs because they fear becoming addicted, but studies have shown that the risk of this is low if the patient takes the drug for pain as directed by the doctor.
"
Pain medicines work best when they are taken on a regular schedule.
They do not work as well if they are only used when the pain becomes severe.
Several long-acting forms of morphine and other opioids are in pill form and only need be taken once or twice a day.
"There is even a long-acting form of the drug fentanyl that is applied as a patch every 3 days.
"
"Common side effects of these drugs are nausea and feeling sleepy, which often get better over time."
"Constipation is a common side effect that does not get better on its own, so it needs to be treated."
Most people need to take stool softeners and/or laxatives daily.
"
Sometimes certain procedures might be needed to treat pain."
"For example, cutting or injecting alcohol into some of the nerves (that carry pain sensations) near the pancreas can often improve pain and may allow you to use lower doses of pain medicines."
"If you are having surgery for some reason (such as to remove the cancer or relieve bile duct blockage), this can usually be done as part of the same operation.
"
This can also be done as a separate procedure.
"The doctor might do a nerve block by injecting the nerves near the pancreas with either an anesthetic or a medicine that destroys the nerves.
"
"This can be done with the help of an ultrasound or CT scan either by:
>passing a needle through the skin or
>by using an
   endoscope
   (a long, flexible tube that is passed down the throat and past the stomach) that guides a needle to the nerves.
"
"Treating the cancer with chemotherapy and/or radiation therapy can also sometimes relieve pain by shrinking the size of the cancer.
"
"For more information on pain and what can be done about it, see Cancer Pain .
"
"

Radiation therapy uses high-energy x-rays (or particles) to kill cancer cells."
It can be helpful in treating some pancreatic cancers.
"
>Radiation might be given after
   surgery
   (known as
   adjuvant
   treatment) to try to lower the chance of the cancer coming back."
"The radiation is typically given along with
   chemotherapy
   , which is together known as
   chemoradiation
   or
   chemoradiotherapy.
"
">For borderline resectable tumors, radiation might be given along with chemotherapy before surgery (
   neoadjuvant
   treatment) to try to shrink the tumor and make it easier to remove completely.
"
">Radiation therapy combined with chemotherapy may be used as part of the main treatment in people whose cancers have grown beyond the pancreas and can’t be removed by surgery (locally advanced/unresectable cancers).
"
>Radiation is sometimes used to help relieve symptoms (such as pain) in people with advanced cancers or in people who aren’t healthy enough for other treatments like surgery.
"
The type of radiation most often used to treat pancreatic cancer (known as external beam radiation therapy ) focuses radiation from a source outside of the body on the cancer.
"
"Getting radiation therapy is much like getting an x-ray, but the radiation is stronger."
The procedure itself is painless.
"Each treatment lasts only a few minutes, although the setup time – getting you into place for treatment – usually takes longer."
"Most often, radiation treatments are given 5 days a week for several weeks."
"
Some of the more common side effects of radiation therapy include:
>Skin changes in areas getting radiation, ranging from redness to blistering and peeling
>Nausea and vomiting
>Diarrhea
>Fatigue
>Loss of appetite
>Weight loss
Radiation can also lower blood counts, which can increase the risk of serious infection.
"
Usually these effects go away within a few weeks after the treatment is complete.
"Ask your doctor what side effects to expect and how to prevent or relieve them.
"
"

Two general types of surgery can be used for pancreatic cancer:
>Potentially curative surgery
   is used when the results of exams and tests suggest that it’s possible to remove (resect) all the cancer.
"
">Palliative surgery
   may be done if tests show that the cancer is too widespread to be removed completely."
"This surgery is done to relieve symptoms or to prevent certain complications like a blocked bile duct or intestine, but the goal is not to cure the cancer."
"
To determine which type of surgery might be best, it’s important to know the stage (extent) of the cancer."
But it can be hard to stage pancreatic cancer accurately just using imaging tests .
"Sometimes laparoscopy is done first to help determine the extent of the cancer and if it can be resected.
"
"For this procedure, the surgeon makes a few small incisions (cuts) in the abdomen (belly) and inserts long, thin instruments."
One of these has a small video camera on the end so the surgeon can see inside the abdomen and look at the pancreas and other organs.
Biopsy samples of tumors and other abnormal areas can show how far the cancer has spread.
"
Studies have shown that removing only part of a pancreatic cancer doesn’t help patients live longer, so potentially curative surgery is only done if the surgeon thinks all of the cancer can be removed.
"
This is a very complex surgery and it can be very hard for patients.
It can cause complications and might take weeks or months to recover from fully.
"If you're thinking about having this type of surgery, it’s important to weigh the potential benefits and risks carefully.
"
Fewer than 1 in 5 pancreatic cancers appear to be confined to the pancreas at the time they are found.
"Even then, not all of these cancers turn out to be truly resectable (able to be completely removed)."
Sometimes after the surgeon starts the operation it becomes clear that the cancer has grown too far to be completely taken out.
"If this happens, the operation may be stopped, or the surgeon might continue with a smaller operation with a goal of relieving or preventing symptoms (see “Palliative surgery” below)."
This is because the planned operation would be very unlikely to cure the cancer and could still lead to major side effects.
"It would also lengthen the recovery time, which could delay other treatments.
"
"Surgery offers the only realistic chance to cure pancreatic cancer, but it doesn’t always lead to a cure."
"Even if all visible cancer is removed, often some cancer cells have already spread to other parts of the body."
"These cells can grow into new tumors over time, which can be hard to treat.
"
Curative surgery is done mainly to treat cancers in the head of the pancreas.
"Because these cancers are near the bile duct, they often cause jaundice, which sometimes allows them to be found early enough to be removed completely."
"Surgeries for other parts of the pancreas are described below, and are done if it’s possible to remove all of the cancer."
"
"
"This is the most common operation to remove a cancer in the head of the pancreas.
"
"During this operation, the surgeon removes the head of the pancreas and sometimes the body of the pancreas as well."
"Nearby structures such as part of the small intestine, part of the bile duct, the gallbladder, lymph nodes near the pancreas, and sometimes part of the stomach are also removed."
The remaining bile duct and pancreas are then attached to the small intestine so that bile and digestive enzymes can still go into the small intestine.
"The end pieces of the small intestine (or the stomach and small intestine) are then reattached so that food can pass through the digestive tract (gut).
"
"Most often, this operation is done through a large incision (cut) down the middle of the belly."
"Some doctors at major cancer centers also do the operation laparoscopically, which is sometimes known as keyhole surgery (see What’s New in Pancreatic Cancer Research? ).
"
A Whipple procedure is a very complex operation that requires a surgeon with a lot of skill and experience.
It carries a relatively high risk of complications that can be life threatening.
"When the operation is done in small hospitals or by doctors with less experience, as many as 15% of patients may die as a result of surgical complications."
"In contrast, when the operation is done in cancer centers by surgeons experienced in the procedure, fewer than 5% of patients die as a direct result of surgery.
"
"To have the best outcome, it’s important to be treated by a surgeon who does many of these operations and to have the surgery at a hospital where many of them are done."
"In general, people having this type of surgery do better when it's done at a hospital that does at least 15 to 20 Whipple procedures per year.
"
"Still, even under the best circumstances, many patients have complications from the surgery."
"These can include:
>Leaking from the various connections between organs that the surgeon has to join
>Infections
>Bleeding
>Trouble with the stomach emptying after eating
>Trouble digesting some foods (which might require taking some pills to help with digestion)
>Weight loss
>Changes in bowel habits
>Diabetes"
"
In this operation, the surgeon removes only the tail of the pancreas or the tail and a portion of the body of the pancreas."
The spleen is usually removed as well.
"The spleen helps the body fight infections, so if it’s removed you’ll be at increased risk of infection with certain bacteria."
"To help with this, doctors recommend that patients get certain vaccines before this surgery.
"
This surgery is used to treat cancers found in the tail and body of the pancreas.
"Unfortunately, many of these tumors have usually already spread by the time they are found and surgery is not always an option."
"
This operation removes the entire pancreas, as well as the gallbladder, part of the stomach and small intestine, and the spleen."
This surgery might be an option if the cancer has spread throughout the pancreas but can still be removed.
"But this type of surgery is used less often than the other operations because there doesn’t seem to be a major advantage in removing the whole pancreas, and it can have major side effects.
"
It’s possible to live without a pancreas.
"But when the entire pancreas is removed, people are left without the cells that make insulin and other hormones that help maintain safe blood sugar levels."
"These people develop diabetes, which can be hard to manage because they are totally dependent on insulin shots."
"People who have had this surgery also need to take pancreatic enzyme pills to help them digest certain foods.
"
"Before you have this operation, your doctor will recommend that you get certain vaccines because the spleen will be removed."
"
If the cancer has spread too far to be removed completely, any surgery being considered would be palliative (intended to relieve symptoms)."
"Because pancreatic cancer can spread quickly, most doctors don’t advise major surgery for palliation, especially for people who are in poor health.
"
"Sometimes surgery might be started with the hope it will cure the patient, but once it begins the surgeon discovers this is not possible."
"In this case, the surgeon might do a less extensive, palliative operation known as bypass surgery to help relieve symptoms.
"
Cancers growing in the head of the pancreas can block the common bile duct as it passes through this part of the pancreas.
This can cause pain and digestive problems because bile can’t get into the intestine.
"The bile chemicals will also build up in the body, which can cause jaundice, nausea, vomiting, and other problems."
There are two main options to relieve bile duct blockage in this situation:
"
The most common approach to relieving a blocked bile duct does not involve actual surgery."
"Instead, a stent (small tube, usually made of metal) is put inside the duct to keep it open."
"This is usually done through an endoscope (a long, flexible tube) while you are sedated."
Often this is part of an endoscopic retrograde cholangiopancreatography (ERCP) .
The doctor passes the endoscope down the throat and all the way into the small intestine.
"Through the endoscope, the doctor can then put the stent into the bile duct."
The stent can also be put in place through the skin during a percutaneous transhepatic cholangiography (PTC).
"(See Tests for Pancreatic Cancer .)
"
The stent helps keep the bile duct open even if the surrounding cancer presses on it.
"But after several months, the stent may become clogged and may need to be cleared or replaced."
"Larger stents can also be used to keep parts of the small intestine open if they are in danger of being blocked by the cancer.
"
A bile duct stent can also be put in to help relieve jaundice before curative surgery is done (which would typically be a couple of weeks later).
This can help lower the risk of complications from surgery.
"
In people who are healthy enough, another option for relieving a blocked bile duct is surgery to reroute the flow of bile from the common bile duct directly into the small intestine, bypassing the pancreas."
"This typically requires a large incision (cut) in the abdomen, and it can take weeks to recover from this."
Sometimes surgery can be done through several small cuts in the abdomen using special long surgical tools.
"(This is known as laparoscopic or keyhole surgery .)
"
"Having a stent placed is often easier and the recovery is much shorter, which is why this is done more often than bypass surgery."
"But surgery can have some advantages, such as:
>It can often give longer-lasting relief than a stent, which might need to be cleaned out or replaced.
"
">It might be an option if a stent can’t be placed for some reason.
"
">During surgery, the surgeon may be able to cut some of the nerves around the pancreas or inject them with alcohol."
"Because pancreatic cancer often causes pain if it reaches these nerves, this procedure may reduce or get rid of any pain caused by the cancer.
"
"Sometimes, the end of the stomach is disconnected from the duodenum (the first part of the small intestine) and attached farther down the small intestine during this surgery as well."
This is known as a gastric bypass .
"This is done because over time the cancer might grow large enough to block the duodenum, which can cause pain and vomiting and often requires urgent surgery."
"Bypassing the duodenum before this happens can sometimes help avoid this.
"
"Bypass surgery can still be a major operation, so it’s important that you are healthy enough to tolerate it and that you talk with your doctor about the possible benefits and risks before you have the surgery.
"
"

As researchers have learned more about the changes in pancreatic cancer cells that help them grow, they have developed newer drugs to specifically target these changes."
These targeted drugs work differently from standard chemo drugs.
"Sometimes they work when standard chemo drugs don’t, and they often have different side effects."
(See What’s New in Pancreatic Cancer Research?
for more information.)
"
Erlotinib (Tarceva) is a drug that targets a protein on cancer cells called EGFR , which normally helps the cells grow."
"In people with advanced pancreatic cancer, this drug can be given along with the chemo drug gemcitabine."
"Some people may benefit more from this combination than others.
"
"This drug is taken as a pill, once a day.
"
"Common side effects of erlotinib include an acne-like rash on the face and neck, diarrhea, loss of appetite, and feeling tired."
"Less common but more serious side effects can include serious lung, liver, or kidney damage; holes (perforations) forming in the stomach or intestines; serious skin conditions; and bleeding or blood clotting problems."
"
In a small number of pancreatic cancers, the cells have changes in one of the BRCA genes ( BRCA1 or BRCA2 )."
"Changes in one of these genes can sometimes lead to cancer.
"
Olaparib (Lynparza) is a type of drug known as a PARP inhibitor .
PARP enzymes are normally involved in a pathway that helps repair damaged DNA inside cells.
"The BRCA genes are normally involved in a different pathway of DNA repair, and mutations in one of these genes can block that pathway."
"By blocking the PARP pathway as well, this drug makes it very hard for tumor cells with a mutated BRCA gene to repair damaged DNA, which often leads to their death.
"
"Olaparib can be used to treat advanced pancreatic cancer in people with a known or suspected BRCA gene mutation, whose cancer has not gotten worse after at least 4 months of chemo that included a platinum drug (such as oxaliplatin or cisplatin).
"
"This drug has been shown to help shrink or slow the growth of some advanced pancreatic cancers, although so far it's not clear if it can help people live longer.
"
"This drug is taken by mouth as pills, typically twice a day.
"
"Side effects of this drug can include nausea, vomiting, diarrhea or constipation, fatigue, feeling dizzy, loss of appetite, taste changes, low red blood cell counts (anemia), low white blood cell counts (with an increased risk of infection), belly pain, and muscle and joint pain."
"Less common but more serious side effects can include inflammation in the lungs and the development of certain blood cancers, such as myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML)."
"
A small number of pancreatic cancers have changes in one of the NTRK genes."
"These gene changes can sometimes lead to abnormal cell growth and cancer.
"
Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) target the proteins made by the NTRK genes.
"These drugs can be used in people with advanced pancreatic cancer that has been found to have an NTRK gene change, typically when the cancer is still growing despite other treatments.
"
"These drugs are taken as pills, once or twice daily.
"
"Common side effects of these drugs can include dizziness, fatigue, nausea, vomiting, constipation, weight gain, and diarrhea."
"Less common but more serious side effects can include abnormal liver tests, heart problems, and confusion.
"
"

Pancreatic neuroendocrine tumors (NETs) are rare."
"Less than 2% of all cancers found in the pancreas each year are pancreatic NETs.
"
The number of pancreatic NETs diagnosed each year has been rising over time.
"This is thought to be partly because they are being found more often incidentally, when imaging tests such as CT or MRI scans of the abdomen are done for other reasons."
"The ability to distinguish these tumors from other types of cancers in the lab has also improved, leading to more of them being diagnosed.
"
"Most people with pancreatic NETs are older, with the average age of diagnosis being 60."
"These tumors are slightly more common in men than women.
"
"For statistics related to survival, see Pancreatic Neuroendocrine Tumor Survival Rates by Stage.
"
"Visit our Cancer Statistics Center for more key statistics.
"
"

Pancreatic neuroendocrine tumors (NETs), or islet cell tumors, are a type of cancer that starts in the pancreas."
(Cancer starts when cells in the body begin to grow out of control.
"To learn more about how cancers start and spread, see What Is Cancer? )
"
Pancreatic NETs are a less common type of pancreatic cancer.
"They make up less than 2% of pancreatic cancers, but tend to have a better outlook (prognosis) than the more common type ."
"
Pancreatic neuroendocrine tumors start in neuroendocrine cells, a special kind of cell found in the pancreas."
"Neuroendocrine cells are also found in other areas of the body, but only cancers that form from neuroendocrine cells in the pancreas are called pancreatic neuroendocrine tumors."
"
Neuroendocrine cells are like nerve cells in some ways and like hormone-making endocrine cells in other ways.  "
Cells in this system don't form actual organs.
"Instead, they are scattered throughout other organs like the esophagus, stomach, pancreas, intestines, and lungs.
"
Neuroendocrine cells (sometimes just called endocrine cells ) in the pancreas are found in small clusters called islets (or islets of Langerhans ).
"These islets make important hormones like insulin and glucagon (which help control blood sugar levels), and release them directly into the blood."
"
The pancreas is an organ that sits behind the stomach."
"It's shaped a bit like a fish with a wide head, a tapering body, and a narrow, pointed tail."
"In adults it's about 6 inches (15 centimeters) long but less than 2 inches (5 centimeters) wide.
"
">The head of the pancreas is on the right side of the abdomen (belly), behind where the stomach meets the duodenum (the first part of the small intestine).
"
">The body of the pancreas is behind the stomach.
"
">The tail of the pancreas is on the left side of the abdomen next to the spleen.


"
Neuroendocrine tumors start in the endocrine cells of the pancreas.
But most of the pancreas is actually made up of another type of cell called exocrine cells.
These cells form the exocrine glands and ducts.
The exocrine glands make pancreatic enzymes that are released into the intestines to help you digest foods (especially fats).
"The most common type of pancreatic cancer, adenocarcinoma of the pancreas, starts from exocrine cells."
"See Pancreatic Cancer for more about this type.
"
"If you are diagnosed with pancreatic cancer, it’s very important to know if it's an exocrine cancer (see Pancreatic Cancer) or endocrine cancer (discussed here)."
"
Pancreatic neuroendocrine tumors (NETs) are classified by tumor grade, which describes how quickly the cancer is likely to grow and spread.
"
">Grade 1
   (also called
   low-grade
   or well-differentiated
   ) neuroendocrine tumors have cells that look more like normal cells and are not multiplying quickly.
"
">Grade 2
   (also called
   intermediate-grade
   or moderately differentiated)
   tumors have features in between those of low- and high-grade (see below) tumors.
"
">Grade 3
   (also called
   high-grade
   or poorly differentiated
   ) neuroendocrine tumors have cells that look very abnormal and are multiplying faster.
"
Cancers that are grade 1 or 2 are called pancreatic neuroendocrine tumors .
"These cancers tend to grow slowly and can possibly spread to other parts of the body.
"
Cancers that are grade 3 are called pancreatic neuroendocrine carcinomas (NECs) .
"These cancers tend to grow and spread quickly and can spread to other parts of the body.
"
Another important part of grading is measuring how many of the cells are in the process of dividing into new cells.
This is described in more detail in Pancreatic Neuroendocrine Tumor Stages .
"
Pancreatic NETs are also named based on whether they are functioning (making hormones that cause symptoms) or non-functioning (not making hormones).
"
Functioning NETs: About half of pancreatic NETs make hormones that are released into the blood and cause symptoms .
These are called functioning NETs.
"Each one is named for the type of hormone the tumor cells make.
"
">Insulinomas
   come from cells that make insulin.
"
">Glucagonomas
   come from cells that make glucagon.
"
">Gastrinomas
   come from cells that make gastrin.
"
">Somatostatinomas
   come from cells that make somatostatin.
"
">VIPomas
   come from cells that make vasoactive intestinal peptide (VIP).
"
">ACTH-secreting tumors
   come from cells that make adrenocorticotropic hormone (ACTH).
"
Most (up to 70%) functioning NETs are insulinomas.
"The other types are much less common.
"
Non-functioning NETs: These tumors don’t make enough excess hormones to cause symptoms.
"Because they don’t make excess hormones that cause symptoms, they can often grow quite large before they're found."
"Symptoms that may occur when they grow to a large size include abdominal (belly) pain, lack of appetite, and weight loss.
"
"Carcinoid tumors: These NETs are much more common in other parts of the digestive system , although rarely they can start in the pancreas."
"These tumors often make serotonin.
"
"The treatment and outlook for pancreatic NETs depend on the specific tumor type and the stage (extent) of the tumor , but the outlook is generally better than for pancreatic exocrine cancers.
"
"

For some people with a pancreatic neuroendocrine tumor (NET), treatment can remove or destroy the cancer."
Completing treatment can be both stressful and exciting.
"You may be relieved to finish treatment, but find it hard not to worry about cancer coming back."
"This is very common if you’ve had cancer.
"
"For other people, the cancer might never go away completely, or it might come back in another part of the body."
"These people may stay on drug therapy or get regular treatments with chemotherapy, radiation therapy, or other therapies to help keep the cancer under control for as long as possible."
Learning to live with cancer that does not go away can be difficult and very stressful.
"
"
"When treatment ends, your doctors will still want to watch you closely."
It is very important to go to all your follow-up appointments.
"During these visits, your doctors will ask if you are having any problems, examine you, and order lab tests or x-rays and scans if needed to look for signs of cancer or treatment side effects."
Almost any cancer treatment can have side effects .
"Some may last for a few weeks to months, but others might last a long time."
Some side effects might not even show up until years after you have finished treatment.
"It’s important for all pancreatic NET survivors, to let their health care team know about any new symptoms or problems, because they could be caused by the cancer coming back or by a new disease or second cancer ."
"
Your schedule of doctor visits, exams, and tests will depend on the original extent of your cancer, the specific type of pancreatic NET you had, how it was treated, and other factors.
"
Doctors often advise most people who have had their pancreatic NET completely removed to return in 6-12 months for a complete physical exam and certain imaging tests to look for any signs of recurrence.
Blood and or urine tests may be helpful for some patients.
"One year after surgery, further visits with labs and imaging may be recommended every 6-12 months to continue for 10 years.
"
"Follow-up visits and imaging tests may be slightly more frequent if your cancer could not be completely removed with surgery, or if the cancer has spread to other organs like the liver or is growing very quickly."
"
Talk with your doctor about developing a survivorship care plan for you."
"This plan might include:
>A suggested schedule for follow-up exams and tests
>A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
>A schedule for other tests you might need, such as
   early detection (screening) tests
   for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
>Diet and physical activity suggestions that might improve your health, including possibly lowering your chances of the cancer coming back
>Reminders to keep your appointments with your primary care provider (PCP), who will monitor your general health care"
"
Even after treatment, it’s very important to keep health insurance ."
"Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
"
"At some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history."
It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment.
Learn more in Keeping Copies of Important Medical Records .
"
If you have (or have had) pancreatic NET, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements."
"Unfortunately, it’s not yet clear if there are things you can do that will help.
"
"Adopting healthy behaviors such as not smoking , eating well , getting regular physical activity , and staying at a healthy weight is important."
We know that these types of changes can have positive effects on your health that can extend beyond your risk of cancer.
"
Smoking has been linked to pancreas NET, so not smoking may help reduce your risk."
"We don’t know for certain if this will help, but we do know that quitting smoking can have other health benefits such as improved healing, lowering your risk of some other cancers, as well as improving your outcome (prognosis) from the cancer."
"If you want to quit smoking and need help, call the American Cancer Society at 1-800-227-2345."
"
So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of pancreatic NET progressing or coming back."
"This doesn’t mean that no supplements will help, but it’s important to know that none have been proven to do so.
"
"Dietary supplements are not regulated like medicines in the United States – they do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do."
"If you’re thinking about taking any type of nutritional supplement, talk to your health care team."
They can help you decide which ones you can use safely while avoiding those that might be harmful.
"
If your cancer does come back at some point, your treatment options will depend on the where the cancer is, what treatments you’ve had before, and your current health and preferences."
"Treatment options might include surgery, radiation therapy, chemotherapy, targeted therapy or some combination of these."
"For more on how recurrent cancer is treated, see Treatment of Pancreatic Neuroendocrine Tumor, Based on Extent of the Tumor .
"
"For more general information on recurrence, see Understanding Recurrence ."
"
People who’ve had a pancreatic NET might still get other cancers."
Learn more in Second Cancers After Pancreatic Neuroendocrine Tumor.
"
Some amount of feeling depressed, anxious, or worried is normal when pancreatic NET is a part of your life."
Some people are affected more than others.
"But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups, professional counselors, or others."
"Learn more in Life After Cancer .
"
"

Survivors of pancreatic neuroendocrine tumors (NETs) can be affected by a number of health problems, but often their greatest concern is facing another cancer."
Cancer that comes back after treatment is called a recurrence .
"But some cancer survivors develop a new, unrelated cancer later."
"This is called a second cancer .
"
"Unfortunately, being treated for one cancer doesn’t mean you can’t get another."
People who have had a pancreatic NET can still get the same types of cancers that other people get.
"In fact, they might be at higher risk for certain types of cancer.
"
"People who have or had a pancreatic NET can get any type of second cancer, but they have a higher risk than the general population of developing:
>Prostate cancer
>Female breast cancer
>Colon and rectal cancer
>Lung cancer"
"
Many people with a pancreatic NET are treated with medicines that keep the disease in check without curing the disease, so they need to see their doctors regularly."
Let your doctor know if you have any new symptoms or problems.
"They could be from the pancreatic NET getting worse or from a new disease or cancer.
"
All people with a pancreatic NET should avoid tobacco smoke .
Smoking is linked to an increased risk of many cancers and might further increase the risk of some of the second cancers seen in patients with pancreatic NETs.
"They should also keep up with early detection (screening) tests for other types of cancer.
"
"To help maintain good health , pancreatic NET survivors should also:
>Get to and stay at a healthy weight
>Keep physically active and limit the time you spend sitting or lying down
>Follow a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and limits or avoids red and processed meats, sugary drinks, and highly processed foods
>Not drink
   alcohol
   ."
"If you do drink, have no more than 1 drink per day for women or 2 per day for men
These steps may also lower the risk of some other health problems.
"
"See Second Cancers in Adults for more information about causes of second cancers.
"
"

There is no sure way to prevent pancreatic neuroendocrine tumors (NETs)."
Some risk factors such as family history can’t be controlled.
But there are things you can do that might lower your risk.
"
Smoking is an avoidable risk factor for pancreatic NET."
Quitting smoking may help lower risk.
"If you smoke and want help quitting, please talk to your health care provider or call us at 1-800-227-2345."
"
Heavy alcohol use has been tied to pancreatic NETs in some studies but not in others."
"This link is still not certain, but heavy alcohol use can lead to conditions such as chronic pancreatitis, which has been associated with an increased risk of pancreatic NET.
"
"

A risk factor is anything that increases your chance of getting a disease such as cancer."
Different cancers have different risk factors.
"Some risk factors, like smoking, can be changed."
"Others, like a person’s age or family history, can’t be changed.
"
"But having a risk factor, or even many risk factors, does not mean that you will get the disease."
"And some people who get the disease may have few or no known risk factors.
"
Several factors can affect a person’s chance of getting a neuroendocrine tumor (NET) of the pancreas.
"
Smoking is a risk factor for pancreatic NETs."
"Most research shows that heavy smoking increases risk, but some studies show that any history of smoking could put you at risk."
"
Some studies have shown a link between heavy alcohol use and pancreatic NETs."
This link appears to be mostly related to functioning pancreatic NETs rather than nonfunctioning pancreatic NETs.
"Heavy alcohol use can also lead to conditions such as chronic pancreatitis, which may increase pancreatic NET risk."
"
Pancreatic NETs seem to run in some families."
"In some of these families, the high risk is due to an inherited syndrome (explained below)."
"In other families, the gene causing the increased risk is not known."
"If family history is a risk factor, it usually involves a first degree relative (parent, sibling, child), a family history of pancreatic NET, or a family history of any cancer."
"
Inherited gene changes (mutations) can be passed from parent to child."
"Sometimes these changes result in syndromes that include increased risks of other cancers (or other health problems).
"
"Pancreatic neuroendocrine tumors and cancers can also be caused by genetic syndromes, such as:
>Neurofibromatosis, type 1
   , which is caused by mutations in the
   NF1
   gene."
"This syndrome leads to an increased risk of many tumors, including somatostatinomas.
"
">Multiple endocrine neoplasia, type I (MEN1)
   , caused by mutations in the
   MEN1
   gene."
"This syndrome leads to an increased risk of tumors of the parathyroid gland, the pituitary gland, and the islet cells of the pancreas.
"
">Von Hippel-Lindau (VHL) syndrome,
   which is caused by mutations in the
   VHL
   gene."
"This syndrome leads to an increased risk of many tumors, including pancreatic NETs.
"
Changes in the genes that cause some of these syndromes can be found by genetic testing.
"For more information on genetic testing, see Can Pancreatic Neuroendocrine Tumor Be Found Early?"
"
Pancreatic NETs are more common in people with diabetes."
The reason for this is not known.
Most of the risk is found in people with type 2 diabetes.
This type of diabetes most often starts in adulthood and is often related to being overweight or obese.
It’s not clear if people with type 1 (juvenile) diabetes have a higher risk.
"
Chronic pancreatitis, a long-term inflammation of the pancreas, is linked with an increased risk of pancreatic NETs."
"If chronic pancreatitis is because of heavy alcohol use, then stopping alcohol may help decrease the risk of pancreatic NETs."
"
Being overweight or obese could be a risk factor for pancreatic NET."
Studies so far are inconclusive.
"
Some older studies have suggested that drinking coffee might increase the risk of pancreatic NET, but more recent studies have not confirmed this.
"
"

