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Why do I have a gastroenterologist on my cancer care team?

Gastroenterologists reviewing an x-ray together
Gastroenterologists specialize in diseases of the digestive tract, so why are they involved in treating breast, lung and other cancers that do not involve the GI tract?

Breast cancer patients often have a number of questions and concerns during the treatment journey. Should I get breast reconstruction? What do I do about hair loss once I start taking chemotherapy? Should I get genetic testing? One additional question they may have upon meeting their treatment team is, Why would I need to see a gastroenterologist who specializes in stomach issues? The short answer: Breast cancer patients, like those with cancer of the lung, skin, bone and other areas of the body that do not involve the digestive tract, often experience side effects that impact their gastrointestinal (GI) system, and treating these conditions may be key to their recovery. And then there’s the assistance GI specialists offer in diagnosing and staging a breadth of diseases. "We do many consultations with the breast cancer team," says Jeffrey Weber, MD, Gastroenterologist at our hospital near Phoenix. "And the patient is often thinking, 'What does gastroenterology have to do with breast cancer?'"

What do gastroenterologists do?

Gastroenterologists are trained to treat diseases of the GI system, which includes the esophagus, stomach, small intestines, colon, rectum gallbladder, bile ducts and liver—all the organs involved in digesting food and processing waste. But in cancer treatment, these doctors do a lot more. Gastroenterologists may help medical oncologists diagnose and stage tumors or search for metastatic disease. Using a colonoscopy or endoscopy, they may help surgical oncologists locate tumors during surgery. They also may help cancer patients cope with myriad disease and treatment side effects, many of which are GI-related, such as vomiting, diarrhea, constipation and weight loss. "Symptoms related to the gastrointestinal tract represent a major part of the symptoms that cancer patients experience," says Toufic Kachaamy, MD, Medical Director of Interventional Gastroenterology, Endoscopy and Innovation at our hospital near Phoenix.

A gastroenterologist experienced in taking care of cancer patients works with the oncology team to manage symptoms and improve quality of life and nutrition. All these help patients tolerate cancer treatment better.” - Toufic Kachaamy, MD,  Gastroenterologist & Advanced Endoscopist

When would a gastroenterologist step in?

For example, say a patient’s lung cancer has spread and the tumor is blocking the bile duct, causing jaundice, or a yellowing of the skin caused by a buildup of waste material in the blood. A gastroenterologist may treat the condition by inserting tubes called stents, which allow fluid to flow through the body's ducts and blood vessels. Or say a patient is losing weight after constant bouts of nausea and vomiting, caused either by treatment or a tumor blocking the GI tract. A gastroenterologist may work with a dietitian to develop a nutrition plan to help get the patient eating again and prevent malnutrition, which a leading cause of cancer deaths. A GI specialist may also use cryotherapy to remove blockages caused by tumors in the esophagus that may prevent patients from eating or swallowing. 

Gastroenterologists also play important roles in cancer prevention, as well as the diagnosis and staging of GI tract cancers. And their role is continuing to evolve, according to John M. Carethers, MD, of the University of Michigan. A gastroenterologist may have once been called on simply to diagnose and treat a GI-related condition. But as cancer care has advanced and patients’ needs grow more complex, the gastroenterologist is emerging as a key player offering a wide range of skills and expertise."The gastroenterologist is evolving from a pure diagnostician to an endoscopic surgeon, a geneticist, a nutritionist, an immunologist and chemotherapist, and palliative care physician," he writes in an article published on PubMed Central. "This transformation allows the gastroenterologist to be a larger part of the continuum of care for cancer patients."