Dr. Denise Harnois, a Mayo Clinic transplant hepatologist, explains how this innovative strategy is expanding treatment options and improving outcomes.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:13) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Learning you have advanced colorectal cancer that has spread to the liver can be scary. In some cases, a liver transplant may offer hope, providing better outcomes when other treatments aren't an option. 

"In those circumstances where patients have colon cancer that's gone to the liver that doesn't seem to be anyplace else within the body, but they're not eligible for consideration of doing a surgical resection — in those circumstances, we can consider replacing the entire liver, and that involves a liver transplant," explains Dr. Harnois.

It's a complex surgery requiring experts from multiple teams working together.

"We're working together as a team to make sure we are offering the best options for the potential for cure for these patients," she says.

Liver transplants have greatly improved survival rates. One-year survival is 80% to 100%, three-year survival is around 80%, and five-year survival is between 60% and 80%.

"Without consideration of liver transplant, their five-year survival rate would have been 15%. So we can offer a dramatic improvement in survival rates in patients that undergo liver transplant," says Dr. Harnois.

Related posts:

• Liver transplants offer new hope for colorectal cancer patients with liver metastasis
• Mayo Clinic Q and A:  Understanding colorectal cancer
• Mayo Clinic Minute: Warning signs of colorectal cancer in younger adults
• Innovative treatments for rectal cancer

The post Mayo Clinic Minute: Liver transplant for patients with advanced colorectal cancer appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: A friend was just diagnosed with colorectal cancer. She's only 30. I didn't know young people could get this cancer. Can you tell me more about it?

ANSWER: Unfortunately, your friend is among a growing number of adults under 50 who are being diagnosed with colorectal cancer. Many younger adults don't consider themselves at risk, since screening for colorectal cancer typically doesn't start until age 45.

That's why it's especially important to know the warning signs of colorectal cancer and not put off getting medical attention. Early diagnosis is essential to surviving colorectal cancer. If this cancer is found when it's only in the colon or rectum, the five-year survival rate is over 90%. That survival rate drops to roughly 15% if the cancer spreads beyond the colon and rectum.

 What is colorectal cancer?

It's not one type of cancer but two: colon and rectal cancer. The large intestine has several regions. The last part of the large intestine is known as the rectum. The other areas of the large intestine are called the colon. The treatments for cancers of the colon and rectum are different.

Who is at risk for this cancer?

Risk factors for colorectal cancer include:

• Older age
• Black race 
• Low-fiber, high-fat diet 
• Not exercising regularly
• Diabetes 
• Obesity 
• Smoking
• Drinking alcohol 

Those who are at higher risk for colorectal cancer tend to have at least one of these factors:

• Medical condition that places them at higher risk.
• Genetic condition that increases their risk. 
• Family history that places them at higher risk. For example, this is could be a first-degree family member such as parents or siblings who have had a diagnosis of colorectal cancer or advanced polyps.

Are there warning signs?

Four warning signs of colorectal cancer are:

• Abdominal pain
• Rectal bleeding
• Diarrhea
• Iron deficiency anemia

Although these symptoms can be embarrassing, you need to share them with a healthcare professional — don't put it off.

You may not easily notice blood loss after bowel movements, but that bleeding can lead to low iron levels. If a routine blood test reveals iron deficiency in a young adult, it can prompt the primary care clinician to consider colorectal cancer.

What is the screening process for colorectal cancer?

Your primary healthcare professional may order a screening that can help detect colon polyps or cancer. These tests include:

Stool DNA test. This test uses a stool sample to look for changes in cells' genetic material. Certain DNA changes are a sign that cancer is present or that it might happen in the future. The stool DNA test also looks for hidden blood in the stool.

If your stool DNA test returns positive (abnormal), you'll need a follow-up colonoscopy.

Colonoscopy. This test looks inside the colon. For it to be most effective, you need to thoroughly cleanse your colon, which involves reducing the fiber in your diet. The last step is consuming a special solution to ensure your colon is clean so the gastroenterologist is able to get a clear view. Although preparing for the procedure can be unpleasant, your care team can provide tips to make it more doable.

If the gastroenterologist finds any precancerous growths, called polyps, these will be removed during the colonoscopy and sent for testing. The number, size and type of polyps removed help determine when the next colonoscopy should be scheduled. If cancer is found, your care team will discuss treatment options with you.

How can I reduce my risk for colorectal cancer?  

No matter your age, there are five steps you can take to avoid developing colon cancer:

1. Eat your vegetables and healthy fats. Research has shown that the Western diet correlates to higher colorectal cancer rates. People who eat high-fiber diets are less likely to develop the disease.
2. Get moving. Exercise benefits your heart and helps you maintain your weight. It also can lower your colon cancer risk. Aim for 30 minutes of moderate exercise on most days of the week.
3. Watch your weight. Talk to your health care team if you need help losing weight.
4. Limit alcohol and don't smoke. If you choose to drink alcohol, do so moderately. That means no more than one drink a day for women or two drinks a day for men. And if you smoke, quit.
5. Follow colorectal cancer screening guidelines.

