Gastrointestinal Tumors Research Articles

Combined application of the preclosure technique and traction approach facilitates endoscopic full-thickness resection of gastric submucosal tumors

BACKGROUND Gastrointestinal submucosal tumors (SMTs) mostly grew in the lumen, but also some of the lesions were extraluminal, in which the stomach was the most common site. Gastrointestinal stromal tumor account for a large proportion of SMT. Due to the deep lesion location of gastric SMT, endoscopic submucosal dissection related techniques are difficult to operate, while endoscopic full-thickness resection (EFTR) has been widely used in clinical practice because it is less invasive and can preserve the physiological structure and function of the stomach. However, complete closure of the gastrectomy site after EFTR is critical. If the closure is incomplete, it may cause peritonitis, late perforation and other conditions, and even require further surgical intervention. Although there are currently a number of suture devices and techniques that can be used to promote closure, they have the problem of requiring additional equipment or being inconvenient to use. Although metal clips are widely used, their effectiveness depends on the size and tension of the defect. Therefore, an effective and convenient endoscopic closure technique is urgently needed to solve the closure problem of gastric SMTs after treatment. AIM To investigate the effect of combined application of the preclosure technique and dental floss traction in gastric wound closure following EFTR. METHODS In this study, the data of 94 patients treated for gastric SMTs at the Gastrointestinal Endoscopy Center of the Affiliated Union Hospital of Fujian Medical University from April 2022 to May 2023 were retrospectively analyzed. The patients were divided into a preclosure group (54 patients) and a non-preclosure group (40 patients) on the basis of the timing of wound closure with titanium clips after dental floss traction-assisted EFTR. Each patient in the preclosure group had their wounds preclosed with titanium clips after subtotal lesion resection, whereas each patient in the non-preclosure group had their wounds closed with titanium clips after total lesion resection. The lesion size, wound closure time, number of titanium clips used, incidence of postoperative complications, and postoperative hospitalization time were compared between the two groups. RESULTS The wound closure time was significantly shorter in the preclosure group than in the non-preclosure group (6.69 ± 2.109 minutes vs 11.65 ± 3.786 minutes, P < 0.001). The number of titanium clips used was significantly lower in the preclosure group (8.93 ± 2.231) than in the non-preclosure group (12.05 ± 4.495) (P < 0.001). There was no significant difference between the two groups in terms of the need for an indwelling gastric tube or the length of postoperative hospital stay (6.41 ± 1.31 vs 6.13 ± 1.06 days). For all patients in the preclosure group and the non-preclosure group, resection was completed successfully without bleeding, abdominal pain, abdominal distension, or other postoperative complications. CONCLUSION Application of the preclosure technique combined with dental floss traction can be used intraoperatively to effectively close the surgical wound in patients undergoing EFTR, reliably preventing the tumor from falling into the peritoneal cavity.

Hyperthermia combined with opioid therapy: Enhancing cancer pain management and reducing surgical stress in gastrointestinal cancer patients

In this article, we evaluate the findings of the study by Qian et al , which explores the efficacy of combining hyperthermia with opioid therapy for enhanced cancer pain management in patients with middle and late-stage gastrointestinal tumors. The study undertakes a retrospective analysis comparing traditional opioid therapy to an integrated approach of hyperthermia and opioids across 70 patients, highlighting significant benefits in pain control, reduction of opioid dosage, and minimization of adverse reactions. In our article, we not only discuss these findings but also emphasize the broader implications for clinical practice, particularly in enhancing patient outcomes through innovative pain management strategies. We advocate for further research to establish more robust data supporting this approach and to explore the mechanistic insights that enable these benefits. This discussion reflects on the potential paradigm shift in managing debilitating cancer-related pain, urging a reevaluation of current practices to incorporate these findings effectively.

Epigenetic Regulation of Cellular Senescence in Gastrointestinal Cancer.

