Hepato-gastroenterologists and oncologists are complementary in the management of digestive cancers

Abstract

1. Digestive oncology – a changing fieldDigestive cancer accounts for a quarter of all cancers and con-siderable knowledge of the particular features of these disordersis required for correct treatment. Digestive oncology (DO) is amajor field of activity for hepato-gastroenterologists (HGE), whoare involved at all stages, from screening to diagnosis, follow-up,tumour evaluationandpalliativetreatment.HGEhavealsorecentlybeen recruited to multidisciplinary teams, due to their consider-able competence in the management of digestive cancers. OverallDO accounts for more than 50% of all admissions to most gas-troenterology (GI) departments. In Belgium, France and Germany,HGE withspecific,recognizedcompetenceareallowedtoadminis-ter chemotherapy and targeted therapies. In these countries, suchcompetence isconsideredtobeattainedaftertwoyearsoftrainingwith an additional course and certification controlled by special-ists in oncology. HGE work in close collaboration with the otherspecialists responsible for managing digestive cancer, as part ofmultidisciplinary teams. Together, Belgium, France and Germanyaccount for 40% of the European population (about 200 millionEuropean citizens). The system works well in these countries andit is not clear why other European countries have not also electedto allow HGE to perform these functions after specific training.Chemotherapy and targeted therapies are no more complex toadminister than other drugs regularly prescribed by HGE, suchas immunosuppressants, antiviral treatments and anti-TNF treat-ments.The reasonsforthissituationmaybehistorical,demographicoreven political.1.1. Historical aspectsWhen 5FU (fluorouracil Roche lb), the first antineoplastic drug,was discovered 50 years ago, HGE expressed great scepticism con-cerning its utility. However, the situation changed in the 1990s,