Robert B. Den, MD , 2025-04-28 15:13:00
April 28, 2025
3 min read
Key takeaways:
- Upper gastrointestinal cancers remain the second leading cause of cancer-related deaths in the U.S.
- Gastroenterologists and oncologists must collaborate to optimize patient care and outcomes.
Gastroenterologists are uniquely positioned to expand their critical role in detecting and treating gastrointestinal diseases, shaping the future of care and improving patient experiences.
Several notable treatments for GI-related diseases have been greenlit by the FDA in recent years. With each advancement fueling further research, the field is poised for even more innovation, particularly in the realm of radiotherapy.
This progress is critical, as upper GI cancers, including those of the esophagus, stomach and pancreas, remain the second leading cause of cancer-related deaths in the U.S. These cancers are often diagnosed at advanced stages when treatment options are limited and outcomes are poor.
Targeted treatments
Gastroenterologists’ expertise places them at the forefront of delivering emerging cancer therapies due to their expertise in endoscopic ultrasound (EUS) procedures. These minimally invasive techniques allow for precise intratumoral placement of therapeutic agents such as radiotherapy sources.
In the context of pancreatic cancer, this approach allows for targeted treatment without the need for invasive surgery, offering a promising option for patients with limited therapeutic alternatives. As such treatments are integrated into GI practices, they could meaningfully expand the therapeutic arsenal for this particularly aggressive disease.
Additionally, combining systemic therapies, such as chemotherapy or immunotherapy, with EUS-guided approaches may further enhance tumor control and increase the likelihood of converting borderline unresectable tumors into candidates for surgical resection.
While pancreatic cancer is not the most common GI-related disease, it remains a leading cause of cancer-related deaths. Its challenging detection and limited treatment options — especially when surgery is not feasible — make it particularly difficult to manage.
With the American Cancer Society projecting 67,440 new cases of pancreatic cancer in the U.S. in 2025, the need for novel and accessible treatment options has never been more urgent.
Gastroenterologists trained in EUS already play a crucial role in diagnosing pancreatic lesions, and now they have the opportunity to use the tools they are proficient with to pioneer the integration of new therapies. This unique experience allows them to offer patients more timely, targeted treatments, especially in community or outpatient settings where access to comprehensive cancer care may be limited.
Integrating these therapies could reduce the need for more systemic treatments such as chemotherapy, which often come with significant side effects. Cancer care has increasingly focused on improving quality of life in recent years, especially as Americans live longer and cancer rates continue to increase.
‘Poised to be pioneers’
GI specialists play a pivotal part in improving patient outcomes and have a critical role in expanding access to these therapies. Moreover, GIs can collaborate to deliver a combination of immunotherapies and other treatments, such as select radiotherapies, offering the potential for a more comprehensive and personalized approach to care.
As cancer therapies become more personalized and technologically advanced, collaboration among specialists will be paramount. Gastroenterologists, radiation oncologists and medical oncologists must work hand-in-hand to identify appropriate patients, plan treatment and monitor outcomes.
Rather than operating in silos, specialists are aligning across disciplines to improve care pathways and patient outcomes. This convergence is reshaping cancer care and placing GI specialists at the forefront of that transformation.
As medical technology and innovative therapies continue to advance in oncology, GI specialists are poised to be pioneers. Their procedural expertise and close relationships with patients facing GI cancers make them ideal partners in delivering the next generation of personalized, localized therapies.
By actively seeking opportunities, such as participating in clinical trials that leverage their expertise, gastroenterologists can help improve survival rates and quality of life for patients, while driving innovation in how cancer care is delivered.
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Robert B. Den, MD, is a radiation oncologist and associate professor at Thomas Jefferson University and chief medical officer at Alpha Tau Medical. He can be reached at robert.den@jefferson.edu.
