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.
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