Scientists don’t know exactly what causes most pancreatic neuroendocrine tumors (NETs), but they have found several risk factors that can make a person more likely to get this disease."
"Some of these risk factors affect the DNA of cells in the neuroendocrine system in the pancreas, which can result in abnormal cell growth and may cause cancers to form.
"
"DNA is the chemical in our cells that carries our genes, which control how our cells function."
We look like our parents because they are the source of our DNA.
"But DNA affects more than just how we look.
"
"Some genes control when our cells grow, divide into new cells, and die:
>Genes that help cells grow, divide, and stay alive are called
   oncogenes
   .
"
">Genes that help keep cell division under control, repair mistakes in DNA, or cause cells to die at the right time are called
   tumor suppressor genes
   .
"
Cancers can be caused by DNA changes (mutations) that turn on oncogenes or turn off tumor suppressor genes.
"
Although 90% of PNETs are sporadic (random), some people inherit gene changes from their parents that raise their risk of pancreatic NET."
"Sometimes these gene changes are part of syndromes that include increased risks of other health problems as well.
"
"Syndromes related to changes in three tumor suppressor genes are responsible for many inherited cases of pancreatic NETs:
>Multiple Endocrine Neoplasia Type 1
   (MEN1) syndrome:
   Most inherited cases of PNETs are due to changes in the MEN1 gene."
"This syndrome can cause cancer in the pancreas, parathyroid glands, and
   pituitary glands
   ."
These tumors usually happen at younger ages and tend to be non-functioning.
"Screening people with the MEN1 gene or their family members can sometimes help find pancreatic NET before symptoms appear.
"
">Von Hippel-Lindau (VHL)
   syndrome
   :
   Changes in the
   VHL
   gene cause a small number of pancreatic NETs, usually developing at earlier ages (sometimes as early as the 20s)."
"These tumors tend to be non-functioning and slow growing.
>Neurofibromatosis type 1 (NF1)
   syndrome
   :
   "
"A small number of pancreatic NETs (usually somatostatinomas) are caused by changes in the
   NF1
   gene."
"Other cancers are also associated with this syndrome, including brain tumors or benign tumors that form in nerves under the skin (neurofibromas),
The treatment for a pancreatic NET that's caused by a genetic syndrome might be slightly different compared to treatment for a pancreatic NET in someone without a gene mutation."
"
Most gene mutations related to neuroendocrine tumors of the pancreas are caused by random changes."
"These random mutations are called acquired if they occur after a person is born, rather than having been inherited."
These acquired gene mutations sometimes result from exposure to cancer-causing chemicals (like those found in tobacco smoke ).
"But often what causes these changes is not known.
"
"

Pancreatic neuroendocrine tumors (NETs) are hard to find early."
"The pancreas is deep inside the body, so small tumors can’t be seen or felt by health care providers during routine physical exams."
"People usually have no symptoms until the cancer has already spread to other organs.
"
"At this time, no major professional groups recommend routine screening for pancreatic NET in people who are at average risk."
( Screening means testing for a disease in people who have no symptoms or history of the disease.)
"
Some people might be at increased risk of pancreatic NET because of a family history of the disease (or a family history of certain other cancers)."
"Sometimes this increased risk is due to a specific genetic syndrome .
"
Some of the gene changes that increase pancreatic NET risk can be tested for.
"Knowing if you are at increased risk can help you and your doctor decide if you should have tests to look for pancreatic NET early, when it might be easier to treat."
But determining whether you might be at increased risk is not simple.
"Talking to someone with experience in hereditary cancer syndromes such as a genetic counselor, geneticist, or an oncologist (doctor who treats people with cancer) is often helpful.
"
"The American Cancer Society strongly recommends that anyone thinking about genetic testing talk with a genetic counselor, nurse, or doctor qualified to interpret and explain the test results before they proceed with testing."
"Before deciding to be tested, it’s important to understand what the tests can − and can’t − tell you, and what any results might mean.
"
Genetic tests look for mutations in your genes that cause inherited conditions.
"The tests are used to look for these inherited conditions, not the cancer itself."
"Your risk may be increased if you have one of these conditions, but it doesn’t mean that you have or definitely will get pancreatic NET."
"
For people in families at high risk of pancreatic NET, such as MEN1 syndrome, tests for detecting cancer early may help."
"Although definitive screening guidelines for people with the MEN1 gene or their family members are not available, doctors have been able to find early, treatable pancreatic NETs in some members of high-risk families with these tests."
"Some tests that might be considered include:
>An endoscopic ultrasound of the pancreas every few years.
"
">A MRI of the pancreas every few years.
"
">Checking blood levels of certain hormones such as insulin, prolactin, gastrin, and calcium every few years."
"(Sometimes, changes in hormones can occur 10 years before the tumor is found by clinical symptoms.)
"
">An Octreoscan on a regular basis.
"
"

Certain signs and symptoms might suggest that a person could have a pancreatic neuroendocrine tumor (NET), but tests are needed to confirm the diagnosis."
"
In taking your medical history, the doctor will ask you questions about your general health, lifestyle habits, symptoms, and risk factors."
"The doctor will also probably ask about symptoms related to excess hormone production such as diarrhea, abdominal (belly) pain, or rash.
"
Your doctor will also examine you to look for signs of pancreatic NET or other health problems.
The exam will probably focus mostly on your belly.
"Pancreatic NETs can sometimes cause the liver or gallbladder to swell, which the doctor might be able to feel during the exam.
"
"If the results of the exam are abnormal, your doctor will probably order tests, such as imaging, labs, or other procedures, to help find the problem."
You might also be referred to a gastroenterologist (a doctor who treats digestive system diseases) for further tests and treatment.
"
A CT scan uses x-rays taken from different angles, which are combined by a computer to make detailed pictures of the organs."
This test is most often used to look at the chest and/or belly (abdomen) to see the pancreas clearly and if the pancreatic NET has spread to nearby lymph nodes or other organs such as the liver.
It can also be used to guide a biopsy needle into an area of concern.
"
Like CT scans, MRI scans show detailed images of soft tissues in the body."
But MRI scans use radio waves and strong magnets instead of x-rays.
A dye called gadolinium may be injected into a vein before the scan to see details better.
"A MRI scan sometimes can see cancer spread to the liver better than a CT scan.
"
"MR cholangiopancreatography (MRCP) , is a special type of MRI scan, which can be used to look at the pancreatic and bile ducts, and is described below in the section on cholangiopancreatography."
"
Ultrasound tests use sound waves to create images of organs such as the pancreas.
"
"Abdominal ultrasound: For this test, a wand-shaped probe is moved over the skin of the abdomen."
It gives off sound waves and detects the echoes as they bounce off organs.
"If it’s not clear what might be causing a person’s abdominal symptoms, this might be the first test done because it is easy to do and it doesn’t expose a person to radiation.
"
Endoscopic ultrasound (EUS): This test uses an endoscope with a small ultrasound probe on the end. 
"The scope is then passed through your mouth or nose, down through the stomach, and into the first part of the small intestine."
"It is then pointed toward the pancreas, which is next to the small intestine."
"The probe on the tip of the endoscope can get very close to the pancreas, so this is a very good way to look at it."
"If a tumor is seen, a small, hollow needle can be passed down the endoscope to get biopsy samples of it."
"
"
"This is an imaging test that looks at the pancreatic ducts and bile ducts to see if they are blocked, narrowed, or dilated."
These tests can help show if someone might have a pancreatic neuroendocrine tumor that is blocking a duct.
They can also be used to help plan surgery.
"The test can be done in different ways, each of which has pros and cons.
"
Endoscopic retrograde cholangiopancreatography (ERCP):
"For this test, an endoscope (a thin, flexible tube with a tiny video camera on the end) is passed down the throat, through the esophagus and stomach, and into the first part of the small intestine."
"This is usually done while you are sedated (given medicine to make you sleepy).
"
The doctor can see through the endoscope to find the ampulla of Vater (where the common bile duct empties into the small intestine).
The doctor guides a catheter (a very small tube) through the tip of the endoscope and into the common bile duct.
"A small amount of dye is then injected into the common bile duct, and x-rays are taken."
This dye outlines the bile and pancreatic ducts.
The x-rays can show narrowing or blockage in these ducts that might be due to pancreatic neuroendocrine tumor.
"The doctor doing this test can also put a small brush through the tube to remove cells for a biopsy (see below).
"
"ERCP can also be used to place a stent (small tube) into a bile or pancreatic duct to keep it open if a nearby tumor is pressing on it.
"
Magnetic resonance cholangiopancreatography (MRCP):
This is a non-invasive way to look at the pancreatic and bile ducts using the same type of machine used for standard MRI scans.
"Unlike ERCP, it does not require an injection of a dye."
"Because this test is non-invasive, doctors often use MRCP if the purpose is just to look at the pancreatic and bile ducts."
"But this test can’t be used to get biopsy samples of tumors or to place stents in ducts.
"
"Percutaneous transhepatic cholangiography (PTC): In this procedure, the doctor puts a thin, hollow needle through the skin of the belly and into a bile duct within the liver."
"A dye is then injected through the needle, and x-rays are taken as it passes through the bile and pancreatic ducts."
"As with ERCP, this approach can also be used to take fluid or tissue samples or to place a stent into a duct to help keep it open."
"Because it is more invasive (and might cause more pain), PTC is not usually used unless ERCP has already been tried or can’t be done for some reason."
"
Scans using small amounts of radioactivity and special cameras can be helpful in looking for pancreatic NETs."
"They can help find tumors or look for areas of cancer spread if doctors aren’t sure where it is in the body.
"
" Positron emission tomography (PET) scan: For most types of cancer, PET scans use a form of radioactive glucose (sugar) to find tumors."
"This type of PET scan is useful in finding poorly differentiated pancreatic neuroendocrine carcinomas (NECs), but a newer type of PET scan, called a Gallium-68 PET/CT Dotatate scan is being used for pancreatic NETs."
It uses the radioactive agent gallium-68 dotatate which attaches to the somatostatin protein on neuroendocrine tumor cells.
A special camera can detect the radioactivity.
"This Gallium-68 PET/CT scan is slowly becoming more widely available since it was approved by the FDA in 2016 and is able to find neuroendocrine tumors better than an OctreoScan (described below).
"
Somatostatin receptor scintigraphy (SRS or OctreoScan) :
This test can be very helpful in finding pancreatic NETs.  
It uses a drug called octreotide joined to radioactive indium-111.
Octreotide is a hormone-like substance that attaches to pancreatic NET cells.
A small amount of the octreotide-radioactive substance is injected into a vein and travels though the blood where it attaches to the tumor types of many types of pancreatic NET cells (although it is less helpful for insulinomas).  
"A few hours after the injection, a special camera can be used to show where the radioactivity has collected in the body."
More scans may be done over the next few days as well.
"Along with showing where tumors are, this test can also tell whether treatment with certain drugs such as octreotide and lanreotide is likely to be helpful."
"
Several types of blood and urine tests can be used to help diagnose pancreatic NET or to help determine treatment options if it is found.
"
">
Blood tests looking at the levels of certain pancreatic hormones can often help diagnose pancreatic NETs."
"Tests might be done to check blood levels of:
>Hormones made by different types of pancreatic NET cells, such as insulin, gastrin, glucagon, somatostatin, pancreatic polypeptide, and VIP (vasoactive intestinal peptide)
>Chromogranin A (CgA)
>Glucose and C-peptide (for insulinomas)
"
"Carcinoid tumors: For carcinoids, a blood test may be done to look for serotonin, which is made by many of these tumors."
"The urine might also be tested for serotonin and for related chemicals such as 5-HIAA and 5-HTP.
"
"Other common tests to look for carcinoids include blood tests for chromogranin A (CgA), neuron-specific enolase (NSE), substance P, and gastrin.
"
"Depending on where the tumor might be located and the patient’s symptoms, doctors might do other blood tests as well.
"
"Some of these tests can also be used to show how well treatment is working, since the levels of these substances tend to go down as tumors shrink."
"
In many cases, the only way to know for sure if a person has some type of pancreatic NET is to remove cells from the tumor and look at them in the lab. "
This procedure is called a biopsy .
"Biopsies can be done in different ways.
"
Percutaneous (through the skin) biopsy:
"For this test, a doctor inserts a thin, hollow needle through the skin over the abdomen and into the pancreas to remove a small piece of a tumor."
This is known as a fine needle aspiration (FNA).
"The doctor guides the needle into place using images from ultrasound or CT scans.
"
Endoscopic biopsy:
Doctors can also biopsy a tumor during an endoscopy.
"The doctor passes an endoscope (a thin, flexible, tube with a small video camera on the end) into the throat, down the esophagus, and into the small intestine near the pancreas."
"At this point, the doctor can either use endoscopic ultrasound (EUS) to pass a needle into the tumor or endoscopic retrograde cholangiopancreatography (ERCP) to remove cells from the bile or pancreatic ducts."
"These tests are described in more detail above.
"
Surgical biopsy:
"In rare cases, an endoscopic biopsy or a CT-guided needle biopsy will not be able to get enough tissue to identify the type of tumor."
"In such cases, surgery may be needed to remove a tissue sample. "
"Surgical biopsies are done much less often now than in the past since PNETs are mostly diagnosed using imaging (CT or MRI scans), somatostatin receptor-based imaging, EUS biopsy, and checking for excessive levels of hormones."
"
Rarely, the doctor might not do a biopsy on someone who has a neuroendocrine tumor in the pancreas if imaging tests, blood tests, and somatostatin receptor-based imaging show the tumor is very likely to be cancer and if it looks like surgery can remove all of it."
"Instead, the doctor will proceed with surgery, at which time the tumor cells can be looked at in the lab to confirm the diagnosis."
"During surgery, if the doctor finds that the cancer has spread too far to be removed completely, only a sample of the cancer may be removed to confirm the diagnosis, and the rest of the planned operation may be stopped.
"
"See Testing Biopsy and Cytology Specimens for Cancer to learn more about different types of biopsies, how the biopsy samples are tested in the lab, and what the results will tell you.
"
"

After someone is diagnosed with a pancreatic neuroendocrine tumor (NET), doctors will try to figure out if it has spread, and if so, how far."
This process is called staging .
The stage of a cancer describes how much cancer is in the body.
It helps determine how serious the cancer is and how best to treat it.
"Doctors also use a cancer's stage when talking about survival statistics.
"
The stages of pancreatic NET range from I (1) through IV (4).
"As a rule, the lower the stage, the less the cancer has spread."
"A higher number, such as stage IV, means cancer has spread more."
"Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way."
"
The staging system most often used for pancreatic NETs is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:
>The size and extent of the main
   tumor (T):
   How large is the tumor?"
"Has it grown into nearby structures or organs?
>"
"The spread to nearby lymph
   nodes (N):
   Has the cancer spread to nearby lymph nodes?
>The spread (
   metastasis
   ) to distant sites
   (M):
   "
Has the cancer spread to distant organs?
"(The most common site of spread is the liver.)
"
"Numbers or letters after T, N, and M provide more details about each of these factors."
Higher numbers mean the cancer is more advanced.
"Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage."
"For more information, see Cancer Staging .
"
"The system described below is the most recent version of the AJCC system, effective as of January 2018."
"It is used to stage well-differentiated pancreatic NETs, but not high-grade pancreatic NETs (known as neuroendocrine carcinomas ) or other types of pancreatic cancer, which have their own staging system .
"
"Pancreatic NETs are typically given a clinical stage based on the results of a physical exam, biopsy, and imaging tests (as described in Tests for Pancreatic Neuroendocrine Tumor )."
"If surgery is done, the pathologic stage (also called the surgical stage ) is determined by examining tissue removed during the operation.
"
Staging for pancreatic NETs can be complex.
"If you have any questions about the stage of your cancer or what it means, please ask your doctor to explain it to you in a way you understand."
"
AJCC Stage
Stage grouping
Stage description*
I
T1 N0 M0
The tumor is less than 2 centimeters (cm) across and is still just in the pancreas (T1)."
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).


"
"II
T2 N0 M0
The tumor is at least 2 cm across but no more than 4 cm across, and it is still just in the pancreas (T2)."
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"OR
T3 N0 M0
The tumor is more than 4 cm across and is still just in the pancreas, OR the tumor has grown into the duodenum (the first part of the small intestine) or the common bile duct (T3)."
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).


"
"III
T4"
"N0 M0
The tumor has grown into nearby organs (such as the stomach, spleen, colon, or adrenal gland) or it has grown into nearby large blood vessels (T4)."
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"OR
"
"Any T N1 M0
The tumor can be any size and might or might not have grown outside of the pancreas (any T)."
"It has spread to nearby lymph nodes (N1), but not to distant parts of the body (M0).
"
"IV
Any T Any N M1
"
The tumor can be any size and might or might not have grown outside of the pancreas (any T).
It might or might not have spread to nearby lymph nodes (any N).
"The cancer has spread to distant parts of the body (M1).
"
*
"The following additional categories are not listed in the table above:
>TX:
   "
"The main tumor cannot be assessed due to lack of information.
"
">T0:
   There is no evidence of a main tumor.
"
">NX:
   "
Nearby lymph nodes cannot be assessed due to lack of information.
"
Although not formally part of the TNM system, other factors can also be important in determining a person’s prognosis (outlook)."
"
The grade describes how quickly the cancer is likely to grow and spread."
"For pancreatic NETs, an important part of grading is measuring how many of the cells are in the process of dividing into new cells."
"This is determined by:
>The
   mitotic count
   , which is the number of cells seen under a microscope that are in the process of splitting into two new cells (mitosis).
"
">The
   Ki-67 index
   , which is a measure of the portion of cells that are almost ready to start splitting.
"
"Based on these tests, NETs are divided into 2 main groups:
>Well-differentiated tumors
   (which include low-grade [G1] and intermediate-grade [G2] tumors) have 20 or fewer mitoses and a Ki-67 index of 20% or lower.
"
">Poorly differentiated tumors
   (high-grade [G3] tumors) have more than 20 mitoses or a Ki-67 index of more than 20%."
"These are also called
   neuroendocrine carcinomas (NECs)
   , and they often grow and spread quickly."
"
The outlook for pancreatic NETs can be affected by whether the tumor is functioning (making hormones) or non-functioning ."
"For functioning tumors, the type of hormone can also be important."
"For example, insulinomas (NETs that make insulin) tend to have a lower risk of spreading than other types of NETs.
"
"

Having one or more of the symptoms below does not mean you have a pancreatic neuroendocrine tumor (NET)."
"In fact, many of these symptoms are more likely to be caused by other conditions."
"Still, if you have any of these symptoms, it’s important to have them checked by a doctor so that the cause can be found and treated, if needed.
"
Pancreatic NETs often release excess hormones into the bloodstream.
"Different types of tumors make different hormones, which can lead to different symptoms."
"
These tumors make gastrin, a hormone that tells the stomach to make more acid."
"Too much gastrin causes a condition known as Zollinger-Ellison syndrome , in which the stomach makes too much acid."
"This leads to stomach ulcers, which can cause pain, nausea, and loss of appetite."
Severe ulcers can bleed.
"Even if the bleeding is mild, it can lead to anemia (too few red blood cells), which can cause symptoms like feeling tired and being short of breath."
"If the bleeding is more severe, it can make stool black and tarry."
"Severe bleeding can itself be life-threatening.
"
"If the stomach acid reaches the small intestine, it can damage the cells of the intestinal lining and break down digestive enzymes before they have a chance to digest food."
This can cause diarrhea and weight loss.
"
"
"These tumors make glucagon, a hormone that increases glucose (sugar) levels in the blood."
"Most of the symptoms that can be caused by a glucagonoma are mild and are more often caused by something else.
"
"Excess glucagon can raise blood sugar, sometimes leading to diabetes."
"This can cause symptoms such as feeling thirsty and hungry, and having to urinate often.
"
"People with these tumors can also have problems with diarrhea, weight loss, and malnutrition."
"The nutrition problems can lead to symptoms like irritation of the tongue and the corners of the mouth.
"
The symptom that brings most people with glucagonomas to their doctor is a rash called necrolytic migratory erythema.
This is a red rash with swelling and blisters that often travels from place to place on the skin.
"
These tumors make insulin, which lowers blood glucose levels."
"Too much insulin leads to low blood sugar, which can cause symptoms like weakness, confusion, sweating, and rapid heartbeat."
"When blood sugar gets very low, it can lead to a person passing out or even going into a coma and having seizures."
"
"
"These tumors make somatostatin, which helps regulate other hormones."
"Symptoms of this type of tumor can include belly pain, nausea, poor appetite, weight loss, diarrhea, symptoms of diabetes (feeling thirsty and hungry, and having to urinate often), and jaundice (yellowing of the skin and eyes) .
"
"The early symptoms of a somatostatinoma tend to be mild and are more often caused by other things, so these tumors tend to be diagnosed at an advanced stage."
"Often, they are not found until they spread to the liver, when they cause problems like jaundice and pain."
"
These tumors make a substance called vasoactive intestinal peptide (VIP)."
Too much VIP can lead to problems with diarrhea.
"This may be mild at first, but gets worse over time."
"By the time they are diagnosed, most people have severe, watery diarrhea.
"
"Other symptoms can include nausea, vomiting, muscle cramps, feeling weak or tired, and flushing (redness and warmth in the face or neck).
"
"People with these tumors also tend to have low levels of acid in their stomachs, which can lead to problems digesting food."
"
"
"These tumors often make serotonin or its precursor, 5-HTP."
Carcinoid tumors often don’t cause symptoms until they spread outside the pancreas.
"When these tumors do spread, it is most often to the liver."
"There, the cancer cells can release hormones directly into the blood."
"This can cause the carcinoid syndrome, with symptoms including flushing (redness and warmth in the face or neck), diarrhea, wheezing, and a rapid heart rate."
"These symptoms often occur in episodes, between which the person may feel fine.
"
"Over a long time, the hormone-like substances released by these tumors can damage heart valves, causing shortness of breath, weakness, and a heart murmur (an abnormal heart sound)."
"
"
"These tumors don’t make excess hormones, so they don’t cause symptoms in early stages and often grow quite large before they are found."
Most of these start to cause problems as they get larger or spread outside the pancreas.
"Symptoms can be like those from exocrine pancreas cancers, including jaundice (yellowing of the eyes and skin), belly pain, and weight loss."
"Sometimes, as a pancreatic NET grows, it can go from making too little of a hormone (nonfunctioning) to making too much of a specific hormone (functioning) which causes symptoms."
"
When pancreatic NETs spread, most often they go to the liver."
"This can enlarge the liver, which can cause pain and loss of appetite."
"It can also affect liver function, sometimes leading to jaundice (yellowing of the skin and eyes) and abnormal blood tests.
"
These cancers can also spread to other organs and tissues.
The symptoms depend on where the cancer is growing.
"For example, cancer spread to the lungs can cause shortness of breath or a cough."
"Spread to bones can cause pain in those areas.
"
"

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed."
"They can’t tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
"
"Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they can’t predict what will happen in any particular person’s case."
These statistics can be confusing and may lead you to have more questions.
Ask your doctor how these numbers might apply to you.
"
A relative survival rate compares people with the same type and stage of pancreatic neuroendocrine tumor (NET) to people in the overall population."
"For example, if the 5-year relative survival rate for a specific type and stage of pancreatic NET is 90%, it means that people who have that cancer are, on average, about 90% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed."
"
The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results (SEER) database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer.
"
"The SEER database tracks 5-year relative survival rates for pancreatic NET in the United States, based on how far the cancer has spread."
"The SEER database, however, does not group cancers by AJCC TNM stages (stage 1, stage 2, stage 3, etc.)."
"Instead, it groups cancers into localized, regional, and distant stages:
>Localized:
   There is no sign the cancer has grown outside of the pancreas.
"
">Regional:
   "
"The cancer has grown outside the pancreas into nearby tissues or has spread to nearby lymph nodes.
"
">Distant:
   "
"The cancer has spread to distant parts of the body such as the lungs, liver or bones."
"
(These numbers are based on people diagnosed with pancreatic NET between 2012 and 2018.)
"
"*SEER= Surveillance, Epidemiology, and End Results
Understanding the numbers
>These numbers apply only to the stage of the cancer when it is first diagnosed.
   "
"They do not apply later on if the cancer grows, spreads, or comes back after treatment.
"
">These numbers don’t take everything into account.
   "
"Survival rates are grouped based on how far the cancer has spread, but your age, overall health, how well the cancer responds to treatment,
   tumor grade, tumor function
   , and other factors can also affect your outlook.
"
">People now being diagnosed with pancreatic NET may have a better outlook than these numbers show.
   "
"Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least five years earlier.
"
"

It’s important to have honest, open discussions with your cancer care team."
"They want to answer all your questions, so that you can make informed treatment and life decisions.  "
"For instance, consider these questions:"
"
>What
   kind of pancreatic neuroendocrine tumor
   do I have?
>Has my cancer spread beyond where it started?
"
">What is the
   stage
   of my cancer and what does that mean?
>Is my cancer resectable (removable by surgery)?
"
">Are my symptoms because the cancer is making too many hormones?
"
">Will I need any other tests before we can decide on treatment?
>Will I need to see other doctors or health care professionals?
>"
"If I’m concerned about the costs and insurance coverage for my diagnosis and treatment, who can help me?"
"
>How much experience do you have treating this type of cancer?
>"
"What are my
   treatment options
   ?
>"
"What do you recommend and why?
"
">What is the goal of the treatment?
>Should I get a
   second opinion
   ?"
How do I do that?
"Can you recommend a doctor or cancer center?
>How is treatment likely to help me?
>What risks or side effects might I expect?"
"Are there things I can do to reduce these side effects?
>Should I think about taking part in a
   clinical trial
   ?
>How quickly do I need to decide on treatment?
"
">What should I do to be ready for treatment?
>How long will treatment last?"
What will it be like?
"Where will it be done?
>"
"What are the chances the cancer will
   recur
   (come back) with these treatment plans?
>Will treatment affect my daily activities?"
"Can I still work full time?
>"
"What would my options be if the treatment doesn’t work or if the cancer comes back?
>"
"What if I have
   transportation problems
   getting to and from treatment?"
"
Once treatment begins, you’ll need to know what to expect and what to look for."
"Not all of these questions may apply to you, but getting answers to the ones that do may be helpful.
"
">How will we know if the treatment is working?
>Is there anything I can do to help manage
   side effects
   ?
>"
"What symptoms or side effects should I tell you about right away?
>How can I reach you on nights, holidays, or weekends?
"
">Do I need to change what I eat during treatment?
>Are there any limits on what I can do?
>"
Can I exercise during treatment?
"If so, what kind should I do, and how often?
"
>
"Can you suggest a mental health professional I can see if I start to feel
   overwhelmed, depressed, or distressed
   ?"
"
>Are there any limits on what I can do?
"
Do
"I need a special diet after treatment?
>What symptoms should I watch for?
>"
"What kind of exercise should I do now?
>What type of
   follow-up
   will I need after treatment?
"
>How often will I need to have follow-up exams and tests?
"Will I need any blood tests?
>How will we know if the cancer has come back?"
"What should I watch for?
"
"What will my options be if the cancer comes back?
"
"Along with these sample questions, be sure to write down some of your own."
Keep in mind that doctors aren’t the only ones who can give you information.
"Other health care professionals, such as nurses and social workers, can answer some of your questions."
"To find out more about speaking with your health care team, see The Doctor-Patient Relationship .
"
"
"
"
A pancreatic neuroendocrine tumor (NET) is a type of cancer that starts in the pancreas."
"It happens when endocrine cells (a type of cell found in the pancreas) start to change and grow out of control, crowding out normal cells.
"
"Your pancreas has 2 jobs:
>It makes a substance that helps break down (digest) the food you eat.
"
">it makes hormones that help control the levels of sugar, insulin, and other substances in your blood.
"
Pancreatic NETs start in the type of cells that make hormones ( end ocrine cells ).
"But there's another, more common type of pancreatic cancer that starts from the cells that help digest food ( exocrine cells )."
"If you've been diagnosed with pancreatic cancer, ask your doctor which type you have."
"The two types of pancreatic cancer are treated differently and have different outlooks.


"
"Ask your doctor to use this picture to show you where your cancer is located .
"
Pancreatic NETs can spread to other parts of the body.
"When cancer does this, it's called metastasis ."
But the type of cancer is based on the type of cells it started from.
"So even if a pancreatic NET spreads to your liver, for example, it's is still called a pancreatic NET, not liver cancer.


