Digestive Tract Malignancies Research Articles

A Genetic Variant in miRNA-219-1 Is Associated with Risk of Esophageal Squamous Cell Carcinoma in Chinese Kazakhs.

Background. Esophageal cancer (EC), an aggressive digestive tract malignancy, is one of the leading causes of cancer-related deaths worldwide. Besides environmental risk factors, genetic factors might play a key role in the EC carcinogenesis. The aim of the study is to evaluate the association of miR219-1 single-nucleotide polymorphisms (SNPs) with EC. Methods. A total of 248 Kazakh esophageal squamous cell carcinoma (ESCC) cases and 300 frequency-matched control subjects were recruited for this study. Genomic DNA was isolated from the samples. The miR-219-1 rs107822G > A and rs213210T > C genotypes were determined by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Linkage disequilibrium (LD) and haplotype analysis were used to detect the degree of association on miR-219-1 rs107822 and rs213210. Real-time quantitative polymerase chain reaction (qRT-PCR) was performed to detect miR-219-1 expression with miR-219-1 rs107822 polymorphism. Result. The SNP rs107822G > A in the miR-219-1 gene decreased the risk of Kazakh ESCC. Furthermore, two miR-219-1 SNPs, namely, rs107822 and rs213210, may tag each other to decrease the risk of Kazakh ESCC. These findings indicated that functional polymorphisms miR-219-1 rs107822G > A might change individual susceptibility to Kazakh ESCC.

The Genus Streptococcus – Part I: Emerging Pathogens in the “Pyogenic Cocci” and the “Streptococcus bovis” Groups

In this first part of a two-part update on the streptococci, new and emerging pathogens in the “pyogenic cocci group” and the “Streptococcus bovis group” are addressed. Among the pyogenic cocci, several new species have been described, and some of these are becoming relevant agents of human disease. Streptococcus porcinus and Streptococcus pseudoporcinus are β-hemolytic streptococci that are found in swine and humans, respectively. S. pseudoporcinus has been isolated primarily from the female genital tract and may play a role in genitourinary tract infections, wound infections, and adverse pregnancy outcomes. Streptococcus iniae, Streptococcus hongkongensis, and Streptococcus ictaluri are fish pathogens, and S. iniae, in particular, has been isolated from several human infections in persons who handle raw seafood or experience penetrating injuries from fish spines or crab pincers. Streptococcus gallolyticus subspecies (i.e., the former “S. bovis group”) are well-recognized causes of bacteremia, meningitis, and endocarditis. S. gallolyticus subsp. gallolyticus is known to be associated with colon cancer, and current studies suggest that other S. gallolyticus subspecies (particularly S. gallolyticus subsp. pasteurianus) may also be associated with meningitis and other digestive tract malignancies. In this review, current research on S. gallolyticus subspecies and proposed mechanisms for their involvement in the pathogenesis of colonic carcinoma are also briefly addressed.

Expression of PI3k, akt, p-akt, bad, and p-bad in radiosensitivity induced by aresenic trioxide in human esophageal carcinoma.

e15039 Background: Esophageal cancer is one of the common malignant digestive tract tumors. Increasing the radiation sensitivity to tumor cells is a potential method to improve the efficacy of radi...

Bacteraemia due to Streptococcus gallolyticus subspecies pasteurianus is associated with digestive tract malignancies and resistance to macrolides and clindamycin

This study was intended to delineate the association between digestive tract malignancies and bacteraemia due to Streptococcus gallolyticus subspecies pasteurianus. We reviewed the medical records and microbiological results of patients with bacteraemia due to Streptococcus bovis during the period 2000-2012. Species and subspecies identification of isolates originally classified as S. bovis was confirmed by 16S rRNA sequencing and PCR restriction fragment length polymorphism (PCR-RFLP) assays. Minimum inhibitory concentrations of antimicrobial agents were determined by the broth microdilution method. Of the 172 S. bovis complex isolates obtained from 172 patients (age range, <1-94 years, median age, 66) with bacteraemia, 31 isolates were identified to be S. gallolyticus subspecies gallolyticus, 126 were S. gallolyticus subspecies pasteurianus, and 15 were shown to be Streptococcus infantarius. The majority (n = 104, 60%) of patients were male and had underlying malignancies (n = 87, 51%). Bacteraemia due to S. gallolyticus subspecies gallolyticus was significantly associated with endocarditis while S. gallolyticus subspecies pasteurianus was more likely to be associated with malignancies of the digestive tract, including gastric, pancreatic, hepatobiliary and colorectal cancers. Septic shock at presentation was the only factor associated with mortality among patients with bacteraemia due to either subspecies of S. bovis. Isolates of S. gallolyticus subspecies pasteurianus had higher rates of resistance to macrolides and clindamycin than isolates of S. gallolyticus subspecies gallolyticus. Extensive diagnostic work-up for digestive tract malignancies and trans-esophageal echocardiogram should be investigated in patients with bacteraemia caused by S. gallolyticus.