Derek Ebner, M.D., Gastroenterology, Mayo Clinic in Rochester

The post Mayo Clinic Q and A: Colorectal cancer in young adults appeared first on Mayo Clinic News Network.

The body has a built-in defense: the immune system, which consists of white blood cells, lymph system tissues and organs that work together to identify and destroy infections and abnormal cells. However, cancer cells use genetic changes to hide their abnormality or interfere with the immune system's ability to detect and destroy them. Immunotherapy helps the immune system overcome these defenses.

"We're working with what the body naturally does but has not done perfectly, as it has allowed cancer to develop. We're trying to reinforce the body's natural defenses," says Svetomir Markovic, M.D., Ph.D., a Mayo Clinic Comprehensive Cancer Center medical oncologist who researches immunotherapy for melanoma and non-Hodgkin lymphoma.

"Immunotherapy leverages the patient's immune system to fight cancer. It activates and pushes it to find the tumors and kill them," says Haidong Dong, M.D., Ph.D., a Mayo Clinic Comprehensive Cancer Center cancer immunologist. "You can use different tools — T cells, vaccines, targeted drugs — but they all use the patient's immune cells to fight their tumors."

Dr. Markovic and Dr. Dong discuss the history of cancer immunotherapy at Mayo Clinic, how it works, its benefits and risks, and its future:

The roots of cancer immunotherapy at Mayo Clinic

In the late '90s, Dr. Dong and his colleagues at Mayo Clinic discovered that a protein called PD-L1 regulates the immune system's response to cancer cells and other threats. PD-L1 acts as a check or brake by binding to another protein in T cells called PD-1. This discovery led them to develop an antibody that blocks PD-L1's function.

"Using the antibody to block PD-L1 restores the immune system's ability to kill the tumor," says Dr. Dong, the Iris and Winston Clement Professor of Research. "This breakthrough laid the foundation for immunotherapy drugs that target the PD-L1 pathway."

In 2002, Dr. Dong and his team reported their findings, paving the way for the development of new immunotherapy drugs called immune checkpoint inhibitors. In 2014, the Food and Drug Administration approved pembrolizumab as the first immune checkpoint inhibitor to treat melanoma. Today, pembrolizumab is approved to treat 18 types of cancer.

How does cancer immunotherapy work?

Cancer immunotherapy drugs don't directly target cancer cells. Instead, they enhance the body's immune cells, improving their ability to recognize and destroy cancer cells.

"Immunotherapy helps the immune system see where the tumor is in the body. The immune system can see a single cancer cell. That's powerful," says Dr. Dong.

"Immunotherapy helps the immune system see where the tumor is in the body. The immune system can see a single cancer cell. That's powerful."Dr. Haidong Dong

"It's almost like cancer therapy by proxy," says Dr. Markovic, the Charles F. Mathy Professor of Melanoma Research. "We're engaging the body to do its job in ways that make it uniquely effective."

Some of the most common immunotherapies used in cancer treatment include:

Immune checkpoint inhibitors

Immune checkpoint inhibitors are immunotherapy drugs that block checkpoint proteins, such as PD-L1, on cancer cells from binding to their partner proteins on immune cells (T cells). This allows the immune system to destroy cancer cells. Pembrolizumab is one example of an immune checkpoint inhibitor. Eleven immune checkpoint inhibitors have now been approved to treat cancer.

Most of these drugs are used for advanced cancer or cancer that has spread (metastasized). However, some immune checkpoint inhibitors are now being used in earlier stages of cancer to prevent its spread and recurrence. Clinical trials are also investigating combinations of these drugs with other treatments and new immune checkpoint inhibitors.

Learn about immune checkpoint inhibitors and related research at Mayo Clinic:

• Immune checkpoint inhibitors: Immunotherapy for people with triple-negative breast cancer
• From molecule to melanoma: A foundation of research brings new cancer immunotherapies to patients

Oncolytic viruses

Oncolytic viruses use naturally occurring or lab-made viruses to infect cancer cells, causing them to rupture. This stimulates the immune system to attack the remaining cancer cells.

Most oncolytic virus treatments for cancer are still in clinical trials. A weakened form of herpes simplex virus type 1 given by injection is approved to treat melanoma on the skin or in lymph glands.

Learn about oncolytic virus research at Mayo Clinic:

• Novel oncolytic immunotherapy shows promise for patients with bladder cancer
• Unleashing viruses aimed at killing cancer
• Mayo Clinic researchers load CAR-T cells with oncolytic virus to treat solid cancer tumors

Personalized cancer vaccines

Personalized cancer vaccines train the immune system to recognize a specific cancer-related protein from a person's tumor. As the immune system learns to recognize the protein, it can fight it. This treatment is still being studied in clinical trials.