"
"
>Why do you think I have cancer?
>Is there a chance I don’t have cancer?
"
">Would you please write down the kind of cancer you think I might have?
"
>What will happen next?
"
Sometimes it can be hard to find a pancreatic NET when it's still small."
"Not all pancreatic NETs cause signs and symptoms , but some make different types of hormones that might cause problems that you notice."
"
"
The doctor will ask questions about your health and do a physical exam.
"The pancreas is deep inside the body, so it can be hard for the doctor to see or feel something wrong if the cancer is still small."
"If signs are pointing to pancreatic NET, more tests will be done."
"Here are some of the tests you may need :
Biopsy : The doctor takes out a little bit of tissue or some cells to check for cancer."
A biopsy is the only way to tell for sure if you have cancer.
"There are different ways to do biopsies, so ask your doctor which type of biopsy you will have.
"
CT or CAT scan:
This test uses x-rays to make pictures of your insides.
"This can show clear pictures of the pancreas and the area around it to see if the cancer has spread.
"
MRI scan: This test uses radio waves and strong magnets instead of x-rays to make clear pictures of the inside of the body.
This test may be used to learn more about the cancer’s size and spread.
"Special types of MRI scans can also be used to look at ducts and blood vessels in and around the pancreas.
"
Endoscopic ultrasound (EUS): This test uses sound waves to make pictures of the inside of your body.
"A small ultrasound on the tip of a thin tube is passed down your throat, into the stomach, and then into the first part of the small intestine."
The ultrasound tip can be pointed to look at the pancreas.
"It can also be used to take out a little bit of tissue that can be checked for cancer.
"
"Endoscopic retrograde cholangiopancreatography (ERCP): A small camera on the tip of a thin tube is passed down your throat, into the stomach, and then into the first part of the small intestine."
This test can check if the ducts are blocked due to pancreatic NET.
"It can also be used to help open a blocked duct or take out some cells.
"
Radionuclide scans : These are tests that use a small amount of radiation and special cameras to find where the pancreatic NET is located or spread.
"They are also helpful to choose certain drugs for treatment and to see if treatment is working.
"
"Liver function tests: These are blood tests to see how well the liver is working.
"
Tumor marker tests: Your blood might be checked for proteins or hormones that certain types of pancreatic NETs make.
"This test can help your doctor find out the kind of pancreatic NET that you have.
"
Other blood tests: You might have other tests to help find out if you have any other health problems such as kidney disease or bone marrow problems.
"
>What tests will I need to have?
>"
"Who will do these tests?
>Where will they be done?
"
>
"Who can explain the tests to me?
>"
"How and when will I get the results?
>Who will explain the results to me?
>What do I need to do next?"
"
If you have a pancreatic NET, the doctor will want to find out how far it has spread ."
This is called staging .
Your doctor will want to find out the stage of your cancer to help decide what treatment is best for you.
"Your cancer can be staged 1, 2 ,3 or 4."
"The lower the number, the less the cancer has spread."
"
Grading means checking the cancer cells from your biopsy test to see how much they look like normal cells."
This helps doctors tell how fast the cancer is likely to grow and spread.
Your tumor will be given a grade between 1 and 3.
"The lower the number, the more the cancer cells look like normal cells and tend to grow more slowly."
"The tumor grade helps the doctor decide which treatment is best for you, so ask your doctor to explain your cancer's grade and what it means for your treatment."
"
>Do you know the stage of the cancer?
>If not, how and when will you find out the stage of the cancer?
"
">Would you explain to me what the stage means in my case?
>Based on the stage of the cancer, how long do you think I’ll live?
"
">What is the grade of the cancer and what will what mean for treatment?
>What will happen next?"
"
The main ways to treat pancreatic NET are surgery, radiation therapy, chemotherapy or other drugs."
Ask your doctor what treatments can help you.
"Even for cancers that are more advanced and harder to cure, treatment can often make symptoms better and slow down the cancer's growth."
"Talk with your doctor to find out your options.
"
"The treatment plan that’s best for you will depend on:
>The stage and grade of the cancer
>The chance that a type of treatment will cure the cancer or help with symptoms
>"
"Your age
>Other health problems you have
>Your feelings about the treatment and the side effects that come with it"
"
If the cancer is small and has not spread, surgery is done to try to take all of it out."
"Sometimes, surgery can be done to take out only the cancer, and leave the rest of the pancreas alone."
"But often, depending on how large the cancer is, parts, or even all, of your pancreas and other organs might need to be removed, too."
Ask your doctor what kind of surgery you will have.
"If the cancer is too large or has spread too far, surgery might not be possible, and other treatments might be done instead."
"
Surgery for pancreatic NET can be a small or very big operation, but all surgery can have risks and side effects."
"Be sure to ask the doctor what to expect, and let your doctor know if you have any problems after surgery."
"Possible problems from surgery are:
>Leaking inside the body
>Infection
>Bleeding
>Trouble eating
>Weight loss
>Changes in bathroom habits
>Diabetes"
"
Tumor ablation or embolization can help if a pancreatic NET has spread to the liver."
It destroys the tumor without taking it out by surgery.
It may be done if you are too sick to have surgery.
"There are many ways to do this, such as heating the tumor with radio waves or microwaves, freezing the tumor, or killing the tumor by blocking the blood supply that feeds the liver."
Talk to your doctor about what to expect.
"
Radiation uses high energy x-rays to kill cancer cells or shrink tumors."
Radiation might be used if the cancer has grown too much to be taken out by surgery.
It might also be used after surgery if all the cancer was not removed and is still causing problems.
"Radiation can also help make symptoms better, such as pain caused by the cancer."
"
If your doctor suggests radiation, ask about what side effects might happen."
"The most common side effects of radiation are:
>Skin changes where the radiation is given
>Feeling very tired
>Feeling sick to your stomach
>Losing weight"
"
Sometimes special drugs that have small amounts of radiation inside are used to treat pancreatic NETs."
"These drugs can bring radiation straight to the cancer, without hurting as many healthy cells.
"
"The most common side effects of radioactive drugs are nausea, kidney and liver problems, low white blood counts, and vomiting."
"
Chemo is the short word for chemotherapy, the use of drugs to fight cancer."
"These drugs are mainly used for pancreatic NETs that have spread, are growing fast, are causing bad symptoms, or when other drugs have not worked.
"
"Some chemo drugs are given through a needle into a vein (called an infusion ), and others are taken as pills."
These drugs go into the blood and spread through the body.
Chemo is given in cycles or rounds.
Each round of treatment is followed by a break to allow your body to get better from the side effects.
"Different kinds of chemo drugs can be used together or alone, and often with other types of drugs, too."
Treatment often lasts for many months.
"
Common side effects are:
>Hair loss
>Mouth sores
>Not feeling like eating
>Diarrhea
>Feeling sick to your stomach
>Infections
>Bruising and bleeding easily
>Tiredness
These problems usually go away after treatment ends, and there are ways to treat most chemo side effects. "
"If you have side effects, be sure to talk to your cancer care team so they can help."
"
Targeted therapy drugs work differently from chemo drugs."
These drugs affect mainly cancer cells and not normal cells in the body.
They may work even if other treatments don't.
The types of targeted therapy drugs that are used for pancreatic NETs are taken as pills.
"The side effects will depend on which targeted therapy drug you are given, so talk to your doctor what to expect."
"Often, the side effects are different than the side effects for chemo."
"
Octreotide and lanreotide : These drugs are helpful in treating the symptoms caused by many pancreatic NETs."
"Sometimes they can temporarily shrink these tumors, but they can't cure them."
These drugs are given as shots (injections) just under the skin.
"
Clinical trials are research studies that test new drugs or other treatments in people."
"They compare standard treatments with others that may be better.
"
Clinical trials are one way to get the newest cancer treatment.
They are the best way for doctors to find better ways to treat cancer.
"If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part."
"And if you do sign up for a clinical trial, you can always stop at any time.
"
"If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials."
See Clinical Trials to learn more.
"
"
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms.
These may not always be standard medical treatments.
"These treatments may be vitamins, herbs, special diets, and other things ."
"Some of these are known to help, but many have not been tested."
Some have been shown not to help.
A few have even been found to be harmful.
"Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else."
"
>What treatment do you think is best for me?
>What’s the goal of this treatment?"
"Do you think it could cure the cancer?
>Will treatment include surgery?"
"If so, who will do the surgery?
>What will the surgery be like?
"
">Will I need other types of treatment, too?"
"What’s the goal of these treatments?
>What side effects could I have from these treatments?
>What can I do about side effects that I might have?
"
">Is there a clinical trial that might be right for me?
>"
What about special vitamins or diets that friends tell me about?
"How will I know if they are safe?
>How soon do I need to start treatment?
"
">What should I do to be ready for treatment?
"
">Is there anything I can do to help the treatment work better?
>"
What’s the next step?
"
You’ll be glad when treatment is over ."
"For years after treatment ends, you will see your cancer doctor."
Be sure to go to all of these follow-up visits.
"You will have exams, blood tests, and maybe other tests to see if the cancer has come back."
"At first, your visits may be every 3 to 6 months."
"Then, the longer you’re cancer-free, the less often the visits are needed.
"
Sometimes treatments may not cure your cancer.
You many need to keep getting treatment and care.
"From time to time tests will be done to see how your treatment is working.
"
"Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways."
Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.
You can’t change the fact that you have cancer.
"What you can change is how you live the rest of your life.
"
"

Ablation and embolization treatments are different ways of destroying tumors, rather than removing them with surgery."
"
Ablation or embolization can sometimes be used to help treat pancreatic neuroendocrine tumor (NET) that has spread to other organs, especially the liver."
"When pancreatic NETs have spread to other sites, these treatments can often reduce tumor size and improve symptoms. "
But these treatments are very unlikely to cure cancers on their own.
"They are more likely to be used to help prevent or relieve symptoms, and are often used along with other types of treatment."
"
Ablation refers to treatments that destroy tumors, usually with extreme heat or cold."
They are generally best for tumors no more than about 2 cm (a little less than an inch) across.  
"There are different kinds of ablative treatments:
>Radiofrequency ablation (RFA)
   uses high-energy radio waves."
"A thin, needle-like probe is put through the skin and into the tumor."
Placement of the probe is guided by an ultrasound or CT scan.
"The tip of the probe releases a high-frequency electric current which heats the tumor and destroys the cancer cells.
"
">Microwave thermotherapy
   is similar to RFA, except it uses microwaves to heat and destroy the cancer cells.
"
">Ethanol (alcohol) ablation
   (also known as
   percutaneous ethanol injection
   ) kills the cancer cells with concentrated alcohol injected directly into the tumor."
"This is usually done using a needle through the skin, guided by ultrasound or CT scans.
"
">Cryosurgery
   (also known as
   cryotherapy
   or
   cryoablation
   ) destroys a tumor by freezing it with a thin metal probe."
The probe is guided through the skin and into the tumor using an ultrasound.
"Then very cold gasses are passed through the probe to freeze the tumor, killing the cancer cells."
"This method may be used to treat larger tumors than the other ablation techniques, but it sometimes requires general anesthesia (where you are asleep)."
"
Possible side effects after ablation therapy include abdominal pain, infection, and bleeding inside the body."
"Serious complications are uncommon, but they are possible."
"
During embolization, substances are injected into an artery to try to block the blood flow to cancer cells, causing them to die."
"This may be used for larger tumors (up to 5cm or 2 inches across) in the liver.
"
"There are 3 main types of embolization:
>Arterial embolization
   (also known as
   trans-arterial embolization
   or
   TAE
   ) involves putting a catheter (a thin, flexible tube) into an artery through a small cut in the inner thigh and threading it up into the hepatic artery feeding the tumor."
Blood flow is blocked (or reduced) by injecting materials to plug up that artery.
"Most of the healthy liver cells will not be affected because they get their blood supply from a different blood vessel, the portal vein.
"
">Chemoembolization
   (also known as
   trans-arterial chemoembolization
   or
   TACE
   ) combines embolization with
   chemotherapy
   ."
"Most often, this is done by using tiny beads that give off a chemotherapy drug during the embolization."
"TACE can also be done by giving chemotherapy through the catheter directly into the artery, then plugging up the artery.
"
">Radioembolization
   combines embolization with
   radiation therapy
   .
   "
"In the United States, this is done by injecting small radioactive beads (called
   microspheres
   ) into the hepatic artery."
"The beads lodge in the blood vessels near the tumor, where they give off small amounts of radiation to the tumor site for several days."
"Since the radiation travels a very short distance, its effects are limited mainly to the tumor."
"
Possible complications after embolization include abdominal pain , fever , nausea , infection , and blood clots in nearby blood vessels."
"Serious complications are not common, but they can happen.
"
"

Chemotherapy (chemo) uses anti-cancer drugs injected into a vein or taken by mouth to kill cancer cells."
"These drugs enter the bloodstream and reach almost all areas of the body, making this treatment useful for some types of cancers that have spread.
"
"Chemo is most often used to treat pancreatic neuroendocrine tumors (NETs) if they:
>Have not responded to other medicines (such as
   somatostatin drugs
   or
   targeted therapy
   ),
>Have spread to other organs,
>Are large or growing quickly,
>Are causing severe symptoms,
   or
>Are high grade (grade 3)
"
"The most commonly used drugs for pancreatic NETs include:
>Doxorubicin (Adriamycin)
>Streptozocin
>Fluorouracil (5-FU)
>Dacarbazine (DTIC)
>Temozolomide (Temodar)
>Capecitabine (Xeloda)
>Oxaliplatin (Eloxatin)
"
Some tumors might be treated with more than one drug.
"Possible combinations include:
>Doxorubicin plus streptozocin
>5-FU plus doxorubicin plus streptozocin
>Temozolomide plus capecitabine
>5-FU plus streptozocin"
"
Chemo drugs are typically given into a vein (IV), either as an injection over a few minutes or as an infusion over a longer period of time."
"This can be done in a doctor’s office, chemotherapy clinic, or in a hospital setting.
"
"Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs."
Cycles are most often 2 or 3 weeks long.
The schedule varies depending on the drugs used.
"For example, with some drugs, the chemo is given only on the first day of the cycle."
"With others, it is given for a few days in a row, or once a week."
"Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
"
The length of treatment for advanced pancreatic NETs is based on how well it is working and what side effects you have.
"
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells."
"But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly."
"These cells are also likely to be affected by chemo, which can lead to side effects.
"
The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken.
"Common side effects can include:
>Nausea and vomiting
>Loss of appetite
>Hair loss
>Mouth sores
>Diarrhea or constipation
>Increased chance of infections (from having too few white blood cells)
>Easy bruising or bleeding (from having too few blood platelets)
>Fatigue (from having too few red blood cells)
"
Most side effects go away after treatment is finished.
"Tell your cancer care team about any side effects or changes you notice while getting chemotherapy, so that they can be treated promptly."
Often medicines can help prevent or minimize many of the side effects.
"For example, your doctor can prescribe drugs to help prevent or reduce nausea and vomiting."
"In some cases, the doses of the chemo drugs might need to be lowered or treatment might need to be delayed or stopped to keep the effects from getting worse.
"
"

For people with advanced pancreatic neuroendocrine tumors (NETs), several medicines can help control symptoms and tumor growth."
These drugs are used mainly when the tumor can’t be removed with surgery.
"
Somatostatin analogs are related to somatostatin, a natural hormone in the body."
They can help slow the growth of neuroendocrine tumor cells. 
"They can be very helpful for some patients with pancreatic NETs because these drugs stop tumors from releasing hormones into the bloodstream, which can often relieve symptoms and help patients feel better."
"They also seem to help slow the growth of some tumors, but cannot cure them.
"
"These drugs can help reduce diarrhea in patients with VIPomas, glucagonomas, and somatostatinomas, help the rash of glucagonomas, and  lower the levels of insulin in insulinomas."
"They are very useful in people who have carcinoid syndrome (facial flushing, diarrhea, wheezing, rapid heart rate), although this syndrome is not as common with NETs in the pancreas as it is with NETs found in other places."
"The drugs are also helpful for people whose tumors show up on a somatostatin receptor scintigraphy (SRS) scan or gallium-68 Dotatate scans.
"
">Octreotide (Sandostatin):
   One version of octreotide is short-acting and is injected 2 to 4 times a day under the skin."
"There is also a long-acting form of the drug (called Sandostatin LAR Depot) that only needs to be given once a month, by injection into a muscle."
"Depending on the severity of symptoms, some people are given injections every day when first starting treatment."
"Once symptoms are controlled, the longer-acting monthly injection may then be used."
"Other times, the long acting drug may be started from the beginning.
"
">Lanreotide (Somatuline Depot):
   This somatostatin analog is injected under the skin about once a month.
"
"Either drug may be given by your doctor or nurse, or you may learn how to give the injection at home."
"
The main side effects of these drugs are pain at the site of the injection, and rarely, stomach cramps, nausea, vomiting, headaches, dizziness, and fatigue."
"These drugs can also cause sludge to build up in the gallbladder, which can lead to gallstones."
"They can also make the body resistant to the action of insulin, which can raise blood sugar levels and make pre-existing diabetes harder to control."
"As a result, these drugs are only used to treat insulinomas if the tumor has somatostatin receptors as seen by a positive somatostatin receptor scintigraphy (SRS) or gallium-68 Dotatate scan."
"
Somatostatin analogs can be used to treat most pancreatic NETs."
"But other drugs may be added to treat specific symptoms or problems that are caused by the excess hormone being produced by the cancer.
"
"Gastrinomas make too make gastrin, which increases stomach acid levels, and can lead to stomach ulcers."
"Proton pump inhibitors, for example omeprazole (Prilosec), esomeprazole (Nexium), or lansoprazole (Prevacid), block stomach acid production and may be given to decrease the chance of ulcers forming.
"
Insulinomas make too much insulin which causes very low blood glucose (sugar) levels.
"If the somatostatin receptor scintigraphy (SRS) or gallium-68 Dotatate scans are negative, showing the cancer does not have the somatostatin protein, then other treatments besides somatostatin analogs are considered to even out glucose levels."
"Diazoxide, a drug that keeps insulin from being released into the bloodstream, or diet changes (higher carbohydrate intake or more frequent meals) may be started to raise glucose levels.
"
"Glucagonomas make too much glucagon, a hormone that increases blood glucose (sugar) levels."
It works opposite of insulin.
"These cancers may be treated with medicines for diabetes if somatostatin analogs alone are not enough to control the high glucose levels.
"
"VIPomas make too much vasoactive intestinal peptide (VIP), a hormone that regulates water and mineral (such as potassium and magnesium) levels in the gut."
"Treatment may involve giving intravenous (IV) fluids to treat the dehydration from diarrhea as well as certain minerals that are low.
"
"

Treatment of pancreatic neuroendocrine tumors (NETs) depends to a large extent on whether they can be resected (removed) completely or not."
"But other factors, such as your overall health, can also affect treatment options."
"Talk to your doctor if you have any questions about the treatment plan they recommend.
"
"Sometimes it can be hard to determine if cancer is resectable – that is, if it can be removed completely – using just imaging tests ."
A laparoscopy might be done before surgery to help determine if the tumor can be removed.
"But even then, cancers sometimes turn out to have spread farther than was first thought.
"
Pancreatic NETs are more likely to be resectable than exocrine pancreas cancers (the most common type of pancreatic cancer).
Most NETs that have not spread to distant parts of the body are resectable.
Even some NETs that have spread might be resectable if they have not spread too far (such as only to a few spots in the liver).
"
If the tumor is resectable, surgery will be recommended."
"The procedure used depends on the type of tumor, its size, and its location in the pancreas."
Surgery can range from as little as enucleation (removing just the tumor) to as much as a Whipple procedure (pancreaticoduodenectomy).
"Lymph nodes are often removed to check for tumor spread.
"
"Before any surgery, medicines are often given to control any symptoms caused by the tumor."
"For example, drugs to block stomach acid (like proton pump inhibitors) are used for gastrinomas."
"Often, people with insulinomas are treated with diazoxide to keep blood sugar from getting too low."
"If the tumor was visible on somatostatin receptor scintigraphy, a somatostatin analog such as octreotide may be used to control any symptoms.
"
"Surgery alone is all that is needed for many pancreatic NETs, but after surgery, close monitoring is important to look for signs that the cancer may have come back or spread."
"
Unresectable tumors can’t be removed completely with surgery."
"Pancreatic NETs are often slow growing, so lab and imaging tests are used to monitor the tumor(s) and look for signs of growth.
"
People with NETs that have spread outside the pancreas often have symptoms like diarrhea or hormone problems.
"These can often be helped with medicines like octreotide, lanreotide, diazoxide, and proton pump inhibitors ."
"Some of these might also slow the growth of the tumor.
"
"If further treatment is needed, chemotherapy or targeted drugs (such as sunitinib or everolimus) might be used, but this is usually delayed until a person is having symptoms that can’t be controlled with other drugs or has signs of tumor growth on scans."
"Surgery or ablative techniques might also be used to treat cancer spread to the liver.
"
"For people with poorly differentiated tumors (neuroendocrine carcinomas), chemotherapy is typically the first treatment.
"
"For adults with somatostatin (a type of hormone) receptor-positive pancreatic neuroendocrine tumors, a radiopharmaceutical drug , called Lutathera (lutetium Lu 177 dotatate), is also an option for treatment.
"
"If treatment is no longer working at some point, you might want to think about taking part in a clinical trial testing a newer treatment."
"While these are not always the best option for every person, they may benefit you as well as future patients.
"
"

Radiation therapy uses high-energy rays (such as x-rays) or radioactive particles to kill cancer cells.
"
"Surgery is the main treatment for most pancreatic neuroendocrine tumors (NETs), but radiation therapy may be an option for those who can’t have surgery for some reason."
It may also be given after surgery in some cases if there’s a chance some of the tumor was not removed and is causing problems.
Radiation is sometimes used to treat pancreatic NETs that have spread to the bone and are causing pain.
It may also be used in the form of radioembolization to treat NETs that have spread to the liver.
(See Ablation or Embolization Treatments for Pancreatic Neuroendocrine Tumor .)
"
External beam radiation therapy uses a machine that delivers a beam of radiation to a specific part of the body.
"
"Before your treatment starts, the radiation team will determine the correct angles for aiming the radiation beams and the proper dose of radiation. "
"The treatment is much like getting an x-ray, but the radiation is stronger."
The procedure itself is painless.
"Each treatment lasts only a few minutes, although the setup time – getting you into place for treatment – usually takes longer."
"Most often, radiation treatments are given 5 days a week for several weeks, but this can vary based on the reason it’s being given.
"
"Some common side effects of radiation therapy include:
>Skin changes in areas getting radiation, ranging from redness to blistering and peeling
>Nausea and vomiting
>Diarrhea
>Fatigue
>Loss of appetite
>Weight loss
>Low blood counts, which can increase the risk of serious infection.
"
Usually these side effects go away within a few weeks after the treatment is complete.
Ask your doctor what side effects to expect and how to prevent or relieve them.
"
Radioembolization combines embolization with radiation therapy and can be used to treat liver metastases."
Small beads called microspheres are attached to a radioactive element called yttrium - 90 (or 90Y ) and then injected into an artery close to the liver.
The beads travel in the liver blood vessels until they get stuck in small blood vessels near the tumor.
"There they give off radioactivity for a short while, killing nearby tumor cells."
"The radiation travels a very short distance, so its effects are limited mainly to the tumor."
"
People with somatostatin receptor-positive neuroendocrine tumors may be candidates for PRRT."
"In PRRT, a radioactive element is linked to a small part (peptide) of a somatostatin analog , and injected into a vein in the arm."
"The drug travels throughout the body, attaches to the somatostatin receptor (a protein) on the cancer cell, and gives off radiation to kill it."
"The radiation is delivered directly to the tumor, so there is less effect on healthy tissue."
"There are several drugs that might be used:
>The radioactive element
   Yttrium-90
>The radioactive element
   Lutathera (lutetium or Lu-177 dotatate)
"
"If you are already taking octreotide or lanreotide, you will most likely need to stop taking these medicines for a certain time before you can be treated with PRRT.
"
"Common side effects of PRRT include low levels of white blood cells, abnormal liver tests, nausea and vomiting, high levels of blood sugar, and pain.
"
"Serious side effects include low levels of blood cells, development of certain blood or bone marrow cancers, kidney damage, liver damage, abnormal levels of hormones in the body, and infertility."
"Tell your cancer care team if you are pregnant or might become pregnant, because Lu-177 dotatate can harm the baby."
"There is not enough information regarding Yttrium-90 in pregnant women so you should discuss this with your doctor.
"
"Since these drugs expose you to radiation, people who might come into contact with you need to follow certain radiation safety practices to limit their exposure."
"See Systemic Radiation Therapy for more information.
"
"

Two general types of surgery can be used for pancreatic neuroendocrine tumors (NETs):
>Potentially curative surgery
   is used when the results of exams and tests suggest that it’s possible to remove (resect) all the cancer.
"
">Palliative surgery
   may be done if imaging tests show that the cancer is too widespread to be removed completely."
This surgery is done to reduce tumor size to relieve symptoms from excess hormone production or to prevent certain complications like a blocked bile duct or intestine.
"The goal is not to try to cure the cancer.
"
"Before any surgery is done, it is important to treat and control any symptoms caused by too much hormone production."
This may be done by starting somatostatin analog drugs or other medicines .
"
To determine which type of surgery might be best, it’s important to know the stage (extent) of the cancer."
Sometimes it can be hard to stage pancreatic NETs accurately just using imaging tests .
"Exploratory laparoscopy may be done first to help determine the extent of the cancer and if it can be resected.
"
"For this procedure, the surgeon makes a few small incisions (cuts) in the abdomen (belly) and inserts long, thin instruments."
One of these has a small video camera on the end so the surgeon can see inside the abdomen.
The surgeon can look at the pancreas and other organs for tumors and take biopsy samples of abnormal areas to learn how far the cancer has spread.
"
Pancreatic NETs that have not spread outside the pancreas should be completely removed, if possible, because these tumors are more likely to be cured with surgery.  "
"Sometimes, however, after the surgeon starts the operation it becomes clear that the cancer has grown too far to be completely taken out."
"If this happens, the operation may be stopped, or the surgeon might continue with a smaller operation to help prevent or relieve symptoms. "
(See “Palliative surgery” below.)
This is because the planned operation would be very unlikely to cure the cancer and could still lead to major side effects.
"It would also make the recovery time longer, which could delay other treatments.
"
Many of these types of surgery are complex and can be very hard for patients.
They can cause complications and can take weeks or months to make a full recovery.
"If you're thinking about having this type of surgery, it’s important to weigh the potential benefits and risks carefully.
"
"Types of potentially curative surgery include enucleation (removing only the tumor), central pancreatectomy, distal pancreatectomy, the Whipple procedure (pancreaticoduodenectomy), and total pancreatectomy."
"The type of surgery needed depends on several factors, including the location, size, and specific kind of pancreatic NET (functioning or nonfunctioning)."
"
Sometimes if a pancreatic NET is small, just the tumor itself is removed."
This is called enucleation .
"This operation may be done using a laparoscope, so that only a few small cuts on the belly are needed.
"
This operation may be all that is needed to treat an insulinoma.
"Small gastrinomas and some other pancreatic NETs may also be treated with enucleation, but sometimes the duodenum (the first part of the small intestine) is removed as well.
"
The lymph nodes around the pancreas might also be removed so that they can be checked for cancer cells.
"
A central pancreatectomy is used to treat small, low grade tumors."
"For this operation, the surgeon removes only the neck and part of the body of the pancreas keeping the head and tail intact."
This helps maintain most of the function of the pancreas.
"
A distal pancreatectomy is used to treat pancreatic NETs found in the tail and body of the pancreas."
"In this operation, the surgeon removes only the tail of the pancreas or the tail and a portion of the body of the pancreas."
"The spleen is usually removed as well.
"
"The spleen helps the body fight infections, so if it’s removed you’ll be at increased risk of infection with certain bacteria."
"To help with this, doctors recommend that patients get certain vaccines before this surgery."
"
A Whipple procedure is used to treat pancreatic NETs found in the head of the pancreas."
"During this operation, the surgeon removes the head of the pancreas and sometimes the body of the pancreas as well."
"Nearby structures such as part of the small intestine, part of the bile duct, the gallbladder, lymph nodes near the pancreas, and sometimes part of the stomach are also removed."
The remaining bile duct and pancreas are then attached to the small intestine so that bile and digestive enzymes can still go into the small intestine.
"The pieces of the small intestine (or the stomach and small intestine) are then reattached so that food can pass through the digestive tract.
"
"Most often, this operation is done through a large incision (cut) down the middle of the belly."
"Some doctors at major cancer centers also do the operation laparoscopically, which is sometimes known as keyhole surgery (see What’s New in Pancreatic Neuroendocrine Tumor Research? ).
"
This is a very complex operation that requires a surgeon with a lot of skill and experience.
It carries a relatively high risk of complications that can be life threatening.
"When the operation is done in small hospitals or by doctors with less experience, as many as 15% of patients may die as a result of surgical complications."
"In contrast, when the operation is done in cancer centers by surgeons experienced in the procedure, less than 5% of patients die as a direct result of surgery.
"
"To have the best outcome, it’s important to be treated by a surgeon who does many of these operations and to have the surgery at a hospital where many of them are done."
"In general, people having this type of surgery do better when it's done at a hospital where at least 15 to 20 Whipple procedures are done per year.
"
"Still, even under the best circumstances, many patients have complications from the surgery."
"These can include:
>Leaking from the various connections between organs that the surgeon has joined
>Infections
>Bleeding
>Trouble with the stomach emptying after eating
>Trouble digesting some foods (which might require taking pancreatic enzymes in pill form to help with digestion)
>Weight loss
>Changes in bowel habits
>Diabetes"
"
Total pancreatectomy might be an option if the cancer has spread throughout the pancreas but can still be removed."
"This operation removes the entire pancreas, as well as the gallbladder, part of the stomach and small intestine, and the spleen."
"But this type of surgery is used less often than the other operations because there doesn’t seem to be a major advantage in removing the whole pancreas, and it can have major side effects.
"
It’s possible to live without a pancreas.
"But when the entire pancreas is removed, people are left without the cells that make insulin and other hormones that help maintain safe blood sugar levels."
"These people develop diabetes, which can be hard to manage because they are totally dependent on insulin shots."
"People who have had this surgery also need to take pancreatic enzyme pills to help them digest certain foods.
"
"Before you have this operation, your doctor will recommend that you get certain vaccines because the spleen will be removed."
"
If the cancer has spread too far to be removed completely, any surgery being considered would be palliative (intended to relieve symptoms)."
"This type of surgery may be considered in some people with pancreatic NETs whose tumor has recurred and is causing local problems or is making too many hormones that are causing symptoms.
"
"Sometimes surgery might be started with the hope it will cure the patient, but once it begins the surgeon discovers this is not possible."
"In this case, the surgeon might do a less extensive, palliative operation known as bypass surgery instead to help prevent or relieve symptoms.
"
Cancers growing in the head of the pancreas can block the common bile duct as it passes through this part of the pancreas.
This can cause pain and digestive problems because bile can’t get into the intestine.
"The bile chemicals will also build up in the body, which can cause jaundice, nausea, vomiting, and other problems.
"
"There are 2 main options for relieving bile duct blockage: stent placement, and bypass surgery."
"
The most common approach to relieving a blocked bile duct does not involve actual surgery."
"Instead, a stent (small tube, usually made of metal) is put inside the duct to keep it open."
"This is usually done through an endoscope (a long, flexible tube) while you are sedated."
Often this is part of an endoscopic retrograde cholangiopancreatography (ERCP).
The doctor passes the endoscope down the throat and all the way into the small intestine.
The doctor can then insert the stent into the bile duct through the endoscope.
The stent can also be put in place through the skin during a percutaneous transhepatic cholangiography (PTC).
"(These tests are described in Tests for Pancreatic Neuroendocrine Tumor .)
"
The stent helps keep the bile duct open even if the surrounding cancer presses on it.
"But after several months, the stent may become clogged and may need to be cleared or replaced."
"Larger stents can also be used to keep parts of the small intestine open if they are in danger of being blocked by the cancer.
"
A bile duct stent can also be put in to help relieve jaundice before curative surgery is done (which would typically be a couple of weeks later).
This can help lower the risk of complications from surgery.
"
In people who are healthy enough, another option for relieving a blocked bile duct is surgery to reroute the flow of bile from the common bile duct directly into the small intestine, bypassing the pancreas."
"This typically requires a large incision (cut) in the abdomen, and it can take weeks to recover from this."
Sometimes surgery can be done through several small cuts in the abdomen using special long surgical tools.
"(This is known as laparoscopic or keyhole surgery .)
"
"Having a stent placed is often easier and the recovery is much shorter, which is why this is done more often than bypass surgery."
"But this surgery can have some advantages:
>It can often give longer-lasting relief than a stent, which might need to be cleaned out or replaced.
"
">It might be an option if a stent can’t be placed for some reason.
"
">During surgery, the surgeon may be able to cut some of the nerves around the pancreas or inject them with alcohol."
"This may reduce or get rid of any pain caused by the cancer.
"
"Sometimes, the end of the stomach is disconnected from the duodenum (the first part of the small intestine) and attached farther down the small intestine during this surgery as well."
(This is known as a gastric bypass .)
"This is done because over time the cancer might grow large enough to block the duodenum, which can cause pain and vomiting and often requires urgent surgery."
"Bypassing the duodenum before this happens can sometimes help avoid this.
"
"Bypass surgery can still be a major operation, so it’s important that you are healthy enough to withstand it and that you talk with your doctor about the possible benefits and risks before you have the surgery."
"
Surgery may be used to remove metastases if a pancreatic NET has spread to the liver (the most common site of spread) or the lungs."
Surgically removing metastases can improve symptoms and help patients with pancreatic NETs live longer.
"In rare cases, a liver transplant might be used to treat pancreatic NETs that have spread to the liver.
"
"

