Rapid Review Quiz: Noncolorectal Gastrointestinal Cancers
According to current National Comprehensive Cancer Network (NCCN) guidelines, pancreatic cancer surveillance should be considered in individuals with pathogenic variants in the STK11 germline, such as Peutz-Jeghers syndrome. An expert review of the current clinical practice guidance from the American Gastroenterological Association concurs that surveillance should be considered in patients with Peutz-Jeghers syndrome or other genetic syndromes associated with an increased risk of pancreatic cancer.
Having only one first-degree relative with pancreatic cancer can increase risks; however, surveillance is generally recommended only when there is a stronger family history, such ≥ 2 affected relatives (along a the first-degree relative with pancreatic cancer) or additional genetic risk factors.
Although smoking is a known risk factor for pancreatic cancer, surveillance in all smokers is typically not advised.
Learn more about workup for pancreatic cancer.
Over the past several decades, the number of new esophageal squamous cell carcinoma cases has declined in Western nations, including the US. However, the number of new esophageal adenocarcinoma diagnoses has simultaneously risen considerably in the West. This is consistent with other epidemiological data.
Esophageal squamous cell carcinoma, rather than esophageal adenocarcinoma, has been strongly linked to alcohol use. Conversely, esophageal adenocarcinoma is more strongly associated with GERD and Barrett esophagus. Of the two main types of esophageal cancer, data indicate squamous cell carcinoma generally has a poorer prognosis than adenocarcinoma.
Learn more about the background of esophageal cancer.
Although incidence is decreasing, hepatitis B infection remains the most common cause of HCC globally. However, MASLD has overtaken hepatitis C virus infection as the leading cause of HCC in patients listed for liver transplantation in the US. Further, one study found that MASLD represented the most common (35.6%) underlying cause of the condition. Alcohol-associated liver disease accounts for a minority of HCC cases in the US, representing up to 5.6% in recent analyses.
Learn more about HCC etiology.
Gallstones are an established risk factor for gallbladder carcinoma. Most cases of gallbladder cancer are adenocarcinoma rather than squamous cell carcinoma. Unfortunately, gallbladder carcinomas are usually identified at nonresectable stages , largely owing to the similarity in symptoms to more benign conditions, such as cholecystitis. Jaundice is typically an indicator of poor prognosis in gallbladder carcinoma.
Learn more about deterrence/prevention of gallbladder cancer.
The latest guidelines from the NCCN recommend patients with previously untreated, advanced, HER2-positive gastric cancer receive a combination of platinum- and fluoropyrimidine-based chemotherapy and HER2-targeted therapy in the form of trastuzumab as an initial therapy. Guidelines from the American Society of Clinical Oncology similarly recommend trastuzumab plus pembrolizumab in conjunction with chemotherapy that is either fluoropyrimidine- or oxaliplatin-based as an initial therapy for this population.
Chemotherapy with ICI is generally indicated for HER2-negative cases, not as an initial therapy in HER2-positive cases. Chemotherapy alone is not considered optimal therapy in confirmed HER2-positive cases, and ICI monotherapy is not recommended as an initial therapy for this group.
Learn more about the treatment of gastric cancer.
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