Learn about personalized cancer vaccine research at Mayo Clinic:

• Mayo Clinic Minute: How personalized vaccines target cancer tumors
• Vaccines: The next frontier of lung cancer treatment and prevention
• Tomorrow's Cure: How personalized vaccines combat cancer
• Mayo Clinic researchers design personalized vaccines to fight cancer
• Harnessing the immune system to fight ovarian cancer

Cellular therapies

Cellular therapies involve collecting cells from blood and modifying them to attack cancer cells. These include chimeric antigen receptor (CAR)-T cell therapy and tumor-infiltrating lymphocyte (TIL) therapy.

• CAR-T cell therapy: For this therapy, white blood cells called T cells are removed from a person's blood and genetically modified to produce chimeric antigen receptors. CARs allow T cells to recognize markers on the surface of cancer cells, activating the T cells to kill them. The modified CAR-T cells are then infused into the patient's body to identify and destroy their cancer. The FDA has approved CAR-T cell therapy to treat several types of blood cancer, and clinical trials are exploring its use for solid tumor cancers.
• TIL therapy: This therapy involves surgically removing a person's cancerous tumor, extracting immune cells (lymphocytes) from it, and enriching them. During this process, the patient receives chemotherapy to prepare to receive the enriched immune cells, which are later infused into their body to target any remaining cancer. "The first treatment the patient receives warms up the immune system — improves it to a degree ­— but not enough to kill the tumor. TIL therapy gives the immune cells more power to finish the job," says Dr. Dong. In 2024, the FDA approved the first TIL therapy, lifileucel, for people with melanoma that has spread or cannot be removed by surgery.

Learn about cellular therapy research at Mayo Clinic:

• What is CAR-T cell therapy?
• Understanding CAR-T cell therapy for cancer: Mayo Clinic expert explains how it works
• Unleashing CAR-T cell therapy to destroy solid tumors in thyroid cancer
• Using molecular scissors to improve CAR-T cell therapy
• Preparing to biomanufacture a new CAR-T cell therapy for B-cell cancers

Cytokines

Cytokines are proteins made by white blood cells that signal the immune system to either activate or slow down. Cytokines used as immunotherapy drugs include interleukins and interferons:

• Interleukins: These act as chemical signals between white blood cells. Aldesleukin is a lab-made interleukin (IL-2) that increases the growth and activity of certain white blood cells. It is used to treat melanoma and kidney cancer that has spread throughout the body.
• Interferons: These help the body resist viruses and cancer cells. Interferon alfa-2b is a type of interferon (IFN-alpha) used to treat hairy cell leukemia, melanoma, follicular lymphoma and AIDS-related Kaposi sarcoma.

Bispecific antibodies

When the immune system detects cancer cells or other abnormal cells, it produces immune cells called antibodies to attack them. Bispecific antibodies are lab-made antibodies that can bind to both cancer and immune cells simultaneously, bringing them close together to enhance the immune system’s ability to destroy cancer cells.

The FDA has approved seven immunotherapy drugs that use bispecific antibodies to treat cancer.

Learn about bispecific antibody research at Mayo Clinic: "New research discovers a new combination of therapy for people with a type of leukemia, leading them to live longer."

What are the benefits and risks of immunotherapy?

Immunotherapy is effective against many types of cancer because it uses the immune system to recognize and attack cancer cells. "We don't yet know which immunotherapy best suits all malignancies. As we learn the biology of all this, as our intervention tools become more sophisticated, the number of cancers we can treat increases," says Dr. Markovic.

"We don't yet know which immunotherapy best suits all malignancies. As we learn the biology of all this, as our intervention tools become more sophisticated, the number of cancers we can treat increases."Dr. svetomir Markovic

Immunotherapy can also produce long-lasting responses to treatment by training the immune system to recognize cancer and respond quickly if it returns.

However, immunotherapy can cause side effects. "That’s the price we pay," says Dr. Markovic. "When turned on, the immune system attacks the cancer but may also attack noncancerous tissue, producing side effects similar to autoimmune disease symptoms. They mimic allergic reactions."

Side effects vary based on the type of immunotherapy. Some can be serious, but most can be managed, treated and resolved. Common side effects include redness, itching or blistering of the skin, flu-like symptoms, diarrhea, swelling and weight gain.

Mayo Clinic scientists and colleagues worldwide are researching how to reduce immunotherapy's side effects and increase its benefits. "As we get better with cancer immunotherapy, our treatments become more effective, less toxic and help more people," says Dr. Markovic.

The future of cancer immunotherapy

Scientists are researching ways to improve immunotherapy outcomes and reduce its limitations. Dr. Dong says research is exploring these key areas:

• Understanding why the responses vary from person to person.
• Combining immunotherapy with other treatments, such as chemotherapy, radiation therapy, or targeted drug therapy, to produce the best outcomes.
• Reducing side effects.
• Identifying biomarkers to help predict which people will respond to immunotherapy.

