Cleveland Clinic Florida's surgical oncology program is dedicated to offering cutting-edge, multidisciplinary treatment of primary and metastatic tumors. Specialists from our Cancer Center collaborate with experts from at the Taussig Cancer Institute in Cleveland, and are part of a dedicated team of physicians working closely to provide patients with comprehensive care for cancers of the liver, pancreas, abdominal cavity, adrenal gland, soft tissue and breast. Our surgeons have all been fellowship trained and are experts in treating gastric cancer, pancreatic cancers, metastatic colon cancer, appendiceal cancers, sarcomas and melanomas.
At our multidisciplinary surgical oncology clinic, patients can visit with specialists from surgical oncology, medical oncology, radiation therapy and plastic surgery during a single visit.
You may schedule an appointment online or by calling 877.463.2010.
Conditions & Treatments
Malignant Disease of the Esophagus, Stomach and Duodenum
Barrett’s esophagus is an irritation in the lining of the esophagus caused by chronic reflux of the contents from the stomach and small intestine into the esophagus. A premalignant condition, Barrett's esophagus may lead to the development of cancer of the esophagus in a small number of patients. This type of cancer is called esophageal adenocarcinoma. Esophageal cancer develops through a sequence of changes in the cells of the esophagus known as dysplasia, which can only be detected by endoscopic biopsies. Patients with Barrett's esophagus should have regular surveillance exams to detect cancer at an early and potentially curable stage.
At Cleveland Clinic Florida, Barrett’s esophagus with dysplasia or cancer is treated using photodynamic therapy, radiofrequency ablation, cryotherapy, endoscopic mucosal resection or surgical removal of almost all the esophagus.
The esophagus is the muscular tube that connects the mouth and throat with the stomach. There are two major kinds of cancer of the esophagus. The first, squamous cell carcinoma, is associated with tobacco and alcohol abuse, some nutritional deficiencies, ongoing esophageal injury, and certain dietary irritants.
The second kind of esophageal cancer is adenocarcinoma. It has now overtaken squamous cell carcinoma as the most common form of this disease in North America. Its incidence is increasing at a rate faster than any other malignancy in the United States. It is much less commonly associated with tobacco or alcohol abuse, and tends to develop most frequently in middle aged and older Caucasian males.
In patients with early stage disease, the optimal cancer treatment approach is surgery. Although an esophagectomy (removal of the esophagus) is a major operation and may not be an appropriate cancer treatment in elderly or debilitated patients, it is associated with an excellent cure rate in patients with early stage diseases.
Unfortunately, most patients with esophageal cancer present with either locally or regionally advanced disease. In this situation, surgery as a single form of cancer treatment is not effective. Multi-modality approaches to cancer treatment using surgery, radiation and chemotherapy have been recommended instead and can result in cure in a percentage of patients. Radiation therapy by itself has been relatively unsuccessful, but when combined with chemotherapy, it has been curative. Whether the use of surgery in conjunction with radiation and chemotherapy can further improve the results is still being investigated. Other patients, unexpectedly found to have more advanced disease at the time of their surgery, will benefit from post-operative, or adjuvant, chemotherapy and radiation.
In patients with widespread, incurable cancer, single-modality chemotherapy and/or radiation therapy can provide significant symptomatic relief. There are also a number of endoscopic techniques available for cancer treatment that can successfully address the swallowing problems for those with locally advanced cancer. Endoscopic stent placement, photodynamic therapy, laser photoablation and esophageal dilatation have all been used in this situation.
Cancer of the stomach, also called gastric cancer, is a disease in which malignant cells arise from the lining of the stomach. Stomach cancers can develop in any part of the stomach and then may spread throughout the stomach and to other organs.
Types of stomach cancer include: adenocarcinoma, which is the most common type, starts in the glandular tissue of the stomach and accounts for 95 percent of all stomach cancers; lymphomas involve the lymphatic system; and sarcomas affect the connective tissue, such as muscle, fat or blood vessels.
