Competence Center of Rare Gastrointestinal and Hepatopancreatobiliary Diseases

The Competence Center of Rare Gastrointestinal and Hepatopancreatobiliary Diseases (RGHD) is specialized in diagnostics and treatment of:

• Rare gastric diseases
• Rare pancreatic diseases
• Rare liver diseases
• Rare bile duct diseases
• Rare intestinal diseases

Rare Tumours

According to EU definition, rare tumours are tumours with frequency (incidence) of 6 or less cases per 100 000 population per year [RARECARENet, http://www.rarecarenet.eu/]. Overall incidence of rare tumours in the EU is increasing due to improvements in pathological and molecular diagnostics and fragmentation of common tumour forms into molecular types. Currently, rare tumours comprise over 20% of all tumours, diagnosed in the EU. Rare tumours comprise ~15% of all gastrointestinal tumours. Although survival of patients with rare tumours is improving (according to RARECARENet, survival rate has improved by 3% between 1997 and 2007), significant differences remain when compared to common tumours. The main factors leading to these differences are biological factions of the diseases, limited access to timely and accurate diagnosis and lack of effective, modern treatment methods, medicines and guidelines.

Specialized treatment

The RGHD Competence center provides all secondary and tertiary inpatient and outpatient abdominal surgery services, emergency and scheduled healthcare, all modern abdominal surgery procedures, including liver, pancreas, simultaneous pancreas and kidney transplants. In cases of malignant tumours surgery is usually combined with preoperative or postoperative chemotherapy or radiotherapy. Each year, about 800 patients with gastrointestinal tumours are treated and about 120 new patients are diagnosed. All patients are thoroughly examined before surgery by using modern imaging (endosonoscopy, CT, MRI, gamma camera) and laboratory (cancer markers, inflammatory markers, hormones, oncogenes) tests, pelviperineology, functional gastrointestinal and coloproctological laboratories and are discussed in multidisciplinary team meetings. When possible, diseases are treated by minimally invasive laparoscopic surgery. In cases of widespread, unresectable tumours of pancreas, bile ducts, rectum, duodenum or esophagus with tumour induced narrowing, the narrowing is dilated with endoscopically placed stents. Patients with locally spread tumours undergo complex multivisceral oncological surgeries, during which irreversibly damaged organs are removed (in accordance with the principles of good practice in the treatment of oncological diseases, en bloc). If required, abdominal vascular reconstruction surgery is performed. If cancer is spread in the abdomen, cytoreductive treatment and hyperthermic intraperitoneal chemotherapy (HIPEC) are performed. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is also available.

Radiotherapy

NCI is the pioneer of radiotherapy in Lithuania, has accumulated long-term experience in the fields and uses modern linear accelerators in treatment. These devices allow three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), stereotactic radiosurgery (SRS), stereotactic radiotherapy (SRT), stereotactic body radiation therapy (SBRT), image-guided radiation therapy (IGRT), radiotherapy for respiratory tumours (4D-CT, RPM), HDL and LDR brachytherapy. 

Chemotherapy

In NCI Chemotherapy department and Day hospital and VUH SK Oncochemotherapy department and Day hospital, patients are treated with all chemotherapeutic medicines available in Lithuania: intravenous, subcutaneous, short-term or long-term and oral, as well as biological therapy, immunotherapy, hormone therapy, bisphosphonate treatment, blood component transfusions, management of side effects of the treatment. Patients treated with a combination of chemotherapy and radiotherapy are also treated here. Complex treatment methods are used in collaboration with other highly skilled specialists: intraarterial chemotherapy (e.g. direct medicine administration to the blood vessels of the liver), intraperitoneal chemotherapy, chemoembolization (for treatment of hepatic metastases) or hypertonic intraperitoneal chemotherapy (for the treatment of peritoneal carcinoma of the stomach, intestinal cancer, peritoneal mesothelioma and others).

Clinical research

The implementation of applied oncology research and clinical research, the introduction of advanced diagnostic and treatment methods into clinical practice and cooperation with other scientific institutions and international organizations are an integral part of NCI and VUH SK activities. Specialists of the competence center are actively participating in international clinical trials to provide patients with gastrointestinal tumours (especially rare tumours) access to innovative treatment or extensive markers and genetic testing.

Multidisciplinarity

Multidisciplinarity in NCI and VUH SK has been applied for many years. All primary patients with gastrointestinal tumours and more complex cases are discussed during multidisciplinary meetings. Multidisciplinary meetings help to ensure the most appropriate, coordinated, rational, timely, guideline-based diagnostics, treatment and monitoring of patients with rare diseases.