Dr. Dong says this research could improve the effectiveness of immunotherapy and patients’ quality of life. It will also help care teams make more informed treatment decisions and may decrease the financial burden of cancer treatment.

"Immunotherapy has fundamentally changed cancer medicine with the possibility of a cure for cancers that have been considered completely incurable," says Dr. Markovic. "It was once unheard of for patients with metastatic, advanced melanoma to be cured of their disease. Today, a person with this diagnosis has a one in three chance of being cured. That’s a dramatic improvement in outcomes."

Learn more

Drs. Dong and Markovic encourage you to ask your care team specific questions about your treatment. Other trusted sources of information about immunotherapy include:

• American Cancer Society
• Cancer Research Institute
• National Cancer Institute
• National Comprehensive Cancer Network

Find a clinical trial at Mayo Clinic.

Join a support group on Mayo Clinic Connect, an online community moderated by Mayo Clinic for patients and caregivers.

This article first published on the Mayo Clinic Comprehensive Cancer Center blog.

The post What is cancer immunotherapy? appeared first on Mayo Clinic News Network.

ROCHESTER, Minnesota — Dr. Eric Moore has been appointed medical director, International at Mayo Clinic. Dr. Moore will begin his new position in April.

Dr. Moore exemplifies dedication to patient care and is globally recognized as a leader in his field. He brings more than three decades of experience in clinical care, education and research to the role. He is a professor and chair of the Department of Otolaryngology — Head and Neck Surgery at Mayo Clinic in Rochester.

Dr. Moore is known for advancing care for complex ear, nose and throat conditions and leveraging research expertise to innovate therapies. He is passionate about sharing knowledge and expertise to improve global healthcare. Dr. Moore is a pioneer in minimally invasive transoral robotic surgery and has improved outcomes for patients with HPV-related cancers and oropharyngeal cancers.

As a dedicated mentor, Dr. Moore has contributed to otolaryngology education and received multiple awards for his work. He is a five-time recipient of the Mayo Fellows Teacher of the Year Award.

Before joining Mayo Clinic, Dr. Moore was a major in the U.S. Air Force. He attended medical school at Jefferson Medical College in Philadelphia and completed residency training at Mayo and a fellowship in Austria.

###

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Elizabeth Baxter, Mayo Clinic Communications, newsbureau@mayo.edu

The post Dr. Eric Moore appointed medical director, International at Mayo Clinic appeared first on Mayo Clinic News Network.

Editor's note: March is Colorectal Cancer Awareness Month.

Colorectal cancer is no longer a disease of older people. People in their 50s, 40s and younger are increasingly being diagnosed with cancers of the colon and rectum. Incidence rates increased by about 2% per year in people younger than 50 during the past decade, according to the American Cancer Society. In 2019, 20% of colorectal cancers were in people ages 54 years or younger, up from 11% in 1995.

Another trend: Rectal cancer is more common than colon cancer in younger people. Of the estimated 46,050 new cases of rectal cancer in 2023, 37% will be in people younger than 50 versus 24% in people 65 or older.

Because of these trends, experts now recommend screening for colorectal cancer at age 45. But Derek Ebner, M.D., a Mayo Clinic Comprehensive Cancer Center gastroenterologist, says adults of all ages should be aware of the symptoms of colon and rectal cancer and report them to a healthcare professional.

"When we detect cancer early, and it's still confined to the colon or the rectum, that five-year survival is wonderful — it's 90% or better. Detecting cancer later, when it's had an opportunity to move beyond the colon or the rectum, the five-year survival is much lower — typically 15% or less," says Dr. Ebner.

Here's what you need to know to prevent colorectal cancer or catch it early when it's most treatable:

Everyone is at average or high risk of colorectal cancer.

"The truth is everyone's at risk for colorectal cancer," says Dr. Ebner. "But we typically divide people into two groups, those who are average risk and those who are high risk."

People at average risk of colorectal cancer might not experience symptoms associated with the disease and don't have any known factors that make them high risk.

"For those at high risk, there tends to be at least one of three variables: A medical condition, a genetic condition, or a family history that places them at higher risk," says Dr. Ebner.

Medical conditions that increase the risk of colorectal cancer include a personal history of colorectal cancer or polyps, inflammatory bowel disease, diabetes and obesity.

Genetic conditions that increase the risk of colorectal cancer include familial adenomatous polyposis and Lynch syndrome. Familial adenomatous polyposis (FAP) is a rare condition caused by a defect in the adenomatous polyposis coli (APC) gene. While most people inherit the gene from a parent, the genetic mutation occurs spontaneously in 25% to 30% of people with FAP. Lynch syndrome is a condition that increases the risk of many kinds of cancer, including colon and endometrial cancer, and it is passed from parents to children.

Family history associated with a higher risk of colorectal cancer involves a first-degree family member — a parent or sibling — with a colorectal cancer diagnosis or precancerous polyps. If you have a family history, you must start screening sooner and perhaps more often than people at average risk.