Stomach cancer can often be cured if it is found and treated at an early stage. At Cleveland Clinic Florida, stomach cancer may be treated with the following, in combination or alone:
- Surgery, called gastrectomy, to remove all or part of the stomach, as well as some of the tissue surrounding the stomach
- Radiation therapy
- Biological therapy (may need to explain. I have not heard of this treatment modality)
During a gastrectomy, lymph nodes near the stomach are also removed and biopsied to check for cancer cells. Lymphoma of the stomach is more frequently treated by gastrectomy than adenocarcinoma of the stomach. Only about one-third of stomach cancer cases can be treated and cured surgically.
Gastrointestinal Stromal Tumors (GISTs)
Gastrointestinal stromal tumors (GISTs) are uncommon tumors of the GI tract. These tumors start in very early forms of special cells found in the wall of the GI tract, called the interstitial cells of Cajal (ICCs). Sometimes called the “pacemakers” of the GI tract, ICCs signal the muscles in the digestive system to contract to move food and liquid through the GI tract.
More than half of GISTs start in the stomach. Yet, others may start in the small intestine (duodenum), or 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 layer of tissue that lines the organs and walls of the abdomen).
The main treatment for a gastrointestinal stromal tumor (GIST) that has not spread is usually surgery, with the goal of removing all of the cancer. If the tumor is small, it often can be removed along with a small area of normal tissue around it through an incision in the skin (open procedure). Unlike many other cancers, GISTs almost never spread to the lymph nodes, usually eliminating the need to remove nearby lymph nodes.
Laparoscopic surgery may be an option for some small GISTs. The laparoscopic approach involves making several small incisions and inserting long, thin surgical tools through these incisions (along with a tiny video camera) to remove the tumor. Because the incisions are small, patients usually recover more quickly from this type of surgery than from traditional surgery. If the tumor is large or growing into other organs, the surgeon could still try to remove it entirely. To do this, portions of organs (such as sections of the intestines) may have to be removed. The surgeon might also remove GISTs that have spread elsewhere in the abdomen, such as the liver.
Malignant Disease of the Pancreas
A pear-shaped gland, the pancreas is about six inches in length, located deep within the abdomen, between the stomach and the spine. It is referred to in three parts: the widest part is called the head, the middle section is the body and the thin end is called the tail.
Pancreatic cancer develops when cells in the pancreas begin to grow "out of control,” developing into cancer cells that have the ability to spread to nearby lymph nodes and organs (such as the liver and lungs) and form tumors (neoplasms). When cancer spreads, it is called metastatic.
About seventy percent of pancreatic cancers occur in the head of the pancreas (pancreatic adenocarcinoma). Treatment options may include:
- An operation to remove the mass
- Radiation therapy
If a surgical cure is not possible, surgery might still be used to relieve an obstruction of the bile duct or stomach.
Intraductal Papillary Mucinous Neoplasm (IPMN)
A growing number of patients are being diagnosed with an intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Intraductal papillary mucinous neoplasms are tumors that grow within the pancreatic ducts (intraductal) characterized by the production of thick fluid by the tumor cells (mucinous). If left untreated, IPMN neoplasms may progress to invasive cancer. The management of IPMN can be complicated. As many as 70 percent of main duct type intraductal papillary mucinous neoplasms harbor high-grade dysplasia (the phase just before an invasive cancer develops) or an invasive cancer. In general, most main duct intraductal papillary mucinous neoplasms should be surgically resected. Surgical treatments for IPMN include:
- Distal pancreatectomy (laparoscopic, minimally invasive approach for neoplasms of the tail of the pancreas)
- Whipple procedure (pancreaticoduodenectomy for neoplasms in the head or uncinate process of the pancreas)
- Total pancreatectomy (removal of the entire gland)
Malignant Disease of the Liver and Biliary Tract
Primary malignant liver tumors treated at Cleveland Clinic Florida include:
- Hepatocellular carcinoma
- Cystadenocarcinoma (cystic tumors that may become malignant)
Treatment options include the following:
- Partial Hepatectomy - removing part of the liver, ranging from a smaller wedge to an entire lobe.