Gastrointestinal (GI) cancers, encompassing malignancies of the digestive tract, are significant contributors to global cancer morbidity and mortality. Despite advancements in molecular insights and therapeutic approaches, the prognosis remains dismal due to persistent treatment resistance and metastasis. Cellular senescence, a permanent halt in the cell cycle due to various stressors, playing dual roles in tumor suppression and promotion. Interestingly, epigenetic modifications-heritable shifts in gene level without altering the DNA sequence-are identified as key regulators of cellular senescence. These modifications, such as DNA methylation, histone alterations, chromatin remodeling, and non-coding RNA interactions, shape the senescence phenotype and influence cancer progression and therapy resistance. Recent research underscores the potential of "pro-senescence" therapies, leveraging epigenetic modulators and senescence-inducing agents to counteract GI cancer progression. This review explores the relationship between cellular senescence and epigenetic regulation in the context of GI cancer highlighting the characteristics of senescence, the epigenetic mechanisms at play, their impact on GI cancer senescence, and the promising horizon of anti-senescence therapies. Through a detailed examination of current research, we propose that understanding the intricacies of epigenetic regulation in cellular senescence offers a novel vista for therapeutic intervention in GI cancers, potentially paving the way for improved clinical outcomes.

Unlocking the Therapeutic Potential of Natural Polyphenols in Esophageal Cancer.

Esophageal cancer (EC), one highly malignant upper gastrointestinal cancer, is the eighth most commonly occurring cancer and the sixth leading cause of cancer-related deaths worldwide. Clinically, this malignancy is considered to be one of the most difficult-to-treat cancers, owing to its resistance to common therapies like chemotherapy and radiotherapy, and few targeted therapies are available. There is currently an unmet need for treatment of EC. Polyphenols are naturally occurring plant secondary metabolites in response to environmental threats and injury. Epidemiological evidence suggests that long-term consumption of a polyphenol-rich diet is inversely associated with the risk of cancer. Currently, natural polyphenols have received increased attention for their potential therapeutic effects on EC. In this review, we summarize and discuss recent progress in the therapeutic potential of natural polyphenols in EC, as well as their sources, oral bioavailability, and pharmacokinetics. We review natural polyphenols combined with approved chemotherapy and radiotherapy to overcome challenges faced by either monotherapy. We also discuss the current challenges and future directions to accelerate the clinical application of natural polyphenols in EC. We concluded that natural polyphenols represent promising candidates for the management of EC. Well-designed randomized controlled studies are warranted to verify the efficacy and safety of natural polyphenols for EC. Knowledge gained from this review will outline possible future research directions and should help to develop new therapeutics for this disease.

The Role of the Interventional Radiologist in Stopping Bleeding in Cancer Patients.

Malignancy-related hemorrhage is a complex and potentially life-threatening complication that requires a multidisciplinary approach. This review examines the role of endovascular interventions in achieving hemostasis when conservative measures fail, focusing on their indications, efficacy, and associated risks. Endovascular therapies have demonstrated high success rates in controlling hemorrhage from various malignancies. Bronchial artery embolization (BAE) effectively manages hemoptysis in lung cancer, though recurrence remains a challenge. Gastrointestinal tumor bleeding can be treated with targeted embolization, but ischemic complications require careful technique. Hematuria due to urinary and prostate malignancies responds well to superselective embolization, and uterine artery embolization (UAE) is a viable option for gynecologic malignancy-related bleeding. Emerging techniques, such as bronchial artery chemoembolization, show promise in improving long-term control. Endovascular interventions are a cornerstone in the management of malignancy-related hemorrhage, offering minimally invasive and effective hemostatic solutions. While recurrence and complications remain a concern, advancements in embolization techniques and materials continue to improve outcomes. A multidisciplinary approach is essential to optimizing patient care.

Evaluating ACOs impact on Gastrointestinal Cancer Care: Are they Falling Short on Health Outcomes?