Targeted drugs work differently from standard chemotherapy (chemo) drugs."
These drugs target specific parts of cancer cells.
"They are sometimes helpful when chemo is not, and they often have different side effects than chemo.
"
The targeted drugs used to treat pancreatic neuroendocrine tumors (NETs) work by blocking angiogenesis (the growth of new blood vessels that nourish cancers) or important proteins (called tyrosine kinases ) in cancer cells that help them grow and survive.
"
Sunitinib blocks several tyrosine kinases and attacks new blood vessel growth."
It has been shown to help slow tumor growth.
"This drug is taken as a pill once a day.
"
"The most common side effects are nausea, diarrhea, changes in skin or hair color, mouth sores, weakness, and low blood cell counts."
"Other possible effects include tiredness, high blood pressure, heart problems, bleeding, hand-foot syndrome (redness, pain, and skin peeling of the palms of the hands and the soles of the feet), and low thyroid hormone levels."
"
Everolimus blocks a protein known as mTOR , which normally helps cells grow and divide."
It has been shown to help treat advanced pancreatic NETs. 
"Everolimus is a pill taken once a day.
"
"Common side effects of this drug include mouth sores, infections, nausea, loss of appetite, diarrhea, skin rash, feeling tired or weak, fluid buildup (usually in the legs), and increases in blood sugar and cholesterol levels."
"A less common but serious side effect is damage to the lungs, which can cause shortness of breath or other problems."
"
Belzutifan is a type of drug known as a HIF inhibitor ."
"It blocks a protein called hypoxia-inducible factor 2 alpha (HIF-2a), which is involved in both cancer cell growth and the formation of new blood vessels in tumors."
"This drug is taken as pills, typically once a day.
"
"Belzutifan can be used in people with von Hippel-Lindau (VHL) disease who have a pancreatic NET and don’t need surgery right away.
"
"Common side effects of this drug include low red blood cell counts (anemia), feeling tired and/or dizzy, nausea, headache, increased blood sugar levels, and changes in lab tests showing the drug might be affecting the kidneys."
"Less common but more serious side effects can include very low red blood cell counts (severe anemia), which might require blood transfusions, and low oxygen levels in the body, for which you might need oxygen therapy or even be admitted to the hospital.
"
"

"
"Although the small intestine makes up the largest part of the gastrointestinal (GI) tract, small intestine cancers are rare in the United States."
"In fact, they account for fewer than 1 in 10 cancers of the gastrointestinal (GI) tract, and fewer than 1 in 100 cancers overall.
"
"The American Cancer Society estimates for these cancers in the United States for 2023 are:
>About 12,070 people will be diagnosed with some type of small intestine cancer.
>About 2,070 people will die of small intestine cancer.
"
Cancers of the small intestine tend to occur more often in older people.
"They are most often found in people in their 60s and 70s.
"
"Visit the American Cancer Society’s Cancer Statistics Center for more key statistics.
"
"

Cancer starts when cells in the body begin to grow out of control."
"Cells in nearly any part of the body can become cancer, and can spread to other areas of the body."
"To learn more about how cancers start and spread, see What Is Cancer?
"
Small intestine cancer starts when cells in the small intestine start to grow out of control.
"The small intestine is part of the gastrointestinal (GI) tract, also known as the digestive tract."
"The GI tract processes food for energy and rids your body of solid waste.
"
"
To understand small intestine cancer, it helps to know about the small intestine and how it works.
"
"After you chew and swallow your food, it goes through the esophagus , a tube that carries food through the neck and chest and into the stomach ."
"The stomach is a sac-like organ that helps the digestive process by mixing the food with gastric juices.
"
"The food and gastric juices are mixed into a thick fluid, which is then emptied into the small intestine (also known as the small bowel )."
The small intestine continues breaking down the food and absorbs most of the nutrients.
"Even though it's called the small intestine, it's actually the longest section of the GI tract (about 20 feet long).
"
"The small intestine has 3 sections.
"
">The
    duodenum:
    "
This is the first section and is only about a foot long.
"A short distance from where the duodenum attaches to the stomach, the pancreatic duct and bile duct enter the duodenum at the
    ampulla of Vater.
    "
"Fluids from the pancreas and liver enter the small intestine here, helping to further digest the food.
"
">The
    jejunum
    and
    ileum:
    "
"These parts make up most of the small intestine, and are where most of the nutrients in food are absorbed into the bloodstream.
"
The ileum empties into the colon (the first part of the large intestine).
This muscular tube is about 4 to 5 feet long.
It absorbs water and some remaining mineral nutrients from the food matter.
"The waste left after this process goes into the rectum , where it is stored until it passes out of the body through the anus .

"
"
The small intestine is made up of many different types of cells, so different types of cancer can start here."
"The 4 major types of small intestine cancers are:
>Adenocarcinomas:
   "
These cancers start in the gland cells that line the inside of the intestine.
"They account for about 1 in 3 small intestine cancers.
"
">Carcinoid tumors:
   These tumors are a type of neuroendocrine tumor (NET), and they tend to be slow growing."
They are the most common type of small intestine tumor.
"To learn more, see
   Gastrointestinal Carcinoid Tumors
   .
"
">Lymphomas:
   These cancers start in immune cells called lymphocytes."
"Lymphomas can start almost anywhere in the body, including the small intestine."
"For more on these cancers, see
   Non-Hodgkin Lymphoma
   .
"
">Sarcomas:
   These are cancers that start in connective tissues, such as muscle."
"The most common sarcomas in the intestine are known as
   gastrointestinal stromal tumors (GISTs)
   .


"
Most experts think that cancer of the small intestine develops much like colorectal cancer.
"It first begins as a small growth on the inner lining of the intestine, called a polyp ."
"Over time, the polyp can change into a cancer.
"
Most small intestinal cancers (especially adenocarcinomas) develop in the duodenum.
Cancers that develop in the duodenum are often found at the ampulla of Vater.
"But because this area is closely associated with the pancreas, cancers of the ampulla of Vater (also known as ampullary cancers) are treated like pancreatic cancer .

"
"

For some people with small intestine cancer, treatment can remove or destroy the cancer."
Completing treatment can be both stressful and exciting.
"You may be relieved to finish treatment, but find it hard not to worry about cancer coming back."
"When cancer comes back after treatment, it is called a recurrence ."
"This is a very common concern if you've had cancer.
"
"For some people, the cancer may never go away completely."
"They may get regular treatments , such as chemotherapy, radiation therapy, or other therapies to try to help keep the cancer in check and to help relieve symptoms."
Learning to live with cancer that doesn't go away can be difficult and very stressful.
It has its own type of uncertainty.
"
Whether you have completed treatment or are still being treated, your doctors will still want to watch you closely."
"It’s very important to go to all follow-up appointments, as small intestine cancers can sometimes come back after treatment.
"
Some treatment side effects might last a long time or might not even show up until years after you have finished treatment.
Your doctor visits are a good time to ask questions and talk about any changes or problems you notice or concerns you have.
"
During your follow-up visits, your doctor will ask about symptoms, examine you, and may order blood tests or imaging tests like CT scans."
Your visits will likely be at least once every few months at first.
The time between visits might then be extended over time if there are no signs that the cancer has returned.
"
Talk with your doctor about developing a survivorship care plan for you."
"This plan might include:
>A summary of your treatment
>A suggested schedule for follow-up exams and tests
>A schedule for other tests you might need in the future, such as early detection (screening) tests for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
>A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
>Diet and physical activity suggestions"
"
Even after treatment, it’s very important to keep health insurance ."
"Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
"
"At some point after your treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history."
It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment.
Learn more in Keeping Copies of Important Medical Records .
"
If you have (or have had) a small intestine cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements."
"Unfortunately, it’s not yet clear if there are things you can do that will help.
"
"Adopting healthy behaviors such as not smoking , eating well, getting regular physical activity, and staying at a healthy weight might help, but no one knows for sure."
"However, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of small intestine cancer or other cancers."
"
So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of small intestine cancer progressing or coming back."
"This doesn’t mean that no supplements will help, but it’s important to know that none have been proven to do so.
"
"Dietary supplements are not regulated like medicines in the United States – they do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do."
"If you’re thinking about taking any type of nutritional supplement, talk to your health care team."
They can help you decide which ones you can use safely while avoiding those that might be harmful.
"
"
"If cancer does recur, your treatment options will depend on the location of the cancer, what treatments you’ve had before, and your current health and preferences."
"For more information on how small intestine cancer is treated, see Treatment Choices for Small Intestine Cancer (Adenocarcinoma), Based on Tumor Spread .
"
"For more general information on dealing with a recurrence, see Understanding Recurrence ."
"
Unfortunately, being treated for cancer doesn’t mean you can’t get another cancer."
People who have had small intestine cancer can still get the same types of cancers that other people get.
"In fact, they are at higher risk for certain types of cancer."
"For example, they have an increased risk of other digestive tract cancers, especially colon cancer.
"
"Because of this, it’s important to do what you can to lower your cancer risk, such as not smoking, staying at a healthy weight, staying active, and eating a healthy diet."
And be sure to talk to your doctor about which cancer screening tests are right for you.
"
Some amount of feeling depressed, anxious, or worried is normal when cancer is a part of your life."
Some people are affected more than others.
"But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups, professional counselors, or others."
"To learn more about this, see Coping With Cancer .
"
"

At this time, there is no known way to prevent most small intestine adenocarcinomas."
"There are some factors that might increase the risk for these cancers , such as smoking, drinking alcohol, and eating a diet that’s high in red meats, so making healthier choices concerning these risk factors might lower your risk."
"Small intestine cancers are rare to begin with, but making these types of healthy choices might also lower your risk of some other types of cancer."
"
For some people at high risk of small intestine cancer because of certain inherited syndromes , surgery might be an option to lower risk."
"For example, people with familial adenomatous polyposis (FAP) can have a very high risk of small intestine cancer starting in the duodenum (the first part of the small intestine)."
"If a person has many duodenal polyps (growths), doctors may suggest surgery to remove the duodenum before cancer can develop.
"
The procedure most often used is called a pancreaticoduodenectomy (or Whipple procedure ).
"This is a complex operation that removes the duodenum, part of the pancreas, the gallbladder, the common bile duct, and part of the stomach."
"It can have major side effects, so it’s important to understand the possible pros and cons before having this type of surgery."
"This procedure is discussed in more detail in Surgery for Small Intestine Cancer (Adenocarcinoma) .
"
Research is also looking at whether medicines might help lower the risk of small intestine cancer in people with many polyps.
"Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, are one type of medicine being studied.
"
"

A risk factor is anything that changes your chance of getting a disease such as cancer."
Different cancers have different risk factors.
"Some risk factors, like smoking, can be changed."
"Others, like a person’s age or family history, can’t be changed.
"
But risk factors don’t tell us everything.
"Having a risk factor, or even several, does not mean that a person will get the disease."
"And many people who get the disease may have few or no known risk factors.
"
"Because small intestine adenocarcinoma is so uncommon, risk factors for this disease have been hard to study."
Some of the known risk factors include:
"
Small intestine cancer occurs slightly more often in men than in women."
"
Cancers of the small intestine tend to occur more often in older people."
They are most often found in people in their 60s and 70s.
"
In the United States, African Americans are affected more often by these cancers than people of other races/ethnicities."
"
Some studies have found an increased risk with either smoking or drinking alcohol, but not all studies have found this."
"
Some research has suggested that diets high in red meat and salted or smoked foods might raise the risk of small intestine cancer."
"
For people with celiac disease, eating gluten (a protein that is found in wheat and some other types of grain) causes the body's immune system to attack the lining of the intestines."
People with celiac disease have an increased risk of a certain kind of lymphoma of the intestine called enteropathy-associated T-cell lymphoma .
They may also have an increased risk of small intestine cancer.
"
People who have had colon cancer have an increased risk of getting cancer of the small intestine."
This could be due to shared risk factors.
"
Crohn's disease is a condition in which the immune system attacks the gastrointestinal (GI) tract."
"This disease can affect any part of the GI tract, but it most often affects the lower part of the small intestine."
People with this condition have a much higher risk of small intestine cancer (particularly adenocarcinoma).
"These cancers are most often seen in the ileum (the last part of the small intestine, near the colon)."
"
People with certain inherited conditions have a higher risk of small intestine cancer (mainly adenocarcinoma)."
"
In this condition, many (often hundreds) of polyps develop in the colon and rectum."
"If the colon isn’t removed, one or more of these polyps will become cancerous."
"Polyps can also develop in the stomach and the small intestine, and they can lead to cancers in these areas."
"In FAP, most small intestine cancers are found in the duodenum."
"This condition is caused by an abnormal change (mutation) in the APC gene, and is discussed more in Colorectal Cancer ."
"
In most cases, this disorder is caused by a defect in one of several mismatch repair (MMR) genes, such as MLH1 , MSH2 , MSH6 , PMS1 , or PMS2 ."
Having an abnormal version of any one of these genes reduces the body’s ability to repair damage to its DNA.
"This results in an increased risk for cancer of the colon and small intestine, as well as a high risk of endometrial and ovarian cancer."
This condition is also discussed in Colorectal Cancer .
"
People with this condition develop polyps in the stomach and intestines, as well as in other areas including the nose, the airways of the lungs, and the bladder."
"They can also have dark freckle-like spots on the lips, inner cheeks and other areas."
"PJS can increase the risk of many types of cancer, including small intestine adenocarcinoma."
This syndrome is caused by mutations in the STK11 ( LKB1 ) gene.
"
People with this syndrome develop colon polyps which will almost always become cancerous if the colon is not removed."
They also can get polyps in the small intestine and have an increased risk of small intestine cancer.
"People with this syndrome can also get cancers of the skin, ovary (in women), and bladder."
This syndrome is caused by mutations in the MUTYH gene.
"
People with this condition have severe lung problems."
"Often, in someone with CF, the pancreas cannot make the enzymes that break food down so that it can be absorbed."
People with CF have an increased risk of small intestine cancer.
"A child must have 2 abnormal copies of the CFTR gene (one from each parent) to get this disease.
"
"

"
"While there are several known risk factors for small intestine adenocarcinoma, not much is known about exactly what causes these cancers."
"In fact, many experts wonder why it’s so rare."
"The small intestine is the longest part of the gastrointestinal (GI) tract, yet only a very small percentage of GI adenocarcinomas start here.
"
Scientists have found some DNA changes inside small intestine adenocarcinoma cells that seem to help them grow and spread.
"DNA is the chemical in each of our cells that makes up our genes , which control how our cells function."
We usually look like our parents because they are the source of our DNA.
"But DNA affects more than just how we look.
"
"Some genes control when cells grow and divide into new cells:
>Certain genes that help cells grow and divide are called
   oncogenes
   .
"
">Genes that help keep cell division under control, cause cells to die at the right time, or help fix mistakes in DNA are called
   tumor suppressor genes
   .
"
"Cancers can be caused by DNA changes that turn on oncogenes or turn off tumor suppressor genes.
"
"For example, one cause of these cancers is thought to be problems with the tumor suppressor genes that normally help repair damaged DNA."
"When one of these genes isn’t working, DNA mistakes aren’t corrected, so gene mutations are passed on to new cells."
"If enough changes build up inside the cells, it can lead to cancer.
"
"Many small intestine cancers have specific known gene changes, but often it’s not clear what causes these changes."
"Sometimes they can be inherited from a parent, or they might be caused by things like alcohol or a diet that’s high in red meats."
But sometimes the gene changes that lead to small intestine cancer seem to occur for no apparent reason.
"Many of the changes are probably just random events that sometimes happen inside a cell, without having an outside cause.
"
"Gene changes inside cells can build up over a person’s lifetime, which might help explain why small intestine cancer largely affects older people.
"
"

Screening is testing for diseases like cancer in people who do not have any symptoms."
"Screening tests can find some types of cancer early, when treatment is most likely to be effective."
"
For people with certain inherited genetic syndromes who are at increased risk of small intestine cancer, doctors might recommend regular tests to look for cancer early, especially in the duodenum (the first part of the small intestine)."
"Tests that might be done include upper endoscopy (in which a long tube with a tiny video camera on the end is passed down the throat, through the stomach, and into the duodenum), CT scans, and endoscopic ultrasound (EUS)."
"See Tests for Small Intestine Cancer (Adenocarcinoma) to learn more about these tests.
"
"

Small intestine cancers are often found because of signs or symptoms a person is having."
But these symptoms aren’t usually enough to know for sure if a person has a small intestine cancer or some other type of health problem.
"If a tumor is suspected, exams and tests will be needed to confirm the diagnosis."
"
"
"When a doctor takes your medical history, you will be asked about your symptoms, possible risk factors , family history, and other medical conditions."
"The doctor will then examine you, focusing on your abdomen looking for any swelling or sounds of the bowel trying to overcome a blockage."
"
If your doctor suspects a small intestine cancer, they will likely order some blood tests, such as:
>A
   complete blood count (CBC)
   , which measures the levels of red blood cells, white blood cells, and platelets."
"Small intestine cancer often causes bleeding into the intestines, which can lead to a low red blood cell count (anemia).
"
">Blood chemistry tests
   to look for signs that a cancer might have spread to the liver, or other problems."
"
Imaging tests use x-rays, magnetic fields, or radioactive substances to create pictures of the inside of the body."
"Imaging tests might be done for a number of reasons, including:
>To help determine if symptoms are being caused by a tumor
>To learn how far cancer has spread
>To help determine if treatment is working
>To look for signs that the cancer has come back
Most patients who have or may have a small intestine tumor will have one or more of these tests."
"
For these tests, a liquid containing barium (a chalky substance) is put into the body to coat the lining of the gastrointestinal (GI) tract, and then x-rays are taken."
"The barium helps outline any abnormal areas in the esophagus, stomach, and intestines, making them more visible."
"These x-rays are most often used to look for tumors in the upper or lower parts of the GI tract, but they are less helpful in finding small intestine tumors."
"Barium tests were used more often before endoscopy was available (see below).
"
">Upper GI series:
   For this test, you will be given a barium liquid to drink, and then x-rays are done to look at the upper part of the digestive tract (the esophagus, stomach, and first part of the small intestine)."
"To look for problems in the rest of the small intestine, more x-rays can be taken over the next few hours as the barium passes through the intestines."
"This is called a
   small bowel follow-through
   ."
"This test often gives good pictures of the first part of the small intestine (the duodenum), but the rest of the small intestine may be hard to see in detail.
"
">Enteroclysis:
   This test gives more detailed pictures of the small intestine than the upper GI series with small bowel follow-through."
"A thin tube is passed down the nose or mouth, through the stomach, and into the small intestine."
Then barium is sent through the tube directly into the small intestine.
"X-rays are taken as the liquid moves through the small intestine.
"
">Barium enema (lower GI series):
   "
This is a way to look at the large intestine (colon and rectum).
"Before this test, the bowel needs to be cleaned out."
This is done by using strong laxatives and enemas the night before and the morning of the exam.
"For this test, the barium solution is given into the large intestine through a flexible tube that is put into the anus (like an enema)."
"For better pictures, air can also be injected into the intestine through a tube."
"This is called
   air contrast
   ."
"This procedure is meant to be used to look at the large intestine, but sometimes the last part of the small intestine can be seen as well."
"
A CT scan uses x-rays to make detailed cross-sectional images of your body."
"Unlike a regular x-ray, a CT scan creates detailed images of the soft tissues in the body.
"
CT scans are often done if you have abdominal (belly) pain to try to find the source of the problem.
"Although small intestine tumors may not always be seen well on a CT, these scans are good at showing some of the problems that these tumors can cause (like an obstruction or perforation )."
"CT scans can also help find areas of cancer spread.
"
CT enteroclysis: This test is sometimes used to get a better view of the intestine than a standard CT can provide.
"Before the scan, a thin tube is passed down your nose or mouth and down to the small intestine."
"A large volume of a liquid contrast agent is then put into the tube, which helps expand the intestine and makes it easier to see on a CT scan.
"
CT-guided needle biopsy:
CT scans can also be used to guide a biopsy needle precisely into an abnormal area that could be cancer spread.
"For this procedure, called a CT-guided needle biopsy , you will stay on the CT scanning table while the doctor moves a biopsy needle through the skin and toward the location of the mass/tumor."
CT scans are repeated until the needle is within the mass.
Small samples of tissue are then removed and looked at under a microscope.
"
Like CT scans, MRI scans show detailed images of soft tissues in the body."
"But MRI scans use radio waves and strong magnets instead of x-rays.
"
"MRI scans can sometimes be useful in people with suspected small intestine tumors, because they can show a lot of details in soft tissues."
"But a CT scan is often done instead, as it is typically an easier test to have done.
"
MR enteroclysis: This test is sometimes used to get a better view of the intestine than a standard MRI can provide.
"Before the scan, a thin tube is passed down the nose or mouth and down to the small intestine."
"A large volume of a liquid contrast agent is then put into the tube, which helps expand the intestine and makes it easier to see on an MRI."
"
For an endoscopy, the doctor puts a flexible, lighted tube (endoscope) with a tiny video camera on the end into the body to see the inner lining of the GI tract."
"If abnormal areas are found, small pieces can be biopsied (removed) through the endoscope."
"
Upper endoscopy (also called esophagogastroduodenoscopy or EGD ) is used to look at the esophagus, stomach and duodenum (the first part of the small intestine)."
"The endoscope is put in through the mouth, and then passes through the esophagus, into the stomach, and then into the first part of the small intestine."
"If the doctor sees any abnormal areas, small pieces of tissue can be removed to be looked at under a microscope to see if cancer is present.
"
Most people having this test are given medicine to make them sleepy.
"If this is the case, you will usually need someone to take you home (not just a cab or rideshare service).
"
This test is helpful in looking at the first part of the small intestine.
"Other tests, such as capsule endoscopy and double-balloon enteroscopy, are needed to look at the rest of the small intestine."
"
This procedure does not actually use an endoscope."
"Instead, you will swallow a capsule (about the size of a large vitamin pill) that has a light and a very small camera."
"Like any other pill, the capsule goes through the stomach and into the small intestine."
"As it travels through the small intestine (usually over about 8 hours), it takes thousands of pictures."
The camera sends the images to a device that you wear around the waist while going about your normal daily activities.
"The pictures can then be downloaded onto a computer, where the doctor can look at them as a video."
The capsule passes out of the body during a normal bowel movement and is flushed away.
"
Most of the small intestine can't be viewed with an upper endoscopy because it is too long (about 20 feet) and has too many curves."
"Double-balloon enteroscopy gets around these problems by using a special endoscope that is made up of 2 tubes, one inside the other.
"
"You are given intravenous (IV) medicine to help you relax, or even general anesthesia (so that you are asleep)."
"The endoscope is then inserted either through the mouth or the anus, depending on if there is a specific part of the small intestine to be looked at.
"
"Once in the small intestine, the inner tube, which is an endoscope, is pushed forward a small distance, and then a balloon at its end is inflated to anchor it."
Then the outer tube is pushed forward to near the end of the inner tube and it is then anchored in place with a balloon.
"This process is repeated over and over, letting the doctor see the intestine a foot at a time.
"
This test can sometimes be helpful when done along with capsule endoscopy.
"An advantage of this test over capsule endoscopy is that the doctor can biopsy anything that looks abnormal.
"
"Because you will be given medicine to make you sleepy for the procedure, usually someone you know will need to drive you home (not just a cab or rideshare service)."
"
Procedures such as endoscopy and imaging tests can find areas that look like cancer, but the only way to know for certain is to do a biopsy."
"In a biopsy, a piece of the abnormal area is removed and looked at under a microscope.
"
"There are different ways to take biopsy samples of an intestinal tumor.
"
">A biopsy can be done during an
   endoscopy
   ."
"When a tumor is found, the doctor can use biopsy forceps (pincers or tongs) through the tube to take small samples of the tumor."
"The samples are very small, but doctors can usually make an accurate diagnosis."
Bleeding after a biopsy is a rare but potentially serious problem.
"If bleeding becomes a problem, doctors can sometimes inject drugs that constrict blood vessels through the endoscope and into the tumor to stop the bleeding.
"
">For some patients,
   surgery
   is needed to biopsy a tumor in the intestines."
"This may be done if the tumor cannot be reached with an endoscope.
"
">Sometimes CT scans or other imaging tests are used to guide a thin, hollow
   needle
   to biopsy tumors in other organs (like the liver) to see if they are cancer."
"
Doctors can usually tell if a biopsy sample contains cancer (adenocarcinoma) cells by looking at it under a microscope."
"But other tests might be done on the samples as well.
"
"For example, the cancer cells might be tested for certain gene changes that could affect treatment options."
"Changes in mismatch repair (MMR) genes, or another genetic change known as microsatellite instability (MSI), make it more likely that the cancer might respond to treatment with immunotherapy drugs called checkpoint inhibitors .
"
"

The symptoms of small intestine cancers are often vague and can have other, more common causes."
"Unfortunately, this means that it’s often at least several months from the time symptoms start until the cancer is diagnosed.
"
"Some of the more common symptoms of small intestine cancer are:
>Pain in the belly (abdomen)
>Nausea and vomiting
>Weight loss (without trying)
>"
"Weakness and feeling tired (fatigue)
"
">Dark-colored stools (from bleeding into the intestine)
>Low red blood cell counts (anemia)
>Yellowing of the skin and eyes (jaundice)
"
"Often, the first symptom is pain in the stomach area."
This pain is often crampy and may not be constant.
"For example, it may start or get worse after you eat.
"
"As the tumor gets larger, it can slow the passage of digested food through the intestine."
This can lead to increased pain.
"If the tumor gets large enough, it can cause an obstruction , in which the intestine is completely blocked and nothing can move through."
"This leads to pain with severe nausea and vomiting.
"
"Rarely, a cancer will cause a hole (perforation) to form in the wall of the intestine ."
This hole lets the contents of the intestine spill into the abdomen.
"Symptoms of perforation can include sudden severe pain, nausea, and vomiting.
"
Sometimes a tumor will start bleeding into the intestine.
"If the bleeding is slow, it could lead to a low red blood cell count (anemia) over time."
Symptoms of anemia include weakness and fatigue.
"If the bleeding is rapid, the stool can become black and tarry from digested blood, and the person may feel lightheaded or even pass out.
"
"Less often, a tumor in the duodenum (the first part of the small intestine) can cause jaundice ."
"This can happen if the tumor blocks the bile duct, which can prevent the contents from the liver from entering the intestine.
"
These problems are more often caused by things other than cancer.
"Still, if you have any of them, especially if they don't go away or are getting worse, have them checked by your doctor to find the cause so it can be treated, if needed.
"
"

After someone is diagnosed with small intestine cancer, doctors will try to figure out if it has spread, and if so, how far."
This process is called staging .
The stage of a cancer describes the extent of the cancer in the body.
It helps determine how serious the cancer is and how best to treat it.
"Doctors also use a cancer's stage when talking about survival statistics.
"
The earliest stage small intestine cancers are called stage 0
"(carcinoma in situ), and then range from stages I (1) through IV (4)."
"As a rule, the lower the number, the less the cancer has spread."
"A higher number, such as stage IV, means cancer has spread more."
"Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way."
"
Small intestine cancers are typically given a clinical stage based on the results of any exams, biopsies, and imaging tests that might have been done."
"If surgery has been done, the pathologic stage (also called the surgical stage ) can also be determined.
"
Small intestine cancers typically start in the inner lining of the intestine.
"As they grow, they can spread into deeper layers."
"These layers include:
>Mucosa:
   "
This is the innermost layer.
"It has 3 parts: the top layer of cells (called the
   epithelium
   ), a thin layer of connective tissue (called the
   lamina propria
   ), and a thin layer of muscle (called the
   muscularis mucosa
   ).
"
">Submucosa:
   "
"This is the fibrous tissue that lies beneath the mucosa.
"
">Thick muscle layers (muscularis propria):
   This layer of muscle contracts to force the food along the GI tract.
"
">Subserosa and serosa:
   "
These are the thin outermost layers of connective tissue that cover the GI tract.
"The serosa is also known as the
   visceral peritoneum
   .

