Progress and Management in Gastrointestinal Oncology

The prognosis of advanced gastrointestinal cancers has improved modestly over the last two decades. The targeted therapies and personalized medicine for many cancer types will soon become the standard of care.

First line therapy for advanced gastroesophageal cancer- Human epidermal growth factor receptor 2 (HER2) exhibits tyrosine kinase activity and functions as a growth factor receptor. The overexpression of HER2 as a result of gene amplification has been demonstrated in solid tumors such as breast and gastric cancers, and correlates with aggressive course and poor prognosis.

Treatment of localized gastroesophageal cancer- Neoadjuvant chemoradiotherapy (CRT) is commonly used before esophagecomy for esophageal cancer. Oxaliplatin is used in the neoadjuvant setting and in future may replace cisplatin when given with concurrent 5-FU and radiation. Minimally invasive esophagectomy (MIE) in a prospective multi-center trial that involves thoracoscopic and laparoscopic techniques in place of 'open' surgery.

Hepatobiliary cancers- The mortality of cholangiocarcinoma is increasing world-wide. Gemcitabine or fluoropyrimidines are commonly utilized for the treatment of advanced disease. Gemcitabine plus oxaliplatin chemotherapy alone or in combination with cetuximab in patients can be treated with advanced biliary cancer. Transarterial hepatic chemoembolization (TACE) is widely used for the management of regionally advanced hepatocellular carcinoma (HCC). TACE improves local control and is palliative, although its survival impact is controversial.

Pancreatic cancer- Deep vein thrombosis (DVT) is a commonly encountered problem in patients with pancreatic cancer. Pro-thrombotic factors generated by the cancer cells, debility of the patients, dehydration and systemic chemotherapy have been thought to be the attributing factors. DVT in pancreatic cancer patients is associated with a poor prognosis and therefore its prevention is required.

Neuroendocrine tumors- Long-acting somatostatin analogues are widely used for symptomatic, low-grade neuroendocrine tumors such as carcinoids.

Anal cancer- Squamous cell carcinoma of anus is an uncommon malignancy of lower gastrointestinal tract. Various studies Shows that CRT with 5-FU and mitomycin-C (MMC) as standard treatment yielding high rates of local control and 5-year disease-free survival without needing surgery or colostomy.

Rectal cancer- Rectal cancer carries a high chance of local recurrence. Neoadjuvant CRT is considered a standard treatment for patients with locally advanced rectal cancer (LARC) such as T3 or T4 lesion or with regional lymph node involvement.

Immunological and molecular characteristics of Hepatitis A

Hepatitis A virus causes an infection of liver, with high prevalence rate and affects all age groups. The hepatitis A virus (HAV) is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person.

Disparate hepatitis B and C, hepatitis A contagion does not cause chronic liver disease and is rarely deadly, but it can cause person weak and infirm and severe or sudden hepatitis (acute liver failure) which is often deadly.

Hepatitis A is an acute infection with generalized symptoms accompanied by jaundice and it represents mainly a disease of the paediatric population. In children, the diseases with Hepatitis A virus (HAV) is generally have no symptoms while in case of non-immune adolescents and adults may result in acute clinical disease like fulminant hepatic failure (FHF). Most children (90%) have been infected with the hepatitis A virus before the age of 10 years; those infected in childhood do not experience any noticeable symptoms.

HAV is not enveloped and contains a single-stranded RNA packaged in a protein shell. There is only one serotype found in this, the region that codes for the HAV capsid is highly conserved clusters of rare codons that restrict antigenic variability. Naturally the humans and vertebrates are hosts. Transmission routes are faecal-oral and blood.

HAV and hepatitis E virus (HEV) have an indistinguishable clinical presentation and the same mode of transmission.

Investigations (e.g., serum acetaminophen) may be necessary, depending on the findings from the history and clinical examination. Molecular diagnostic techniques performed on blood and faeces for HAV RNA are purely research tools at present.

Hepatitis A treatment usually focuses on keeping comfortable and controlling signs and symptoms.

You may need to:

Rest. Many people with hepatitis A infection feel tired and sick and have less energy.

Avoid alcohol and use medications with care. Your liver may have difficulty processing medications and alcohol. One should not drink alcohol during medication. It can cause more liver damage.

