Management Of Gastrointestinal Malignancies Research Articles

Biomarkers in Early Detection, Prognostication and Management of Gastrointestinal Tract Malignancies: A Review

Each year the risk of cancer cases is constantly on the rise. The reoccurrence of this dilemma is due to late diagnosis, and as a result the survival rate is low. This indicates the significance of creating more efficient instruments for timely detection of cancerous cells, assessment, as well as prognosis. Hence, the objective of this paper was to provide a critical review of biomarkers in early detection, prognostication and management of gastrointestinal tract malignancies by harvesting data from online sources and libraries. Data obtained reveals that gastrointestinal tracts (GI) malignancies, encompasses malignancies that may arise from the gastric, hepatic, colonic, esophagus, gallbladder, rectal and stomach tumors are a common kind of cancer and could affect 1.400,000 - 952,000,000 people worldwide. A potential method for improving the diagnosis as well as prognosis of GI malignancy is the use of biomarkers, which are quantifiable indicators of biological processes or state of the ailments. Significant development has been made recently in detecting and validating biomarkers for various clinical procedures. This review discuss the present situation of gastrointestinal cancer biomarker research, with an emphasis on moral issues and other clinical implications that may arise from the incorporation of biomarkers in clinical practices, and also the different category of biomarkers, including genetic, epigenetic, and protein-based markers, are examined, along with their contributions to future outcomes in the management of gastrointestinal malignancies.

Response Evaluation Criteria in Gastrointestinal and Abdominal Cancers: Which to Use and How to Measure.

As the management of gastrointestinal malignancy has evolved, tumor response assessment has expanded from size-based assessments to those that include tumor enhancement, in addition to functional data such as those derived from PET and diffusion-weighted imaging. Accurate interpretation of tumor response therefore requires knowledge of imaging modalities used in gastrointestinal malignancy, anticancer therapies, and tumor biology. Targeted therapies such as immunotherapy pose additional considerations due to unique imaging response patterns and drug toxicity; as a consequence, immunotherapy response criteria have been developed. Some gastrointestinal malignancies require assessment with tumor-specific criteria when assessing response, often to guide clinical management (such as watchful waiting in rectal cancer or suitability for surgery in pancreatic cancer). Moreover, anatomic measurements can underestimate therapeutic response when applied to molecular-targeted therapies or locoregional therapies in hypervascular malignancies such as hepatocellular carcinoma. In these cases, responding tumors may exhibit morphologic changes including cystic degeneration, necrosis, and hemorrhage, often without significant reduction in size. Awareness of pitfalls when interpreting gastrointestinal tumor response is required to correctly interpret response assessment imaging and guide appropriate oncologic management. Data-driven image analyses such as radiomics have been investigated in a variety of gastrointestinal tumors, such as identifying those more likely to respond to therapy or recur, with the aim of delivering precision medicine. Multimedia-enhanced radiology reports can facilitate communication of gastrointestinal tumor response by automatically embedding response categories, key data, and representative images. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Role of therapeutic endoscopic ultrasound in gastrointestinal malignancy- current evidence and future directions

Endoscopic ultrasound (EUS) has come a long way from a mere diagnostic tool to an advanced therapeutic modality. With the advent of better technologies and accessories, EUS has found ground in the management of gastrointestinal (GI) malignancies, not only for diagnosis but also for therapeutic purposes. EUS can tackle a host of conditions, including hepato-pancreatico-biliary malignancies. Advances and experience in various EUS-guided biliary drainage techniques have enabled the endosonologist to tackle biliary obstruction when conventional techniques of endoscopic retrograde cholangiopancreatography (ERCP) and/or percutaneous transhepatic biliary drainage (PTBD) fails. More and more emerging data not only establishes the safety of EUS-BD but also demonstrates superior efficacy over PTBD and sometimes even ERCP. Malignant gastric outlet obstruction can now be safely managed with EUS-guided gastroenterostomy. Starting from pain management in malignant tumors through celiac plexus neurolysis to various tumor ablative therapies, EUS has forged ahead over percutaneous treatment or surgical options in the management of GI malignancies. Additional data is now coming up on the prospects of EUS-guided immunotherapy and biological therapy for tumor management. The future of EUS therapeutics in the field of GI malignancies is bright. With increasing evidence, this modality becoming a key player in management of a host of complex clinical conditions arising out of GI malignancies is in the offing. This review focuses on elucidating the role of therapeutic EUS in the management of GI malignancies, a synopsis of various techniques, data on its safety and efficacy as well as future advancements in this domain.