"
"
The staging system most often used for small intestine cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:
>The extent (size) of the main
   t
   umor
   (T):
   How far has the cancer grown into the layers of the wall of the small intestine?"
"Has the cancer reached nearby structures or organs?
>The spread to nearby lymph
   n
   odes
   (N):
   Has the cancer spread to nearby lymph nodes?
>"
"The spread (
   m
   etastasis
   ) to distant sites
   (M):
   Has the cancer spread to distant parts of the body?"
"The most common sites of spread are the liver and the inner lining of the abdomen (peritoneal cavity).
"
"Numbers or letters after T, N, and M provide more details about each of these factors."
"Higher numbers mean the cancer is more advanced.
"
"Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage."
"For more information see Cancer Staging .
"
"The system described below is the most recent AJCC system, effective January 2018."
"It is only used for staging adenocarcinoma of the small intestine.
"
Small intestine cancer staging can be complex.
"If you have any questions about the stage of your cancer or what it means, ask your doctor to explain it to you in a way you understand."
"
AJCC Stage
Stage grouping
Stage description*
0

Tis
N0
M0
The cancer is only in the epithelium (the top layer of cells of the mucosa)."
"It has not grown into the deeper tissue layers (Tis).
"
"It has not spread to nearby lymph nodes (N0) or distant parts of the body (M0).
"
"I

T1 or T2
N0
M0
The cancer has grown into deeper layers (the lamina propria or the submucosa) (T1) OR it has grown through the submucosa into the muscularis propria (T2).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"IIA

T3
N0
M0
The cancer has grown through the muscularis propria and into the subserosa.
"
"It has not started to grow into any nearby organs or structures (T3).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"IIB
T4
N0
M0
The cancer has grown through the outer layer of tissue covering the intestine (the serosa or visceral peritoneum) or into nearby organs or structures (T4).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

"
"IIIA

Any T
N1
M0
The cancer might have grown into any layers of the wall of the small intestine (Any T)."
"It has spread to 1 or 2 nearby lymph nodes (N1) but not to distant parts of the body (M0).
"
"IIIB

Any T
N2
M0
The cancer might have grown into any layers of the wall of the small intestine (Any T)."
"It has spread to 3 or more nearby lymph nodes (N2) but not to distant parts of the body (M0).

"
"IV
Any T
Any N
M1
"
"The cancer might have grown into any layers of the wall of the small intestine (Any T).
"
"It might or might not have spread to nearby lymph nodes (Any N).
"
"It has spread to distant lymph nodes or organs such as the liver or the peritoneum (the inner lining of the abdomen) (M1).
"
"The following additional categories are not listed on the table above:
>TX:"
"Main tumor cannot be assessed due to lack of information.
"
>T0:
"No evidence of a main tumor.
"
">NX: Nearby lymph nodes cannot be assessed due to lack of information.
"
"

(Note: This information is about small intestine cancers called adenocarcinomas."
"To learn about other types of cancer that can start in the small intestine, see Gastrointestinal Carcinoid Tumors, Gastrointestinal Stromal Tumors, or Non-Hodgkin Lymphoma.)
"
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed.
"They can’t tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
"
"Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they can’t predict what will happen in any particular person’s case."
These statistics can be confusing and may lead you to have more questions.
Ask your doctor how these numbers might apply to you.
"
A relative survival rate compares people with the same type and stage of small intestine cancer to people in the overall population."
"For example, if the 5-year relative survival rate for a specific stage of small intestine cancer is 80%, it means that people who have that cancer are, on average, about 80% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed."
"
The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results (SEER) database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer.
"
"The SEER database tracks 5-year relative survival rates for small intestine cancer in the United States, based on how far the cancer has spread."
"The SEER database, however, does not group cancers by AJCC TNM stages (stage 1, stage 2, stage 3, etc.)."
"Instead, it groups cancers into localized, regional, and distant stages:
>Localized:
   The cancer is limited to the wall of the small intestine.
"
">Regional:
   "
"The cancer has spread outside the wall of the small intestine into nearby structures or lymph nodes.
"
">Distant:
   "
The cancer has spread to distant parts of the body such as the liver or peritoneum (the inner lining of the abdomen).
"
(These numbers are based on people diagnosed with small intestine cancer between 2012 and 2018.)
"
SEER*
"Stage
5-Year Relative Survival Rate
Localized
84%
Regional
78%
Distant
42%
All SEER stages combined
69%
*SEER= Surveillance, Epidemiology, and End Results"
"
>These numbers apply only to the stage of the cancer when it is first diagnosed.
   "
"They do not apply later on if the cancer grows, spreads, or comes back after treatment.
"
">These numbers don’t take everything into account.
   "
"Survival rates are grouped based on how far the cancer has spread, but your age, overall health, how well the cancer responds to treatment, and other factors can also affect your outlook.
"
">People now being diagnosed with small intestine cancer may have a better outlook than these numbers show.
   "
"Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least five years earlier.
"
"

It’s important to have honest, open discussions with your cancer care team."
"Ask any question, no matter how minor it might seem."
"For instance, consider these questions:"
"
>What
    type of small intestine cancer
    do I have?"
"How might this affect my treatment and outlook?
>Where is the cancer located?
"
>
"What is the
    stage
    (extent) of my cancer, and what does that mean for me?
>Will I need any other
    tests
    before we consider treatment options?
>Will I need to see any other types of doctors?
"
">If I’m concerned about costs and insurance coverage for my diagnosis and treatment, who can help me?"
"
>How much experience do you have treating this type of cancer?
>"
"What are my
    treatment options
    ?
>"
"What do you recommend and why?
"
">What is the goal of the treatment?
>Should I get a
    second opinion
    ?"
How do I do that?
"Can you recommend someone?
>Based on what you’ve learned about my cancer, what is my outlook?
>How quickly do we need to decide on treatment?
"
">What should I do to be ready for treatment?
>How long will treatment last?"
What will it be like?
"Where will it be done?
>What risks or side effects are there to the treatments you suggest?
"
">Will treatment affect my daily activities?
>How likely is it that the cancer will come back after treatment?"
Is there anything I can do to lower this risk?
"
Once treatment begins, you’ll need to know what to expect and what to look for."
"Not all of these questions may apply to you, but getting answers to the ones that do may be helpful.
"
">How will we know if the treatment is working?
>Is there anything I can do to help manage side effects?
>"
"What symptoms or side effects should I tell you about right away?
>How can I reach you (or someone from your office) on nights, holidays, or weekends?
"
">Do I need to change what I eat during treatment?
>Are there any limits on what I can do?
"
>
Should I exercise?
"What should I do, and how often?
"
">Can you suggest a mental health professional I can see if I start to feel overwhelmed, depressed, or distressed?"
"
>Are there any limits on what I can do?
>"
"What symptoms should I watch for?
>"
"What type of
    follow-up
    will I need after treatment?
>How will we know if the cancer has come back?"
"What should I watch for?
"
"What will my options be if the cancer comes back?
>Where can I find more information and support?
"
"Along with these sample questions, be sure to write down any others you want to ask."
"For instance, you might want information about recovery times so that you can plan your work or activity schedule."
"Or you might want to ask about clinical trials that might be right for you.
"
Keep in mind that doctors aren’t the only ones who can give you information.
"Other health care professionals, such as nurses and social workers, can answer some of your questions."
"To learn more about speaking with your health care team, see The Doctor-patient Relationship .
"
"
"
"
Cancer can start any place in the body."
Cancer that starts in the small intestine is often called small intestine cancer.
It starts when cells in the small intestine grow out of control and crowd out normal cells.
"This makes it hard for the body to work the way it should.
"
"Cancer cells in the small intestine can sometimes spread to other parts of the body, like the liver, and grow there."
"When cancer cells do this, it’s called metastasis (pronounced meh-TAS-tuh-sis)."
"To doctors, the cancer cells in the new place look just like the ones from the small intestine.
"
Cancer is named for the place where it starts.
"So when small intestine cancer spreads to the liver (or any other place), it’s still called small intestine cancer."
"It’s not called liver cancer unless it starts from cells in the liver.

"
"
The small intestine is part of the digestive system."
"This is where food is broken down to make energy and where the body gets rid of solid waste (poop or stool).
"
"The small intestine is a long, hollow tube."
"It is attached to the stomach on one end, and to the large intestine on the other end."
"As food travels through the small intestine, it absorbs most of the nutrients from the food and into our bodies."
"
There are 4 main types of small intestine cancers , which start in different kinds of cells.
"
The type we’re talking about here is called adenocarcinoma (AD-uh-no-KAR-sin-
O -muh).
This type starts in the gland cells that line the inside of the small intestine.
"Other types of cancer that can start in the small intestine are:
>Gastrointestinal (GI) carcinoid tumor
>Gastrointestinal stromal tumor (GIST)
>Non-Hodgkin lymphoma
These other types behave and are treated differently, so they are discussed on other pages."
It’s important to know which type you have.
"If you’re not sure, ask your doctor."
"
>Why do you think I have cancer?
>Is there a chance I don’t have cancer?
"
">Would you please write down the kind of cancer you think I might have?
"
">Where is the cancer?
>What will happen next?"
"
The symptoms of small intestine cancer can include belly pain, throwing up, weight loss, feeling tired, or having dark colored stools (poop)."
"Your doctor will ask questions about your symptoms and do a physical exam.
"
"If your doctor thinks you might have a small intestine cancer (or some other type of cancer), more tests will be done."
"Here are some of the tests you might need :
Blood tests: Certain blood tests can tell the doctor more about your health.
"
Barium x-ray tests: Different types of x-ray tests can be used to look at the inside of your intestines.
"For these tests, you either swallow a chalky liquid, it is put into your intestines through a tube put down your throat, or it is put in through your rectum."
The barium in the liquid outlines the inner lining of the intestines on x-rays.
"These types of tests aren’t used as much as they were in the past.
"
CT scan: This test uses x-rays to make detailed pictures of the inside of your body.
"CT scans can often show the size, shape, and place of tumors in the intestines."
"This test might also be done to see if cancer has spread.
"
MRI scan: MRIs use radio waves and strong magnets instead of x-rays to make very detailed pictures of the inside of your body.
"MRIs can make it easier to see the size and shape of the tumor.
"
"Endoscopy (end-AH-skuh-pee): For these tests, the doctor puts a flexible lighted tube with a tiny video camera on the end into the body to see the inner lining of the GI tract."
"Depending on where the tumor is thought to be, the tube can be put down the throat (for an upper endoscopy) or put into the rectum."
"If abnormal areas are seen, small samples can be taken out for a biopsy (see below)."
"Another option might be to swallow a capsule with a tiny camera in it, which takes pictures as it goes through the small intestine.
"
Biopsy (BY-op-see):
"In a biopsy, the doctor takes out small pieces of an abnormal area to check for cancer cells."
This is the best way to know for sure if you have cancer.
"If cancer is found, lab tests will also be done to find out what type of cancer it is.
"
There are different ways to do a biopsy.
"It can be done during endoscopy or surgery, or sometimes using a thin, hollow needle to get biopsy samples."
The type used will depend on the size of the tumor and where it is.
"Ask your doctor what kind you will need.
"
"If a small intestine cancer is found, tests might be done on the biopsy samples to see if the cancer cells have certain gene changes."
This might affect your treatment.
"
>What tests will I need?
>"
"Who will do these tests?
"
">Where will they be done?
>How and when will I get the results?
>Who will explain the results to me?
>"
What do I need to do next?
"
If you have small intestine cancer, the doctor will want to find out how far it has spread."
This is called the stage of the cancer.
"Your doctor will want to find out the stage to help decide what type of treatment is best for you.
"
"The stage is based on how much the cancer has grown through the layers of the wall of the intestine, as well as if the cancer has grown into nearby areas or spread to organs farther away.
"
"Your cancer can be stage 0, 1, 2, 3, or 4."
"The lower the number, the less the cancer has spread."
"A higher number, like stage 4, means a more serious cancer that has spread from where it first started."
"Ask the doctor about the cancer stage and what it means for you.
"
"When trying to decide on treatment, doctors often use a simpler system that divides small intestine cancers into 2 main groups:
>Resectable tumors:
   those that can be removed with surgery
>Unresectable tumors:
   those that can’t be removed with surgery"
"
>Do you know the stage of the cancer?
>If not, how and when will you find out the stage of the cancer?
"
">Would you explain to me what the stage means in my case?
>How does the stage of the cancer affect my treatment options?
>What will happen next?"
"
The main types of treatment are surgery, chemotherapy, and radiation."
Sometimes newer types of treatment might be options as well.
"Two or more types of treatment may be used at the same time, or they may be given one after the other.
"
"The treatment plan that’s best for you will depend on:
>The stage of the tumor and where it is
>"
"If the tumor can be removed safely with surgery
>"
"The chances of the tumor coming back after treatment
>Your age and overall health
>Your feelings about the treatment and the side effects that can come with it"
"
Surgery is the main treatment for small intestine cancers if it can be done."
The type of surgery depends on where the tumor is and the goal of the surgery.
"If the doctor thinks all of the tumor can be removed, surgery is used to take out the tumor and a margin or edge of the healthy tissue around it."
"But even if not all of the tumor can be removed, surgery is sometimes done to help prevent or relieve problems caused by the cancer."
Ask your doctor what kind of surgery you will need and what to expect.
"
Surgery can have risks and side effects, such as bleeding, infections, and changes in how you’re able to eat."
Ask the doctor what you can expect.
"If you have problems, let your doctors and nurses know."
They can help you with any problems that come up.
"
Chemotherapy (KEY-mo-THAIR-uh-pee), or chemo for short, is the use of certain types of drugs to fight cancer."
The drugs are often given through a needle into a vein or taken as pills.
"These drugs go into the blood and spread through the body.
"
"Sometimes chemo can be given directly into the belly during surgery, which might help limit its side effects.
"
Chemo is given in cycles or rounds.
Each round of treatment is followed by a break.
"Most of the time, 2 or more chemo drugs are given."
"Treatment often lasts for many months.
"
Chemo can be given after surgery to try to lower the chance that the cancer will come back.
It can also be used as the main treatment for advanced cancer.
"
Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out."
But these problems tend to go away after treatment ends.
Some chemo drugs can cause other side effects as well.
"Ask your cancer care team what you can expect.
"
There are ways to treat most chemo side effects.
"If you have side effects, talk to your cancer care team so they can help."
"
Radiation therapy uses high-energy rays (like x-rays) to kill cancer cells."
"After surgery, radiation can be used to try to kill areas of cancer that could not be removed."
"Radiation can also be used to ease some problems caused by the cancer.
"
Radiation for small intestine cancer is aimed at the tumor from a machine outside the body.
This is called external beam radiation.
"
If your doctor suggests radiation treatment, talk about what side effects might happen."
Side effects depend on the area being treated.
"Some common side effects of radiation are:
>Skin changes where the radiation is given
>Feeling tired
>Feeling sick to your stomach
Most side effects get better after treatment ends."
Talk to your cancer care team about what you can expect during and after treatment.
"
Clinical trials are research studies that test new drugs or other treatments in people."
"They compare standard treatments with others that may be better.
"
Clinical trials are one way to get the newest cancer treatments.
They are the best way for doctors to find better ways to treat cancer.
But they might not be for everyone.
"If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part."
"And if you do sign up for a clinical trial, you can always stop at any time.
"
"If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials."
See Clinical Trials to learn more.
"
"
"When you have cancer, you might hear about other ways to treat it or to treat your symptoms."
These may not always be standard medical treatments.
"These treatments may be vitamins, herbs, diets, or other things ."
"You may wonder about these treatments.
"
"Some of these might help, but many have not been tested."
Some have been shown not to help.
A few have even been found to be harmful.
"Talk to your cancer care team about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else."
"
>Will I need to see any other types of doctors?
>"
"What treatment do you think is best for me?
>What’s the goal of this treatment?"
"Do you think it could cure the cancer?
>Will treatment include surgery?"
"If so, who will do the surgery?
>What will the surgery be like?
"
">How will my body look and work after surgery?
"
">Will I need other types of treatment, too?
>"
"What will these treatments be like?
>"
"What’s the goal of these treatments?
>What side effects could I have from these treatments?
>What can I do about side effects that I might have?
"
">Is there a clinical trial that might be right for me?
>"
What about vitamins or diets that friends tell me about?
"How will I know if they are safe?
>How soon do I need to start treatment?
"
">What should I do to be ready for treatment?
"
">Is there anything I can do to help the treatment work better?
>"
What’s the next step?
"
You’ll be glad when treatment is over."
But it’s hard not to worry about cancer coming back.
"Even when cancer never comes back, people still worry about it.
"
It’s important to keep seeing your cancer doctor.
Be sure to go to all of your follow-up visits .
"Your doctor will ask about symptoms, do physical exams, and may do blood tests or other tests to see if the cancer has come back."
"At first, your visits may be every few months."
"Then, the longer you’re cancer-free, the less often the visits are needed.
"
"Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways."
You might be thinking about how to improve your health.
"Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.
"
You can’t change the fact that you have had cancer.
"What you can change is how you live the rest of your life – making healthy choices and feeling as good as you can.
"
"

The treatment of small intestine cancer depends mainly on whether or not the cancer can be removed completely with surgery."
"Cancers that can be removed completely are called resectable , while those that cannot are called unresectable ."
"
Resectable cancers are treated with surgery to remove the cancer and some healthy surrounding tissue."
"The type of surgery will depend on where the cancer is:
>"
"If the cancer is in the duodenum (the first part of the small intestine), an extensive operation called a Whipple procedure (or pancreaticoduodenectomy) is typically done.
"
">If the cancer is in another part of the small intestine, a segmental resection (removing the part of the intestine containing the tumor) is more likely to be done.
"
">If the cancer is near the end of the small intestine, part of the large intestine (colon) might need to be removed as well.
"
"If the cancer has grown through the wall of the intestine or spread to nearby lymph nodes, the doctor may recommend adjuvant chemotherapy (chemo) or radiation therapy after surgery to try to kill any cancer cells that may have been left behind but were too small to see."
The hope is that this treatment will help keep the cancer from coming back (recurring).
"It’s not yet clear if adjuvant treatment can help people with small intestine cancer live longer.
"
Some doctors are also testing if giving chemo or radiation before surgery (known as neoadjuvant therapy ) might be helpful.
"The hope is that this might shrink the tumor and make surgery easier, but so far it’s not clear how helpful this treatment might be."
"
A small intestine cancer may be unresectable if it has grown into nearby tissues or if it has spread to other organs and tissues  (or if a person isn’t healthy enough for major surgery).
"
Some people with unresectable cancers still have surgery to treat blocked intestines.
"This might include removing a large part of the tumor, or bypassing the tumor in some way."
"This type of palliative surgery can often help prevent or relieve symptoms like nausea, vomiting, and abdominal pain.
"
"Whether or not surgery is done, chemotherapy is typically part of treatment."
"If the cancer is in the lining of the abdomen, chemo might be given right into the abdominal space just after surgery (known as intraperitoneal chemotherapy )."
"Radiation therapy can also be used to treat cancer that has spread, especially to the brain or bones (such as the spine).
"
"Another treatment option for some people might be immunotherapy, which uses medicines to boost the body’s own immune response against the cancer."
"For people whose cancer cells have certain gene changes, such as mismatch repair (MMR) gene mutations or microsatellite instability (MSI), treatment with medicines called checkpoint inhibitors , such as pembrolizumab (Keytruda), might be helpful.
"
"Because there is no generally accepted standard treatment for these advanced cancers, taking part in a clinical trial is also a good option.
"
"

Chemotherapy (chemo) uses drugs to kill cancer cells."
"Often, these drugs are injected into a vein (IV) or given by mouth."
"They enter the bloodstream and can reach cancer cells anywhere in the body.
"
"Unfortunately, small intestine adenocarcinoma does not seem to be very sensitive to chemo, so it is not often part of the main treatment for this cancer."
"Still, it may be used in some situations:
>If the cancer has spread (metastasized) to other parts of the body
>After the tumor is removed with surgery (called
    adjuvant treatment
    ), to try to lower the chance that the cancer will come back."
"It's not yet clear how well this works or small intestine cancer.
"
">As
    i
    ntraperitoneal chemotherapy
    for cancer that has spread to the inner lining of the abdomen (called the
    peritoneum
    )."
"For this treatment, chemo is put directly into the abdomen right after surgery."
The chemo is often heated first to help it work better.
"This is known as
    hyperthermic intraperitoneal chemotherapy (HIPEC)
    ."
"
Some of the chemo drugs that can be used include:
>Capecitabine
>5-fluorouracil (5-FU)
>Oxaliplatin
>Irinotecan
5-FU is often given with a vitamin-like drug called leucovorin, which helps it work better.
"
"Because small intestine cancer is rare, it has been hard to study which chemo drugs work best."
"Some of the drug combinations that seem to work in advanced small intestine cancer include:
>Capecitabine and oxaliplatin (called CAPOX)
>5-FU and leucovorin with oxaliplatin (FOLFOX)
>5-FU and leucovorin with irinotecan (FOLFIRI)."
"
Chemo drugs kill cancer cells but also damage some normal cells, which can lead to side effects ."
"These depend on the type and dose of drugs, and the length of treatment."
"Common short-term side effects might include:
>Nausea and vomiting
>Loss of appetite
>Loss of hair
>Mouth sores
>Diarrhea
Chemo can also damage the blood-making cells of the bone marrow, so you may have low blood cell counts."
"This can lead to:
>An increased risk of infection (from a shortage of white blood cells)
>Bleeding or bruising after minor cuts or injuries (from a shortage of blood platelets)
>Fatigue (tiredness) or shortness of breath (from a shortage of red blood cells)
"
"Along with these, some other side effects can be seen with certain medicines, for example:
>Capecitabine or 5-FU (when given as an infusion) can cause
    hand-foot syndrome
    ."
"This starts out as redness in the hands and feet, which can then progress to pain and sensitivity in the palms and soles."
"If it worsens, blistering or skin peeling can occur, sometimes leading to open, painful sores."
"These symptoms gradually get better when the drug is stopped or the dose is lowered, so it's important to tell your doctor when symptoms first come up.
"
">Oxaliplatin can often cause
    neuropathy
    (nerve damage)."
"Symptoms can include numbness, tingling, and even pain in the hands and feet."
"It can also make you very sensitive to hot and cold, especially in the throat and esophagus (the tube connecting the throat to the stomach), which can make swallowing liquids painful."
"More information about neuropathy can be found in
    Peripheral Neuropathy Caused by Chemotherapy
    .
"
">Many of these drugs commonly cause
    diarrhea,
    but it can be particularly bad with irinotecan."
"If you get diarrhea while being treated with irinotecan, it needs to be treated right away – at the first loose stool – to prevent severe dehydration.
"
Most side effects tend to go away after treatment is finished.
"But some, such as hand and foot numbness, might last for a long time."
"Talk to you cancer care team about any side effects you have, because there are often ways to lessen chemo side effects."
"For example, drugs can be given to help prevent or reduce nausea and vomiting.
"
"

Radiation therapy uses high-energy radiation to kill cancer cells."
It may be an option for those whose cancer cannot be removed completely with surgery and is causing problems such as pain or bleeding into the intestines.  
"Radiation might also be used after surgery to try to kill any remaining cancer cells (known as adjuvant therapy ), although it’s not yet clear how helpful this is.
"
External-beam radiation therapy is the type of radiation used most often for small intestine cancer.
"For this treatment, radiation beams are aimed at the tumor from a machine outside the body.
"
"Before treatment starts, the radiation team will take careful measurements to find the correct angles for aiming the radiation beams and the proper dose of radiation."
"This planning session, called simulation , usually includes getting imaging tests such as CT or MRI scans.
"
"Radiation therapy is much like getting an x-ray, but the radiation is much stronger."
The treatment itself is painless.
"It lasts only a few minutes, although the setup time – getting you into place for treatment – usually takes longer."
You might get radiation treatment for several days in a row.
"
The main side effects of radiation therapy to the intestines include:
>Fatigue (tiredness)
>Nausea and vomiting
>Diarrhea
>Skin changes in the area where the radiation beams passed through, which can range from mild redness to blistering and peeling
"
"

Surgery is typically the main treatment for small intestine cancer."
"For some people, t might be the only treatment they need."
"At this time, surgery is the only treatment that can cure a cancer of the small intestine."
"
>For people whose cancer is only in or near the place where it started (that is, in the small intestine and perhaps nearby organs), surgery is typically done to try to remove all of the cancer.
"
">If the cancer has spread too far to be removed completely, surgery might be done to help prevent or relieve problems that could be caused by the tumor growing large enough to block the intestine (or other problems).
"
"The type of operation will depend on a number of factors, including the size and location of the tumor, and whether a person has any serious health problems."
"
This operation removes (resects) the segment of intestine that has the tumor, as well as some of the normal tissue on either side of the tumor."
The 2 cut ends of intestine are then attached back together.
Some nearby tissue containing lymph nodes is also removed.
Tumors in the end of the ileum (the last part of the small intestine) may require removing the right side of the colon (the first part of the large intestine).
"This surgery is called a hemicolectomy .
"
Usually this surgery is done through a long cut made in the abdomen.
"Another option for some smaller cancers might be “keyhole” (laparoscopic) surgery, in which the operation is done through several small cuts using long, thin surgical tools.
"
"After surgery, it can take a few days before a person can eat and drink normally."
"Removing a small piece of intestine usually doesn’t cause long-term problems with eating or bowel movements, but there are more likely to be issues if part of the colon is removed as well."
"
This extensive operation can be used to treat cancers of the duodenum (the first part of the small intestine), although it is more often used to treat pancreatic cancer ."
"It removes the duodenum, part of the pancreas, part of the stomach, and nearby lymph nodes."
"The gallbladder and part of the common bile duct are also removed, and the remaining bile duct is then attached to the small intestine so that bile from the liver can continue to enter the small intestine.
"
"This is a complex operation that carries a fairly high risk of complications, which can sometimes even be fatal."
"Because of this, it’s important that it is done by a surgeon (and at a center) that has a lot of experience with it."
"Still, even in the best hands, many patients have side effects from the surgery."
"These can include:
>Leaking from the various connections that the surgeon has to make
>Infections
>Bleeding
>Trouble with the stomach emptying itself after eating
>Trouble digesting some foods
>Changes in bowel habits
>Significant weight loss"
"
If the cancer can't be removed completely because it has spread too far, surgery might still be a good option to help prevent or relieve some symptoms from the cancer."
This is known as palliative surgery .
"Often, these operations are done to relieve a blocked intestine, to decrease pain, nausea, and vomiting, and allow the patient to eat normally.
"
"If possible, the surgeon will remove enough of the tumor and nearby intestine to allow digested food to pass through.
"
"Bypass surgery: Another option might be for the surgeon to leave the tumor in place and to reroute normal parts of the small intestine around the tumor to prevent or relieve a blockage.
"
"Stent or tube placement: If major surgery isn’t a good option for some reason, sometimes an endoscope can be used to pass a fairly rigid tube (called a stent ) down the digestive tract and into the blocked part of the intestine."
"The stent is left in place to help keep the intestine open and allow digested food to pass.
"
"If this can’t be done, a thin, flexible tube may be placed through the skin and into the stomach to drain it."
"The tube can be left in place to help prevent problems with nausea and vomiting.
"
"
"
"
The American Cancer Society’s estimates for stomach cancer (also known as gastric cancer) in the United States for 2023 are:
>About 26,500 new cases of stomach cancer (15,930 in men and 10,570 in women)
>About 11,130 deaths from this type of cancer (6,690 men and 4,440 women)
Stomach cancer accounts for about 1.5% of all new cancers diagnosed in the US each year."
"
Stomach cancer mostly affects older people."
The average age of people when they are diagnosed is 68.
"About 6 of every 10 people diagnosed with stomach cancer each year are 65 or older.
"
The lifetime risk of developing stomach cancer is higher in men (about 1 in 96) than in women (about 1 in 152).
But each person's risk can be affected by many other factors .
"
In the US, the number of new cases of stomach cancer has been dropping by about 1.5% each year over the last 10 years.

