Understanding Endoscopic Oncology

Endoscopic oncology: uses advanced endoscopic procedures to help prevent, detect, diagnose, stage, treat, and relieve symptoms caused by gastrointestinal cancers. In some situations, these procedures can provide treatment without traditional surgery. In others, they are an important part of a broader treatment plan involving oncology, surgery, radiology, pathology, and other specialists.

This website is designed to help you understand your options, prepare for conversations with your healthcare team, and feel more informed throughout your care.

What Is an Endoscopy?

An endoscope is a thin, flexible tube with a camera and light that allows a physician to examine areas inside the digestive system.

Depending on the procedure, an endoscope may be used to look at the:

• Esophagus

• Stomach

• Small intestine

• Colon and rectum

• Pancreas

• Bile ducts

• Nearby lymph nodes and structures

During some procedures, your physician can also take biopsies, remove abnormal tissue, treat bleeding, open blocked areas, or perform other treatments.

How Can Endoscopy Help With Cancer?

Endoscopy may play a role at many different points in cancer care.

Prevention and Early Detection

Some gastrointestinal cancers begin as precancerous changes that can be identified before they become invasive cancer.

For example, colonoscopy can identify and remove colon polyps, while upper endoscopy can help monitor conditions such as Barrett's esophagus that may increase the risk of esophageal cancer.

Finding abnormalities early can sometimes allow for less invasive treatment.

Diagnosis

If an abnormal area is discovered on imaging or during an endoscopy, a small sample of tissue may be removed. This is called a biopsy.

A pathologist examines the tissue under a microscope to determine whether cancer or precancerous changes are present.

Staging

Once cancer is diagnosed, your healthcare team needs to understand its location, depth, and whether it has spread.

Endoscopic ultrasound, often called EUS, can provide detailed images of tumors and nearby lymph nodes (locoregional staging). It may also allow your physician to obtain tissue samples using a small needle.

Treatment

Some early gastrointestinal cancers can be removed or destroyed using endoscopic techniques.

Potential treatments include:

• Endoscopic mucosal resection, or EMR

• Endoscopic submucosal dissection, or ESD

• Radiofrequency ablation

• Cryotherapy and other ablation techniques

• Removal of complex or precancerous polyps

These treatments are not appropriate for every cancer. Your medical team will consider the type, location, size, depth, and other features of the tumor before recommending an approach.

Organ Preservation

One of the most exciting areas of endoscopic oncology is the possibility of treating selected early cancers while preserving the affected organ.

For certain patients, endoscopic treatment may reduce the need for major surgery. This can potentially shorten recovery and preserve function and quality of life.

Organ preservation is not appropriate for every patient, and decisions should be made carefully by an experienced multidisciplinary team.

When Cancer Causes Symptoms

Endoscopy can also help people living with more advanced cancer.

A tumor may cause symptoms by blocking part of the digestive system or bile ducts, causing bleeding, or making it difficult to eat or swallow.

Endoscopic procedures may sometimes help relieve these problems.

Examples include:

• Placing a stent to open a blocked esophagus, intestine, or bile duct

• Treating tumor related bleeding

• Relieving jaundice caused by bile duct obstruction

• Helping improve swallowing

• Supporting nutrition

• Managing complications from cancer or cancer treatment

In these situations, the goal is often to improve comfort, function, and quality of life.

A Team Approach to Your Care

Cancer care is rarely provided by one specialist alone.

Your care team may include:

• Gastroenterologists and advanced endoscopists

• Medical oncologists

• Surgical oncologists

• Radiation oncologists

• Radiologists

• Pathologists

• Oncology nurses

• Advanced practice providers

• Dietitians

• Genetic counselors

• Palliative care specialists

These professionals often work together to review your diagnosis and determine the treatment approach that best fits your individual situation.

You may hear this called a multidisciplinary team or tumor board.