THE IMPACT OF THE COVID-19 PANDEMIC ON MANAGEMENT OF GASTROINTESTINAL MALIGNANCIES; A NARRATIVE REVIEW

The advent of the COVID-19 pandemic has led to widespread disruptions in the delivery of all essential and non-essential health care globally, with individuals afflicted with cancer representing a particularly vulnerable sub set of those affected. This article reviews the published literature and guidelines on the management of gastrointestinal malignancies during the COVID-19 pandemic worldwide and summarizes the challenges posed, innovations made and outcomes of the various screening, diagnostic and therapeutic modalities employed during the period from March to December 2020.

Guanylyl cyclase C as a biomarker for immunotherapies for the treatment of gastrointestinal malignancies.

Gastrointestinal cancers encompass a diverse class of tumors arising in the GI tract, including esophagus, stomach, pancreasand colorectum. Collectively, gastrointestinal cancers compose a high fraction of all cancer deaths, highlighting an unmet need for novel and effective therapies. In this context, the transmembrane receptor guanylyl cyclase C(GUCY2C) has emerged as an attractive target for the prevention, detectionand treatment of many gastrointestinal tumors.GUCY2C is an intestinally-restricted protein implicated in tumorigenesis that is universally expressed by primary and metastatic colorectal tumors as well as ectopically expressed by esophageal, gastricand pancreatic cancers. This review summarizes the current state of GUCY2C-targeted modalities in the management of gastrointestinal malignancies, with special focus on colorectal cancer, the most incident gastrointestinal malignancy.

Efficiency of Electronic List-Based Multidisciplinary Team Meetings in Management of Gastrointestinal Malignancy: A Single-Center Experience in Southern China

Yuan, Yujie MD; Ye, Jinning MD; Ren, Yufeng MD; Dai, Weigang MD; Peng, Jianjun MD; Cai, Shirong MD; Chen, Chuangqi MD; Tan, Min MD; He, Yulong MD Author Information

The efficiency of electronic list-based multidisciplinary team meetings in management of gastrointestinal malignancy: a single-center experience in Southern China

BackgroundThe multidisciplinary team (MDT) discussion has earned increasing popularity for the delivery of cancer care. However, MDT meeting (MDTM) is time and resource intensive, and some efforts to optimize discussion processes are required. This study aims to investigate the efficiency of electronic list-based MDTM in treatment of gastrointestinal (GI) malignancy.MethodsBetween January 2015 and December 2016, patients with GI cancers were retrospectively reviewed. Patients permitting an MDTM with our novel technique (eMDT group) were compared with those undergoing a traditional discussion (cMDT group). The efficiency of MDT working, including time cost per meeting or case and overall number of reviewed cases, was checked, with accuracy of clinical staging and other outcomes explored meanwhile.ResultsThree thousand six hundred seventy-four patients were included, with 2156 (58.7%) and 1518 (41.3%) cases for eMDT and cMDT groups, respectively. Comparisons in age (P = 0.529), gender (P = 0.844), cancer type (P = 0.218), treatment plan (P = 0.737), and pathological stage (P = 0.098) were not significant between groups. However, the average time cost in both each meeting (149.4 vs. 205.1 min; P < 0.001) and each case (3.1 vs. 6.2 min; P < 0.001) was markedly reduced. Besides, this novel technique was associated with improved accuracy of clinical staging (P = 0.070) and reduced hospital stay (P < 0.001) compared with the traditional approach, with similar incidence of complications observed (P = 0.243).ConclusionsThe MDT working based on an intelligent checklist could save considerable time while not affecting treatment of GI malignancies. The improved efficiency also earns an increased capacity of hospital admission and in-patient care.

