Gastrointestinal Cancer

Although candidate genes for hereditary pancreatic cancer have been identified (Figure 1), namely p16 and BRCA2, pancreatic cancer patients having an inherited predisposition will not be easy to recognize on clinical grounds.

WASHINGTON--The colorectal cancer rate continues to rise in African-American men while dropping for whites of both sexes and for black women, reported David S. Alberts, MD, associate dean for research, Arizona Cancer Center of the University of Arizona College of Medicine, Tucson.

The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative extent of disease evaluation, and role of the surgeon in

This special series on cancer and genetics is compiled and edited by Henry T. Lynch, MD, director of the Hereditary Cancer Institute, professor of medicine, and chairman of the Department of Preventive Medicine and Public Health, Creighton University School of Medicine, and director of the Creighton Cancer Center, Omaha, Nebraska. Part I of this three-part series on pancreatic cancer appeared in June 1997. Part II (below) reviews the gene mutations thought to contribute to the development of hereditary pancreatic cancer, and Part III will explores the clinical recognition of a hereditary predisposition to pancreatic cancer.

The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative extent of disease evaluation, and role of the surgeon in

CHICAGO--After many years of frustration, there may finally be a reason for guarded optimism about the development of effective therapy for patients with advanced stage pancreatic cancer, Mace Rothenberg, MD, said at the 9th annual meeting of the Network for Oncology Communication and Research, based in Atlanta.

Hereditary nonpolyposis colorectal cancer (HNPCC) is a dominantly inherited syndrome that is estimated to be responsible for between 0.5% to 5% of all colorectal cancers.[1] The syndrome is caused by germline mutations in any of at least four mismatch repair genes.

FORT LAUDERDALE, Fla--Clinicians now have at their disposal more accurate staging technologies for pancreatic cancer than were available in the past.

HOUSTON--A new tumor-selective agent may permit delivery of higher levels of 5-fluorouracil (5-FU) with lower toxicity, said Richard Pazdur, MD, of M.D. Anderson Cancer Center. A phase III trial of capecitabine is ongoing in colorectal cancer, and it is also under study for the treatment of breast cancer.

ROCKVILLE, Md--In the first report issued under its new Evidence-based Practice Initiative, the Agency for Health Care Policy and Research (AHCPR) has reaffirmed that early detection and treatment provide the primary means of preventing death from colorectal cancer.

Dr. Rich presents a comprehensive overview of adjuvant therapy for advanced operable rectal cancer. He emphasizes the roles of infusional chemoradiation in both the adjuvant setting and as sole therapy. Unless otherwise specified, the following comments pertain to clinically resectable B2-C (T3, N0-N1) adenocarcinoma of the rectum.

The use of adjuvant irradiation combined with systemic chemotherapy, or "chemoradiation," in the management of patients with operable rectal cancer has enabled more conservative surgery to be performed. Chemoradiation

CHICAGO--With an overall response rate of only 2.8% to drugs tested on more than 1,200 colorectal cancer patients over the last 20 years, new drug development has given gastrointestinal oncologists little to be enthusiastic about.

Until 1980, the greatest advances in the management of rectal cancer were technical ones. Whereas in the past most patients with rectal cancer underwent an abdominoperineal resection, it became possible in the 1980s to maintain intestinal continuity in the majority of patients with a low anterior resection and colorectal anastomosis and, more recently, with a low anterio resection and coloanal anastomosis. These advances were due, in part, to the development of stapling devices, which allowed surgeons to perform anastomoses that were technically difficult to perform by hand. More importantly, it became clear that in tumors identified at a relatively early stage, retrograde tumor spread was uncommon, and a 2-cm distal margin was generally adequate.

Dr. Enker offers an orderly presentation of many of the factors related to sphincter-preserving operations, quality of life, and outcome in the surgical management of the patient with rectal cancer. From the practical perspective of a very experienced surgeon, he provides broad guidelines for sphincter-conservation surgery that both the surgeon and nonsurgeon should find useful.

This review nicely summarizes the current state of combined-modality therapy for resectable rectal cancer, largely covering trials currently in progress in the United States. Although the article's title is "Multidisciplinary management of resectable rectal cancer," it really doesn't emphasize how multiple specialists manage rectal cancer patients per se, and thus, the article would probably be more appropriately titled, "Combined-modality therapy in resectable rectal cancer." It would have been interesting if the article had included more details on how radiation oncologists, medical oncologists, and surgeons can cooperate to deliver combined-modality therapy in higher proportions of patients with resectable rectal cancer, but this is a minor criticism.

The standard adjuvant therapy for resectable T3 and/or N1-2 rectal cancer is pelvic radiation therapy plus fluorouracil (5-FU)-based chemotherapy. Two randomized intergroup trials, INT 0114 and INT 0144, will help

In his excellent, thorough review of the current status of multidisciplinary treatment for rectal cancer, Dr. Minsky appropriately emphasizes the role that data from prospective clinical trials have played in providing the foundation for adjuvant therapy for patients with this disease. The principal therapeutic options discussed by Dr. Minsky are preoperative therapy and postoperative therapy.

Based on our experience and a review of the literature, we conclude that superficial, well- to moderately differentiated T1 cancers of the anal margin may be successfully treated with radiotherapy alone or local

Sphincter-preserving operations represent an important model for integrating the goals of surgery for rectal cancers. These goals--the achievement of cure and local control and the preservation of autonomic visceral

BUFFALO, NY--New analysis of familial colorectal cancer data suggests that the disease is not associated with genetic anticipation--the earlier onset of disease in successive generations--said Gloria M. Petersen, PhD, at the Eighth Annual Meeting of the ICG-HNPCC (International Collaborative Group-Hereditary Nonpolyposis Colorectal Cancer).

During our medical training, we were often reminded that our purpose is not just to take care of a disease, but rather, to take care of the person with that disease. We learned that a patient's physical condition represents only one aspect of that disease

A month of postoperative radiotherapy preceded by radiosensitizing boluses of fluorouracil (5-FU) slashed the recurrence rate and markedly improved survival in patients with Dukes B and C rectal cancer in a study from the Norwegian Adjuvant Rectal Cancer Project Group, presented at the European Cancer Conference (ECCO-8).

Most patients who have pancreatic cancer present with advanced disease that is not amenable to surgery. For patients whose disease is amenable to surgery and who are managed with surgical resection alone, local

The past 20 years have witnessed important changes in the manner in which many people with cancer are opting to deal with their disease. In the past, patients yielded to their physicians' treatment choices and assumed that they

Alleviation of tumor-related symptoms may be a more appropriate basis for judging drug efficacy in pancreatic cancer than is tumor shrinkage. Clinical benefit response (CBR), a new

Many people who are diagnosed with pancreatic cancer react with a normal level of sadness. In others, however, depression represents a concomitant illness, perhaps with a biologic basis. Regardless of their origin, these mood

The treatment of patients with pancreatic cancer requires the expertise of medical oncologists, radiation oncologists, radiologists, and surgical oncologists. The surgeon's role

The goals of oncology social work are to facilitate patient and family adjustment to the diagnosis and treatment of the disease; to promote psychosocial recovery and rehabilitation

For the patient with advanced pancreatic cancer, curative strategies may not be appropriate, and palliative symptom management may be the best approach to patient care. Oncologists,