Cancer Today • Winter 2016 #6

Multidisciplinary Team Treats Complex GI Cancers
Experts Collaborate to Provide Optimal Treatment

Cancers of the upper gastrointestinal (GI) tract — the esophagus, stomach, pancreas, small intestine, bile ducts and liver —are among the most complex diseases, presenting multifaceted diagnostic and management challenges.

To treat patients with this type of cancer, Stony Brook University Cancer Center’s GI Oncology Management Team draws on the expertise of surgeons, medical oncologists, radiation oncologists, radiologists, pathologists and interventional endoscopists. The team provides the full spectrum of care, from expedited, state-of-the-art diagnostics, technologically advanced surgical, radiation and systemic therapies and follow-up services.  

Breath and depth of expertise
What distinguishes the GI Oncology Management Team is its breadth and depth of expertise. The new leaders and Co-Directors of the team — Aaron Sasson, MD, Chief, Division of Surgical Oncology, and Minsig Choi, MD, Director, Gastrointestinal Medical Oncology and Director, Outpatient Medical Oncology —contribute a wealth of clinical, research and academic experience to the team.

Dr. Sasson specializes in highly complex pancreatic surgeries including the Whipple procedure and is considered a national leader in gastrointestinal and pancreatic oncology. In addition, Dr. Sasson is currently conducting research on the development of early diagnostic tests for pancreatic cancer and on multimodality treatment of pancreatic and biliary malignancies.

Dr. Choi is an expert in sophisticated medical oncology regimens for patients with cancers of the GI tract. He oversees highly targeted, individualized treatments, including chemotherapy, biologic response modifiers and other new systemic therapies. In addition, he is a dedicated researcher, with a particular interest in translational research and clinical trials of novel therapies that can change the standard of care.

Both physicians have written extensively on advanced GI cancer treatments, and have established the standards for protocols to follow when patients present with GI cancers. “Treating and managing complex GI cancers is all we do,” said Dr. Sasson. “We are focused 100 percent on improving care and quality of life for patients with these rare, complicated diseases.”

Interventional endoscopy informs treatment
Most often, general practitioners refer patients with suspected or known upper GI cancers to either surgeons or gastroenterologists. At Stony Brook Medicine, the gastroenterologists in the Interventional Endoscopy Center evaluate, diagnose and treat these malignancies. 

To establish the correct treatment plan for each patient, interventional endoscopists employ state-of-the-art diagnostics to determine if cancer is present, followed by staging.

Diagnostic modalities include:
• Endoscopic ultrasonography (EUS) allows for the detailed evaluation of pancreatic and biliary abnormalities
• Fine-needle aspiration (FNA) and biopsy (FNB) using EUS to help diagnose masses
• EUS-guided staging — to determine the size and metastasis of a tumor in the GI tract 

With recent advances in minimally invasive surgeries, endoscopy also has a greater role as a therapeutic specialty. A few of the technologies that are used include:
• Enteral stenting — to relieve an obstruction that may be caused by a tumor
• ERCP with SpyGlass™ cholangioscopy and pancreatoscopy — endoscopic retrograde cholangiopancreatography (ERCP) with SpyGlass technology enables the endoscopist to definitively diagnose malignant tumors in the bile duct and pancreas
• Placement of fiducial markers for XRT — implanting a marker in a tumor for targeting future radiation therapy.

Jonathan Buscaglia, MD, Director, Interventional Endoscopy Center, and Juan Carlos Bucobo, MD, Director, Endoscopy, are advanced endoscopists and are an integral part of the GI Oncology Management Team.  “We collaborate with the surgeons and medical oncologists on a daily basis,” said Dr. Buscaglia.  “This immediate access to each other — the constant dialogue — is what sets us apart from the other centers in our community. We’re on the same team, with the same goal.” 

Patient-centric care across disciplines 
Surgical oncology, radiation oncology and medical oncology are the foundation of the GI Oncology Management Team. Because of the complexities of upper GI tract malignancies, physicians and healthcare professionals from various specialties may be involved in treating a patient at any given time, either sequentially or in concert.

“Our goal, always, is to provide the patient with the most effective, individualized treatments we can, with decreased toxicity, improved quality of life and optimal outcomes,” said Dr. Choi. “We are sincere in our offer to work in partnership with any physician in the community. Whether it is a single question ora second opinion, we would like to assist you with caring for your patient. Don’t hesitate to reach out to us”.

For the full issue: Cancer Today • Winter 2016 Number 6