Photodynamic Therapy with Aminolevulinic Acid: a novel therapeutic Target in the Management of Gastrointestinal Malignancies

Photodynamic Therapy with Aminolevulinic Acid: a novel therapeutic Target in the Management of Gastrointestinal Malignancies

Advances in the management of gastrointestinal cancers--an upcoming role of immune checkpoint blockade.

Gastrointestinal cancers are a group of highly aggressive malignancies, and novel therapeutic strategies with higher clinical efficacy are being actively sought. ‘Immunotherapy’ is now emerging as one such promising strategy for the treatment of these tumors. This article briefly reviews the recent advances that utilize targeting of immune checkpoint pathways, in the management of gastrointestinal malignancies.

Minimally invasive surgery in gastrointestinal cancer: benefits, challenges, and solutions for underutilization.

Background and Objectives:After the widespread application of minimally invasive surgery for benign diseases and given its proven safety and efficacy, minimally invasive surgery for gastrointestinal cancer has gained substantial attention in the past several years. Despite the large number of publications on the topic and level I evidence to support its use in colon cancer, minimally invasive surgery for most gastrointestinal malignancies is still underused.Methods:We explore some of the challenges that face the fusion of minimally invasive surgery technology in the management of gastrointestinal malignancies and propose solutions that may help increase the utilization in the future. These solutions are based on extensive literature review, observation of current trends and practices in this field, and discussion made with experts in the field.Results:We propose 4 different solutions to increase the use of minimally invasive surgery in the treatment of gastrointestinal malignancies: collaboration between surgical oncologists/hepatopancreatobiliary surgeons and minimally invasive surgeons at the same institution; a single surgeon performing 2 fellowships in surgical oncology/hepatopancreatobiliary surgery and minimally invasive surgery; establishing centers of excellence in minimally invasive gastrointestinal cancer management; and finally, using robotic technology to help with complex laparoscopic skills.Conclusions:Multiple studies have confirmed the utility of minimally invasive surgery techniques in dealing with patients with gastrointestinal malignancies. However, training continues to be the most important challenge that faces the use of minimally invasive surgery in the management of gastrointestinal malignancy; implementation of our proposed solutions may help increase the rate of adoption in the future.

Pregnancy and Maternal Outcomes in Women With Prior or Current Gastrointestinal Malignancies

ObjectivesTo review the fetal and maternal outcomes of women with a diagnosis of gastrointestinal (GI) cancer before or during pregnancy. MethodsWe conducted a retrospective cohort study of pregnant women referred to a single tertiary care centre with a current or previous diagnosis of GI malignancy. Maternal, obstetric, and infant data were recorded. ResultsWe identified 18 pregnancies in 13 women. Nine women were found to have a GI malignancy during pregnancy (group 1). There was an indirect maternal death in this group in a woman with advanced gastric adenocarcinoma. Nine unique pregnancies occurred in eight women with diagnosis and management of GI malignancies before their pregnancies (group 2). ConclusionGI malignancies are difficult to diagnose and manage during pregnancy and are usually advanced at the time of diagnosis. Surgery can be performed during pregnancy if necessary, with chemotherapy and radiotherapy usually deferred to the postpartum period. Women who have had a prior GI malignancy have special circumstances related to the type of surgery performed and previous exposure to chemotherapy. These patients may benefit from a multidisciplinary team effort to optimize their care.