Evaluating ACOs impact on Gastrointestinal Cancer Care: Are they Falling Short on Health Outcomes?

Major outcomes of clinical studies and guidelines on nutrological therapy and palliative care in critically ill patients: a systematic review

Introduction: Adequate nutritional therapy is often a missing factor in the treatment of patients receiving end-of-life palliative care. The American Academy of Hospice and Palliative Care defined palliative care as comprehensive and specialized care. The main concerns are nutritional, pain, and symptom management, information sharing and advance care planning, psychosocial and spiritual support, and care coordination. Objective: It was to list the main outcomes of clinical studies and guidelines on enteral/parenteral nutritional therapy and palliative care in critically ill patients. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from June to August 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 93 articles were found. A total of 44 articles were evaluated in full and 16 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 13 studies with a high risk of bias and 27 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=85.9%>50%. It was concluded that palliative nutritional care plans for critically ill patients should be managed by a nutritionist together with patients and family members. The benefits and risks of artificial nutrition and hydration should be discussed with the patient and/or caregiver when palliative care is initiated. The main goal of palliative care is to preserve the patient's quality of life. This includes defending freedom of choice and allowing the patient to determine their level of nutritional intervention. The results suggest that providing nutritional support ( 12 g of protein, 300 kcal) daily prevents the loss of active tissue mass in palliative cancer patients. Based on these results, we recommend the inclusion of this simple nutritional support to prevent malnutrition in cancer patients in palliative care. Furthermore, severe malnutrition is a predictor of reduced survival in patients with advanced gastrointestinal cancer. Information on nutritional status should be considered to individualize the palliative care plan for these patients and, therefore, improve their quality of life. Using the modified Glasgow Prognostic Score to identify the existence and severity of cancer cachexia has the potential to aid clinical decision-making regarding the indication of enteral nutrition in patients with incurable cancer receiving palliative care.

Preoperative Prediction of Sarcopenia in Patients Scheduled for Gastric and Colorectal Cancer Surgery.

Sarcopenia negatively impacts surgical outcomes in gastrointestinal cancer patients, yet practical preoperative screening tools are lacking. The CRP/ALB ratio, a novel biomarker of systemic inflammation and nutritional status, may enhance sarcopenia prediction but remains underexplored in surgical oncology. This study aims to identify the predictors for preoperative sarcopenia prediction in gastric and colorectal cancer patients. This retrospective study analyzed 145 patients undergoing curative surgery (2019-2021). Sarcopenia was defined by sex-specific CT-measured L3 skeletal muscle index (cutoffs, male ≤ 40.8 cm2/m2; female ≤ 34.9 cm2/m2). Multivariable logistic regression identified predictors, with model performance assessed via ROC analysis and Cohen's Kappa. The cohort (median age 64years; 73.8% male) comprised 66 gastric (45.5%) and 79 colorectal (54.5%) cancer patients, with 29 (20%) diagnosed with sarcopenia. Sarcopenic patients exhibited a higher NRS 2002 score (P < 0.001), lower PNI score (P < 0.05), and higher CRP/ALB ratio (P < 0.05). Multivariate logistic regression analysis results showed that CRP/ALB ratio (OR = 3.084, 95% CI 1.071-8.882, P = 0.037), age (OR = 1.074, 95% CI 1.021-1.130, P = 0.006), and BMI (OR = 0.667, 95% CI 0.542-0.820, P = 0.000) were associated with the increased risk of sarcopenia. The combined model achieved superior discrimination (AUC = 0.854, 95% CI 0.770-0.937), yielding 75.86% sensitivity and 84.82% specificity at optimal cutoff value - 1.0340, and a Cohen's Kappa coefficient of 0.542 when compared to CT results. The CRP/ALB ratio combined with BMI and age is utilized as a convenient and effective tool for preoperative sarcopenia screening. This model-driven approach provides robust strategies to facilitate preoperative interventions, optimize perioperative care, and enhance long-term oncological outcomes for patients undergoing gastric and colorectal cancer surgery.