Dr. Ebner says healthcare professionals don't yet know the reason for the increased rate of colorectal cancer among younger people, but suspect environmental factors are involved. "Over the last 50 years, we've had major changes in diet — ultraprocessed food, higher quantities of red meats," he says. "These changes have perhaps led to changes in gut bacteria. Our gut microbiome might not be as protective as it once was. We also question the role of less exercise and increasing obesity rates."

Dr. Ebner encourages everyone to reduce their risk of colorectal cancer by eating a more plant-based diet and exercising regularly.

Non-invasive screening options exist, but you may be unable to avoid a colonoscopy forever.

Most colorectal polyps do not cause symptoms, so you may have polyps without knowing it. This is why beginning colorectal cancer screening at the recommended age of 45 is critical.

Screening reduces the risk of cancer by identifying polyps in the colon and rectum that could develop into cancer. You may need to begin screening younger than 45 if you have risk factors. Ask your healthcare professional when you should start screening.

Dr. Ebner says it's impossible to overemphasize the importance of screening. "If we're able to identify polyps, we have the opportunity to remove them and prevent the development of cancer. If we diagnose cancer, unfortunately, we've missed that opportunity," he says.

In the U.S., colonoscopy is the most common screening method. A long, flexible tube (colonoscope) is inserted into the rectum during a colonoscopy. A tiny video camera at the tip of the tube allows a healthcare professional to look for changes — such as swollen, irritated tissues, polyps or cancer — in the colon and the rectum. The professional can also remove polyps or other types of abnormal tissue through the scope during a colonoscopy. Sedation or anesthesia is usually recommended.

A non-invasive option for colorectal cancer screening is a stool DNA test(offered under the brand name Cologuard), which uses a stool sample to look for signs of colon cancer. The test checks for changes in cells' DNA. Certain DNA changes indicate that cancer is present or might develop. The test also looks for hidden blood in the stool.

"If the result of a stool DNA test or another non-invasive test is positive, it's critical to follow up with a colonoscopy," says Dr. Ebner.

Know the symptoms of colorectal cancer, and don't wait to talk to a healthcare professional if you experience them.

The symptoms of colon and rectal cancer can include:

• A change in bowel habits, such as diarrhea, constipation or more frequent bowel movements.
• Rectal bleeding or blood in the stool.
• Narrow stool.
• Ongoing discomfort in the belly area, such as cramps, gas or pain.
• A feeling that the bowel doesn't empty.
• Weakness or fatigue.
• Losing weight without trying.

People younger than 50 who develop colorectal cancer seem to experience slightly different symptoms than older people diagnosed with the disease, says Dr. Ebner. "We still see abdominal pain and blood after bowel movements, but the change in bowel habits is more often diarrhea," he says.

A recent study of people diagnosed with early-onset colorectal cancer confirms this. Study participants experienced four warning signs in the period of three months to two years before their diagnosis:

• Abdominal pain
• Rectal bleeding
• Diarrhea
• Iron deficiency anemia

"Blood loss after a bowel movement can lead to iron deficiency anemia," says Dr. Ebner. "But sometimes that blood loss is slow or small, so you may not see it. If we see a sign of iron deficiency on a blood test, that will prompt us to explore further."

If you notice any of these symptoms, contact your healthcare professional. "These symptoms can be embarrassing, but I can't stress enough — if you have any of them, share them with a healthcare professional. We see folks experiencing these symptoms for months, sometimes up to a year," Dr. Ebner says. "Any delay in sharing this information translates to a delay in diagnosis, which can lead to later-stage cancer, and later-stage cancers can be more challenging to treat and have lower five-year survival rates. Don't delay. Make an appointment.

This article first published on the Mayo Clinic Comprehensive Cancer Center blog.

Related posts:

• Mayo Clinic Minute: Tips to make colonoscopy bowel prep easier
• Mayo Clinic Minute: Why millennials should know colon cancer symptoms
• Mayo Clinic Minute: What’s the right colorectal cancer screening option for you?

The post You’re at risk of colorectal cancer. Know the symptoms. Get screened. appeared first on Mayo Clinic News Network.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:02) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"Many patients will wonder: 'I have a lump on my arm or my leg. Should I have this evaluated? Who should I see, and when are these symptoms concerning?'" says Dr. Krista Goulding, a Mayo Clinic orthopedic surgeon.

She explains when you should seek medical care, "If you have a lump on your arm or your leg that is growing rapidly or is bigger than the size of a golf ball, this needs rapid attention."

The first step in diagnosing a lump is to get advanced imaging, typically starting with a radiograph or X-ray.

"The next step is to get cross-sectional imaging, which means either an MRI or a CT scan," says Dr. Goulding.

Imaging is then followed by a biopsy to remove a sample of tissue for testing.

"And this helps our multidisciplinary team make decisions about how to treat these tumors because these tumors can be benign. They can be benign aggressive, meaning that they are not cancerous, but they can cause problems locally. And then there can be cancer diagnosis similar to sarcomas and other types of cancers that will need rapid attention," says Dr. Goulding.

