Most people think of cancer treatment in broad terms: surgery, chemotherapy or radiation. But today, treatment for many gastrointestinal cancers is becoming increasingly personalized, thanks to advances in genetic research, targeted therapies and a deeper understanding of how individual tumors behave.
According to Dr. Wasif Saif, medical oncologist at Karmanos Cancer Institute, these advances are helping physicians develop more precise and tailored treatment plans for patients diagnosed with gastrointestinal cancers.
“Gastrointestinal cancers -- including colon, rectal, pancreatic, stomach, liver and esophageal cancers -- are no longer treated with a one-size-fits-all approach. Today, we can increasingly tailor treatment based on the biology of the tumor, blood-based biomarkers, genetics and participation in clinical trials,” said Dr. Saif.
One of the most significant developments has been the ability to perform genomic testing on tumors.
“Genomic testing of the tumor allows us to tailor treatment based on biology and specific mutations in the tumor,” Dr. Saif said.
Rather than treating every patient’s cancer the same way, genomic testing helps physicians identify specific genetic mutations that may influence how cancer grows and responds to treatment. This approach can help doctors select therapies that are more effective for an individual’s unique cancer.
Researchers continue to learn more about the genetic changes that drive certain cancers, creating new opportunities for personalized care. Pancreatic cancer, for example, has been closely linked to mutations in the KRAS gene, which plays a significant role in tumor growth.
“If pancreatic cancer is a speeding car, KRAS is often the accelerator stuck to the floor, explained Dr. Saif. “For decades we could see the problem but couldn’t reach the pedal. Today, science is finally finding ways to slow that engine down, giving patients new hope. In pancreatic cancer, this is particularly important because more than 90% of pancreatic cancers carry a KRAS mutation.”
Scientists at Karmanos are actively researching ways to target these genetic changes more effectively.
Today’s treatment options may also include targeted therapies that attack specific cancer cells, immunotherapy that helps the body’s immune system recognize and fight cancer, more precise radiation techniques and advanced surgical approaches designed to improve recovery while reducing complications.
“These advances mean many patients receive treatments that are more effective, safer and better tolerated than those available decades ago,” Dr. Saif said.
Why specialized expertise matters
As treatments become more sophisticated, so does the importance of receiving care from specialists who focus on gastrointestinal cancers.
Gastrointestinal cancers affect organs throughout the digestive system. At Karmanos, the Gastrointestinal and Neuroendocrine Oncology Multidisciplinary Team (MDT) treats a wide range of cancers, including anal, colorectal, gallbladder, liver, pancreatic, appendix, esophageal, small intestine and stomach cancers.
Because these cancers can affect different organs and behave differently from one patient to the next, treatment often requires expertise from multiple specialists who work together.
“At Karmanos, you don’t just see one doctor -- you’re cared for by an entire team of experts dedicated solely to treating gastrointestinal cancers,” said Dr. Saif, who is also the co-leader of the Gastrointestinal and Neuroendocrine Oncology MDT.
That team may include medical oncologists, radiation oncologists, surgical oncologists, interventional radiologists, pathologists, pharmacists, nurse practitioners, dietitians, social workers and genetic counselors.
Every new gastrointestinal cancer patient is also reviewed by a multidisciplinary tumor board, where specialists collaborate to develop a personalized treatment plan.
“All new patients are presented at the tumor board and reviewed among the group of experts so that the treatment recommendation is a consensus of the entire group,” Dr. Saif said.
Access to tomorrow’s treatments today
For some patients, participation in a clinical trial may provide access to promising new therapies before they become widely available.
As a National Cancer Institute-designated Comprehensive Cancer Center, Karmanos conducts extensive cancer research and offers one of the nation’s most robust clinical trial programs.
“We study tomorrow’s standard of care today, offering patients new treatments even before they get FDA-approved,” Dr. Saif said.
Karmanos also operates the state’s only Phase I Clinical Trials Program, providing access to innovative therapies across a wide range of cancer types and stages.
The importance of screening
While treatment options continue to advance, screening remains one of the most effective tools for detecting certain gastrointestinal cancers early. Screening recommendations depend on the specific gastrointestinal cancer and a person’s risk factors (such as family history, genetic syndromes, inflammatory bowel disease, smoking, obesity and more).
“Screening is increasingly shifting from simple age-based recommendations to risk-adapted screening incorporating family history, genetics, environmental exposures and potentially ctDNA-based approaches in the future,” said Dr. Saif.
For colorectal cancer, screening options include stool-based tests and colonoscopy. While several screening methods are available, colonoscopy continues to be considered the gold standard because it can identify and remove precancerous polyps during the same procedure.
Depending on a person’s family history, genetic risk factors or other medical conditions, additional screening recommendations may be appropriate. That’s why experts encourage individuals to discuss their personal risk factors with their physician.
“The future of gastrointestinal cancer care is increasingly personalized. The combination of screening, molecular testing, multidisciplinary care, second opinions and clinical trials is helping us deliver the right treatment to the right patient at the right time,” Dr. Saif added. “If you or a loved one is diagnosed with a gastrointestinal cancer, ask three questions: Have we done the right molecular testing? Should I get a second opinion? Is there a clinical trial available for me? Those three questions can sometimes change the entire treatment journey.”
Why second opinions are valuable
Receiving a cancer diagnosis can feel overwhelming, and many patients seek a second opinion to better understand their options.
“Second opinions are best practice in oncology,” Dr. Saif said. “I often see patients seeking a second opinion because they want more information and access to the latest treatments, especially for complex or aggressive cancers.”
While many cancer centers offer second opinions, obtaining one can sometimes be complicated by paperwork, medical records and insurance requirements.
“A second opinion isn’t about distrust -- it’s about making sure every option is on the table,” Dr. Saif added.
Karmanos has created a streamlined process designed to eliminate many of those barriers.
When a patient calls or submits a second-opinion request, patient navigators help gather medical records and coordinate insurance authorizations. An oncology nurse reviews the case before the appointment to ensure the physician is prepared with the patient’s information.
Most importantly, patients can meet with a cancer specialist within seven days of requesting a second opinion.
“We’ve removed those barriers,” Dr. Saif said. “Within seven days of the request, the patient will meet with a cancer expert who is familiar with their case and ready to discuss personalized treatment recommendations.”
According to Dr. Saif, second opinions can sometimes uncover additional treatment options or even lead to changes in diagnosis.
“Patients gain access to advanced surgeries, targeted therapies, leading-edge radiation techniques and innovative clinical trials that are exclusively available to Karmanos patients.”
If you or a loved one has been diagnosed with cancer and would like a second opinion, visit the Karmanos Cancer Institute or call 1-800-KARMANOS to learn more.