Oral cavity examination (OCE) during upper aerodigestive tract investigations (UATI)

Introduction: Oral cancer is an ideal candidate for screening. Many oral cancers are preceded by pre malignant lesions which are amenable to detection through simple oral cavity examination (OCE). At present oral cancers frequently present at a late stage with poor prognosis. The risk factors for oral and upper digestive tract malignancy are similar and synchronous carcinoma is sometimes seen. At present oral examinations are not current practice for patients undergoing an UATI with endoscopy, whereas rectal exams for colonoscopy are.

Prophylactic percutaneous endoscopic gastrostomy in head and neck cancer patients: results of tertiary institute

To evaluate the use and complications of a prophylactic percutaneous endoscopic gastrostomy (PEG) in head and cancer patients in our institute. A retrospective study of 194 consecutive patients with a newly diagnosed upper aero digestive tract malignancy who underwent mainly prophylactic PEG tube placement. The procedure is relatively safe: 15 (7.7%) of the complications were considered serious; no deaths occurred. Of the patients 23 (12.5%) did not use the PEG tube at all, but it was not possible to single out a group of patients in which this could be predicted. The majority of the patients were considered to benefit from the prophylactic PEG insertion.

From Trial Highlights to Clinical Context: Putting American Society of Clinical Oncology Gastrointestinal News into Practice

Celebrating its tenth anniversary, the Gastrointestinal Cancers Symposium is a world class, international conference focused on research and multidisciplinary management of digestive tract malignancies, co-sponsored by the American Society of Clinical Oncology, the American Society for Radiation Oncology, the American Gastroenterological Association Institute and the Society of Surgical Oncology. This premium meeting was held from 24 to 26 January 2013 in San Francisco (CA, USA) and, in line with its principal mission, it sought to globally embrace prevention, screening, diagnostics, translational research and multimodal treatment, moving on three major anatomic tracks (upper gastrointestinal cancers, pancreatic/hepatobiliary tumors and colorectal malignancies). Over 2000 healthcare professionals gathered at this valuable 3day scientific event, which included plenary educational sessions and oral presentations of the top-rated abstracts, as well as the exposition of nearly 600 posters. This short article offers a summarized opinion-based overview of the most significant studies presented at the meeting that are likely to impact on clinical practice as well as new drug development, as best exemplified by the three most important messages of the whole meeting: the value of nanoparticle albumin-bound paclitaxel in metastatic pancreatic cancer; that of ramucirumab in second-line gastric cancer; and that of capecitabine and bevacizumab in elderly advanced colorectal cancer patients.

Prevenção do tromboembolismo na cirurgia do câncer do aparelho digestivo

The venous thromboembolism is a common complication after surgical treatment in general and, in particular, on the therapeutic management on cancer. Surgery of the digestive tract has been reported to induce this complication. Patients with digestive cancer have substantial increased risk of initial or recurrent thromboembolism. To provide to surgeons working in digestive surgery and general surgery guidance on how to make safe thromboprophylaxis for patients requiring operations in the treatment of their gastrointestinal malignancies. The guideline was based on 15 relevant clinical issues and related to the risk factors, treatment and prognosis of the patient undergoing surgical treatment of cancer on digestive tract. They focused thromboembolic events associated with operations and thromboprophylaxis. The questions were structured using the PICO (Patient, Intervention or Indicator, Comparison and Outcome), allowing strategies to generate evidence on the main primary bases of scientific information (Medline / Pubmed, Embase, Lilacs / Scielo, Cochrane Library, PreMedline via OVID). Evidence manual search was also conducted (BDTD and IBICT). The evidence was recovered from the selected critical evaluation using discriminatory instruments (scores) according to the category of the question: risk, prognosis and therapy (JADAD Randomized Clinical Trials and New Castle Ottawa Scale for studies not randomized). After defining potential studies to support the recommendations, they were selected by the strength of evidence and grade of recommendation according to the classification of Oxford, including the available evidence of greater strength. A total of 53,555 papers by title and / or abstract related to issue were found. Of this total were selected (1st selection) 478 studies that were evaluated as full-text. From them to support the recommendations were included in the consensus 132 papers. The 15 questions could be answered with evidence grade of articles with 31 A, 130 B, 1 C and 0 D. It was possible to prepare safe recommendations as guidance for thromboembolism prophylaxis in operations on the digestive tract malignancies, addressing the most frequent topics of everyday work of digestive and general surgeons.