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Stomach cancer rates in the United States have been steadily decreasing for decades, but recent trends reveal an increase in early-onset stomach cancer in people younger than 50, particularly women. Trends also reveal younger people have more advanced stomach cancer at the time of diagnosis.

While cancer experts don't yet fully understand why younger people are getting stomach cancer, they know that early diagnosis saves lives. Mojun Zhu, M.D., a Mayo Clinic medical oncologist who specializes in gastrointestinal cancers, says knowing your family history and the symptoms of stomach cancer can help you get diagnosed before the disease has spread. She notes early treatment is most likely to be successful.

Dr. Zhu explains what you should know:

Stomach cancer symptoms can be vague.

Stomach cancer doesn't always cause symptoms in the early stages. When it does, symptoms are vague, and people often treat them with over-the-counter medications or dismiss them.

"The symptoms are not clear-cut, and they overlap with many other benign conditions," says Dr. Zhu. "A lot of our younger patients attribute their symptoms to indigestion or reflux, so they don't follow up or seek medical care immediately."

This delay allows stomach cancer to advance to later stages that are more difficult to treat.

Advanced stomach cancer may cause symptoms such as fatigue, unexplained weight loss, appetite loss, feeling full after eating a small amount of food, anemia, vomiting blood and black stools. Dr. Zhu says these symptoms often prompt her patients to seek medical care. "When people feel their symptoms are not getting better — they've started losing weight, struggling with eating and swallowing — that's when they come to see us."

A family history of cancer might indicate increased stomach cancer risk.

There are no screening recommendations for people at average risk of stomach cancer, but if you have symptoms that align with stomach cancer and a family history of cancer, your healthcare professional might recommend additional screening or genetic testing.

"It's really important to know your first-degree family's history — that's parents, siblings and children — and second-degree family, such as your grandparents, uncles and aunts," says Dr. Zhu. "If you have heard about first- or second-degree family members having breast, stomach, or other types of gastrointestinal cancers before age 50, discuss that with your primary care professionals to see if you should consider more advanced genetic testing or genetic counseling."

If genetic test results indicate you carry an inherited condition that increases your risk of stomach cancer, your healthcare professional may recommend a screening plan tailored to your risk.

Screening for stomach cancer in the U.S. is often done through an upper endoscopy, a procedure where a thin tube with a camera is inserted through the mouth and down the throat into the stomach.

Genetic conditions that increase your risk of stomach cancer include Lynch syndrome, juvenile polyposis syndrome, Peutz-Jeghers syndrome, familial adenomatous polyposis and hereditary diffuse gastric cancer.

Hereditary diffuse gastric cancer is an inherited syndrome caused by a mutation in the CDH1 gene that increases the risk of stomach and breast cancer. "For patients with this syndrome, we recommend early screening — usually beginning in their 20s — for stomach and breast cancer," says Dr. Zhu.

Stomach cancer can be difficult to treat, but therapies are improving.

Though stomach cancer is less common than other cancers, it can be more aggressive, has higher mortality rates, and often recurs. In earlier stages, when stomach cancer is localized, meaning it hasn't spread to other organs or lymph nodes, treatment may be more successful. "If you have stage 1 stomach cancer, it can usually be cured by surgery," says Dr. Zhu. "When you have stage 2 or 3 stomach cancer, despite surgery and chemotherapy, the risk of recurrence can be as high as or greater than 50%. Even though we consider localized stomach cancer to be a curable condition, the risk of having relapse is high."

Dr. Zhu says cancer researchers are making progress in stomach cancer treatment for all stages.

Early-stage stomach cancer

Mayo Clinic cancer researchers are investigating how and why stomach cancer develops and trying to find ways to detect it early in people with high risk. "Our colleagues in Gastroenterology are researching ways to help identify early-stage stomach cancer. This includes upcoming clinical trials to investigate the effectiveness of MRI as a screening test for people at high risk of stomach cancer," she says.

Dr. Zhu adds that researchers are also advancing minimally invasive surgical techniques to improve quality of life for people with early-stage stomach cancer. "Locoregional therapies such as endoscopic mucosal resection may help people with very early-stage stomach cancer avoid a full or partial gastrectomy (removal of all or part of the stomach)," she says.

Similar to an upper endoscopy, an endoscopic resection passes a long narrow tube called an endoscope down the throat and into the stomach. The endoscope can be used to identify and remove abnormal or cancerous tissue.

Advanced stomach cancer

Dr. Zhu says Mayo Clinic is researching new therapies for advanced stomach cancer in clinical trials. These include immunotherapy, which leverages your immune system to attack cancer cells, and targeted drug therapies, which target certain aspects of cancer cells that help them grow, divide and spread.

