Gastrointestinal Cancer

A fairly simple and inexpensive fecal occult blood test (FOBT) that detects blood cells in a person's stool sample has been found to be an effective way to screen for colon cancer. The prospective, 2796 asymptomatic participants from Taiwan participated in the study that was published only on August 2, 2011 in the Canadian Medical Association Journal (DOI:10.1503/cmaj.101248).

In the majority of cases, hepatocellular carcinoma develops in the setting of cirrhosis. Treatment with curative intent is possible in only 20% to 25% of cases and consists of resection or liver transplantation.

In this article, we review the data surrounding the use of chemotherapy (CT) and chemoradiotherapy (CRT) in patients with resectable pancreatic cancer.

In their article “Liver Transplantation for the Treatment of Hepatocellular Carcinoma," Drs. Hanish and Knechtle provide a cogent review of many of the issues surrounding the management of hepatocellular carcinoma (HCC) in patients with cirrhosis.

Hepatocellular carcinoma (HCC) remains a formidable challenge in the United States due to its increasing incidence, its advanced-stage presentation, and its association with chronic liver disease.[1-3]

Progress in the care of mCRC has occurred relatively rapidly, but current methods of management have placed a significant economic burden on the healthcare system.

Advances in the multidisciplinary management of metastatic colorectal cancer have improved survival considerably, and nurses are key to optimal patient care.

In this issue of ONCOLOGY, Golan and Javle provide an excellent update on targeting the insulin-like growth factor 1 receptor (IGF-1R) in gastrointestinal cancers.

In this issue of ONCOLOGY, Golan and Javle present a timely review of the current status of the insulin growth factor-1 receptor (IGF-1R) signaling pathway as a therapeutic target, with a specific focus on gastrointestinal (GI) cancers.

This review highlights the current status of the research in targeting the insulin growth factor pathway with a specific focus on gastrointestinal cancers.

In North America, hepatocellular carcinoma (HCC) is one of only a few malignancies with an increasing incidence in recent years.[1]

The diagnosis and treatment of hepatocellular carcinoma (HCC) constitute a complex and challenging clinical paradigm.

In July1999, I learned I was pregnant with my son. My sister was pregnant, too, and due to deliver in the fall. I was excited to share my happy news. But my father, then 65, had news of his own: he had been diagnosed with stage III colorectal cancer.

In this review article we will discuss the current data on, and future role of, sorafenib in the treatment of hepatocellular carcinoma beyond Child-Pugh A cirrhosis, in conjunction with local therapy, and in a transplant setting.

Colorectal cancer is one of the most commonly diagnosed cancers in the US, and it is the second leading cause of cancer-related deaths. The risk of developing colorectal cancer increases with age.

There are a number of important issues regarding neoadjuvant and adjuvant therapy for pancreatic cancer that must be considered as we design clinical trials in an effort to improve survival for this disease.

Dr Castellanos et al have provided a very comprehensive review of the multimodality therapy of localized pancreatic cancer, with an emphasis on adjuvant and neoadjuvant therapies.

Early trials of adjuvant therapy in pancreatic cancer had multiple limitations including small sample size, population heterogeneity, and inability to distinguish between components of combined modality treatment.

In this issue of ONCOLOGY, the case and discussion provided by Dasari and colleagues highlight a significant problem for many patients with potentially resectable pancreatic cancer (PC)-the rapid emergence of preexisting metastatic disease. The authors describe the case of a 57-year-old woman with a resectable tumor after staging evaluation and management which included an endoscopic ultrasound (EUS), CT imaging, and endoscopic retrograde cholangiopancreatography (ERCP) with insertion of an endobiliary stent. Although the results from EUS are not detailed in the report, there were apparently no preoperative features to suggest more advanced disease, and she underwent surgery. Four weeks later, she presented with advanced disease manifested by an elevated CA 19-9, bilobar liver metastases, and possible local recurrence. This case illustrates some important considerations in the management of PC as we discuss here.

Roche/Genentech releases early results from AVANT trial.

In a large study of resected pancreatic cancer, overall survival did not differ whether patients received gemcitabine or 5-FU/folinic acid.

Despite efforts by the manufacturer to reduce the cost of Avastin, the clinical effectiveness agency for England and Wales says that it will not recommend the drug for the first-line treatment of metastatic colorectal cancer.

Primary surgery with an abdominoperineal resection (APR) was historically the standard of care for localized anal squamous cell carcinoma. APR achieved 40%-70% survival rates at five years, with local failures from 27%-47%.[1,2] With modern technology and radiation dose escalation, external beam radiation therapy (EBRT) studies have improved complete response rates, decreased morbidity, and improved sphincter preservation rates. Nigro et al added 5-fluorouracil (5FU) and mitomycin C (MMC) to concurrent EBRT [3,4] and impressive complete response rates inspired other groups to investigate the role of chemotherapy as a component of sphincter-preserving therapy. The European Organization for Research and Treatment of Cancer (EORTC) and United Kingdom Coordinating Committee on Cancer Research (UKCCCR) studies reported improved local control and colostomy-free survival when chemotherapy (5FU/MMC) was administered in conjunction with radiation.[5,6] The five-year survival rate for patients receiving standard chemoradiation approaches 70%; however, 20%-40% experience grade 3-4 toxicity, and administration with MMC causes profound hematologic toxicity.

The treatment of cancer of the anal canal has changed significantly over the past several decades. Although the abdominoperineal resection (APR) was the historical standard of care, a therapeutic paradigm shift occurred with the seminal work of Nigro, who reported that anal canal cancer could be treated with definitive chemoradiation, with APR reserved for salvage therapy only. This remains an attractive approach for patients and physicians alike and the standard of care in this disease. Now, nearly four decades later, a similar approach continues to be utilized, albeit with higher radiation doses; however, this strategy remains fraught with considerable treatment-related morbidities. With the advent of intensity-modulated radiation therapy (IMRT), many oncologists are beginning to utilize this technology in the treatment of anal cancer in order to decrease these toxicities while maintaining similar treatment efficacy. This article reviews the relevant literature leading up to the modern treatment of anal canal cancer, and discusses IMRT-related toxicity and disease-related outcomes in the context of outcomes of conventionally treated anal cancer.

Early detection of cancer and novel chemotherapy agents have resulted in longer survival following a colorectal cancer diagnosis.

Therapeutic outcomes for patients with most of the cancers originating in the upper gastrointestinal track still remain disappointing.

In this ASCO podcast, Dr. Goldberg, Distinguished Professor, Hematology/Oncology, at the University of North Carolina Lineberger Comprehensive Cancer Center and the Physician-in-Chief of the North Carolina Cancer Hospital, spoke about the new developments in advanced colorectal cancer since his ASCO 2003 practice-changing presentation.

Dr. Abbas and colleagues delineate the current status of chemoradiation for anal carcinoma. Their thorough and thoughtful review serves as an excellent summation of the current therapeutic approach of the past few years.

The treatment of anal squamous cell cancer with definitive chemoradiation is the gold-standard therapy for localized anal cancer, primarily because of its sphincter-saving and colostomy-sparing potential.