"
"For much of the early 20th century, stomach cancer was the leading cause of cancer death in the United States, but today it is well down on this list."
"The reasons for this aren't completely clear, but two main factors are thought to have been important:
"
">The increased use of refrigeration for food storage, which has led to people eating fewer salted and smoked foods (known
   risk factors
   for stomach cancer).
"
">The decline in the number of people infected with the
   Helicobacter pylori
   (
   H pylori
   ) bacteria, which is thought to be a
   major cause
   of stomach cancer.
"
"While stomach cancer has become less common in the US, it's still much more common in some other parts of the world, particularly in East Asia."
"It remains one of the leading causes of cancer-related deaths in the world.
"
"For statistics on survival for stomach cancer, see Survival Rates for Stomach Cancer .
"
"Visit the American Cancer Society’s Cancer Statistics Center for more key statistics.
"
"

Cancer starts when cells in the body begin to grow out of control."
"Cells in nearly any part of the body can become cancer, and can then spread to other areas of the body."
"To learn more about cancer and how it starts and spreads, see What Is Cancer?
Stomach cancer, also called gastric cancer, begins when cells in the stomach start to grow out of control."
"
To understand stomach cancer, it helps to know about the normal structure and function of the stomach.


"
"The stomach is a sac-like organ that’s an important part of the digestive system.
"
"After food is chewed and swallowed, it enters the esophagus , a tube that carries food through the throat and chest to the stomach."
"The esophagus joins the stomach at the gastroesophageal (GE) junction , which is just beneath the diaphragm (the thin sheet of breathing muscle under the lungs)."
The stomach then starts to digest the food by secreting gastric juice.
"The food and gastric juice are mixed and then emptied into the first part of the small intestine called the duodenum .
"
Some people use the word 'stomach' to refer to the belly area.
The medical term for this area is the abdomen .
"For instance, some people with pain in this area would say they have a 'stomach ache', when in fact the pain could be coming from some other organ in the area."
"Doctors would call this symptom 'abdominal pain,' because the stomach is only one of many organs in the abdomen.
"
"Stomach cancer is different from other cancers that can occur in the abdomen, like cancer of the colon or rectum (large intestine) , liver , pancreas , or small intestine ."
"
The stomach has 5 parts.


"
"The first 3 parts make up the proximal stomach :
>Cardia:
   the first part, which is closest to the esophagus
>Fundus:
   the upper part of the stomach next to the cardia
>Body (corpus):
   the main part of the stomach, between the upper and lower parts
Some cells in these parts of the stomach make acid and pepsin (a digestive enzyme), which combine to make the gastric juice that helps digest food."
"They also make a protein called intrinsic factor , which the body needs to absorb vitamin B12.
"
"The lower 2 parts make up the distal stomach :
>Antrum:
   the lower portion (near the small intestine), where the food mixes with gastric juice
>Pylorus:
   the last part of the stomach, which acts as a valve to control the emptying of the stomach contents into the small intestine
Other organs near the stomach include the small intestine, colon, liver, spleen, and pancreas.
"
"The stomach wall has 5 layers:


>The innermost layer is the
   mucosa
   ."
This is where stomach acid and digestive enzymes are made.
"Most stomach cancers start in this layer.
"
">Next is a supporting layer called the
   submucosa
   .
>Outside of this is the
   muscularis propria
   , a thick layer of muscle that helps move and mix the stomach contents.
"
">The outer 2 layers, the
   subserosa
   and the outermost
   serosa
   ,
   wrap the stomach.
"
"The layers are important in determining the stage (extent) of the cancer , which can affect a person’s treatment options and prognosis (outlook)."
"
Stomach cancers tend to develop slowly over many years."
"Before a true cancer develops, pre-cancerous changes often occur in the inner lining (mucosa) of the stomach."
"These early changes rarely cause symptoms, so they often go undetected.
"
Cancers starting in different sections of the stomach can cause different symptoms and tend to have different outcomes.
The cancer’s location can also affect treatment options.
"For example, cancers that start at or grow into the GE junction are usually staged and treated the same as cancers of the esophagus."
"
Most cancers of the stomach (about 90% to 95%) are adenocarcinomas."
"These cancers develop from the gland cells in the innermost lining of the stomach (the mucosa).
"
"If you are told you have stomach cancer (or gastric cancer), it will almost always be an adenocarcinoma."
"The information on the following pages that discusses stomach cancer refers to this type of cancer.
"
"There are 2 main types of stomach adenocarcinomas:
>The
   intestinal
   type tends to have a slightly better prognosis (outlook)."
"The cancer cells are more likely to have certain gene changes that might allow for treatment with
   targeted drug therapy
   .
"
">The
   diffuse
   type tends to grow spread more quickly."
"It is less common than the intestinal type, and it tends to be harder to treat.
"
"
These uncommon tumors start in very early forms of cells in the wall of the stomach called interstitial cells of Cajal."
Some GISTs are much more likely than others to grow into other areas or spread to other parts of the body.
"Although GISTs can start anywhere in the digestive tract, most start in the stomach."
"
Neuroendocrine tumors (NETs) start in cells in the stomach (or other parts of the digestive tract) that act like nerve cells in some ways and like hormone-making (endocrine) cells in others."
"Most NETs tend to grow slowly and do not spread to other organs, but some can grow and spread quickly."
"
These cancers start in immune system cells called lymphocytes."
"Lymphomas usually start in other parts of the body, but some can start in the wall of the stomach."
The treatment and outlook for these cancers depend on the type of lymphoma and other factors.
"
Other types of cancer, such as squamous cell carcinomas, small cell carcinomas, and leiomyosarcomas, can also start in the stomach, but these cancers are very rare.
"
"

For some people with stomach cancer (also known as gastric cancer), treatment can remove or destroy the cancer."
The end of treatment can be both stressful and exciting.
"You may be relieved to finish treatment, but it’s hard not to worry about cancer coming back."
"This is very common if you’ve had cancer.
"
"For other people, the cancer might never go away completely."
"Some people may get chemotherapy, targeted therapy, or other treatments to try to keep the cancer in check for as long as possible and to prevent or limit any problems it might cause."
"Learning to live with cancer that does not go away can be difficult and very stressful.
"
Life after stomach cancer means returning to some familiar things and making some new choices.
"
Even if you have completed treatment, your doctors will still want to watch you closely."
It's very important to go to all of your follow-up appointments.
"During these visits, your doctors will ask questions about any problems you are having and may do exams and lab or imaging tests to look for signs of stomach cancer or treatment side effects.
"
Almost any cancer treatment can have side effects .
"Some might only last for a short time, but others can last longer."
"Your doctor visits are a good time for you to ask questions and talk about any changes, problems, or other concerns you have.
"
"If you have finished treatment, most doctors recommend follow-up visits every 3 to 6 months for the first few years, then less often after that."
These visits usually include a physical exam and review of any symptoms you’re having.
Lab tests and other exams such as upper endoscopy might also be done or ordered at this time.
"Imaging tests such as CT cans are not usually needed at each visit, but they might be done if you have any suspicious symptoms or physical findings on exam."
"
Talk with your doctor about developing a survivorship care plan for you."
"This plan might include:
>A suggested schedule for follow-up exams and tests
>A schedule for other tests you might need in the future, such as early detection (screening) tests for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
>A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
>Diet and physical activity suggestions
>Reminders to keep your appointments with your primary care provider (PCP), who will monitor your general health care"
"
For many people, stomach cancer and its treatment can affect how they eat and absorb nutrition."
"Nausea can be a problem during and after some treatments, and some people lose their appetite (as well as some weight)."
"People also often find they need to change the way they eat, such as eating smaller, more frequent meals instead of a few larger ones each day.
"
"Your cancer care team may refer you to a dietitian, an expert in nutrition, who can help you adjust to changes in your eating habits and can give you ideas on how to deal with some of the nutrition issues that might arise from the cancer or its treatment.
"
"If you have lost or are losing weight, or if you are having trouble eating, do the best you can."
Eat what appeals to you.
"Eat what you can, when you can."
You might find it helps to eat small portions every 2 to 3 hours until you feel better.
"Try to keep in mind that these problems usually improve over time.
"
"If part or all of your stomach has been removed, you might need to eat smaller amounts of food more often."
Your doctor or dietitian may also recommend that you stay upright for some time after eating.
"Your health care team can help you adjust your diet if you are having problems eating .
"
"Some people with stomach cancer have problems with nausea, diarrhea, sweating, and flushing after eating."
This is called dumping syndrome .
"When part or all of the stomach is removed, the food that is swallowed quickly passes into the intestine, leading to these symptoms after eating."
"These symptoms often get better over time, although some people might still need to take medicines to help with long-term diarrhea.
"
People who have had surgery — especially if they had the upper part of their stomach removed (in either a subtotal or total gastrectomy) — will probably need to have blood work done regularly to check their vitamin and mineral levels.
"Some people might need vitamin supplements, which could include B12 injections."
"(The pill form of vitamin B12 isn’t absorbed into the body if the upper part of the stomach has been removed.)
"
Some people may need additional help to make sure they get the nutrition they need.
"For example, some people might need nutritional supplements."
"Some people may even need a feeding tube, called a jejunostomy tube (or J-tube ), put into the small intestine."
This is done through a small hole in the skin over the abdomen during a minor operation.
A J-tube allows liquid nutrition to be put directly into the small intestine to help prevent weight loss and improve nutrition.
"Less often, the tube may be placed into the lower part of the stomach instead."
This is known as a gastrostomy tube or G-tube .
"
Even after treatment, it’s very important to keep health insurance."
"Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
"
"At some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history."
It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment.
Learn more in Keeping Copies of Important Medical Records .
"
If you have (or have had) stomach cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements."
"Unfortunately, it’s not yet clear if there are things you can do that will help.
"
"Eating a diet rich in fruits and vegetables, staying at a healthy weight, getting regular physical activity, and avoiding or limiting alcohol are all linked with a lower risk of getting stomach cancer ."
But we don’t know if these types of changes affect the risk of cancer progressing or coming back.
"However, we do know that they can have positive effects on your health that can extend beyond your risk of cancer.
"
"Tobacco use has clearly been linked to stomach cancer, so not smoking might help reduce your risk."
"We don’t know for certain if this will help, but we do know that it can help improve your appetite and overall health."
It can also reduce the chance of developing other types of cancer.
"If you want to quit smoking and need help, call the American Cancer Society at 1-800-227-2345."
You can also learn more in our Guide to Quitting Tobacco .
"
So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of cancer progressing or coming back."
"This doesn’t mean that no supplements will help, but it’s important to know that none have been proven to do so.
"
"Dietary supplements are not regulated like medicines in the United States – they don't have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do."
"If you’re thinking about taking any type of nutritional supplement, talk to your health care team."
They can help you decide which ones you can use safely while avoiding those that might be harmful.
"
If the cancer does recur at some point, your treatment options will depend on where the cancer is located, what treatments you’ve had before, and your health."
"For more information on how recurrent cancer is treated, see Treatment Choices Based on the Extent of Stomach Cancer .
"
"For more general information on recurrence, you may also want to see Understanding Recurrence ."
"
People who’ve had stomach cancer can still get other cancers."
"They do not get second cancers at an increased rate overall, but they do seem to have an increased risk of cancers of the thyroid and small intestine.
"
Experts do not recommend any additional testing to look for second cancers in people who’ve had stomach cancer.
"Still, it’s important to let your doctor know about any new symptoms or problems you have, because they could be caused by the stomach cancer coming back, or by a new disease or second cancer.
"
"Like other people, survivors of stomach cancer should follow the American Cancer Society guidelines for the early detection of cancer and stay away from tobacco products , which increase the risk of many types of cancers.
"
"To help maintain good health, survivors should also:
>Get to and stay at a healthy weight.
"
">Stay physically active and limit time spent sitting or lying down.
"
">Follow a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and that limits or avoids red and processed meats, sugary drinks, and highly processed foods.
"
>Avoid or limit alcohol.
"If you do drink, have no more than 1 drink per day for women or 2 per day for men.
"
"These steps may also lower the risk of some other health problems.
"
"See Second Cancers for more information about causes of second cancers.
"
"

There is no sure way to prevent stomach cancer (also known as gastric cancer), but there are things you can do that could lower your risk."
"
Being overweight or obese increases the risk of some types of stomach cancer, so getting to and staying at a healthy weight might lower your risk.
"
"G etting regular physical activity might also help lower your risk of stomach cancer.
"
"Aside from possible effects on stomach cancer risk, staying at a healthy weight and being active may also lower your risk of several other cancers and health problems.
"
A diet that includes plenty of fresh fruits and vegetables probably also lowers stomach cancer risk.
"Citrus fruits (such as oranges, lemons, and grapefruit) may be especially helpful,  but be aware that grapefruit and grapefruit juice can change the blood levels of certain drugs you take."
"Talk to your health care team about this before adding grapefruit to your diet.
"
"The American Cancer Society recommends that people follow a healthy eating pattern , which includes a variety of colorful fruits and vegetables and whole grains, and avoids or limits red and processed meats, sugar-sweetened beverages, and highly processed foods.
"
"Alcohol use probably increases the risk of stomach cancer, so avoiding or limiting alcohol might lower your risk.
"
"For more on diet, body weight, physical activity, and alcohol use, see the  American Cancer Society Guideline for Diet and Physical Activity for Cancer Prevention .
Studies that have looked at other dietary factors, such as taking dietary supplements or drinking tea (particularly green tea ) have not led to firm conclusions when it comes to lowering stomach cancer risk."
Further research is needed in these areas.
"
Smoking can increase the risk of cancers of the upper stomach (the portion closest to the esophagus)."
Tobacco use increases the risk for many other types of cancer as well.
"If you don’t use tobacco, don’t start."
"If you already do and want help quitting , call the American Cancer Society at 1-800-227-2345."
"
It's not yet clear if people whose stomach linings are chronically infected with the H pylori bacteria but who do not have any symptoms should be treated with antibiotics."
This is a topic of current research.
Some studies have suggested that giving antibiotics to people with H pylori infection might lower the number of pre-cancerous lesions in the stomach and reduce the risk of developing stomach cancer.
"But not all studies have found this.
"
"While it’s not yet clear if all people with H pylori infection should be treated, some research has shown that it might be helpful to treat people with H pylori who are also at higher risk for stomach cancer for other reasons, such as having a close relative with stomach cancer.
"
"More research is needed to be sure that treating other groups of people with H pylori infection can lower stomach cancer risk.
"
"If your doctor thinks you might have H pylori infection, there are several ways to test for this, including a breath test, a blood test, a stool test, and an endoscopy procedure, in which a biopsy is done."
(See Tests for Stomach Cancer .)
"
Using aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen seems to lower the risk of stomach cancer."
These medicines can also lower the risk of developing colon polyps and colon cancer .
"But they can also cause serious (and even life-threatening) internal bleeding and other potential health risks in some people.
"
"Most doctors consider any reduced cancer risk an added benefit for people who take these drugs for other reasons, such as to treat arthritis."
But doctors do not routinely recommend taking NSAIDs specifically to prevent stomach cancer.
Studies have not yet determined for which people the benefits of lowering cancer risk would outweigh the risks of bleeding complications.
"
Hereditary diffuse gastric cancer (HDGC) is a rare inherited condition in which people have a greatly increased risk of stomach cancer, which often develops at a fairly early age."
"This rare syndrome is most often caused by an inherited mutation in the CDH1 gene.
"
"It's very important to recognize people and families with this inherited syndrome, because most people who have it will develop stomach cancer."
"Families with HDGC typically have two or more close relatives who develop stomach cancer (usually the diffuse type ), and/or at least one person who is diagnosed before age 50."
"Some family members might also develop invasive lobular breast cancer.
"
"Doctors often refer people who might have HDGC to a genetics professional, so they can discuss possibly getting genetic testing ."
"If testing is done and shows a person has a mutation (abnormal change) in the CDH1 gene, doctors often recommend they consider having their stomach removed (typically between the ages of 20 and 30) before cancer develops."
"However, this operation (called a total gastrectomy) can lead to long-term changes in the way a person eats.
"
"Some other hereditary cancer syndromes are also linked with an increased risk for stomach cancer, including Lynch syndrome , familial adenomatous polyposis (FAP) , Li-Fraumeni syndrome , and Peutz-Jeghers syndrome ."
"The risk of stomach cancer with these syndromes is not nearly as high as it is with HDGC, so removal of the stomach is not typically recommended for people who have these syndromes."
"However, doctors might recommend getting regular tests to try to find stomach cancer early in some of these people.

"
"

A risk factor is anything that raises your chances of getting a disease such as cancer."
Different cancers have different risk factors.
"Some risk factors, like smoking, can be changed."
"Others, like a person’s age or family history, can’t be changed.
"
"But having a risk factor, or even several risk factors, does not mean that you will get the disease."
"Many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors.
"
Scientists have found several risk factors that make a person more likely to get stomach cancer.
"Some of these can be controlled, but others cannot."
"
Stomach cancer is more common in men than in women."
"
Stomach cancer can occur in younger people, but the risk goes up as a person gets older."
"Most people diagnosed with stomach cancer are in their 60s, 70s, or 80s."
"
In the United States, stomach cancer is more common in Hispanic Americans, African Americans, Native Americans, Asian Americans, and Pacific Islanders than it is in non-Hispanic White people."
"
Worldwide, stomach cancer is more common in East Asia, Eastern Europe, and South and Central America."
This disease is less common in Africa and North America.
"
Infection with Helicobacter pylori ( H pylori ) bacteria seems to be a major cause of stomach cancer, especially cancers in the lower (distal) part of the stomach."
"Long-term infection of the stomach with this germ may lead to atrophic gastritis and other pre-cancerous changes of the inner lining of the stomach.
"
People with stomach cancer have a higher rate of H pylori infection than people without this cancer.
H pylori infection is also linked to some types of lymphoma of the stomach.
"Even so, most people who carry this germ in their stomach never develop cancer."
"
Being overweight or obese is linked with an increased risk of cancers of the cardia (the upper part of the stomach near the esophagus)."
"
Stomach cancer risk is increased in people whose diets include large amounts of foods preserved by salting, such as salted fish and meat and pickled vegetables.
"
"Eating processed, grilled, or charcoaled meats regularly appears to increase risk of non-cardia stomach cancers.
"
Eating few or no fruits likely increases the risk of stomach cancer.  
"On the other hand, eating lots of fresh fruits (especially citrus fruits) and raw vegetables appears to lower the risk of stomach cancer."
"
Alcohol use probably increases the risk of stomach cancer."
The evidence for this link is strongest for people who have 3 or more drinks per day.
"
Smoking increases stomach cancer risk, particularly for cancers of the upper part of the stomach near the esophagus."
The rate of stomach cancer is about doubled in people who smoke.
"
Stomach cancers are more likely to develop in people who have had part of their stomach removed to treat non-cancerous diseases such as ulcers."
"This might be because the stomach makes less acid, which allows more harmful bacteria to be present."
Reflux (backup) of bile from the small intestine into the stomach after surgery might also add to the increased risk.
These cancers typically develop many years after the surgery.
"
Polyps are non-cancerous growths on the lining of the stomach."
"Most types of polyps (such as hyperplastic polyps or inflammatory polyps) do not seem to increase a person’s risk of stomach cancer much, if at all."
But adenomatous polyps – also called adenomas – can sometimes develop into cancer.
"
Certain cells in the stomach lining normally make a substance called intrinsic factor (IF) that the body needs to absorb vitamin B12 from foods."
"People without enough IF may end up with a vitamin B12 deficiency, which affects the body’s ability to make new red blood cells and can cause other problems as well."
"This condition, called pernicious anemia , can be caused by certain autoimmune conditions, as well as by some types of stomach surgery."
"Along with anemia (having too few red blood cells), people with this disease have an increased risk of stomach cancer."
"
In this condition, excess growth of the stomach's inner lining causes large folds in the lining and leads to low levels of stomach acid."
"Because this disease is very rare, it is not known exactly how much this increases the risk of stomach cancer."
"
Some people inherit gene mutations (changes) from their parents that lead to conditions that can raise their risk of stomach cancer."
These inherited syndromes account for only a small percentage of stomach cancers worldwide.
"
This inherited syndrome greatly increases the risk of developing stomach cancer."
"This condition is rare, but the lifetime stomach cancer risk among affected people is up to 70%."
Women with this syndrome also have an increased risk of invasive lobular breast cancer .
This syndrome is most often caused by mutations in the CDH1 gene.
"
Lynch syndrome (formerly known as HNPCC) is an inherited genetic disorder that increases the risk of colorectal cancer , stomach cancer, and some other cancers."
"This syndrome is caused by mutations in one of the mismatch repair (MMR) genes, such as MLH1 or MSH2 ."
These genes normally help repair DNA that has been damaged.
"
People with FAP get many polyps in the colon, and sometimes in the stomach and intestines, starting at an early age."
People with this syndrome have a very high risk of getting colorectal cancer and a slightly increased risk of getting stomach cancer.
FAP is caused by mutations in the APC gene.
"
This rare condition is caused by a mutation in a specific part of the APC gene."
People with GAPPS develop many polyps in the stomach and have an increased risk of stomach cancer.
"
People with this syndrome have an increased risk of several types of cancer, including developing stomach cancer at a relatively young age."
Li-Fraumeni syndrome is caused by a mutation in the TP53 gene.
"
People with this condition develop polyps in the stomach and intestines, as well as in other areas including the nose, the airways of the lungs, and the bladder."
The polyps in the stomach and intestines are called hamartomas .
They can cause problems like bleeding or blockage of the intestines.
"PJS can also cause dark freckle-like spots on the lips, inner cheeks and other areas."
"People with PJS have an increased risk of several types of cancer, including cancers of the colon, pancreas , stomach, and breast."
This syndrome is caused by mutations in the STK11 gene.
"
People with first-degree relatives (parents, siblings, or children) who have had stomach cancer are more likely to develop this disease, even without one of the inherited cancer syndromes described above."
"Still, most people who get stomach cancer do not have a family history of it."
"
In people with CVID, the immune system can’t make enough antibodies to help protect against germs."
"This can lead to frequent infections as well as other problems, including atrophic gastritis and pernicious anemia."
People with CVID are more likely to get gastric lymphoma and stomach cancer.
"
Epstein-Barr virus causes infectious mononucleosis (also called mono)."
"Most people are infected with this virus at some time in their lives, usually as children or teens.
"
EBV has been linked to nasopharyngeal cancer and to some forms of lymphoma .
"It is also found in the cancer cells of about 5% to 10% of people with stomach cancer, although it isn’t yet clear if the virus actually causes stomach cancer."
Stomach cancers linked to EBV tend to be slower growing and have less of a tendency to spread.
"
Workers in the coal, metal, and rubber industries seem to have a higher risk of getting stomach cancer."
"
Blood type groups refer to certain substances that are normally present on the surface of red blood cells and some other types of cells."
These groups are important in matching blood for transfusions.
"For unknown reasons, people with type A blood have a higher risk of getting stomach cancer.
"
"

There are many known risk factors for stomach cancer (also called gastric cancer), but often it's not clear exactly how these factors might affect how cells in the stomach become cancer cells."
This is the subject of ongoing research.
"
Several changes thought to be pre-cancerous can occur in the inner lining of the stomach.
"
"In atrophic gastritis , the normal gland cells of the stomach are either fewer or absent."
There is also some degree of inflammation (in which the stomach cells are damaged by cells of the immune system).
Atrophic gastritis is often caused by infection with H pylori bacteria (see below).
"It can also be caused by an autoimmune reaction, in which a person’s immune system attacks the cells lining the stomach."
"Some people with this condition go on to develop pernicious anemia or other stomach problems, including cancer.
"
Another possible pre-cancerous change is intestinal metaplasia .
"In this condition, the cells that normally line the stomach are replaced by cells that look like the cells that usually line the intestine."
People with this condition often have chronic atrophic gastritis as well.
"This might also be related to H pylori infection.
"
"Both atrophic gastritis and intestinal metaplasia can lead to having too few gland cells, which would normally secrete substances that help protect the cells in the stomach’s inner lining."
"Damage to the DNA inside these cells can sometimes lead to dysplasia , in which the cells become larger and very abnormal looking (more like cancer cells)."
"In some cases, dysplasia can then progress to stomach cancer."
"
Recent research has provided clues on how some stomach cancers form."
"For instance, H pylori bacteria, particularly certain subtypes, can convert substances in some foods into chemicals that cause mutations (changes) in the DNA of the cells in the stomach lining."
This may help explain why certain foods such as preserved meats increase a person’s risk for stomach cancer.
"On the other hand, some of the foods that might lower stomach cancer risk, such as fruits and vegetables, contain antioxidants (like vitamins A and C) that can block substances that damage a cell’s DNA.
Stomach cancers, like other cancers, are caused by changes in the DNA inside cells."
"DNA is the chemical that carries our genes , which control how our cells function."
We look like our parents because they are the source of our DNA.
"But DNA affects more than how we look.
"
"Some genes control when cells grow, divide into new cells, and die:
"
">Genes that normally help cells grow, divide, and stay alive can sometimes change to become
   oncogenes
   .
"
">Genes that help keep cell division under control, repair mistakes in DNA, or cause cells to die at the right time are called
   tumor suppressor genes
   .
"
"Cancers can be caused by DNA changes that keep oncogenes turned on, or that turn off tumor suppressor genes."
"
Inherited mutations in some genes (as explained in Stomach Cancer Risk Factors ) can increase a person’s stomach cancer risk."
"But these are thought to cause only a small percentage of stomach cancers.
"
Most of the gene changes that lead to stomach cancer occur after birth.
Some of these acquired mutations might be caused by risk factors such as H pylori infection or tobacco use.
"But other gene changes may just be random events that sometimes happen inside cells, without having an outside cause.
"
"

Screening is testing for a disease, such as cancer, in people without symptoms.
"
"
No major medical organizations in the United States recommend routine screening for stomach cancer in people at average risk."
"This is largely because this disease isn’t common in the US, so the benefits of screening most likely would not outweigh the possible harms (such as needing additional tests or procedures, even in some people who might not end up having stomach cancer).
"
"Because routine screening for stomach cancer is not done in the United States, most people are not diagnosed with stomach cancer until they have certain signs and symptoms that point to the need for medical tests.
"
"In some countries in East Asia and South America, where stomach cancer is much more common, mass screening of the population has helped find many stomach cancers at an early, possibly more curable stage."
"
The benefits of screening might outweigh the risks in some people who are at increased risk for stomach cancer because they have certain risk factors (for example, certain potentially pre-cancerous stomach conditions or inherited conditions such as Lynch syndrome or familial adenomatous polyposis [FAP])."
"For example, upper endoscopy might be recommended at regular intervals in these people.
"
"If you have risk factors that might increase your risk of stomach cancer, talk to your doctor about the possible pros and cons of stomach cancer screening for you.
"
Screening isn't usually recommended for people in families with hereditary diffuse gastric cancer (HDGC).
"Instead, doctors often recommend that people who have changes in the CDH1 gene that causes this syndrome consider having their stomach removed (total gastrectomy), because their risk of stomach cancer is very high.
"
"

