Latest news with #NoncolorectalGIcancers
Medscape
6 days ago
- Health
- Medscape
Fact or Fiction: Noncolorectal Gastrointestinal Cancer
Noncolorectal gastrointestinal (GI) cancers present unique challenges in diagnosis, management, and prognosis. Knowledge of risk factors, presenting features, and contemporary treatment guidelines is essential for timely recognition and effective care. Pancreatic cancer is primarily diagnosed among older adults. Nearly 90% of cases occur in individuals older than 55 years. Besides age, additional risk factors include smoking, diabetes, and obesity. Learn more about pancreatic cancer epidemiology. Due to nonspecific symptoms, most patients with gastric cancer present with advanced disease, contributing to a worldwide 5-year survival rate of approximately 10%. Further, a study of patients with gastric cancer younger than 50 years found that 87% were symptomatic at diagnosis. Learn more about gastric cancer presentation. The incidence of esophageal adenocarcinoma in the US rose dramatically from the 1970s until 2006, then leveled off, and it is also continuing to increase in other countries due to certain lifestyle factors. Surveillance, Epidemiology, and End Results data from 2012-2022 show that incidence rates have remained steady at about 5.0-5.1 per 100,000 in males and 0.6-0.8 per 100,000 in females. Although rising obesity and metabolic syndrome rates probably contributed to prior increases, this does not fully explain the subsequent plateau. Learn more about esophageal cancer epidemiology. Current National Comprehensive Cancer Network (NCCN) guidelines recommend adjuvant chemotherapy after resection of biliary tract cancer; capecitabine is the preferred regimen. American Society of Clinical Oncology guidelines also recommend that patients should undergo adjuvant chemotherapy with capecitabine for 6 months after biliary tract cancer resection. Adjuvant chemotherapy or chemoradiation has been shown to improve survival in patients with biliary tract cancer, with the benefit being particularly notable among those with lymph node involvement. Learn more about biliary tract cancer treatment protocols. Studies have shown that the combination of an immune checkpoint inhibitor (ICI) and a vascular endothelial growth factor (VEGF) inhibitor, rather than a TKI plus cytotoxic chemotherapy, is associated with favorable survival outcomes and has recently become the standard initial treatment for advanced HCC. Although TKI may still be used as systemic therapy, c urrent NCCN guidelines recommend atezolizumab (an ICI) plus bevacizumab (a VEGF inhibitor) as one of the preferred initial systemic therapy regimens for advanced HCC; tremelimumab-actl plus durvalumab (both monoclonal antibody therapies) is another preferred initial option. Learn more about HCC treatments. Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.
Medscape
6 days ago
- Health
- Medscape
Rapid Review Quiz: Noncolorectal Gastrointestinal Cancers
Noncolorectal gastrointestinal (GI) cancers represent a clinically significant and diverse group of malignancies impacting patient outcomes across multiple organ systems. Given the range in epidemiology, risk factors, and management strategies for these cancers, it is essential for clinicians to recognize and stay up to date on current guidelines related to their surveillance, diagnosis, and treatment. Familiarity with the evolving landscape of noncolorectal GI cancers is foundational for effective clinical decision making in everyday practice. 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.