Brain metastases from colorectal cancer: microenvironment and molecular mechanisms.

Colorectal cancer is one of the most common digestive tract malignancies in the world. Owing to the newer and more effective systemic therapies, the life of colorectal cancer patients can be remarkably prolonged, and the incidence of brain metastases is increasing. However, little is known about the underlying mechanisms of brain metastasis from colorectal cancer. Here we review the tumor microenvironment and metastasis associated molecules in brain metastases from colorectal cancer. A further understanding of these mechanisms will help us to propose better strategies for colorectal cancer patients with brain metastasis and improve their life quality.

Abstract 3009: Alternative pre-mRNA splicing in digestive tract malignancy

Abstract Alternative pre-mRNA splicing plays an important role in the generation of functional diversity of genome. The process of pre-mRNA splicing is regulated by cis- and trans-elements, and their deregulations result in aberrantly-spliced individual variants and aberrant expression profiles. Accumulating evidence has revealed that aberrant splicing contributes to a number of diseases including human neoplasms. Germ line mutations in cis-element of tumor suppressor genes such as MMR genes, APC gene, and CDH1 gene are involved in Lynch syndrome, familial adenomatous polyposis, and hereditary diffuse gastric cancer, respectively. In addition, somatic mutations in cis-elements also play a role in tumorigenesis. These genetic alterations including nonsense, missense, or silent mutations in cis-elements, led to aberrant transcripts by exon skipping, retention of the intron, or introduction of new splice site (Miura et al., Cancer Science 2011 Feb;102(2):309-16). We present our results and current knowledge of the regulatory mechanism underlying alternative pre-mRNA splicing and aberrant splicing, particularly focusing on digestive tract malignancies. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3009. doi:1538-7445.AM2012-3009

Between Scylla and Charybdis: The Relationship of Gastroesophageal Reflux Disease and H. Pylori

Between Scylla and Charybdis: The Relationship of Gastroesophageal Reflux Disease and H. Pylori As physicians navigate the waters of upper gastrointestinal acid peptic disorders, they are faced with the two most common upper gastrointestinal disorders of Gastroesophageal Reflux Disease (GERD) and Helicobacter pylori (H. pylori). As Scylla and Charybdis they present serious problems that can range from inflammation and ulceration to malignancy. As the prevalence of H. pylori and its associated diseases have declined in the Westernized countries of the world, the incidence of GERD and its complications have increased, suggesting an inverse relationship between the two disease states. There appears to be a worldwide evolution of upper digestive diseases from H. pylori and its related diseases to GERD and its related diseases that alters the type of acid related disorder and malignancies of the upper digestive tract confronting the physician.

Endoscopic mucosal resection of colorectal tumors: Our first experience

Endoscopic mucosal resection (EMR) or mucosectomy is an interventional procedure for minimal invasive endoscopic removal of benign and malignant digestive tract tumors. Mucosectomy removes flat and sessile neoplasms, early colorectal cancer (CRC) confined to mucosa or submucosa and lateral spreading tumors. The aim of the study was to show our first experience in application of this procedure in everyday practice in regarding completeness and efficacy of the procedure, complication rate and incidence of recurrent adenomas. In the prospective study 51 colorectal adenomas were removed in 44 patients by EMR. Single mucosectomy was done in 43 patients, while multiple (8) in one patient. Complete resection was obtained in all procedures. In 36 (68.62%) procedures "en block" resection was done, but in 15 (31.37%) procedures "piece meal" resection was performed. Synchronous colorectal tumors (benign or malignant) were detected in 20 (45.45%) patients. Moderate dysplasia was found in 30 (58.82%) adenomas, but high grade dysplasia in 9 (17.64%) of adenomas. Intramucosal CRC was detected in 11.77% of adenomas. A total of 37 (72.54%) advanced adenomas were removed. There were 3 (5.88%) of recurrent adenomas, 6-30 months after the EMR. Only one (2.2%) case of post procedure bleeding was observed. EMR is a safe and efficious method for removal of flat, sessile adenomas, as well as early CRC. EMR is a routine endoscopic procedure in everyday practice of interventional endoscopist.

