Gastrointestinal Cancer

Solomon et al have written a valuable primer to guide clinicians in identifying, diagnosing, and treating familial colon cancer syndromes. The authors succinctly describe the essential features of each of the well-defined hereditary colon cancer syndromes, including those associated with colonic adenomas (hereditary nonpolyposis colorectal cancer [HNPCC] and familial adenomatous polyposis [FAP]) and colonic hamartomas (Peutz-Jeghers syndrome, juvenile polyposis, and Cowden syndrome). In addition to the specific features that might trigger recognition of one of these syndromes, we advise health-care providers to consider the possibility of hereditary cancer in cases with the following features:

This article is a comprehensive review of genetic testing for hereditary colorectal cancer detection. There is no longer any doubt that hereditary factors contribute to an increased risk of colon cancer. It remains to be seen how great their contribution is, how best to identify high-risk groups, and how best to care for carriers of the mutated genes. Approximately 25% of colorectal cancers occur in younger individuals or those with a family history of the disease, suggesting a heritable susceptibility.[1]

Surgery is still the most important treatment for solid tumors, regardless of the age of the patient. In this article, we discuss the physiology of aging as it relates to risk assessment in the elderly surgical oncology patient. A brief review of the role of surgery in the treatment of breast, colorectal, pancreatic, and gastric cancer is provided, because these solid tumors primarily affect elderly patients.

Over 130,000 new cases of colon cancer are diagnosed annually. Approximately 20% to 30% of these are attributable to familial risk, and 3% to 5% belong to a hereditary colorectal cancer predisposition syndrome.

LISBON, Portugal-The combination of capecitabine (Xeloda) and oxaliplatin (investigational in the United States) produced a 55% response rate in a phase II study of patients with advanced or metastatic colorectal cancer, Chris Twelves, MD, of Beatson Oncology Centre, Glasgow, Scotland, said at the 11th European Cancer Conference (abstract 1005). In addition, he said, 32% of patients in the study had stable disease.

The results of a 10-year study of a three-pronged treatment (surgical resection followed by chemotherapy and radiotherapy) for adenocarcinoma of the stomach showed that patients who underwent both surgical resection and postoperative

LISBON, Portugal-Short-term preoperative radiotherapy significantly lowers the risk of local recurrence in patients with rectal cancer who undergo standardized total mesorectal excision (TME), Cornelis J.H. van de Velde, MD, PhD, reported at

The article by Drs. Levy and Wiersema is an excellent overview of the indications, technical nuances, and efficacy of endoscopic ultrasound in the diagnosis and staging of pancreatic neoplasms. Endoscopic ultrasonography was introduced into the diagnostic armamentarium for gastroenterology approximately 15 years ago. Although the literature suggests a general increase in the utility and experience with endoscopic ultrasound, the technique remains most effective in the hands of experienced experts like Drs. Levy and Wiersema. Their article is a complete and thorough review of the indications and expected accuracy of the technique when evaluating a variety of different pancreatic lesions.

Two decades have elapsed since publication of the first papers describing the examination of the pancreas via the stomach and the duodenum using an ultrasound probe fixed to an endoscope tip. Initial attempts to image the pancreas in this fashion proved difficult and frustrating, but they were promising enough that instrument makers and gastrointestinal endoscopists persisted in developing increasingly effective devices.

Patients with signs and symptoms suggestive of a pancreatic neoplasm typically undergo initial imaging with transabdominal ultrasound or computed tomography. This evaluation often reveals the presence of a pancreatic mass or fullness.

Drs. Levy and Wiersema have provided an authoritative review of the role of endoscopic ultrasonography in the diagnosis and staging of pancreatic cancer. As outlined in their article, endoscopic ultrasound has emerged as an important tool in the diagnostic evaluation of many patients with suspected pancreatic neoplasms. We concur that endoscopic ultrasound is part of the standard preoperative evaluation of patients with biochemically confirmed insulinoma and gastrinoma syndromes and of at-risk patients with multiple endocrine neoplasia type 1. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration (FNA) can also accurately determine the etiology of a cystic pancreatic neoplasm by differentiating between mucinous, serous, and inflammatory (pseudocyst) lesions.

ROCHESTER, Minnesota-Fluorouracil (5-FU)-based chemotherapy after surgery can be given safely to selected elderly patients with stage II/III colon cancer, and these patients derive the same benefits from the treatment as do their younger counterparts, according to results of a pooled analysis of seven clinical trials.

SAN FRANCISCO-Two phase II chemotherapy regimens combining gemcitabine (Gemzar) and docetaxel (Taxotere) in patients with advanced pancreatic cancer show higher response rates than gemcitabine alone and suggest further explorations of the combination are warranted, according to presentations at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO).

Advances in diagnostic and therapeutic radiology and a better understanding of cell biology are being applied in practical ways to modulate treatment morbidity. Conformal radiotherapy targets the cancer precisely and can be combined with new systemically administered radiosensitizers.

SAN FRANCISCO-In patients with advanced pancreatic cancer, the combination of gemcitabine (Gemzar) followed by oxaliplatin (investigational in the United States) (GEMOX) is active with low toxicity, Christophe Louvet, MD, Hôpital St-Antoine, Paris, France, said at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO abstract 506).