- Total Hepatectomy and Liver Transplant - removing the whole liver and replacing it with one from an organ donor.
- Percutaneous Ethanol Injection - This therapy involves an injection of ethanol (alcohol) into a tumor to destroy the cancer.
Metastatic Liver Tumors
Types of metastatic liver tumors treated at Cleveland Clinic Florida include:
- Colorectal metastatic liver disease
- Neuroendocrine tumors
- All other metastatic hepatic diseases
In most cases, treatment requires surgical removal (resection) of the affected part of the intestine. For some colorectal cancers, chemotherapy or — for rectal cancers — radiation is added to manage the disease.
Tumors of the Biliary Tract
Cleveland Clinic Florida treats the following tumors of the biliary tract:
- Perihilar (or hilar) bile duct cancer (also called Klatskin tumor)
Treatments include the following:
- Relief of Biliary Obstruction – one of the most accepted treatment approach for the majority of patients with cholangiocarcinoma. To do this, stents are useful in providing adequate draining of the bile ducts.
- Two Types of Stents:
- Endoscopic stents administered with the use of an endoscope or a slender, tubular optical instrument.
- Percutaneous stents administered through the skin.
- Chemotherapy - Interpretation of the available, limited data that exists suggests a small survival advantage of chemotherapy and radiation for cholangiocarcinoma.
- Liver Transplantation - Liver transplantation is currently an effective method of treatment for cholangiocarcinoma of the hilum of the liver in patients who cannot undergo surgical resection. Patients who are eligible for this protocol at Cleveland Clinic Florida undergo chemotherapy and radiation therapy followed by liver transplantation. Long-term survival following this treatment protocol is similar to survival following liver transplantation for other conditions.
Malignant Disease of the Spleen and Intra-abdominal Organs
Metastases, or the spread of cancer from other areas, to the spleen and other intra-abdominal organs (such as the colon) is common.
Surgical treatment of spleen cancer includes:
- Splenectomy (the surgical removal of the spleen). Removing part of the spleen is called a partial splenectomy. Removing all of the spleen is called a total splenectomy.
Treatment for colon cancer includes:
- Surgery- Surgery the treatment used most often for colorectal cancer. Colon and rectal cancers require surgery if they are to be cured. Surgery usually involves removal of the cancer and some of the surrounding tissue. In most cases, the surgeon can reconnect the remaining healthy portions of the colon (anastomosis) after removing the cancer.
If the surgeon cannot reconnect the healthy portions of the colon, a colostomy will be necessary. A colostomy is an opening (stoma) through the abdominal wall into the colon. This opening provides a new passage for waste to leave the body. The colorectal cancer patient wears a special bag to collect the waste. In most cases, the stoma and colostomy bag are temporary, though for some patients they will be permanent.
- Polypectomy: polyps are removed during a colonoscopy.
- Local excision: This procedure is performed when the cancer is in an early stage. It does not require major abdominal surgery; instead, the cancer is removed through the anus.
- Resection: total removal of parts of the colon and surrounding tissue which requires a major surgery.
The surgical procedures for colon cancer include the following:
The retroperitoneal space (retroperitoneum) is the space in the abdominal cavity behind (retro) the peritoneum (thin membrane that lines the abdominal and pelvic cavities). Retroperitoneal sarcomas are rare cancerous tumors. A complete surgical resection is the most effective treatment of retroperitoneal cancers. Radiation and chemotherapy may also be included in treatment.
HIPEC for Incurable tumors
HIPEC stands for Hyperthermic (or Heated) Intraoperative Peritoneal Chemotherapy. HIPEC is used to treat cancers that have spread to the lining of the abdominal cavity, such as those of the appendix, colon, stomach and ovaries. HIPEC is an alternative and innovative method of delivering chemotherapy, which is commonly used to treat many types of cancer, to the body. Unlike traditional chemotherapy that is delivered intravenously, HIPEC delivers chemotherapy directly into the abdomen making it a good option for cancers that originated in or have spread to the abdominal cavity.