Nemorosone and its emerging anti-neoplastic effects

Dear Editor, The recent article byWestekemper et al. was highly interesting [1]. Nemorosonemay exert a number of anti-neoplastic effects in a number of systemic malignancies. Nemorosone acts on estrogen receptors α, and thereby attenuates tumor growth in breast malignancies. Nemorosone administration results in attenuated expression of pERK1/2 and pAkt [2]. The resulting effect is decreased intra-tumoral apoptosis in G0/G1 phase blockage. Nemorosone is also effective in the management of gastro-intestinal malignancies. For instance, it activates the unfolded protein response (UPR) network in pancreatic malignancies and thereby accentuates tumor apoptosis in these cancers [3]. UPR-mediated apoptosis is regulated primarily by DNA damage inducible transcript 3. Simultaneously, the mitochondrial membrane potential is reduced. A simultaneous accentuation of cytochrome c release is seen. Nemorosone also exerts antiproliferative effects in leukemias by altering hematopoiesis. It mediates these effects in part by modulating Akt/PKB function [4]. The key advantage of nemorosone is that it helps overcome chemo-resistance in leukemias. A simultaneous decline in cyclins A and c-Myb is noticed. Down-regulation of p38 MAPK also accompanies nemorosone administration in leukemia’s. Nemorosone is also effective in inhibiting growth in androgen-dependent prostate malignancies. For instance, 7-epi-nemorosone targets MEK1/2 and thereby induces cytotoxic effects in prostate carcinomas [5]. Nemorosone administration results in a decline in S phase cells and an increase in G0/G1 phase cells. CDK 4/6 is also downregulated. Attenuation of PSA levels occurs subsequently, resulting in better tumor growth control. Nemorosone is also effective in the management of intracranial tumors such as neuroblastomas. It mediates these anti-neoplastic effects by down-regulating N-myc levels [6]. An increase in the activity of caspase-3, and simultaneous inhibition of Akt/PKB also contributes to these anti-neoplastic effects. The above examples clearly illustrate the effectiveness of nemorosone in attenuating tumor growth in a number of systemic malignancies.

Molecular predictors of treatment response in colon and gastric cancer.

619 Background: With the noted exception of KRAS mutational status, currently there exists limited data regarding the incorporation of tumor-derived biomarkers in the clinical management of gastrointestinal malignancies. High ERCC1 levels have been associated with inferior results in platinum-treated patients with non-small cell lung cancer, esophageal cancers, and head and neck cancer. Lenz et al. concluded ERCC-1 gene expression levels may allow the selection of patients who may benefit from FOLFOX chemotherapy in metastatic colon cancer. Low intra-tumoral ERCC1 mRNA expression predicted improved PFS and OS in patients with esophageal adenocarcinoma who were treated with tri-modality therapy in the SWOG 0356 correlative study. Methods: To determine the prevalence and patterns of expression of select tumor biomarkers including ERCC1, TS, HER-2, KRAS, BRAF, and EGFR gene expression was measured in metastatic gastric and colorectal cancers using formalin fixed paraffin embedded tumor samples from 120 metastatic colorectal and 20 metastatic gastric cancer were dissected using laser-captured micro-dissection and analyzed for ERCC-1, TS, EGFR, RRM1, and VEGFR2a mRNA expression using a quantitative RT-PCR methodology. Gene expression values (relative mRNA levels) were recorded as ratios between the target gene and internal reference gene (beta-actin). A retrospective review of the patient’s response to therapy was planned. Results: In colorectal patients, the incidence of KRAS mutations was 50%, specifically Gly12Ser 4%, Gly12Val 11%, Gly12Asp 20%, Gly12 Cys 7% Gly12Ala 2% and Gly13Asp 8%. BRAF expression analysis displayed 91% wild type with 9% V600E mutations. Median expression values for ERCC1, TS, EGFR, RRM1, and VEGFR2A expression levels using RT-PCR were 1.23, 2.28, 1.90, 1.05, and 1.61 respectively in the colorectal subset. In gastric cancer, ERCC1, TS, and Her-2 median expression levels using RT-PCR were 1.54, 3.56, and 0.08 respectively. Correlation with clinical outcome is pending and will be reported later.