Alternative pre-mRNA splicing in digestive tract malignancy

Alternative precursor messenger RNA (pre-mRNA) splicing plays an important role in the generation of functional diversity of the genome. The process of pre-mRNA splicing is regulated by cis- and trans-elements, and their deregulations result in aberrantly spliced individual variants and aberrant expression profiles. Accumulating evidence has revealed that aberrant splicing contributes to a number of diseases including human neoplasms. It is well known that germ line mutations in the cis-element of tumor suppressor genes such as mismatch repair (MMR) genes, the adenomatous polyposis coli (APC) gene and the E-cadherin (CDH1) gene are involved in Lynch syndrome, familial adenomatous polyposis and hereditary diffuse gastric cancer, respectively. In addition, somatic mutations in cis-elements also play a role in tumorigenesis. These genetic alterations including nonsense, missense or silent mutations in cis-elements led to aberrant transcripts by exon skipping, retention of the intron or introduction of a new splice site. The majority of erroneous transcripts with a premature termination codon are eliminated through nonsense-mediated mRNA decay. However, it is difficult to accurately predict the resulting transcripts with current in silico strategies. Correct interpretation of genetic alterations and the investigation of aberrant transcripts are crucial for genetic diagnosis of hereditary diseases and elucidation of the molecular characteristics of neoplasms from a clinical point of view. In this review we summarize the current knowledge of the regulatory mechanism underlying alternative pre-mRNA splicing and aberrant splicing, with particular focus on digestive tract malignancies.

Krukenberg's tumor as the first clinical manifestation of cancer: A single institutional review of cases from 1993-2008 from South India.

e15541 Background: To analyze clinical data such as, presentation, diagnosis, treatment and follow up of patients presenting with Krukenberg's tumor as the first clinical manifestation of cancer to a single institution in South India. Methods: We retrospectively analyzed medical data from 41 patients who were referred to the Medical Oncology Department of the Institute of Obstetrics and Gynecology, Madras Medical College, Chennai between 1993 and 2008. Results: The patients ranged from 24 to 70 years (median, 45.5 years) with 41% of them being pre-menopausal. Abdominal distension or pain accounted for the commonest clinical presentation. Ascites was present in 49% of patients. 58% of the tumors were documented to be bilateral. Before a definitive diagnosis of ovarian tumor, investigations such as ultrasonography and chest X-Ray were undertaken in all patients. Computed tomography and CA-125 results were available for 13 patients. The highest level of CA-125 was 134 IU/mL. 27(66%) patients underwent surgery. The most common surgery performed was a debulking surgery. Microscopy suggested a digestive tract malignancy in 31 patients, ductal carcinoma in 5 patients, and mucinous adenocarcinoma in 5 patients. The details of the work-up for the primary site of cancer was available for all patients. Primary site of malignancy was stomach in 20 (48.4%) patients, colonic cancer in 7 (17%) patients, pancreatic cancer in 1 (2.4%) patient, breast cancer in 5 (12.2%) patients, lung cancer in 1 (2.4%) patient, and unknown primary site in 7 (17%) patients. 29 patients received Palliative chemotherapy. Follow-up data was available for 29 patients. The median overall survival was 7 months in our group of patients. Conclusions: There is poor prognosis for patients presenting with Krukenberg's tumor as the initial clinical manifestation of cancer. Bilateral ovarian tumor with ascites especially in premenopausal women should arouse suspicion. Diagnosis is late and most patients undergo surgery for ovarian tumor. The most common primary tumor is gastrointestinal tract cancer. No significant financial relationships to disclose.

Irinotecan-based combination chemotherapy for metastatic small intestinal adenocarcinoma.

Metastatic small intestinal adenocarcinoma (SIA) is rare among digestive tract malignancies, and a standard therapy has yet to be established. The present study described a patient who was treated with irinotecan-based chemotherapy. A 67-year-old woman with a long history of anemia was diagnosed as having SIA using small bowel endoscopy. Tumor invasion of the mesentery and multiple metastases to the lungs and peritoneal lymph nodes were detected. Nine courses of chemotherapy, each consisting of bolus infusion of 5-fluorouracil at 500 mg/m(2), plus infusion of irinotecan at 100 mg/m(2) with l-leucovorin at 20 mg/m(2) on days 1, 8 and 15, were administered at 4-weekly intervals postoperatively. After two courses, the metastatic nodules in the lungs showed a decrease in number and size, and this response continued for over 6 months. Adverse events were manageable during this period. The patient succumbed to the disease 12 months after the initial diagnosis. The present results therefore suggest that irinotecan-based chemotherapy is a potential treatment for metastatic SIA.