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Treatment of Pancreatic Cancer

Variations in the reporting of potentially confounding variables in studies investigating systemic treatments for unresectable pancreatic cancer poses challenges in drawing accurate comparisons between findings.

Pancreatic ductal adenocarcinoma (PDA) is a human cancer with a poor prognosis. Gemcitabine, a key therapeutic agent for metastatic PDA, and combination treatments have had only a modest impact on extending survival.

PDA has a dismal prognosis and is often discovered at an advanced stage with few therapeutic options. Present conventional regimens for PDA are related with significant morbidity, decreased quality of life, and a considerable financial burden. As a result, few patients turn to integrative medicine therapies as sequential option after a treatment of PDA. Intravenous pharmacologic ascorbic acid (PAA) is one such treatment. The use of PAA has been Issues for many years, but more recent rigorous scientific research has shown that there are significant blood concentration differences when ascorbic acid is given parenterally when compared to oral dosing.

PDA accounts for most of advanced pancreatic cancer cases and carries an expected 5-year survival rate of less than 6%.

Standard therapies for unresectable or metastatic pancreatic cancer currently consist of gemcitabine-based regimens, combination therapies such as folfirinox with or without radiation, and newer agents such as nanoparticle-albumin-bound (nab)-paclitaxel and erlotinib, all of which provide minimal response and a survival advantage measured in a few months.

The use of intravenous ascorbic acid (AA) in oncology has a controversial history and has long been passionately debated.

Psychiatric symptoms may provide an earlier clue to the presence of a growing pancreatic tumour. Yet, depression and anxiety are very general symptoms and not something that can drive testing for pancreatic cancer by itself.

Risk factors:

Age

The risk of developing pancreatic cancer increases with age. Almost all patients are older than 45 years. Nearly 90% are older than 55 years and more than 70% are older than 65.

Diabetes

Exocrine pancreatic cancer is more common in people with this disease. The reason for this link is not known. Most of the risk is found in people with type 2 diabetes. This type of diabetes most often starts in adulthood. It is often related to being overweight or obese.

Family history

Pancreatic cancer seems to run in some families. In some of these families, the high risk is due to an inherited syndrome. In other families, the gene causing the increased risk of pancreatic cancer is not known.

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Endoscopy in patients with Digestive Diseases

Digestive complaints are commonly seen in patients in clinical practice and many undergo endoscopy for further evaluation. However, symptoms may arise from a variety of disorders including functional dyspepsia and irritable bowel syndrome and the potential risk of invasive procedures must be balanced against the benefit of detecting a significant organic disease.

Patient selection based on symptoms alone is unfortunately not reliable both for patients with dyspepsia and with lower abdominal symptoms. Around half of the patients with peptic ulcer disease or esophagitis at endoscopy will be misclassified when presenting with epigastric pain. Accordingly, main pathologies (ulcer, malignancy) are initiated in only a minority of dyspeptic patients. Similarly, in average-risk patients with non-specific lower abdominal symptoms, the overall yield of colonoscopy is low and may be like an average-risk screening population.

The efficient use of endoscopic procedures is paramount to ensure high-quality cost-effective medical care. However, the low specificity of current guidelines of appropriateness substantially reduces the predictive value of relevant endoscopic findings. The benefit of a diagnostic test for inclusion to appropriateness criteria might, therefore, be useful by increasing diagnostic yield.

Calprotectin is an abundant, calcium- and zinc-binding protein found mainly in neutrophils. It correlates well with neutrophil infiltration of the intestinal mucosa and when measured in faeces it is considered as an established biological marker of intestinal inflammation throughout the gastrointestinal tract. It has proven highly useful for the identification of inflammatory bowel disease and for distinguishing between organic and functional disorders of the colon and similar the upper intestinal tract although.

The combined use of EPAGE (European Panel on the Appropriateness of Gastrointestinal Endoscopy) scoring and faecal calprotectin testing led to superior risk stratification in patients with abdominal complaints and increased diagnostic yield in patients requiring endoscopy. This would especially be useful in open-access health care systems when patients are referred for endoscopy by non-gastroenterologists.

Measurement of faecal calprotectin is useful for identifying clinically-significant endoscopic findings in patients with abdominal complaints and when combined with appropriateness guidelines improve the limited diagnostic yield of EPAGE criteria.

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