Chemoradiation Therapy in the Management of Gastrointestinal Malignancies

Concurrent administration of chemotherapy and radiotherapy has been increasingly used in cancer treatment, leading to improvements in survival as well as quality of life. Currently, it is a feasible preference, often regarded as the standard therapeutic option, for many locally confined solid tumors, including anal, bladder, cervical, esophageal, gastric, head and neck, lung, pancreatic and rectal cancers. In patients with these tumors, combined modality therapy improves local tumor control and survival while, in some instances, obviating the need for surgical removal of the organ of origin. The scientific rationale for the use of chemoradiation derives from the preclinical and clinical observations of synergistic interactions between radiotherapy and chemotherapy. When chemotherapy and radiotherapy are administered together, the chemotherapeutic agents can sensitize the cancer cells to the effects of ionizing radiation, leading to increased tumor-killing effects within the radiotherapy field. This, in turn, can improve local control of the primary tumor and, in some cancers, render surgical resection unnecessary. In other cases, patients with tumors that were initially considered unresectable are able to undergo curative interventions after completing chemoradiation. The chemotherapy component can address any potential micrometastatic disease that, without therapy, leads to an increased risk of distant recurrence. A large body of evidence exists that supports the use of chemoradiotherapy in gastrointestinal cancers. In fact, one of the first tumor types in which the superior efficacy of chemoradiation was described was anal cancer. Since then, chemoradiotherapy has been explored in other gastrointestinal malignancies with superior outcomes when compared with either radiation or chemotherapy alone. This article aims to recapitulate the clinical evidence supporting the use of chemoradiotherapy in a variety of gastrointestinal tumor types.

Tumor markers as a diagnostic key for hilar cholangiocarcinoma.

ObjectiveHilar cholangiocarcinoma is the fourth most common gastrointestinal malignancy. CA19-9 and CEA are helpful devices in the management of gastrointestinal malignancies and belong to clinical routine in surgical oncology. But the validity of these parameters in terms of tumor extension and prognosis of bile duct malignancies still remains unclear.MethodsFrom 1998 to 2008, we obtained preoperative CA19-9 and CEA serum levels in 136 patients with hilar cholangiocarcinoma. We correlated tumor stage, resectability rate and survival with preoperative CA 19-9 and CEA serum levels.ResultsCA19-9 (UICC I: 253 ± 561 U/ml; UICC II: 742 ± 1572 U/ml; UICC III: 906 ± 1708 U/ml; UICC IV: 1707 ± 3053 U/ml) and CEA levels (UICC I: 2.9 ± 3.8 U/ml; UICC II: 4.6 ± 6.5 U/ml; UICC III: 18.1 ± 29.6 U/ml; UICC IV: 22.7 ± 53.9 U/ml) increase significantly with rising tumor stage. Patients with pre operative serum levels of CA19-9 (> 1000 U/ml) and CEA (> 14.4 ng/ml) showed a significant poorer resectability rate and survival than patients with lower CA19-9 and CEA serum levels respectively.ConclusionCA19-9 and CEA serum levels are associated with the tumor stage. If preoperatively obtained CA19-9 and CEA serum levels are highly elevated patients have an even worse survival and the frequency of irresectability is significantly higher.

