Pathophysiology
- Most are carcinomas (epithelial origin). Adenocarcinoma arises from glandular tissue (mucus-producing glands in stomach, pancreas)
- The liver is the most common metastatic site from GI organs due to portal vein drainage
- Esophageal: Barrett esophagus from chronic GERD is a precursor to esophageal adenocarcinoma
- Colorectal: Most begin as adenomatous polyps. The polyp-to-cancer sequence takes approximately 10-15 years
- Pancreatic: 85% are adenocarcinoma of the exocrine ducts. Tumors impinge on the celiac ganglion, referring pain to the mid-back
- H. pylori infection is the primary risk factor for stomach cancer. Hepatitis B/C viruses are major causes of liver cancer
Signs and Symptoms
Hallmark Indicators
- Esophageal: Dysphagia. Feeling of food getting "stuck"
- Stomach: Feeling of fullness after a small meal. Vague pain above the navel
- Colorectal: Change in bowel habits (>10 days). Narrowed stools. Rectal bleeding (melena)
- Liver: Jaundice (yellow skin/eyes). Ascites. Right upper quadrant pain
- Pancreatic: Mid-back pain independent of movement. Jaundice. Rapid unintended weight loss
- General: Unexplained weight loss (>10 lbs in 2 weeks). Persistent fatigue. Night sweats
Red Flags and Rule-Outs
- Melena (black, tarry stool): Upper GI bleeding — immediate referral
- Jaundice: Liver or bile duct obstruction — urgent medical evaluation
- Mid-back pain independent of movement: Distinguish from MSK back pain. Suggests pancreatic or retroperitoneal pathology
- Clay-colored stools: Bilirubin not reaching the gut (liver/bile duct obstruction)
- Post-prandial pain unrelated to movement: Differentiates visceral from musculoskeletal pain
- Palpable abdominal mass or hepatomegaly: Advanced disease — do not perform abdominal massage
MT Considerations
- Goal: Supportive care to alleviate pain, anxiety, nausea, fatigue, and depression
- Abdominal work: Avoid intrusive abdominal massage in any client with a history of abdominal cancer
- Bone fragility: Many digestive cancers metastasize to bone. Use conservative pressure
- Medical equipment: Accommodate stomas, colostomy bags, and catheters
- Positioning: Clients with ascites or respiratory compromise may not tolerate prone or supine. Semi-reclined or side-lying preferred
- Chemotherapy/radiation side effects: See chemotherapy and radiation-therapy
- DVT risk: Active cancer increases DVT risk. Screen before compressive lower extremity work
CMTO Exam Relevance
- Know the key "giveaway" signs for each digestive cancer type (dysphagia, melena, jaundice, mid-back pain)
- Distinguish movement-independent visceral pain from musculoskeletal pain
- Melena indicates GI bleeding — immediate referral
- Clay-colored stools indicate bilirubin obstruction
- Liver is the most common metastatic site from GI cancers due to portal vein drainage
Key Takeaways
- Digestive system cancers frequently metastasize to the liver via the portal vein
- Key red flags include dysphagia, melena, jaundice, and movement-independent mid-back pain
- Intrusive abdominal work should be avoided in clients with a history of abdominal cancer
- Accommodate medical devices and position clients with ascites in comfortable alternatives to prone/supine
- Mid-back pain independent of movement is a key red flag for pancreatic cancer (celiac ganglion impingement)