Days at home after treatment of spinal metastases: measurement and validation of a novel patient centered outcome.

Clinically meaningful population health outcomes for patients with spinal metastases are lacking. This study quantifies and validates days at home (DAH) after treatment of spinal metastases, and investigates factors associated with this patient-centered outcome. A population-based cohort study was conducted with the 2007-2019 Ontario Cancer Registry. Patients aged over 18 years undergoing surgery and/or radiation for a spinal metastasis were included. DAH was assessed at 3 months, 6 months (DAH-180), 1 year (DAH-365), and 2 years (DAH-730) after first treatment. Associations between DAH and primary cancer type, age, and frailty were assessed using multivariable quantile regression to estimate adjusted medians differences (aMD) in DAH. Predictive validity was determined with Spearman correlations between DAH-180 and longer-term DAH measures. We identified 36,233 treated patients. Median DAH for patients after 3 months, 6 months, 1 year, and 2 years from treatment were 79 days, 114 days, 120 days, and 121 days, respectively. Lower home time was associated with older age (aMD: -16 days per decade increase in age), and frailty (aMD: -36). Primary cancers associated with the least DAH included gastrointestinal cancer (aMD: -162 days), lung cancer (aMD: -165 days), and melanoma (aMD: -167 days). DAH-180 demonstrated predictive validity with longer term DAH-365 (p < 0.001), and DAH-730 (p < 0.001). These data help validate DAH as a reliable metric for patients treated for spinal metastases. Patients with older age, frailty, high health resource utilization, and primary melanoma, gastrointestinal or lung cancer were found to have the fewest DAH after treatment.

A fusion model to predict the survival of colorectal cancer based on histopathological image and gene mutation

Colorectal cancer (CRC) is a prevalent gastrointestinal tumor worldwide with high morbidity and mortality. Predicting the survival of CRC patients not only enhances understanding of their life expectancies but also aids clinicians in making informed decisions regarding suitable adjuvant treatments. Although there are many clinical, genomic, and transcriptomic studies on this hot topic, only a few studies have explored the direction of integrating advanced deep learning algorithms and histopathological images. In addition, it is still unclear if combining histopathological images and molecular data can better predict patients’ survival. To fill in this gap, we proposed in this study a novel multimodal deep learning computational framework using Multimodal Compact Bilinear Pooling (MCBP) to predict the 5-year survival of CRC patients from histopathological images, clinical information, and molecular data. We applied our framework to the cancer genome atlas (TCGA) CRC data, consisting of 84 samples with histopathological images, clinical information, mRNA sequencing data, and gene mutation data all available. Under the 5-fold cross-validation, the model using only histopathological images achieved an area under the curve (AUC) of 0.743. Whereas, the model combining image and clinical information and the model combining image and gene mutation information achieved AUCs of 0.771 and 0.773 respectively, better than that of the image solely. Our study demonstrates that histopathological images can reasonably predict the 5-year survival of CRC patients, and that the appropriate integration of these images with clinical or molecular data can further enhance predictive performance.

Cutting-edge nanotechnology: unveiling the role of zinc oxide nanoparticles in combating deadly gastrointestinal tumors

Cutting-edge nanotechnology: unveiling the role of zinc oxide nanoparticles in combating deadly gastrointestinal tumors

A Comprehensive Review on Novel Therapies for Gastrointestinal Cancers using Translational Platforms.

