Esophageal Cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2020
Recommendation for management of adenocarcinomas: Direct comparison of nCRT and CRT is lacking, but trials are ongoing.Perioperative chemotherapy with FLOT or ECF is a current standard of care.Or nCRT 41.4–50.4 Gy in 1.8–2.0 Gy with weekly carboplatin-paclitaxel as per CROSS trial can be considered.In the event of complete clinical response, patients should still proceed to surgery.
Upper GI Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
The OGD demonstrates a malignant appearing tumour infiltrating the gastro-oesophageal junction from above. Biopsies confirm adenocarcinoma. What staging investigations are appropriate for this man?I would arrange a CT scan of chest, abdomen and pelvis with IV (if no contraindications) and oral contrast or water, to assess for metastatic disease and the extent of local invasion for more advanced tumours.Provided there is no obvious metastatic disease, I would then arrange a PET-CT and EUS.PET-CT is utilised to assess regional nodal disease and detect distant metastases more accurately.EUS is used for more accurate T staging of the primary tumour and to assess regional lymph node involvement, as FNA samples may be obtained.For T1 tumours, EMR is a more sensitive method of differentiating mucosal from submucosal penetration.Laparoscopy for direct visualisation of low-volume peritoneal and hepatic metastasis tends to be reserved for type II and III tumours and less for type I tumours, given the pattern of disease spread.
Upper Gastrointestinal Surgery
Gozie Offiah, Arnold Hill in RCSI Handbook of Clinical Surgery for Finals, 2019
Adenocarcinoma➢ Rapidly increasing incidence in Europe, North America and Australia and has squamous cell carcinoma in some of these areas.➢ ♂: ♀, 5:1➢ The main pathological pathway is likely due to chronic GORD, causing metaplasia from squamous cell mucosa to specialised columnar epithelium (Barrett’s oesophagus). This metaplasia then progresses to low grade dysplasia, then high-grade dysplasia, and eventually adenocarcinoma.➢ Adenocarcinoma is relatively insensitive to radiotherapy and therefore surgery is the mainstay of treatment.
MEX3A promotes angiogenesis in colorectal cancer via glycolysis
Published in Libyan Journal of Medicine, 2023
Yong Lu, Tienan Bi, Shenkang Zhou, Minhui Guo
Colorectal cancer (CRC) is the third most common malignant tumor, with the mortality rate second only to lung cancer. Despite achievements in clinical practice and screening techniques, the diagnostic efficiency of CRC in most countries, including developed countries, remains lower than expected [1]. Surgery, chemotherapy and radiotherapy were common methods for the treatment of colorectal adenocarcinoma in the past. However, due to difficulties in early diagnosis of CRC, most patients have been in the advanced stages of the disease when diagnosed with CRC, missing the best time for surgery and suffering more side effects of chemotherapy and radiotherapy [2]. Thus, it is of great practical significance to develop new CRC treatment methods for improving the early diagnosis and survival rate of CRC patients. Tumor angiogenesis has been proved to play a critical role in tumorigenesis and tumor development, becoming a hot research topic in the field of cancer. The antiangiogenic drug bevacizumab has been approved for the first- or second-line treatment of metastatic CRC [3]. As the first biological agent approved for treating metastatic CRC, bevacizumab has demonstrated impressive performance [4]. Therefore, it is meaningful to explore the molecular mechanism of CRC angiogenesis in CRC treatment.
Comparative effectiveness of chemotherapy in different histological types of pancreatic cancer: a PSM-based study using the SEER database
Published in Journal of Chemotherapy, 2023
Canhua Luo, Linfeng Fan, Weijian Lun, Miaomiao Ma, Leshi Liang, Changhui Yu
In conclusion, this study’s results suggested that chemotherapy could improve pancreatic cancer patients’ survival and the systematic therapy should be prioritized as long as the patient’s general status permits, especially for patients with advanced disease. In light of the PSM-based study utilizing the SEER database, it can be concluded that variations exist in chemotherapy effectiveness across varying histological types of pancreatic cancer. More notably, patients diagnosed with adenocarcinoma and adenosquamous carcinoma experienced a significant improvement in survival outcomes when treated with chemotherapy as opposed to those with different histological subtypes. Nevertheless, additional research is necessary to validate these results and investigate potential drivers behind the observed differences in chemotherapy response. It is crucial for healthcare providers to take into account the histological type of pancreatic cancer when determining treatment options for their patients.
Pharmacotherapeutic options for pancreatic ductal adenocarcinoma
Published in Expert Opinion on Pharmacotherapy, 2022
Muhammad Sardar, Alejandro Recio-Boiles, Kabir Mody, Christian Karime, Sreenivasa R Chandana, Daruka Mahadevan, Jason Starr, Jeremy Jones, Mitesh Borad, Hani Babiker
The initial workup of PDAC includes imaging with triple-phase abdominal computed tomography (CT) angiography or MRI of the abdomen [16,17]. Also imaging of the chest and pelvis is indicated to complete staging. Positron emission tomography (PET)/CT scans or laparoscopic staging are not the standard of care but can be helpful in selected patients with high suspicion for occult metastasis [18,19]. Endoscopic ultrasound (EUS) guided biopsy of the pancreatic mass has become the main means for obtaining tissue specimens [20]. CA 19–9 is neither sensitive (~80%) nor specific (82–90%) and is utilized mainly for monitoring response to treatment [21]. It may provide prognostic information by identifying patients unlikely to obtain microscopically negative margins [22]. As stated earlier, PDAC has poor prognosis and the 5-year survival in patients who undergo curative intent surgical resection is only 10% in node positive disease and 30% in node negative disease [23]. The 5-year relative survival rate for patients with advanced pancreatic adenocarcinoma is only 3% according to the SEER database [24].
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