Stomach cancer (also known as gastric cancer) is usually found when a person goes to the doctor because of signs or symptoms they are having."
"If stomach cancer is suspected, exams and tests will be needed to find out for sure."
"If cancer is found, other tests might then be needed to learn more about it."
"
"
"When taking your medical history , the doctor will ask about your symptoms (such as eating problems, pain, bloating, etc.) and possible risk factors to see if they might suggest stomach cancer or another cause."
The physical exam can give your doctor information about possible signs of stomach cancer or other health problems.
"In particular, the doctor will feel your belly for anything abnormal.
"
"The doctor might order a blood test to look for anemia (a low red blood cell count), which could be caused by the cancer bleeding into the stomach."
"A test might also be done to look for blood in your stool (feces) that can't be seen by the naked eye, which could also be a sign of bleeding in the stomach.
"
"If your doctor thinks you might have stomach cancer or another type of stomach problem, they will likely refer you to a gastroenterologist (a doctor who treats diseases of the digestive tract), who will examine you and might do further testing."
"
Upper endoscopy (also called esophagogastroduodenoscopy or EGD ) is the test most often done if the doctor thinks you might have stomach cancer.
"
"During this test, the doctor passes an endoscope, which is a thin, flexible, lighted tube with a small video camera on the end, down your throat."
"This lets the doctor see the inner lining of your esophagus, stomach, and first part of the small intestine."
"If abnormal areas are seen, biopsy samples can be removed using instruments passed through the endoscope."
"The tissue samples are sent to a lab, where they are looked at with a microscope to see if they contain cancer.
"
"Unfortunately, some types of stomach cancers can be hard to see during an endoscopy.
"
"Endoscopy can also be used as part of a special imaging test known as endoscopic ultrasound, which is described below.
"
"In some situations, endoscopy can be used to help remove very early stage cancers."
"It can also be used to help prevent or relieve symptoms or other complications from stomach cancer, without the need for more extensive surgery."
"(See Surgery for Stomach Cancer .)
"
You will most likely be given medicine to make you sleepy (sedation) before the endoscopy.
"
Your doctor may suspect cancer if an abnormal-looking area is seen on endoscopy or an imaging test, but the only way to tell for sure if it's cancer is by doing a biopsy ."
"During a biopsy, the doctor removes small pieces (samples) of the abnormal area.
"
Biopsies to check for stomach cancer are most often done during an upper endoscopy.
"If the doctor sees any abnormal areas in the stomach lining during the endoscopy, instruments can be passed down the endoscope to biopsy them.
"
"Some stomach cancers can start deep within the stomach wall, which can make them hard to biopsy with standard endoscopy."
"If the doctor suspects cancer might be deeper in the stomach wall, endoscopic ultrasound (described below) can be used to guide a thin, hollow needle into the wall of the stomach to get a biopsy sample.
"
"Biopsies may also be taken from areas of possible cancer spread, such as nearby lymph nodes or suspicious areas in other parts of the body."
"
Biopsy samples are sent to a lab to be looked at under a microscope."
"The samples are checked to see if they contain cancer, and if they do, what kind it is (for example, intestinal or diffuse adenocarcinoma, carcinoid tumor, gastrointestinal stromal tumor [GIST], or lymphoma).
"
"If stomach cancer is found, more lab tests may be done on the biopsy samples to learn more about the cancer cells. "
"This might affect how the cancer is treated.
"
HER2 testing: The cancer cells may be tested to see if they have too much of a growth-promoting protein called HER2.
Cancers with increased levels of HER2 are called HER2-positive .
"These cancers can be treated with drugs that target the HER2 protein .
"
The biopsy sample is usually tested for HER2 using either immunohistochemistry (IHC) or fluorescent in situ hybridization (FISH).
"Often the IHC test is used first, which gives results on a scale from 0 to 3+.
>"
"If the results are 0 or 1+, the cancer is HER2-negative, so drugs targeting HER2 aren’t likely to be helpful.
"
">If the test comes back 3+, the cancer is HER2-positive, so treatment with drugs targeting HER2 could be an option.
"
">When the result is 2+, the HER2 status of the cancer is not clear, so it needs to be tested with FISH to clarify the result.
"
Testing for other gene or protein changes: The cancer cells may also be tested for other gene or protein changes that might affect treatment.
"For example:
>If the cells have a certain amount of an immune checkpoint protein called
   PD-L1
   , treatment with an
   immune checkpoint inhibitor
   such as pembrolizumab (Keytruda) might be an option.
>"
"If the cells have
   high levels of microsatellite instability (MSI-H)
   or a
   defect in a mismatch repair gene (dMMR)
   , treatment with an immune checkpoint inhibitor might be an option.
"
">If the cells have a
   high tumor mutational burden (TMB-H)
   , meaning they have many gene mutations, treatment with an immune checkpoint inhibitor might be an option.
"
">If the cells have changes in one of the
   NTRK genes
   , certain
   targeted drugs
   might be an option for treatment.
"
"See Testing Biopsy and Cytology Specimens for Cancer to learn more about different types of biopsies and tests, how they are used to diagnose cancer, and what the results can tell you."
"
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body."
"Imaging tests may be done for a number of reasons, including:
>To help find out if a suspicious area might be cancer
>To learn how far cancer may have spread
>To help determine if treatment has been effective"
"
"
"This is an x-ray test to look at the inner lining of the esophagus, stomach, and first part of the small intestine."
"This test is used less often than upper endoscopy to look for stomach cancer or other stomach problems, as it can miss some abnormal areas, and it doesn't allow the doctor to take biopsy samples."
"But it is less invasive than endoscopy, and it might be useful in some situations.
"
"For this test, you drink a white chalky solution containing a substance called barium ."
"The barium coats the inner lining of the esophagus, stomach, and small intestine."
(Air might be pumped into the stomach through a thin tube at this time as well.)
Several x-ray pictures are then taken.
"Because x-rays can’t pass through the coating of barium, this outline any abnormal areas in the lining of these organs."
"
A CT scan uses x-rays to make detailed, cross-sectional images of the soft tissues in the body.
"
CT scans can show the stomach fairly clearly and often can confirm the location of a cancer.
"CT scans can also show other parts of the body to which stomach cancer might have spread, such as the liver and nearby lymph nodes."
"This can help determine the extent (stage) of the cancer and if surgery may be a good treatment option.
"
CT-guided needle biopsy:
CT scans can also be used to guide a biopsy needle into a suspected area of cancer spread.
"For this test, you will lie on the CT scanning table while the doctor moves a biopsy needle through the skin toward the mass."
CT scans are repeated until the needle is within the mass.
A biopsy sample is then removed and sent to a lab for testing.
"
Endoscopic ultrasound (EUS) is often used to see how far a cancer might have spread into the wall of the stomach, or into nearby areas or nearby lymph nodes.
"
"For this test, a small ultrasound probe is placed on the tip of an endoscope."
"While you are sedated, the endoscope is passed down your throat and into the stomach."
The probe is put up against the wall of the stomach where the cancer is.
"It gives off sound waves and detects the echoes as they bounce back, which are then converted into images."
"Doctors can use these images to look at the layers of the stomach wall, as well as the nearby lymph nodes and other structures just outside the stomach.
"
EUS can also be used to help guide a needle into a suspicious area to get a biopsy sample (known as an EUS-guided needle biopsy ).
"
A PET scan can be useful to help determine the extent of the cancer in the body."
"For this test, you are injected with a slightly radioactive form of sugar, which collects mainly in cancer cells."
A special camera is then used to create a picture of areas of radioactivity in the body.
"The picture is not detailed like a CT or MRI scan, but a PET scan can look for possible areas of cancer spread in all areas of the body at once.
"
Many newer machines can do both a PET and CT scan at the same time (PET/CT scan).
"This lets the doctor see areas that “light up” on the PET scan in more detail.
"
"Although PET scans can be useful for finding areas of cancer spread, they aren’t always helpful in certain kinds of stomach cancer because some types don’t take up much of the radioactive sugar."
"
Like a CT scan, an MRI can show detailed images of soft tissues in the body."
"But MRIs use radio waves and strong magnets instead of x-rays.
"
"This test is not used as often as CT scans to look for stomach cancer, but it may be helpful in certain situations, such as when looking for tumors in the liver."
"
This test can help show if the cancer has spread to the lungs."
"It might also be used to help determine if a person has any serious lung or heart diseases, which might affect whether surgery would be a treatment option."
"A chest x-ray isn’t needed if a CT scan of the chest has been done.
"
You can read more about imaging tests in Imaging (Radiology) Tests for Cancer.
"
"
"If stomach cancer has already been found, and imaging tests such as CT or PET scans have not shown it has spread to other parts of the body, doctors might do a laparoscopy before any other surgery ."
"This can help confirm the cancer is still only in the stomach, which means surgery to remove it might still be an option.
"
This procedure is done in an operating room while you are under general anesthesia (in a deep sleep).
"A laparoscope (a thin, flexible tube with a small video camera on the end) is inserted through a small cut in the belly."
"This lets the doctor look closely at the surfaces of the organs and nearby lymph nodes inside the abdomen, or even remove small samples of tissue, which can then be tested for cancer.
"
"If it doesn’t look like the cancer has spread, sometimes the doctor will “wash” the abdomen with saline (saltwater)."
This is called peritoneal washing .
"The fluid is then collected and checked for cancer cells.
"
Sometimes laparoscopy is combined with ultrasound to give a better picture of the cancer.
"If cancer is found, the doctor might recommend certain lab tests, especially if surgery might be an option."
"For instance, blood tests will be done to make sure your liver and kidneys are working normally and that your blood clots normally.
"
"If surgery is planned or you are going to get medicines that can affect the heart, you may also have an electrocardiogram (EKG) and/or an echocardiogram (an ultrasound of the heart) to make sure your heart is functioning well.
"
"

Early-stage stomach cancer (gastric cancer) rarely causes symptoms."
"In countries where screening for stomach cancer is not routine, such as the United States, most stomach cancers aren’t found until they’ve grown fairly large or have spread outside the stomach.
"
"When stomach cancer does cause signs and symptoms, they can include:
>Poor appetite
>Weight loss (without trying)
>Abdominal (belly) pain
>Vague discomfort in the abdomen, usually above the navel
>Feeling full after eating only a small meal
>Heartburn or indigestion
>Nausea
>Vomiting, with or without blood
>Swelling or fluid build-up in the abdomen
>Blood in the stool
>Feeling tired or weak, as a result of having too few red blood cells (anemia)
>"
"Yellowing of the skin and eyes (jaundice), if the cancer spreads to the liver
Most of these symptoms are more likely to be caused by things other than stomach cancer, such as a viral infection or an ulcer."
Some of these symptoms may also be caused by other types of cancer.
"But people who have any of these problems, especially if they don’t go away or get worse, should see a doctor so the cause can be found and treated, if needed.
"
"

After someone is diagnosed with stomach cancer (gastric cancer), doctors will do exams and tests to help determine if it has spread, and if so, how far."
This process is called staging .
The stage of a cancer describes the extent of the cancer in the body.
It helps determine how serious the cancer is and how best to treat it.
"Doctors also use a cancer's stage when talking about survival statistics.
"
"Although each person's cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way."
"
The staging system most often used for stomach cancer is the American Joint Committee on Cancer (AJCC) TNM system, which was last updated in 2018.
"
This system is used to stage all stomach cancers (carcinomas) except those starting in the gastroesophageal junction (where the stomach and the esophagus meet) or those that start in the cardia (the first part of the stomach) and are growing into the gastroesophageal junction.
Those cancers are staged (and often treated) like cancers of the esophagus .
"Other types of cancer that can start in the stomach, such as gastrointestinal stromal tumors (GISTs) and lymphomas , are staged differently as well.
"
"The TNM system for stomach cancer is based on 3 key pieces of information:
"
"The T category describes the extent of the main (primary) tumor , including how far it has grown into the layers of the stomach wall and if it has reached nearby structures or organs.


"
"The 5 layers of the stomach wall include:
>Mucosa:
   the innermost layer, where nearly all stomach cancers start."
"The mucosa has 3 parts: epithelial cells, a layer of connective tissue (the
   lamina propria
   ), and a thin layer of muscle (the
   muscularis mucosa
   ).
"
">Submucosa:
   a supporting layer under the mucosa
>Muscularis propria:
   a thick layer of muscle that moves and mixes the stomach contents
>Subserosa
>Serosa:
   the outer, wrapping layer of the stomach
The N category describes any cancer spread to nearby lymph nodes .
"
"The M category describes any spread ( metastasis ) to distant parts of the body, such as the liver or lungs.
Numbers or letters after T, N, and M provide more details about each of these factors."
Higher numbers mean the cancer is more advanced.
"
Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage."
The earliest stage stomach cancers are called stage 0
"(carcinoma in situ), and then range from stages I (1) through IV (4)."
"The lower the number, the less the cancer has spread."
See the table below for more details about the stage grouping for stomach cancer.
"
Stomach cancer might be staged at different times during the course of a person’s treatment.
"
"Usually, the cancer is first given a clinical stage ."
"This is based on the results of any physical exams, biopsies, imaging tests, and procedures (such as upper endoscopy or laparoscopy) that have been done."
(These exams and tests are described in Tests for Stomach Cancer .)
"The clinical stage can be used to help plan treatment.
"
"If surgery is done to remove the cancer, the pathological stage (also called the surgical stage ) can be determined."
"This is based on the results of any exams or tests that have been done, as well as the results from the surgery."
"Sometimes the pathological stage is different from the clinical stage—for example, if surgery finds the cancer has spread farther than could be seen on imaging tests.
"
"Some people might get other treatments before surgery, such as chemotherapy or radiation, to try to shrink the cancer and make the surgery easier."
This is known as neoadjuvant treatment .
"Staging might be done again after this treatment to assess how well it worked.
"
"The table below, describing the TNM stage grouping in more detail, is based on the pathological stage of the cancer."
"If your cancer has been clinically staged or if you have had neoadjuvant therapy, it's best to talk to your doctor about the specific stage for your situation.
"
"AJCC Stage
Stage grouping
Stage description*
0

Tis
N0
M0
There is high grade dysplasia (very abnormal looking cells) in the stomach lining, OR there are cancer cells only in the top layer of cells of the mucosa (innermost layer of the stomach) that have not grown into deeper layers of tissue such as the lamina propria (Tis).
"
"The cancer has not spread to nearby lymph nodes (N0) or distant parts of the body (M0).
"
"This stage is also known as carcinoma in situ .
"
"IA

T1
N0
M0
The main tumor has grown from the top layer of cells of the mucosa into the next layers below such as the lamina propria, the muscularis mucosa, or submucosa (T1).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"IB


T1
N1
M0
The main tumor has grown from the top layer of cells of the mucosa into the next layers below such as the lamina propria, the muscularis mucosa, or submucosa (T1), AND the cancer has spread to 1 to 2 nearby lymph nodes (N1).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T2
N0
M0
The main tumor is growing into the muscularis propria layer (T2).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

"
"IIA
T1
N2
M0
The main tumor has grown from the top layer of cells of the mucosa into the next layers below such as the lamina propria, the muscularis mucosa, or submucosa (T1), AND the cancer has spread to 3 to 6 nearby lymph nodes (N2).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T2
N1
M0
The main tumor is growing into the muscularis propria layer (T2), AND the cancer has spread to 1 to 2 nearby lymph nodes (N1).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T3
N0
M0
The main tumor is growing into the subserosa layer (T3).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"IIB

T1
N3a
M0
The main tumor has grown from the top layer of cells of the mucosa into the next layers below such as the lamina propria, the muscularis mucosa, or submucosa (T1), AND the cancer has spread to 7 to 15 nearby lymph nodes (N3a).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T2
N2
M0
The main tumor is growing into the muscularis propria layer (T2), AND the cancer has spread to 3 to 6 nearby lymph nodes (N2).
"
"The cancer has not spread to distant parts of the body (M0).


"
"T3
N1
M0
The main tumor is growing into the subserosa layer (T3), AND the cancer has spread to 1 to 2 nearby lymph nodes (N1).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T4a
N0
M0
The main tumor has grown through the stomach wall into the serosa, but it hasn’t grown into any of the nearby organs or structures (T4a).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"IIIA

T2
N3a
M0
The main tumor is growing into the muscularis propria layer (T2), AND the cancer has spread to 7 to 15 nearby lymph nodes (N3a).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T3
N2
M0
The main tumor is growing into the subserosa layer (T3), AND the cancer has spread to 3 to 6 nearby lymph nodes (N2).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T4a
N1
M0
The main tumor has grown through the stomach wall into the serosa, but it has not grown into any of the nearby organs or structures (T4a). "
"The cancer has spread to 1 to 2 nearby lymph nodes (N1).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T4a
N2
M0
The main tumor has grown through the stomach wall into the serosa, but it has not grown into any of the nearby organs or structures (T4a)."
"The cancer has spread to 3 to 6 nearby lymph nodes (N1).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T4b
N0
M0
The main tumor has grown through the stomach wall and into nearby organs or structures (T4b).
"
"The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
"
"IIIB

T1
N3b
M0
The main tumor has grown from the top layer of cells of the mucosa into the next layers below such as the lamina propria, the muscularis mucosa, or submucosa (T1), AND the cancer has spread to 16 or more nearby lymph nodes (N3b).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T2
N3b
M0
The main tumor is growing into the muscularis propria layer (T2), AND the cancer has spread to 16 or more nearby lymph nodes (N3b).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T3
N3a
M0
The main tumor is growing into the subserosa layer (T3), AND the cancer has spread to 7 to 15 nearby lymph nodes (N3a).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T4a
N3a
M0
The main tumor has grown through the stomach wall into the serosa, but it has not grown into any of the nearby organs or structures (T4a), AND the cancer has spread to 7 to 15 nearby lymph nodes (N3a).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T4b
N1
M0
The main tumor has grown through the stomach wall and into nearby organs or structures (T4b)."
"The cancer has spread to 1 to 2 nearby lymph nodes (N1).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T4b
N2
M0
The main tumor has grown through the stomach wall and into nearby organs or structures (T4b)."
"The cancer has spread to 3 to 6 nearby lymph nodes (N1).
"
"The cancer has not spread to distant parts of the body (M0).
"
"IIIC
T3
N3b
M0
The main tumor is growing into the subserosa layer (T3), AND the cancer has spread to 16 or more nearby lymph nodes (N3b).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T4a
N3b
M0
The main tumor has grown through the stomach wall into the serosa, but it has not grown into any of the nearby organs or structures (T4a), AND the cancer has spread to 16 or more nearby lymph nodes (N3b).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T4b
N3a
M0
The main tumor has grown through the stomach wall and into nearby organs or structures (T4b), AND the cancer has spread to 7 to 15 nearby lymph nodes (N3a).
"
"The cancer has not spread to distant parts of the body (M0).
"
"OR
T4b
N3b
M0
The main tumor has grown through the stomach wall and into nearby organs or structures (T4b), AND the cancer has spread to 16 or more nearby lymph nodes (N3b).
"
"The cancer has not spread to distant parts of the body (M0).
"
"IV
Any T
Any N
M1
"
"The cancer might or might not have grown into any of the layers of the stomach wall (Any T), and it might or might not have spread to nearby lymph nodes (Any N).
"
"The cancer has spread to distant organs such as the liver, lungs, brain, or the peritoneum (the lining of the space around the digestive organs) (M1).
"
"*The following additional categories are not listed in the table above:
>TX:
   "
"Main tumor cannot be assessed due to lack of information.
"
">T0:
   "
"No evidence of a primary tumor.
"
">NX:
   Regional lymph nodes cannot be assessed due to lack of information.
"
"Stomach cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.
"
"For more general information on how cancer is staged, see Cancer Staging .
"
"

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed."
"They can’t tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
"
"Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they can’t predict what will happen in any particular person’s case."
These statistics can be confusing and may lead you to have more questions.
Ask your doctor how these numbers might apply to you.
"
A relative survival rate compares people with the same type and stage of cancer to people in the overall population."
"For example, if the 5-year relative survival rate for a specific stage of stomach cancer is 70%, it means that people who have that cancer are, on average, about 70% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed."
"
The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results (SEER) database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer.
"
"The SEER database tracks 5-year relative survival rates for stomach cancer (also known as gastric cancer) in the United States, based on how far the cancer has spread."
"The SEER database, however, does not group cancers by AJCC TNM stages (stage 1, stage 2, stage 3, etc.)."
"Instead, it groups cancers into localized, regional, and distant stages:
>Localized:
   There is no sign that the cancer has spread outside of the stomach.
"
">Regional:
   "
"The cancer has spread outside the stomach to nearby structures or lymph nodes.
"
">Distant:
   "
"The cancer has spread to distant parts of the body, such as the liver."
"
These numbers are based on people diagnosed with cancers of the stomach between 2012 and 2018.
"
"SEER* stage
5-year relative survival rate
Localized
72%
Regional
33%
Distant
6%
All SEER stages combined
33%
*SEER = Surveillance, Epidemiology, and End Results"
"
>These numbers apply only to the stage of the cancer when it is first diagnosed.
   "
"They do not apply later on if the cancer grows, spreads, or comes back after treatment.
"
">These numbers don’t take everything into account.
   "
"Survival rates are grouped based on how far the cancer has spread, but your age and overall health, how well the cancer responds to treatment, and other factors can also affect your outlook.
"
">People now being diagnosed with stomach cancer may have a better outlook than these numbers show.
   "
"Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least five years earlier.
"
"

It’s important to have honest, open discussions with your cancer care team."
"Feel free to ask any question, no matter how small it might seem."
Here are some questions you might want to ask.
"
>What
   kind of stomach cancer
   do I have?
"
">Where is the cancer in my stomach?
>What is the
   stage of my cancer
   , and what does that mean in my case?
>Are there other
   tests
   that need to be done before we can decide on treatment?
"
">Will I need to see any other types of doctors?
>How much experience do you have treating this type of cancer?
>Based on what you’ve learned about my cancer, what is my prognosis (outlook)?"
"
>What
   treatment choices
   do I have?
"
">What do you recommend and why?
"
">What is the goal of treatment (to cure the cancer, slow its growth, ease symptoms, etc.)?
"
">Are there any
   clinical trials
   I should think about now?
"
>
"Should I get a
   second opinion
   ?"
How do I do that?
"Can you recommend a doctor or cancer center?
>How quickly do we need to decide on treatment?
"
">What should I do to be ready for treatment?
>How long will treatment last?"
What will it involve?
"Where will it be done?
>What risks or side effects are there to the treatments you suggest?"
"How long are they likely to last?
>How will treatment affect my daily life?"
Will it affect the way I eat?
"
Once treatment begins, you’ll need to know what to expect and what to look for."
"Not all of these questions may apply to you, but getting answers to the ones that do may be helpful.
"
">How will we know if the treatment is working?
>Is there anything I can do to help manage side effects?
>"
"What symptoms or side effects should I tell you about right away?
>How can I reach you or someone on your team on nights, weekends, or holidays?
"
">Do I need to change what I eat during treatment?
>Are there any limits on what I can do?
"
>
Should I exercise?
"What should I do, and how often?
"
">Do you know of any local or online support groups where I can talk to others who have been through this?
"
">Can you suggest a mental health professional I can see if I start to feel overwhelmed, depressed, or distressed?"
"
>Are there any limits on what I can do?
>"
"What symptoms should I watch for?
"
">Should I exercise or follow a special diet?
>What type of
   follow-up
   will I need after treatment?
"
>How will we know if the cancer has come back?
"What should I watch for?
"
"What will my options be if the treatment doesn't work or if the cancer comes back?
>Where can I find more information and support?
"
"Along with these sample questions, be sure to write down some of your own.
"
Keep in mind that doctors aren’t the only ones who can give you information.
"Other health care professionals, such as nurses and social workers, can answer some of your questions."
"To find more about speaking with your health care team, see The Doctor-Patient Relationship .
"
"
"
"
Cancer can start any place in the body."
Stomach cancer (also called gastric cancer ) starts in the stomach.
It starts when cells in the stomach grow out of control and crowd out normal cells.
"This makes it hard for the body to work the way it should.
"
Cancer cells can spread to other parts of the body.
"For example, cancer cells in the stomach can sometimes travel to the liver and grow there."
"When cancer cells do this, it’s called metastasis ."
"To doctors, the cancer cells in the new place look just like the ones from the stomach.
"
Cancer is always named based on the place where it starts.
"So when stomach cancer spreads to the liver (or any other part of the body), it’s still called stomach cancer."
"It’s not called liver cancer unless it starts from cells in the liver.


"
Ask your doctor to show you where your cancer is .
"
There are many types of stomach cancer ."
Some are very rare.
Most stomach cancers are adenocarcinomas.
These cancers start from gland cells that line the inside of the stomach.
"If you are told you have stomach cancer (or gastric cancer), it will almost always be an adenocarcinoma."
"
>Why do you think I have stomach cancer?
>Is there a chance I don’t have stomach cancer?
>"
"What type of stomach cancer do I have?
"
>What will happen next?
"
Symptoms of stomach cancer can include:
>Belly pain
>Heartburn
>Not feeling hungry, or losing weight without trying
>Feeling full after only a small meal
>Feeling sick to your stomach or vomiting
If you have symptoms that might be from stomach cancer, your doctor will ask you questions about them and do a physical exam."
"You might also be referred to a gastroenterologist (a doctor who treats diseases of the digestive system), who might do more exams and tests."
"
Here are some of the exams and tests you may need:
Tests to look for bleeding: The doctor might order a blood test to check for a low red blood cell count, which could be caused by the cancer bleeding into the stomach."
"A test might also be done to look for blood in your stool (feces) that can't be seen by the naked eye, which could also be a sign of bleeding in the stomach.
"
Upper endoscopy or EGD:
This is the test most often done if you might have stomach cancer.
"For this test, a bendable, thin tube with a tiny light and video camera on the end is put in your mouth and passed down into your throat and stomach."
"If there are any spots that look like cancer, small pieces of them can be taken out (biopsied) through the tube and checked for cancer cells.
"
Endoscopic ultrasound (EUS): This test can be done during an upper endoscopy.
A small probe is placed on the tip of the thin tube that is passed down the throat into the stomach.
It uses sound waves and their echoes to make pictures of the layers of the stomach wall.
"It can also be used to take out small pieces of abnormal areas that can be checked for cancer.
"
"Upper GI series: This test is a series of x-rays taken after you swallow barium, a thick, chalky liquid that shows up on x-rays."
"This can show problems in the inner lining of the throat, stomach, and part of the small intestine.
"
CT or CAT scan:
This test uses x-rays to make detailed pictures of your insides.
"This can show the size of the cancer and if it has spread.
"
MRI scan: This test uses radio waves and strong magnets to make detailed pictures.
"It can show more about the size of the cancer and its spread.
"
PET scan: This test uses a special kind of sugar that can be seen inside your body with a special camera.
"If there is cancer, this sugar shows up as “hot spots” where the cancer is found."
"This test can help show if the cancer has spread.
"
"Laparoscopy: If stomach cancer has been found, this exam might be done to see if surgery could be a treatment option."
"A thin, bendable tube with a small video camera on the end is put into the belly through a small cut."
"This lets the doctor look for the growth or spread of cancer inside the belly.
"
Lab tests: Lab tests might be done to check your blood.
"They can offer details about your health status, or about the cancer itself."
They can be used to find problems and guide treatment.
"
In a biopsy, the doctor takes out small pieces of abnormal areas that might be cancer."
These are checked for cancer cells.
A biopsy is the only way to tell for sure if you have cancer.
"For stomach cancer, a biopsy is most often done during an upper endoscopy."
"
>What tests will I need?
>"
"Who will do these tests?
>Where will they be done?
"
>
"Who can explain them to me?
>"
"How and when will I get the results?
>Who will explain the results to me?
>What do I need to do next?"
"
If you have stomach cancer, the doctor will want to find out how far it has spread to help decide what type of treatment is best for you."
This is called the stage of the cancer.
"The tests above are used to help stage the cancer.
"
The stage describes the growth or spread of the cancer in the stomach or into nearby areas.
"It also tells if the cancer has spread to other parts of the body that are farther away.
"
"Your cancer can be stage 1, 2, 3, or 4."
"The lower the number, the less the cancer has spread."
A higher number means the cancer has spread more.
Be sure to ask the doctor about the cancer stage and what it means for you.
"
>Do you know the stage of the cancer?
>If not, how and when will you find out the stage?
"
">Would you explain what the stage means in my case?
>How might the stage of the cancer affect my treatment?
>What will happen next?"
"
There are many ways to treat stomach cancer , but the main types of treatment are:
>Surgery
>Chemotherapy (chemo)
>Radiation treatments
>Targeted drugs
>Immunotherapy
Often more than one treatment is used.
"
"The treatment plan that’s best for you will depend on:
>Where the cancer is in the stomach
>If the cancer has spread outside the stomach
>The chance that a type of treatment will cure the cancer or help in some way
>Your age and overall health
>Your feelings about the treatment and the side effects that come with it"
"
Surgery is often part of the treatment for stomach cancer if it can be done."
There are different kinds of surgery.
The type that’s best for you depends on how big the cancer is and where it is in the stomach.
Surgery might be done for different reasons.
"If the cancer is small enough, it might be done to try to remove all of it."
"If the cancer can’t be removed, surgery might be done to help prevent or relieve symptoms."
Ask your doctor what kind of surgery you will have and what to expect.
"
Any type of surgery can have risks and side effects, such as bleeding or infections."
"If part or all of your stomach is removed, it can affect the way you eat."
Be sure to ask the doctor what you can expect.
"If you have problems, let your doctors know."
Doctors who treat people with stomach cancer should be able to help you with any problems that come up.
"
Chemo is the short word for chemotherapy – the use of drugs to fight cancer."
The drugs may be given into a vein or taken as pills.
These drugs go into the blood and spread through the body.
Chemo is given in cycles or rounds.
Each round of treatment is followed by a break.
"Most of the time, 2 or more chemo drugs are given."
Treatment often lasts for many months.
Chemo can be given before or after surgery.
It can also be given together with radiation.
Ask your doctor what to expect.
"
Chemo can make you feel very tired or sick to your stomach."
"You might have diarrhea or mouth sores, and your hair might fall out."
"But these problems often go away after treatment ends.
"
There are ways to treat most chemo side effects.
"If you have side effects, be sure to talk to your cancer care team so they can help."
"
Radiation uses high-energy rays (like x-rays) to kill cancer cells."
It is aimed at the cancer from a machine outside the body.
"Radiation might be used along with chemo (before or after surgery), or it might be used by itself."
"
Side effects depend on where the radiation is aimed."
"The most common side effects of radiation are:
>Skin changes where the radiation is given
>Feeling very tired
>Nausea and vomiting
>Diarrhea
Most side effects get better after treatment ends."
Some might last longer.
Talk to your cancer care team about what you can expect.
"
Targeted drugs are newer treatments that may be used for some types of stomach cancer."
These drugs affect mainly cancer cells and not normal cells in the body.
They may work even if other treatments don’t.
"These drugs have different side effects from chemo, so talk to your cancer care team about what to expect."
"
Immunotherapy is treatment that boosts the body's immune system to help fight the cancer."
The type of immunotherapy used to treat stomach cancer is given into a vein (IV).
"
The side effects of these drugs tend to be mild, but rarely they can cause the immune system to attack normal cells in the body, which can lead to serious problems."
Talk to your cancer care team so you know what to expect and when you might need to contact them.
"
Clinical trials are research studies that test new drugs or other treatments in people."
"They compare standard treatments with others that may be better.
"
Clinical trials are one way to get the newest cancer treatments.
They are the best way for doctors to find better ways to treat cancer.
"Still, they’re not right for everyone."
"And it’s up to you whether to take part in a clinical trial.
"
"If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials."
See Clinical Trials to learn more.
"
You might hear about other ways to treat the cancer or to treat your symptoms."
These may not always be standard medical treatments.
"These treatments may be vitamins, herbs, special diets, and other things.
"
"Some of these are known to help, but many have not been tested."
Some have been shown not to help.
A few have even been found to be harmful.
"Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else."
"
>What treatment do you think is best for me?
>What’s the goal of this treatment?"
"How likely is it to cure the cancer?
>Will treatment include surgery?"
"If so, who will do the surgery?
>What will the surgery be like?
"
">Will I need other types of treatment, too?
>"
"What’s the goal of these treatments?
>What side effects could I have from these treatments?
>What can I do about side effects that I might have?
"
">Is there a clinical trial that might be right for me?
>"
What about special vitamins or diets that friends tell me about?
"How will I know if they are safe?
>How soon do I need to start treatment?
"
">What should I do to be ready for treatment?
"
">Is there anything I can do to help the treatment work better?
>"
What’s the next step?
"
If you've completed treatment, you’ll be glad when it's over."
But it can be hard not to worry about cancer coming back.
"Even when cancer never comes back, people still worry about it.
"
"For years after treatment ends, it will still be important to see your cancer doctors."
Follow-up is needed to watch for treatment side effects and to check for cancer that has come back or spread.
Be sure to go to all of your follow-up visits.
"During these visits, they will ask about symptoms and examine you."
"If you're having symptoms, you might need to get lab tests, imaging tests, or an endoscopy.
"
"At first, follow-up visits may be every few months."
"Over time, the visits might be needed less often."
"Your cancer care team can tell you more about these visits, when you might need to contact them if problems come up, and what else to expect after treatment.
"
"