Influence of psychological care and health education on patients with digestive tract cancer receiving chemotherapy

Objective To study the impact of psychological care and health education on patients with digestive tract cancer and abnormal emotion receiving chemotherapy. Methods A retrospective analysis was carried out in 245 patients with malignant digestive tract cancer from July 2005 to July 2009 treated in our hospital, 147 cases of these patients received psychological care and health education besides conventional therapy were set as the intervention group, 98 cases given only basic nursing care were set as the control group. The clinical efficacy was analyzed in the two groups before and after chemotherapy using anxiety and depression indexes as indicators. Results After chemotherapy, SAS and SDS scores were significantly lower, while the survival time was significantly higher in the intervention group than those of the control group. Conclusions Psychological care and health education can reduce abnormal emotion in patients with malignant digestive tract cancer receiving chemotherapy and prolonged their survival time. Key words: Digestive tract cancer; Psychological care; Health education

Apigenin: A Promising Molecule for Cancer Prevention

Apigenin, a naturally occurring plant flavone, abundantly present in common fruits and vegetables, is recognized as a bioactive flavonoid shown to possess anti-inflammatory, antioxidant and anticancer properties. Epidemiologic studies suggest that a diet rich in flavones is related to a decreased risk of certain cancers, particularly cancers of the breast, digestive tract, skin, prostate and certain hematological malignancies. It has been suggested that apigenin may be protective in other diseases that are affected by oxidative process, such as cardiovascular and neurological disorders, although more research needs to be conducted in this regard. Human clinical trials examining the effect of supplementation of apigenin on disease prevention have not been conducted, although there is considerable potential for apigenin to be developed as a cancer chemopreventive agent.

Chondrosarcoma of the arytenoids- a rare laryngeal malignancy.

Even though laryngeal malignancies are the most frequent primary malignancies of the upper aero digestive tract except for oral cavity cancers, laryngeal chondrosarcomas are rare tumors, constituting less than 1% of all laryngeal tumors. We present a rare case of chondrosarcoma arising from the right arytenoid cartilage with sub glottic extension. The mode of presentation and management of the case is presented along with a review of the literature.

Postoperative regression of clubbing at an unexpected rate in a patient with aortic and mitral valve replacement due to infective endocarditis

Pulmonary diseases such as malignancies, empyema, bronchiectasis, digestive tract malignancies, inflammatory bowel diseases, cyanotic congenital heart diseases and infective endocarditis can cause clubbing. We present a 63-year-old female patient with infective endocarditis, who had clubbing that resolved very rapidly after cardiac surgery due to rupture of the mitral papillary muscle. She had persistent fever and in her echocardiographic examination rupture of the papillary muscle of the anterior mitral valve and significant aortic regurgitation was noted. She was scheduled for emergency operation and had debridement and replacement of the mitral and the aortic valves. During the follow-up, she had complaints of pain in the distal parts of the fingers. The convex shape of the nails changed and basal portions were apparently thinner and paler than the previous thickened and discoloured, hyperkeratotic nails. This newly growing tissue rapidly replaced the old thick nails in 3 days.

Endoscopic mucosal resection for squamous premalignant and early malignant lesions of the esophagus

BACK AND STUDY AIMS: Endoscopic mucosal resection (EMR) is used to treat premalignant and malignant digestive tract lesions. This report presents the efficacy and safety of EMR for squamous superficial neoplastic esophageal lesions. A retrospective cohort study presented data from 51 patients with 54 lesions over an 8-year period, between November 1997 and September 2005. Dysplasas or mucosal (m) T1 carcinomas were treated with repeated EMR until there was a complete local remission. Patients with submucosal (sm) T1 carcinomas were treated with repeated EMR until there was a complete local remission. Patients with submucosal (sm) T1 carcinomas or more advanced stage were offered surgery or chemoradiotherapy. There was no mortality, perforation, or major hemorrhage, and there were three easily dilated stenoses. Of the patients, 16 had lesions graded as T1sm or more advanced and one patient was found to have normal tissue post EMR. Complete local remission was achieved in 31 of the 34 patients with dysplasia or T1 m cancers (91%). There was no distant relapse and there was local disease recurrence in eight of the 31 patients (26%). The 5-year survival rate was 95%. EMR for squamous superficial neoplastic lesions of the esophagus is safe and provides satisfactory survival results.