"There are newer classes of medications called antibody drug conjugates and bispecific antibodies that have demonstrated promising results in early-phase clinical trials," she says. Antibody drug conjugates attach a cancer-killing drug to an antibody that targets cancer cells, delivering the drug directly to cancer cells to minimize damage to healthy cells. Bispecific antibody drugs bind to cancer cells and immune cells, bringing them together so the immune cells can attack and destroy the cancer cells.

In late 2024, the FDA also approved the use of a new monoclonal antibody drug that uses a lab-made protein that binds to a specific target on a cancer cell to help the immune system identify and attack it. This drug can be used in combination with first-line chemotherapy in patients with certain advanced stomach cancers that cannot be surgically removed, have spread to other parts of the body, and are HER2-negative.

Hyperthermic intraperitoneal chemotherapy (HIPEC), a heated liquid form of chemotherapy, is also an option for some people with advanced stomach cancer. It can be used in combination with surgery to kill any remaining cancer cells left behind in the abdominal cavity after tumor removal. Recent studies have shown this drug combination is extending the lives of people with stage 4 gastric cancers that have spread in the abdominal cavity.

Stomach cancer spread and related cancer development

People with stomach cancer have a high risk of developing peritoneal carcinomatosis, a metastatic disease that occurs when cancer spreads and grows in the membrane that drapes over the organs in the abdomen and pelvis. "Up to 50% of stomach cancer patients develop peritoneal disease down the road despite having a total gastrectomy. Our surgeons are developing clinical trials to look at the use of intraperitoneal therapy (treatment placed directly in the abdominal cavity) to lower the risk," says Dr. Zhu.

Though there are still many unanswered questions about the increasing incidence of stomach cancer in younger people, knowing your family history and stomach cancer symptoms can help you catch the disease early when it's most treatable. If you have new symptoms associated with stomach cancer, don't delay — talk to your healthcare professional. Ask if screening or genetic testing is right for you.

Learn more

Learn more about stomach cancer and find a clinical trial at Mayo Clinic.

Join the Stomach Cancer Support Group on Mayo Clinic Connect, an online community moderated by Mayo Clinic for patients and caregivers.

This article first published on the Mayo Clinic Comprehensive Cancer Center blog.

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ROCHESTER, Minn. — A new study by Mayo Clinic Comprehensive Cancer Center researchers found that the presence of a specific genetic mutation — KRAS circulating tumor DNA (ctDNA) — strongly indicates a higher risk of cancer spread and worse survival rates for patients with pancreatic ductal adenocarcinoma (PDAC). The mutation was identified using a readily available and clinically approved blood and abdominal fluid test.

PDAC is an aggressive form of cancer that is often difficult to diagnose. Most patients already have cancer spread to other parts of their body when initially diagnosed, and current tests often miss this hidden spread. This makes it challenging to determine the best treatment strategy. The findings, published in the Annals of Surgical Oncology, may help identify patients who are more likely to have cancer spread to other parts of the body, therefore providing doctors and patients with the right information to make informed decisions about treatment.

"This is a major advancement for pancreatic ductal adenocarcinoma," says Mark Truty, M.D., hepatobiliary and pancreatic surgical oncologist within Mayo Clinic's Department of Surgery. Dr. Truty is senior author of the study. "We've had this genetic testing available for a number of years, however, we did not know the significance of the results or how to interpret them. Having the KRAS status will allow the patient and their provider to make better decisions about their individual cancer treatment."

The prospective cohort study, involving nearly 800 patients — the largest patient series to date in the literature using ctDNA — found that 20%-30% of patients with PDAC have detectable mutant KRAS ctDNA in the blood and/or peritoneum, and that those without any previous treatment, such as chemotherapy, had the highest incidence. Thus, the study suggests that ctDNA assays should be performed prior to treatment to have the highest yield.

The researchers examined data between 2018 and 2022. Blood sample tests revealed that 104 patients (14%) had KRAS ctDNA mutation. These patients were more likely to develop advanced, spreading cancer and had a lower survival rate. Further testing of fluid from around the abdominal cavity in 419 patients showed similar results: 123 (29%) had the marker, and these patients also experienced worse outcomes. The presence of this marker, whether in blood or abdominal fluid, indicated a poorer prognosis.

The study highlights that while surgery is the only known cure, most patients experience cancer spread after surgery. The test helps identify patients less likely to benefit from surgery alone, guiding treatment decisions towards chemotherapy and/or radiation before surgery. For patients without the KRAS mutation (approximately 10% of cases), the test is less conclusive and other tests are needed.

"Historically, we've known that KRAS mutations are associated with a more biologically aggressive pancreatic cancer," says Jennifer Leiting, M.D., hepatobiliary and pancreatic surgeon within Mayo Clinic's Department of Surgery. Dr. Leiting is first author of the study. "But this large study gives us a much clearer understanding of how to interpret the test results and use them to improve patient care. It allows for more accurate staging at diagnosis, leading to better treatment decisions."

The researchers suggest that this test should become a standard part of the initial diagnosis for PDAC, enabling more personalized risk stratification and effective treatment plans.

