Improvement in Pancreatic and Colorectal Cancer Therapies

Improvement in medicine has led to advances in the detection, prevention, and analysis of cancer for patients with inherited risks of GI cancer, particularly genetic colorectal cancer and genetic pancreatic cancer.

The current practices for identifying, evaluating, and managing patients with suspected genetic colorectal cancer and pancreatic cancer risk is improving. The impact of next-generation sequencing technologies in the clinical diagnosis of hereditary gastrointestinal cancer and in discovery efforts of novel genes linked to familial cancer risk is increasing. Emerging targeted therapies that may play a particularly important role in the treatment of patients with hereditary forms of colorectal cancer and pancreatic cancer are giving good results.

Recent innovations in genetic medicine and next-generation sequencing technologies have led to tremendous advances in the understanding of the role that genetics plays in carcinogenesis.

The availability of novel diagnostic, risk-reducing, and therapeutic strategies that exist for patients with hereditary risk for colorectal or pancreatic cancer. It is imperative that clinicians be vigilant about evaluating patients for hereditary cancer syndromes. Continuing to advance genetics research in hereditary gastrointestinal cancers will allow for more progress to be made in personalized medicine and prevention.

Colorectal cancer remains the fourth most incident cancer and the second most common cause of cancer-related mortality. Over the past decade, scientific knowledge about the genetics of colorectal cancer has grown exponentially, and the coming years promise continued advances in the identification, management, and understanding of patients with hereditary predisposition to colorectal cancer.

There is no single gene that is responsible for hereditary or familial pancreatic cancer risk. Rather, there are multiple hereditary cancer syndromes and associated genes which confer an increased lifetime risk of pancreatic cancer.

Advances have also been made in the realm of aspirin chemoprevention for patients with hereditary colorectal cancer.

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Effect of Hepatitis C Virus on patients

Liver cirrhosis has a significant impact on patient’s quality of life and socioeconomic status and is associated with increased susceptibility to vehicle accidents and falls.

Hepatic encephalopathy (HE) represents a major cause of morbidity and mortality in patients suffering from chronic liver diseases. It is characterized by serious neuropsychiatric and neurocognitive complications, including confusion, disorientation, ataxia and coma.

It is characterized by poor health-related quality of life, impaired daily functioning, poor socio-economic status, susceptibility to vehicle accidents and, increased occurrence rate of overt HE, leading to increased mortality in patients with liver cirrhosis. Hence early diagnosis of psychosocial impairment is crucial in cirrhotic patients to prevent further progression and potential life-threatening risk.

Now a day, liver biopsy is the standard method for the detection of liver fibrosis. However, invasiveness is an important drawback in implementing this method particularly in patients with early stages of liver fibrosis as well as sampling error and variability in results interpretation.

Transient Elastography (TE) known by the name FibroScan is a non-invasive test to determine the amount of liver fibrosis present. It also identifies and evaluates steatosis concurrently using the Controlled Attenuation Parameter (CAP). It is a type of elastography.

There is no consensus regarding a standard test for early diagnosis of the neuropsychiatric changes, associated with minimal liver encephalopathy. Indeed, there are several confounding factors which strongly affect patient’s performance in neuropsychiatric tests, including age, gender, level of education and socioeconomic status

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The Analysis of Continuous and Malignant Liver Diseases

Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) are the most frequently occurring types of primary liver cancer worldwide and account for 80% and 15% of primary liver cancer respectively. Current studies have reported that the worldwide incidence of these liver and biliary tract diseases is increasing.

Environmental and cultural factors are important determinants of the incidence of HCC. Non-alcoholic liver disease is a potential key player in the increasing incidence of HCC in the population.

Unfortunately, the early diagnosis of these diseases remains difficult and, in most cases, the disease is diagnosed late because of the absence of symptoms in the early stages.

At present, the most accurate diagnostic methods for these disorders, such as endoscopic retrograde cholangio-pancreatography guided by bile duct biopsy, percutaneous Tran’s hepatic cholangiography and endoscopic ultrasonography guided by fine needle aspiration is invasive.

Recently, there has been remarkable progress in applying proteomics to the identification of potential biomarkers for HCC, CCA, and PSC. However, these biomarkers are useful for discriminating between benign and malignant biliary conditions only in patients who have undergone bile drainage.

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Advancement and improvement in Gastroenterology

In present years quality improvement (QI) and quality assurance (QA) have become catch phrases that are extensively used throughout medicine. QA is defined as planned, systematic activities that are implemented to ensure that a level of performance is attained.

In gastroenterology, QI initiatives have largely centred on endoscopy. Endoscopy is an excellent area for QI work because of the high volume of a limited range of invasive procedures with standardized reporting and significant associated risks and expense. QI is widely applicable to gastroenterologists as well as primary care physicians, as they try to streamline care while avoiding unwanted errors in managing a multitude of common gastrointestinal conditions.

The main goal of this is to provide examples of common targets for QI work in outpatient clinical practice suitable for improvement of measurable patient outcomes as well as for accreditation and certification purposes. The QI projects we present will follow the Plan-Do-Study-Act cycle, emphasizing the iterative process and focusing on preidentified measurable outcomes.

To help ensure that gastroenterology practices are free to choose QI initiatives that best serve their specific patients and do not disrupt their clinical environment, it is vital that practices foster internally derived QI efforts.

Many initiatives like practice settings, administrative time can often be leveraged to facilitate these projects, whereas in academic settings, students, residents, and fellows are generally eager to participate; these efforts increase their understanding of the discipline, directly affect patient care, and often lead to publishable data. In addition, a growing number of online resources provide information and resources to assist in developing QI initiatives

At last, QI should be a team effort of the practice.

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