Treatment of stomach cancer (also known as gastric cancer) depends largely on where the cancer is in the stomach and how far it has spread."
"But other factors, such as a person’s age, overall health, and preferences, can be important as well.
"
Stomach cancer typically starts in the inner lining of the stomach.
"From there, it can grow and spread in different ways."
It can grow through the wall of the stomach and into nearby organs.
It might also spread to the nearby lymph nodes (bean-sized structures that help fight infections).
"As the cancer becomes more advanced, it can travel through the bloodstream or lymph system and spread (metastasize) to organs such as the liver, lungs, and bones, which can make it harder to treat.
"
"Surgery to remove the cancer is typically part of treatment if it can be done, as it offers the best chance for long-term survival."
But surgery might not be a good option if the cancer has spread widely or if a person isn’t healthy enough for it.
"Other treatments such as chemotherapy and radiation therapy are often part of treatment as well, either along with or instead of surgery."
"Newer treatments such as targeted drugs and immunotherapy might be helpful in some situations as well.
"
"Because most people will get different types of treatment for their cancer, it’s important that a team of doctors review and discuss the best options for treatment."
"Stomach cancer isn’t common in the United States, and it can be challenging to treat, so it’s important that your cancer care team is experienced in treating stomach cancer.
"
"While the AJCC TNM stage of the cancer can be important when deciding on treatment, doctors often divide stomach cancers into larger groups when determining the best treatment options."
"These include:
>Very early stage cancers.
   "
These cancers have not grown deeply into the wall of the stomach or spread outside the stomach.
"These cancers make up only a small portion of stomach cancers in the United States.
"
">Potentially resectable cancers.
   "
These cancers have grown deeper into the stomach wall and may have grown into nearby areas or lymph nodes.
"But these cancers aren’t thought to have spread to distant parts of the body, so surgery might still be an option to try to remove (resect) them completely.
"
">Unresectable local or regional cancers.
   "
These cancers have also grown deeper into the stomach wall and may have grown into nearby areas or lymph nodes.
"While the cancer hasn’t yet spread to distant parts of the body, it's unlikely it can all be removed with surgery."
"For example, the cancer might be too close to vital areas, or the person might not be healthy enough for major surgery.
"
">Metastatic cancers.
   "
These cancers have spread to distant parts of the body.
"
"
"These cancers are still only in the inner lining layer of the stomach and have not grown into deeper layers of the stomach wall.
"
"Very early stage cancers can typically be treated by surgery, with either subtotal gastrectomy (removal of part of the stomach) or total gastrectomy (removal of the entire stomach)."
"Nearby lymph nodes are removed as well.
"
Some small stage 0 cancers can be treated by endoscopic resection .
In this procedure the cancer and some layers of the stomach wall are removed through an endoscope passed down the throat.
"This procedure is done more often in countries like Japan, where stomach cancer is often detected early during screening."
"It is rare to find stomach cancer so early in the United States, so this treatment has not been used as often here."
"If it is done, it should be at a cancer center that has experience with this technique.
"
"If the results of surgery (or endoscopic resection) show that all of the cancer has been removed, the person can usually be followed closely, without needing any further treatment."
"If it’s not clear that all of the cancer has been removed, chemotherapy and radiation are likely to be recommended."
Another option might be a more extensive surgery to remove the cancer.
"
"
"These cancers have grown deeper into the stomach wall and may have grown into nearby areas, but there are no signs they have spread to other parts of the body, so surgery might be an option to remove (resect) them.
"
"It’s very important that all of the needed tests are done to stage these cancers accurately before surgery is attempted, so the doctors know the true extent of the cancer in the body."
"Trying to remove the cancer isn’t likely to be helpful if it has spread too far, and surgery can have serious side effects, so accurately staging these cancers helps ensure the potential benefits of surgery outweigh the potential downsides."
"Along with imaging tests like CT and PET scans, other tests such as endoscopic ultrasound (EUS) or staging laparoscopy might be done before trying to remove the cancer."
"(See Tests for Stomach Cancer for more on these tests.)
"
"Depending on the location and extent of the cancer, some people might get surgery as their first treatment, with either subtotal gastrectomy (removal of part of the stomach) or total gastrectomy (removal of the entire stomach)."
Nearby lymph nodes (and possibly parts of nearby organs) are removed as well.
"Other people might get chemotherapy alone or chemo plus radiation therapy (known as chemoradiation) first to try to shrink the cancer and make the surgery easier.
"
"After surgery, chemo (or chemoradiation, if it wasn’t used before surgery) might be given to try to kill any remaining cancer cells."
"This is especially true if it’s not clear that all of the cancer was removed, or if too few lymph nodes were removed during surgery."
Another option if not all of the cancer was removed might be a more extensive operation.
"
"
"These cancers haven’t spread to distant parts of the body, but they can’t be removed (resected) completely with surgery.
"
"Options for the first line of treatment for these cancers might include chemotherapy alone, chemo plus immunotherapy, chemo plus immunotherapy plus the targeted drug trastuzumab (if the cancer tests positive for HER2 and for the PD-L1 protein ), or chemo plus radiation therapy (chemoradiation).
"
The stage (extent) of the cancer is then reassessed after treatment.
It’s very important that doctors know the true extent of the cancer at this point.
"Along with imaging tests like CT and PET scans, other tests such as endoscopic ultrasound (EUS) or staging laparoscopy might be done."
"(See Tests for Stomach Cancer for more on these tests.)
"
">If the cancer has shrunk enough with this treatment, surgery to remove the cancer might be an option at this point."
This might be a subtotal gastrectomy (removal of part of the stomach) or total gastrectomy (removal of the entire stomach).
"Nearby lymph nodes (and possibly parts of nearby organs) are removed as well.
"
">If the cancer is still unresectable after the initial treatment, further treatment is aimed at controlling the cancer growth for as long as possible and preventing or relieving any problems it causes."
"This is similar to the treatment of metastatic cancer (described next).
"
"Sometimes, even when the cancer is potentially resectable, a person might not be healthy enough for major surgery, or they might decide not to have it."
Treatment for these cancers is typically aimed at controlling the cancer growth for as long as possible and preventing or relieving any problems it causes.
This is similar to the treatment of metastatic cancer (described next).
"
"
"These cancers have spread to distant parts of the body, and they are very hard to cure."
"But treatment can often help keep the cancer under control and help prevent or relieve problems it might cause.
"
"Treatment aimed at controlling the growth of the cancer might include chemotherapy alone, chemotherapy plus immunotherapy , or chemotherapy along with radiation therapy if a person is healthy enough."
"For people whose cancers test positive for HER2 , the targeted drug trastuzumab can be added to the chemo, which might help it work better."
"If the cancer cells also test positive for the PD-L1 protein, another option is to add the immunotherapy drug pembrolizumab to the trastuzumab and chemo, as part of the first treatment.
"
"If one type of chemo doesn’t work (or if it stops working), another type of chemo might be tried."
"Other options might include a targeted therapy drug or an immunotherapy drug.
"
"Some types of palliative surgery, such as a gastric bypass (or, less often, a subtotal gastrectomy) might be helpful in some situations to keep the stomach and/or intestines from becoming blocked (obstructed) or to control bleeding.
"
"Endoscopic procedures might also be used to help prevent or relieve symptoms, especially in people who can’t have (or don’t want) surgery."
"For example, a laser beam directed through an endoscope (a long, flexible tube passed down the throat) can destroy parts of the tumor to stop it from blocking the passage of food through the stomach."
"If needed, an endoscope can be used to place a stent (a hollow metal tube) where the esophagus and stomach meet to help keep it open and allow food to pass through."
"This can also be done at the junction of the stomach and the small intestine.
"
"Stomach cancer (and its treatment) can often lead to problems with eating, and getting adequate nutrition is often a concern."
Some people might be helped by the placement of a feeding tube.
"If it is only needed for a short time, a thin tube can be passed down the nose and throat and into the stomach or intestine."
"If a feeding tube is needed for a longer time, a minor surgical procedure can be done to place the tube through the skin of the abdomen and into either the lower part of the stomach (a gastrostomy tube or G tube ) or the small intestine (a jejunostomy tube or J tube )."
"Liquid nutrition can then be put directly into the tube.
"
"Because these cancers can be hard to treat, new treatments being tested in clinical trials may benefit some patients.
"
"Even if treatments do not destroy or shrink the cancer, there are often ways to relieve pain, trouble eating, and other symptoms ."
"It's important to tell your cancer care team about any symptoms you have right away, so they can be managed effectively."
"
Cancer that comes back after initial treatment is known as recurrent cancer ."
"Treatment options for recurrent cancer depend on where the cancer recurs, what treatments a person has already had, and the person’s overall health.
"
"If the cancer comes back only in one area near where the original cancer was, surgery might be an option to try to remove it, if a person is health enough for the operation.
"
"If the cancer recurrence is more widespread or is in a distant part of the body, or if a person isn’t healthy enough for surgery, treatment is similar to that for metastatic cancer (described above), in which the main goals are to control the cancer growth for as long as possible and to prevent or relieve any problems it might cause.
"
"For people who are interested, clinical trials of newer treatments may be an option and could be considered.
"
"

Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein (through an IV line or central venous catheter ) or given by mouth as pills."
"These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has spread to organs beyond where it started."
"
Chemo might be used at different times to help treat stomach cancer:
>Chemo can be given
   before surgery
   for stomach cancer."
"This is known as
   neoadjuvant treatment
   .
   "
"(Sometimes chemo is given along with
   radiation therapy
   , which is known as
   chemoradiation
   .)"
Neoadjuvant treatment can often shrink the tumor and possibly make surgery easier.
It may also help keep the cancer from coming back and help patients live longer.
"For some stages of stomach cancer, neoadjuvant chemo is one of the standard treatment options."
"Often, chemo is then given again after surgery.
"
">Chemo may be given
   after surgery
   has been done to remove the cancer."
"This is called
   adjuvant treatment.
   "
The goal of adjuvant chemo is to kill any areas of cancer that may have been left behind but are too small to see.
This can help keep the cancer from coming back.
"Often, for stomach cancer, chemo is given with radiation therapy after surgery."
"This may be especially helpful for cancers that could not be removed completely by surgery.
"
">Chemo may be given as the primary (main) treatment if the cancer has spread (metastasized) to distant parts of the body, or if it can't be removed for some other reason."
"Chemo may help shrink the cancer or slow its growth, which can relieve symptoms and help people live longer.
"
"Doctors give chemo in cycles, with each period of treatment followed by a rest period to allow the body time to recover."
Each cycle typically lasts for a few weeks.
"
Many different chemo drugs can be used to treat stomach cancer, including:
>5-FU (fluorouracil), often given along with leucovorin (folinic acid)
>Capecitabine
>Carboplatin
>Cisplatin
>Docetaxel
>Epirubicin
>Irinotecan
>Oxaliplatin
>Paclitaxel
>Trifluridine and tipiracil (Lonsurf), a combination drug in pill form
Most often, 2 or 3 of these drugs are combined (sometimes along with a targeted drug as well)."
"But this depends on factors such as  the stage of the cancer , the person’s overall health, and whether chemo is combined with radiation therapy."
"Three-drug combinations can have more side effects, so they are usually reserved for people who are in very good health and who can be followed closely by their doctor.
"
"For earlier stage cancers , some common drug combinations used before and/or after surgery include:
>Oxaliplatin plus 5-FU/leucovorin (FOLFOX), or oxaliplatin plus capecitabine (CAPOX)
>FLOT (5-FU/leucovorin, oxaliplatin, and docetaxel)
>Docetaxel or paclitaxel plus either 5-FU or capecitabine
>Cisplatin plus either 5-FU or capecitabine
>Paclitaxel and carboplatin
When chemo is given with radiation after surgery, a single drug such as 5-FU or capecitabine may be used.
"
"For advanced stomach cancer , many of the same combinations of drugs can be used, although doctors often prefer combinations of 2 drugs rather than 3 to try to reduce side effects."
"Some of the most commonly used combinations include:
>Oxaliplatin plus 5-FU/leucovorin (FOLFOX), or oxaliplatin plus capecitabine (CAPOX)
>Cisplatin plus either 5-FU or capecitabine
>Irinotecan plus 5-FU/leucovorin (FOLFIRI)
>Paclitaxel plus either cisplatin or carboplatin
>Docetaxel plus cisplatin
>Epirubicin, either cisplatin or oxaliplatin, and either 5-FU or capecitabine
>Docetaxel, 5-FU, and either cisplatin, carboplatin, or oxaliplatin
If a person isn’t healthy enough to get a combination of chemo drugs, a single drug, such as 5-FU, capecitabine, docetaxel, or paclitaxel, might be used instead.
"
"If one of these combinations (or a single drug) is no longer helpful, another drug or combination of drugs might be tried."
"
Chemo drugs attack cells in the body that are dividing quickly, which can lead to side effects."
"These depend on the type and dose of drugs, and the length of treatment."
"Side effects from chemo can include:
>Nausea and vomiting
>Loss of appetite
>Hair loss
>Diarrhea or constipation
>Mouth sores
>Increased chance of infection (from a shortage of white blood cells)
>Easy bleeding or bruising (from a shortage of platelets)
>Fatigue and shortness of breath (from a shortage of red blood cells)
"
These side effects usually go away once treatment is finished.
"For example, hair will usually grow back after treatment ends."
Be sure to tell your cancer care team about any side effects you have because there are often ways to help with them.
"For example, you can be given drugs to prevent or reduce nausea and vomiting.
"
Some chemo drugs have specific side effects.
"Your treatment team can help you know which of these you might need to look out for.
"
"Nerve damage (neuropathy): Cisplatin, oxaliplatin, docetaxel, and paclitaxel can damage nerves."
"This can sometimes lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness."
"In most cases this goes away once treatment is stopped, but it may be long-lasting in some people."
"Oxaliplatin can also affect nerves in the throat, causing throat pain that is worse when trying to eat or drink cold liquids or foods.
"
Heart damage: Epirubicin and some other drugs can damage the heart if used for a long time or in high doses.
"For this reason, doctors carefully control the doses and use heart tests such as echocardiograms or MUGA scans to monitor heart function."
"Treatment with these drugs is stopped at the first sign of heart damage.
"
Hand-foot syndrome can occur during treatment with capecitabine or 5-FU (when given as an infusion).
"This starts out as redness in the hands and feet, which can then progress to pain and sensitivity in the palms and soles."
"If it worsens, blistering, calluses, or skin peeling can occur, sometimes leading to painful sores."
"The best way to prevent severe hand-foot syndrome is to tell your doctor if you have early symptoms, such as redness or sensitivity, so that steps can be taken to keep things from getting worse.
"
"Diarrhea is a common side effect with many chemo drugs, but it can be particularly bad with irinotecan."
It needs to be treated right away — at the first sign of loose stools — to prevent severe dehydration.
"If you are getting a chemo drug that is likely to cause diarrhea, your doctor will give you instructions on what drugs to take and how often to take them to control this symptom.
"
Some chemo drugs can cause other side effects.
"Talk with your treatment team about what types of side effects you should watch for.
"
"

Immunotherapy is the use of medicines to help a person's own immune system find and destroy cancer cells more effectively."
"
An important part of the immune system is its ability to prevent itself from attacking normal cells in the body."
"To do this, it uses “checkpoint” proteins on immune cells, which act like switches that need to be turned on (or off) to start an immune response."
"Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system.
Drugs that target these checkpoints (called immune checkpoint inhibitors ) can be used to treat some people with stomach cancer (also known as gastric cancer)."
"
Nivolumab (Opdivo) and pembrolizumab (Keytruda) are drugs that target PD-1, a protein on immune system cells called T cells."
The PD-1 protein normally helps keep T cells from attacking other cells in the body.
"By blocking PD-1, these drugs boost the immune response against cancer cells."
"This can shrink some tumors or slow their growth.
"
"Nivolumab can be used in people with advanced stomach cancer, typically along with chemotherapy .
"
"This drug is given as an intravenous (IV) infusion, usually once every 2 or 3 weeks.
"
"Pembrolizumab can be used as part of the first treatment for people with advanced stomach cancer, either:
>"
"Along with
   chemotherapy
   if the cancer cells
   test negative for HER2
   , or
>Along with chemotherapy and the
   targeted drug
   trastuzumab, if the cancer cells test positive for both HER2 and for the PD-L1 protein
This drug can also be used after other treatments including chemotherapy have been tried, and if the cancer cells test positive for any of the following:
>A
   high level of microsatellite instability (MSI-H)
   or a
   defect in a mismatch repair gene (dMMR)
>A
   high tumor mutational burden (TMB-H)
   , meaning they have many gene mutations
This drug is given as an intravenous (IV) infusion, typically once every 3 or 6 weeks."
"
Side effects of these drugs can include:
>Feeling tired or weak
>Fever
>Cough
>Nausea
>Itching
>Skin rash
>Loss of appetite
>Muscle or joint pain
>Shortness of breath
>Constipation or diarrhea
Other, more serious side effects occur less often."
"These can include:
Infusion reactions: Some people might have an infusion reaction while getting one of these drugs."
"This is like an allergic reaction, and can include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing."
"It’s important to tell your doctor or nurse right away if you have any of these symptoms while getting one of these drugs.
"
Autoimmune reactions: These drugs work by basically removing one of the safeguards on the body’s immune system.
"Sometimes this causes the immune system to attack other parts of the body, which can lead to serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, skin, or other organs.
"
It’s very important to report any new side effects to your health care team right away.
"If serious side effects do occur, treatment may need to be stopped and you may get high doses of corticosteroids to suppress your immune system.
"
"

Radiation therapy uses high-energy rays or particles to kill cancer cells in a specific part of the body."
"
Radiation can be used in different ways to help treat stomach cancer (gastric cancer):
>"
"For some earlier stage cancers, radiation can be used along with
   chemotherapy
   (chemo)
   before surgery
   to try to shrink the cancer and make it easier to remove."
"(This combination is known as
   chemoradiation
   .)
"
">After surgery
   , radiation therapy can be used along with chemo to try to kill any cancer cells that weren't removed during the surgery."
"This may help delay or prevent recurrence of the cancer.
"
">For
   cancers that can't be removed by surgery
   , radiation therapy can sometimes be used to help slow the growth of the cancer and ease symptoms, such as pain, bleeding, or eating problems."
"
"
"When radiation therapy is used to treat stomach cancer, the radiation is focused on the cancer from a machine outside the body."
"Often, special types of radiation therapy, such three-dimensional conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT) are used."
These approaches use computers to aim the radiation at the cancer from several angles (as well as other special techniques).
"This can help focus the radiation on the cancer and limit the damage to nearby normal tissues.
"
"Before your treatments start, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation."
"This planning session, called simulation , usually includes getting imaging tests such as CT or MRI scans.
"
"Radiation therapy is much like getting an x-ray, but the radiation is much stronger."
The treatment itself is painless.
"Each treatment lasts only a few minutes, although the setup time — getting you into place for treatment — usually takes longer."
"Treatments are usually given 5 days a week over at least several weeks, but the length of treatment depends on the reason it’s being given."
"
Side effects from radiation therapy for stomach cancer can include:
>Skin problems, ranging from redness to blistering and peeling, in areas the radiation passed through
>Nausea and vomiting
>Diarrhea
>Fatigue
>Low blood cell counts
These usually go away within a few weeks after the treatment is finished.
"
"When radiation is given with chemotherapy, side effects are often worse.
"
Some people may have problems eating and getting enough fluids during and after treatment.
Some might need to have fluids given into a vein (IV) or have a feeding tube placed to get nutrition during treatment.
"If the tube is only needed for a short time, one can be passed down the nose and throat and into the stomach or intestine."
"If the tube is needed for a longer time, it can be placed through the skin in the abdomen and into the intestine during a surgical procedure ."
This is known as a jejunostomy tube or J-tube .
"Liquid nutrition can then be put directly into the tube.
"
"Be sure to tell your doctor about any side effects you have, because there are often ways to relieve them.
"
Radiation might also damage nearby organs.
"This could lead to problems such as heart or lung damage, or even an increased risk of another cancer later on ."
"Doctors do their best to prevent this by using only the needed dose of radiation, carefully controlling where the beams are aimed, and shielding certain parts of the body from the radiation during treatment.
"
"

As researchers have learned more about the changes in cells that cause cancer, they have developed newer drugs that specifically target these changes."
Targeted drugs work differently from standard chemotherapy (chemo) drugs.
"They sometimes work when standard chemo drugs don’t, and they often have different side effects.
"
"Targeted drugs can sometimes be used to treat stomach cancer (gastric cancer), either alone or along with chemo, depending on the situation."
"
In some people with stomach cancer, the cancer cells have too much of a growth-promoting protein called HER2 on their surface."
Cancers with increased levels of HER2 are called HER2-positive .
Drugs that target the HER2 protein can often be helpful in treating these cancers.
"
Trastuzumab is a monoclonal antibody , a man-made version of an immune system protein, which targets HER2."
"Adding trastuzumab to chemo can help some people with advanced, HER2-positive stomach cancer live longer than just chemo alone.
"
"This drug only works if the cancer cells have too much HER2, so samples of the cancer must be tested for HER2 before starting treatment (see Tests for Stomach Cancer ).
"
Trastuzumab is infused into a vein (through an IV line or central venous catheter ).
"For stomach cancer, it is typically given once every 2 or 3 weeks along with chemo.
"
"Herceptin was the original brand name for trastuzumab, but several similar versions (called biosimilars ) are now available as well, including Ogivri, Herzuma, Ontruzant, Trazimera, and Kanjinti."
"
The side effects of trastuzumab tend to be relatively mild."
"They can include fever and chills, weakness, nausea, vomiting, cough, diarrhea, and headache."
"These side effects occur less often after the first dose.
"
This drug can also rarely cause heart damage .
"The risk is higher if trastuzumab is given with certain chemo drugs called anthracyclines, such as epirubicin."
"Before starting treatment with this drug, your doctor may test your heart function with an echocardiogram or a MUGA scan."
"
"
"This is an antibody-drug conjugate (ADC), which is a monoclonal antibody linked to a chemotherapy drug."
"In this case, the anti-HER2 antibody acts like a homing signal by attaching to the HER2 protein on cancer cells, bringing the chemo directly to them.
"
"This ADC can be used by itself to treat advanced HER2-positive stomach cancer, typically after treatment with trastuzumab has been tried.
"
This drug is infused into a vein (through an IV line or central venous catheter).
"For stomach cancer, it is typically given once every 3 weeks."
"
"
"This drug can cause low blood cell counts, which can increase a person’s risk of infections and bleeding."
"Other common side effects of this drug can include nausea, vomiting, diarrhea or constipation, loss of appetite, fever, feeling tired, and hair loss.
"
"This drug can cause serious lung disease in some people, which might even be life threatening."
"It’s very important to let your doctor or nurse know right away if you’re having symptoms such as coughing, wheezing, trouble breathing, or fever.
"
This drug can also rarely cause heart damage .
"Before starting treatment with this drug, your doctor may test your heart function with an echocardiogram or a MUGA scan."
"
For tumors to grow, they need to make new blood vessels to get blood and nutrients."
One of the proteins that tells cells in the body to make new blood vessels is called VEGF .
The VEGF protein does this by attaching to cell surface proteins called VEGF receptors.
"
Ramucirumab is a monoclonal antibody that binds to a VEGF receptor."
This keeps VEGF from binding to cells and telling them to make more blood vessels.
"This can help slow or stop the growth of some cancers.
"
"Ramucirumab is used to treat advanced stomach cancer, most often after at least one chemo drug (or combination) stops working.
"
"This drug is given as infusion into a vein (IV), typically once every 2 weeks."
It can be given by itself or along with chemo.
"
The most common side effects of this drug are high blood pressure, headache, and diarrhea.
"
"Less common but possibly serious side effects can include blood clots, severe bleeding, holes forming in the stomach or intestines (perforations), and problems with wound healing."
"If a hole forms in the stomach or intestine, it can lead to severe infection and may require surgery to correct."
"
A very small number of stomach cancers have changes in one of the NTRK genes."
"This causes them to make abnormal TRK proteins, which can lead to abnormal cell growth and cancer.
"
Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) are drugs that target the TRK proteins.
"These drugs can be used to treat advanced cancers with NTRK gene changes that are still growing despite other treatments.
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"These drugs are taken as pills, once or twice daily."
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Common side effects of these drugs can include dizziness, fatigue, nausea, vomiting, constipation, weight gain, and diarrhea.
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"Less common but serious side effects can include abnormal liver tests, heart problems, and confusion."
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Other targeted therapy drugs are now being tested against stomach cancer."
"Some of these target the HER2 protein, while others have different targets."
"Some of these drugs are discussed in more detail in What’s New in Stomach Cancer Research?
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