Gastrointestinal (GI) cancers, including gastric cancer, are among the most common and deadly cancers worldwide. Patients diagnosed with GI cancer still have a poor prognosis, largely resulting from the late stage of presentation for most of these patients and resistance to conventional therapy. This review covers new therapeutic strategies that apply advances in nanotechnology, immunotherapy, and drug delivery to overcome these challenges. Polymeric and metallic nanoparticles are distinguished for their potential to improve drug stability and solubility, as well as targeting drugs, thus diminishing systemic toxicity. The review centers around the use of immunotherapy in immune checkpoint inhibitors, CAR-T cell therapy, as well as the use of cancer vaccines to re-orient the immune system to be effective against cancer cells. Oncolytic viral therapy and bacteria- based treatments are unique non-conventional approaches that have a potential synergistic impact when used in concomitance with traditional methods. This review presents one of the most promising drug delivery systems: liposomes and micelles that can enhance pharmacokinetics and improve therapeutic results with controlled and site-specific release of anticancer agents. This review critically analyzes the strengths and challenges that include bioavailability, toxicity, and clinical translation, along with strategies to overcome such barriers. The review presents the most salient evidence to date and demonstrates the transformative potential of combining nanotechnology with immunotherapeutic and targeted treatments for managing gastric and other GI cancers. Future research should be focused on optimizing these platforms for clinical applications for the betterment of patient outcomes around the globe.

Molecular tumour board in gastrointestinal cancers.

Molecular tumour board in gastrointestinal cancers.

Illness perception and resilience in patients with cancer: a cross-sectional study

BackgroundCancer is the second leading cause of death after cardiovascular diseases and is considered a debilitating and incurable condition. Following diagnosis, individuals often experience anxiety, depression, and diminished social energy. Therefore, identifying factors that influence the psychological state of these patients and intervening to improve their well-being is crucial.AimThis study aims to examine the relationship between illness perception and resilience in cancer patients visiting healthcare centers.MethodsThe study was conducted in a cross-sectional design, involving 262 cancer patients selected through stratified random sampling from two public and two private oncology treatment centers in Tabriz, Iran. Data were collected using a demographic checklist, the Connor-Davidson Resilience Scale (CD-RISC), and the Revised Illness Perception Questionnaire (IPQ-R). Data analysis was conducted using IBM SPSS Statistics (V.20) at a significance level of 0.05. Statistical methods included descriptive statistics, one-way ANOVA, t-test, Pearson correlation, and multiple linear regression to examine relationships between demographic variables, illness perception, and resilience.ResultsThe majority of participants in the study were male (74%), married (72%), suffering from gastrointestinal cancers (62%), with an average age of 40.9 (SD: 11.9) years. The average overall resilience score was 60.1 (SD: 16.6). Pearson correlation results showed a significant positive correlation between overall resilience and the subscales of illness identity (r = 0.26, p < 0.001), consequences of illness (r = 0.20, p < 0.001), personal control (r = 0.47, p < 0.001), treatment control (r = 0.61, p < 0.001), and time line cyclical (r = 0.33, p < 0.001). Linear regression analysis revealed that illness Identity (B = 0.94, CI [0.43, 1.44], p < 0.001), personal control (B = 1.75, CI [1.30, 2.21], p < 0.001), treatment control (B = 2.37, CI [1.87, 2.88], p < 0.001), and time line cyclical (B = 0.30, CI [0.40, 1.01], p = 0.04) significantly predicted resilience.ConclusionThe findings suggest that improving patients’ understanding and control over their illness may enhance their psychological resilience. These results highlight the importance of patient education and psychological interventions in cancer care, aimed at strengthening personal control and resilience. Integrating these strategies into standard care has the potential to improve patients’ ability to cope with the psychological challenges of cancer and ultimately lead to an enhanced quality of life.

Diagnostic efficacy of an extracellular vesicle-derived lncRNA-based liquid biopsy signature for the early detection of early-onset gastric cancer

BackgroundEarly-onset gastric cancer (EOGC) is a lethal malignancy. It differs from late-onset gastric cancer (LOGC) in clinical and molecular characteristics. The current strategies for EOGC detection have certain limitations in...

Emerging role of deubiquitinases in modulating cancer chemoresistance.

Emerging role of deubiquitinases in modulating cancer chemoresistance.

