Gastrointestinal oncology

ALSO KNOWN AS: Gastroenterology oncology

DEFINITION: Gastrointestinal oncology is the medical specialty for the diagnosis, treatment, and prevention of polyps, tumors, and cancers affecting the digestive system, including the esophagus, stomach, liver, gallbladder, pancreas, small intestine, colon, rectum, and anus.

Subspecialties:Medical oncology and hematology, radiation oncology, surgical oncology, gastrointestinal cancer research

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Cancers treated: Gastrointestinal carcinoid tumor, gastrointestinal stromal tumor, esophageal cancer and adenocarcinoma, gallbladder cancer, gastric (stomach) cancer, liver cancer, pancreatic cancer, colorectal cancer, anal cancer

Training and certification: The field of gastroenterology oncology has evolved rapidly in the twenty-first century. Gastroenterology oncologists may have a background in gastroenterology or oncology with additional training in malignant digestive system conditions. After receiving a four-year medical degree from an accredited program and board certification from the American Board of Internal Medicine, gastroenterologists specializing in oncology complete a one-year internship, followed by three or more years of postgraduate residency training in tumors and other cancerous conditions affecting the digestive system.

Gastroenterology oncologists are trained in histological examination, endoscopic screening procedures, the biology and pathology of gastrointestinal cancers, gastrointestinal imaging procedures, chemotherapy and adjunctive treatment, radiation oncology, surgical oncology, palliative care, gastrointestinal cancer research, and alternative medicine.

Gastrointestinal clinical practice guidelines, quality care standards, and quality assurance measures in the United States have been established by these organizations:

  • American College of Gastroenterology (ACG). The ACG is a professional organization representing thousands of digestive health specialists worldwide. It publishes clinical practice guidelines on malignant gastrointestinal diseases in the American Journal of Gastroenterology. It provides up-to-date scientific information on digestive health and the etiology, symptomatology, and treatment of gastrointestinal disorders.
  • American Gastroenterological Association (AGA). The AGA is a professional association with more than sixteen thousand members, including physicians and scientists who research, diagnose, and treat gastrointestinal tract and liver disorders. It consists of two nonprofit organizations, the AGA and the AGA Institute. The AGA administers all membership and public policy activities, while the AGA Institute runs the organization’s practice, research, and educational programs, including an annual academic conference and the publication of the journals Gastroenterology, Clinical Gastroenterology and Hepatology, and Cellular and Molecular Gastroenterology and Hepatology.

Services and procedures performed: Gastroenterology oncologists work closely with gastroenterologists, who perform patient risk assessments and endoscopic exams to prevent and detect gastrointestinal cancer. Gastroenterologists also identify hereditary syndromes and perform genetic testing when necessary for high-risk patients. Gastroenterology oncologists diagnose and stage digestive cancers and provide cancer treatment, including surgery, chemotherapy, and radiation therapy.

Related specialties and subspecialties: Gastroenterology oncologists work with a team of cancer healthcare providers whose goals are to provide early detection; accurately diagnose the condition; offer prompt, appropriate state-of-the-art treatment to reduce morbidity and improve and survival; provide psychological guidance through complex treatment phases; reduce long-term effects of chemotherapy and radiation therapy; and provide long-term follow-up.

Multidisciplinary team members include the patient’s gastroenterologist, primary care physician, medical oncologist, oncologist surgeon, diagnostic radiologist, and radiation oncologist. Others involved may include infectious disease specialists, pathologists, oncology nurses, physical therapists, oncology social workers, and other allied healthcare professionals, such as educational specialists, registered dietitians, and pharmacologists.

Gastroenterologists are physicians who specialize in disorders and conditions of the gastrointestinal tract. After completing their general medical education, they train for at least two years to become board-certified in internal medicine. Then, gastroenterologists receive two to three more years of training in conditions of the gastrointestinal tract to become board-certified in gastroenterology.

Medical oncologists are often the main healthcare providers for adults diagnosed with cancer. They determine the appropriate systemic or adjunctive drug regimens to treat the patient’s condition and supervise the dosage, schedule, and administration of cancer drugs to treat localized or metastatic malignancies. Medical oncologists are trained and skilled in chemotherapy drug indications and toxicities so that they can safely administer these therapies while minimizing side effects and appropriately managing complications.

Oncologist surgeons use laparoscopy, thoracoscopy, and other surgical techniques to diagnose and treat cancers. In addition to having a four-year medical degree from an accredited program and board certification from the American Board of Surgery, oncologist surgeons have completed five years of residency training in an accredited general surgery program and at least two years of fellowship training in oncological surgery.

Diagnostic radiologists obtain and interpret medical images to diagnose diseases. In addition to having a four-year medical degree from an accredited program and board certification from the American Board of Radiology or the American Osteopathic Board of Radiology, the radiologist must have passed a licensing examination and completed at least four years of residency training in an accredited radiology program.

Radiation oncologists, sometimes called clinical oncologists, treat cancers using radiation. Most radiation oncologists complete a residency training program in radiation oncology approved by the Accreditation Council for Graduate Medical Education or the American Board of Radiology.

Infectious disease specialists are physicians who are experts in diagnosing and treating infectious diseases. In addition to having a four-year medical degree from an accredited program and board certification from the American Board of Internal Medicine, infectious disease specialists have completed three or more years of residency training and two to three years of additional training in infectious diseases.

Pathologists are physicians who are experts in the pathology of hematologic malignancies and solid tumors. They are skilled in immunochemistry and molecular techniques to assess malignancies. In addition to having a four-year medical degree from an accredited program and board certification from the American Board of Internal Medicine, pathologists have completed three or more years of residency training and one to two years of additional training in pathology.

Oncology nurses administer medications and provide medical care and education for the family and patient. Oncology clinical nurse specialists are registered nurses with a master’s degree in oncology nursing. They prepare and administer medications, including chemotherapy, know treatment protocols, and have experience managing treatment complications. Oncology nurse practitioners are registered nurses with a master’s or doctoral degree. The Oncology Nursing Society facilitates the professional development of oncology nurses.

Bibliography

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Berr, Frieder, et al., eds. Early Neoplasias of the Gastrointestinal Tract: Endoscopic Diagnosis and Therapeutic Decisions. 2nd ed., Springer, 2019.

Blay, J.Y., et al. Gastrointestinal Stromal Tumours. Nature Reviews Disease Primers, vol. 7, no. 22, 2021, doi.org/10.1038/s41572-021-00254-5.

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Goldblum, John R., et al. Enzinger and Weiss's Soft Tissue Tumors. 7th ed. Elsevier, 2020.

Jankowski, Janusz A. Z. Gastrointestinal Oncology: A Critical Multidisciplinary Team Approach. 2nd ed., Wiley Blackwell, 2023.

Otto, Florian, and Manfred P. Lutz, eds. Early Gastrointestinal Cancers. Springer, 2012.

Otto, Florian, and Manfred P. Lutz, eds. Early Gastrointestinal Cancers II: Rectal Cancer. Springer, 2014.

Shepherd, Neil A. et al. Morson and Dawson's Gastrointestinal Pathology. 6th ed. Wiley, 2024.

Yalcin, Suayib, and Philip A. Philip. Textbook of Gastrointestinal Oncology. Springer, 2019.