LOS ANGELES-Positron emission tomography (PET) changed the disease management of more than 60% of patients with colorectal cancer, according to a survey of referring physicians. The most striking change occurred among patients for whom surgery was the intended treatment: 41% of these patients had their treatment changed from surgery to medical treatment. Another 13.5% saw the surgical approach changed as a result of the PET findings.

SAN FRANCISCO-Raltitrexed (Tomudex) in combination with oxaliplatin may be used as a replacement for the de Gramont regimen in advanced colorectal cancer, said Vincenzo Catalano, MD, Medical Oncology, Pesaro, Italy.

This article will review the pertinent data on the use of chemotherapy for all stages of pancreatic cancer. For patients with metastatic disease, fluorouracil (5-FU) was the standard of care for several decades until a single

This article will review the pertinent data on the use of chemotherapy for all stages of pancreatic cancer. For patients with metastatic disease, fluorouracil (5-FU) was the standard of care for several decades until a single

This article will review the pertinent data on the use of chemotherapy for all stages of pancreatic cancer. For patients with metastatic disease, fluorouracil (5-FU) was the standard of care for several decades until a single

This article will review the pertinent data on the use of chemotherapy for all stages of pancreatic cancer. For patients with metastatic disease, fluorouracil (5-FU) was the standard of care for several decades until a single

NEW YORK CITY-Irinotecan (Camptosar), oxaliplatin, and other new agents have shown promising activity in rectal cancer and are now being tested in combination regimens with 5-fluorouracil (5-FU) and in new chemoradiotherapy regimens, according to Bruce Minsky, MD.

LITTLE ROCK, Arkansas-The antiangiogenic properties of thalidomide (Thalomid) as well as its ability to inhibit tumor necrosis factor-alpha (TNF-alpha) suggest that thalidomide might be a useful addition to regimens for treating advanced cancers. Rangaswamy Govindarajan, MD, said that thalidomide may enhance the response rate of metastatic colorectal cancer to irinotecan (Camptosar) while also reducing irinotecan-related gastrointestinal toxicities. Dr. Govindarajan is assistant professor of medicine at the University of Arkansas for Medical Science in Little Rock, Arkansas.

COLORADO SPRINGS-Researchers from two large North American Intergroup colorectal cancer trials found an unexpectedly high rate of toxic deaths in trials containing irinotecan (Camptosar). No such problems had been apparently observed by oncologists using the combination of irinotecan, 5-fluorouracil (5-FU), and leucovorin (LV) (IFL) in routine clinical practice, and no such problems had been identified in the pivotal registration and European studies.

CHICAGO-A "dealer’s choice" rectal cancer trial in which treatment would be chosen by the physician and patient together has been proposed by the National Cancer Institute (NCI) Gastrointestinal Intestinal Intergroup. The Intergroup now includes research groups from the American College of Surgeons Oncology Group, Cancer and Leukemia Group B, the Eastern Cooperative Oncology Group, the North Central Cancer Treatment Group, the NCI Canada, the National Surgical Adjuvant Breast and Bowel Project (NSABP), the Radiation Therapy Oncology Group, and the Southwest Oncology Group.

WINSTON-SALEM, North Carolina-Preliminary data from a phase II trial of induction irinotecan (Camptosar)/gemcitabine (Gemzar) followed by twice-weekly gemcitabine and radiation in patients with locally advanced pancreatic cancer show partial responses in 2 of 7 evaluable patients. There were no local progressions, and median time to progression of 6 months, according to A. William Blackstock, MD. Dr. Blackstock is assistant professor at Wake Forest University, Winston-Salem, North Carolina, and at the University of North Carolina at Chapel Hill.

PORTLAND, Oregon-"Very preliminary data suggest that cyclooxygenase-2 (COX-2) inhibitors can be safely used in combination with irinotecan (Camptosar), and even more preliminary data suggest that such combinations are active in advanced colorectal cancer," reported Charles Blanke, MD. He explained that COX-2 is overexpressed in the majority of human colorectal cancers. Dr. Blanke is director of the GI Malignancy Program at the Oregon Cancer Institute in Portland.

HOUSTON-Colon cancer researchers are studying a variety of cell surface molecules and receptors as potential targets for new treatments aimed particularly at preventing or treating metastatic disease. Lee Ellis, MD, professor of surgery and cancer biology at the University of Texas M. D. Anderson Cancer Center in Houston, discussed his group’s current work in three new areas: angiopoietins as a target for blocking tumor angiogenesis, integrins, and the insulin growth factor-1 (IGF-1) system.

SAN FRANCISCO-In an effort to extend the activity of gemcitabine (Gemzar) against pancreatic cancer, researchers have paired an investigational chimeric monoclonal antibody, IMC-C225 (cetuximab) with the standard chemotherapy. IMC-C225 selectively binds to epidermal growth factor receptor (EGFR).

SAN FRANCISCO-In advanced colorectal cancer, the combination of oxaliplatin (investigational) and irinotecan (Camptosar) is beneficial as a first-line therapy, according to phase II clinical trial results presented at the 37th Annual Meeting of the American Society of Clinical Oncology (abstract 538).