Formyl peptide receptor 1 signaling strength orchestrates the switch from pro-inflammatory to pro-resolving responses: The way to exert its anti-angiogenic and tumor suppressor functions.

Formyl peptide receptor 1 signaling strength orchestrates the switch from pro-inflammatory to pro-resolving responses: The way to exert its anti-angiogenic and tumor suppressor functions.

Recent studies of the effects of microgravity on cancer cells and the development of 3D multicellular cancer spheroids.

The still young and developing space age, characterized by lunar and Martian exploration and the vision of extraterrestrial settlements, presents a unique environment to study the impact of microgravity (µg) on human physiology and disease development. Cancer research is currently a key focus of international space science, as µg fundamentally impacts cellular processes like differentiation, adhesion, migration, proliferation, survival, cell death, or growth of cancer cells as well as the cytoskeleton and the extracellular matrix (ECM). By creating three-dimensional (3D) tumor models in a µg-environment, like multicellular spheroids (MCS), researchers can expedite drug discovery and development, reducing the need for animal testing. This concise review analyses the latest knowledge on the influence of µg on cancer cells and MCS formation. We will focus on cells from brain tumors, lung, breast, thyroid, prostate, gastrointestinal, and skin cancer exposed to real (r-) and simulated (s-) µg-conditions.

The Frequency and Characterization of Ovarian Metastasis from Non-Ovarian Cancers Using 18F-fluoro-2-deoxy-D-glucose positron emission tomography computed tomography

Abstract Objective Assessing the frequency of ovarian metastasis from nonovarian cancer (N-OC) and evaluate whether any positron emission tomography (PET)-derived parameters can distinguish metastasis from primary ovarian cancer. Methods Patients undergoing PET/computed tomography (CT) due to suspected ovarian malignancy from 2006-2021 with subsequent histologically proven ovarian metastasis from N-OC were included. Exclusion criteria: ovarian metastasis diagnosed prior to PET/CT or &amp;gt; 3 months after. Baseline characteristics were collected from electronic medical records, and PET/CT data were analysed using Siemens syngo.via software. Results 1502 patients were scanned for suspected ovarian malignancies. 65 patients (4%) were included. The most common origin of metastases was lower gastrointestinal cancer (n = 29, 45%), followed by gynaecological cancer (n = 10, 15%) and breast cancer (n = 9, 14%). Among patients with previous cancer history (n = 26), 18 experienced ovarian metastases from a known cancer. Time from primary diagnosis to ovarian metastasis ranged from 47 days to 11.4 years. There were no differences in SUVmax, SUVpeak or clinical parameters between ovarian metastases and primary ovarian tumours. Conclusion The frequency of ovarian metastases from N-OCs was 4%, the most common origin of metastases was lower gastrointestinal tract. Previous cancer history is an important factor in assessing an unknown tumour of the ovary, as metastases can occur several years later. No PET or clinical parameters were useful for separating primary ovarian cancer from ovarian metastases. Advances in knowledge The study finds a low frequency of ovarian metastasis from N-OC and indicates that no PET- or clinical parameters can distinguish ovarian metastasis from primary ovarian cancer.

Eastern Canadian Gastrointestinal Cancer Consensus Conference 2024

The Eastern Canadian Gastrointestinal Cancer Consensus Conference was an annual meeting that was held in St. John’s, Newfoundland and Labrador, from 26 to 28 September 2024. This included experts in medical oncology, radiation oncology, surgical oncology, nuclear medicine, and general practitioners in oncology (GPO) from across the eastern Canadian provinces who are involved in the management of patients with gastrointestinal malignancies. This consensus statement generated by the conference addresses multiple topics, including the management of localized rectal cancer, liver-limited colorectal cancer, systemic therapy for advanced biliary tract cancers, radioligand therapy for gastroenteropancreatic neuroendocrine tumors (GEP-NETs), systemic therapy for pancreatic and midgut well-differentiated NETs, and systemic therapy for HER2-positive gastroesophageal cancers.