Practice Patterns and Attitudes Toward the Role of Endoscopic Ultrasound in Staging of Gastrointestinal Malignancies: A Survey of Physicians and Surgeons

It is unknown how physician specialties other than gastroenterologists that manage gastrointestinal (GI) malignancies utilize endoscopic ultrasound (EUS) in their practices. The aim of this study was to (i) assess the proportion of gastroenterologists, oncologists, and surgeons that utilize EUS for staging of GI malignancies; (ii) assess the general availability of EUS; and (iii) determine which factors are associated with the use and availability of EUS. A self-administered questionnaire was mailed out to 1,200 randomly selected gastroenterologists, oncologists, and surgeons throughout the United States. The data was analyzed from 521 (43%) responses. There were 60% respondents who had EUS available within their practices. There was greater availability of EUS within the practices of surgeons (81%; p < 0.001), within academic practices (87%; p= < 0.001), and in practices that serve a population >500,000 (p < 0.001). The majority of respondents (71%) utilized EUS in their practices. There was a similar utilization of EUS across specialties (p= NS). There was greater utilization of EUS in academic centers (82%; p < 0.001), in practices that served a community of >500,000 (p= 0.003), and among respondents who had been in practice for less than 5 yr (p= 0.005). Employing logistic regression models for utilization of EUS, lesser number of years in practice, and availability of EUS were found to be the only significant predictors of utilization. The majority of practitioners utilized EUS in management of GI malignancies. There was similar utilization of EUS across specialties. EUS is available to the majority of practitioners who manage GI malignancies.

Endoscopic Mucosal Resection: Treatment of Neoplasia

Techniques of endoscopic mucosal resection (EMR) can dramatically improve the ability to diagnose and treat superficial lesions in the gastrointestinal (GI) tract. Early cancers, submucosal tumors, and sessile polyps can be safely and completely removed in a single procedure, with long-term outcome results comparable to surgery. This is accomplished with a minimum cost, morbidity, and mortality and with little or no impact on the quality of life of patients. This article provides an overview of the techniques, indications, and outcomes of EMR in the management of GI malignancy.

Laparoscopy for malignancy: current status.

The acceptance of laparoscopy for the management of oncologic disease has been slow because of initial fears regarding the effect of this new approach on the interaction between the patient and the tumor. Since the initial attempts at laparoscopic resection, experience and technology have improved in parallel, facilitating improvements in this area. Laparoscopic oncologic surgery has a role in the management of oncologic patients at all stages of disease. Good evidence exists that laparoscopy has become an invaluable staging tool in many upper gastrointestinal cancers as well as lymphomas. The specter of port-site recurrence has loomed over the use of a laparoscopic approach for curative resections. However, it is clear from many reported trials that the initial prevalence of port-site metastases was more a technical issue rather than a problem with laparoscopy. Current large, multicenter trials will report the true outcomes of laparoscopic colon cancer surgery and its comparison with open surgery. It does appear that laparoscopic cancer surgery is feasible, safe, and oncologically sound. We fully believe that laparoscopic cancer surgery will play an increasingly major role in the management of gastrointestinal malignancies.

Is there a role for intraperitoneal therapy in the management of gastrointestinal malignancies?

Is there a role for intraperitoneal therapy in the management of gastrointestinal malignancies?

Cytokine-based biotherapy of gastrointestinal tumors.

Over the past 20 years the administration of cytokines has emerged as an important fourth modality for the treatment of human cancer. Advances in the field of therapy of gastrointestinal tumors have become a major focus of current research, given the lack of progress of conventional antineoplastic therapy in most of these tumors. Among the heterogeneous group of gastrointestinal malignancies, novel therapeutic strategies have been employed for each individual tumor type, and cytokines (interferon-alpha) have gained an established role in the treatment of advanced carcinoid tumors. Although our understanding of the mechanisms of biological response modification is still limited, further improvement in the management of gastrointestinal malignancies can be expected from multimodality therapy regimens employing cytokines in combination with other biological response modifiers, chemotherapeutic agents, active-specific immunotherapy, and immunotoxin- and radionuclide-conjugated monoclonal antibodies. A wide range of clinical and preclinical studies have been conducted in colorectal carcinoma; however, potential therapeutic benefit of cytokine-based biotherapy has not been fully defined. Therefore, largescale, i.e., multicenter, studies are required to quantify the potential therapeutic effects of cytokines in gastrointestinal tumors.