"This improved diagnostic capability offers hope for patients and their families facing this challenging disease," says Dr. Truty. "It's optimistic to see how advances in genetic testing are directly helping our patients."

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About Mayo Clinic 
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

About Mayo Clinic Comprehensive Cancer Center 
Designated as a comprehensive cancer center by the National Cancer Institute, Mayo Clinic Comprehensive Cancer Center is defining the cancer center of the future, focused on delivering the world's most exceptional patient-centered cancer care for everyone. At Mayo Clinic Comprehensive Cancer Center, a culture of innovation and collaboration is driving research breakthroughs in cancer detection, prevention and treatment to change lives.

Media contact:

• Kelley Luckstein, Mayo Clinic Communications, newbureau@mayo.edu

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Dr. Umair Majeed, a Mayo Clinic oncologist, says improved treatment options mean better outcomes for patients, even for those with late-stage colorectal cancer.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:21) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Colon cancer is staged from 0 to 4. The stage determines the extent of the cancer — and the treatment.

"Stages 3 and 4 are considered advanced stages, where the cancer goes into the lymph nodes in stage 3 disease, and it goes into distant organs like the lungs, liver or bones in stage 4 disease," says Dr. Majeed.

When colorectal cancer spreads

The liver is the most common organ colorectal spreads to.

"We are offering liver transplantation as an option to select patients. We have a hepatic artery infusion pump program also available for those patients where the cancer has spread from the colon or the rectum to the liver," he says.

The pump delivers chemotherapy directly to artery that supplies the liver. He says, in addition to surgery, treatment options include better drugs, immunotherapy and targeted therapies. 

"We have surgeons who specialize in advanced procedures such as cytoreductive surgery and HIPEC, which is a form of specialized chemotherapy given into the peritoneum for select patients," Dr. Majeed says.

With all these advanced options, Dr. Majeed remains cautiously optimistic.

"Colorectal cancer is a type of cancer where, even if it's stage 4, there is a chance of cure in select cases," he says.

Related topics:

• Mayo Clinic Minute: Warning signs of colorectal cancer in younger adults
• Mayo Clinic Minute: Are colon and rectal cancers treated differently?
• Hepatic artery infusion pump therapy for colorectal liver metastases

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DEAR MAYO CLINIC: I just turned 45 and am dreading my first colonoscopy. Why do I need to be screened if I'm not having issues? Can you walk me through the process?

ANSWER: Feeling anxious or afraid surrounding a procedure, particularly when you've never done it before, is completely normal. The purpose of screening is to act before someone develops symptoms. If we're able to identify polyps, which are precancerous lesions in the lining of the colon, we would then have the opportunity to remove them and prevent the development of cancer in the first place. So through screening, we can prevent cancer. At the time of diagnosing cancer, we've missed that opportunity. 

There are a number of ways we can screen for colorectal cancer. In the U.S., we most often use a colonoscopy. Colonoscopy is an invasive test, but it allows us an opportunity to not only see polyps, but also remove them at the same time. For people with no additional risk factors besides age, it is recommended to start screening at the age of 45. If other risk factors are present, though, it may be recommended to have a colonoscopy sooner than 45. 

The colon preparation prior to the colonoscopy is key. The goal of colonoscopy prep is to make sure that there is nothing in the colon by using a laxative liquid solution. Then, at the time of the colonoscopy, we're able to see and detect even small precancerous lesions so they can be removed. 

It is very common to hear complaints from patients about the preparation, such as the consistency or taste of the solution, cramping, abdominal bloating or discomfort. That's to be anticipated. Unfortunately, some patients also experience nausea. Try slowing down how fast you are drinking the solution. For those who tend to struggle with the taste or consistency, try drinking it through a straw. You can also bite into a small wedge of lime or lemon, or you can chew gum or ice between drinks. 

After you finish the last of the prep solution and check in for your appointment, you'll often be greeted by the front desk team and then escorted back by a healthcare team member. They will review things like your medical history and medications and see how the colon prep treated you. There is a risk that you may have to come back and repeat the test at a later time if the colon prep was not adequate.

Another critical thing they will do is establish your intravenous therapy or IV. The IV is the route in which they will give you the medication to help make the procedure a little bit more comfortable. Some people don't do any sedation at all, but it is totally appropriate to opt for it. There are several different ways that sedation could be done for the procedure. A lot of that depends upon how the procedure is scheduled with your healthcare team. Then, you will end up going back to the procedure room where they will review the nature of the procedure before starting the colonoscopy. Afterwards, there's a bit of a recovery period, and then you're able to head back home. Because of the sedation, we don't want people driving, consuming alcohol or making any critical decisions for 24 hours. 

We still don't have a perfect recipe for preventing polyps, but maintaining a healthy diet and exercise can protect you. It is important to be aware of any symptoms and then follow through with screening. Best of luck as you take this important first step. — Derek Ebner, M.D., Gastroenterology, Mayo Clinic, Rochester, Minnesota.

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