Gastrointestinal cancer

SALAH OSMAN SALAH-MD

Esophageal cancer

incidence
• The crude incidence of esophageal cancer in the European
Union (EU) is ~4.5 cases/100 000/year (43 700 cases) with
considerable geographical differences along the EU ranging
from 3/100 000 in Greece up to10/100 000 in France.
• The main risk factors for squamous cell carcinomas (SCCs) in
Western countries are smoking and alcohol consumption,
whereas adenocarcinomas (ACs) predominantly occur in
patients with gastroesophageal reflux disease and their risk is
correlated with the patient’s body-mass index.
• Diagnosis
• endoscopic biopsy with the histology to be given according to
World Health Organization criteria.
• Staging:
clinical examination
blood work up
Images(CXR-CT scan-Barium swallow-PET scan)
laproscopy in GEJ

• TREATMENT
• The main factors for selecting primary therapy are
tumor stage
 location.
histological type.
medical condition.
requests of the patients
Surgery
• Surgery is regarded as standard treatment :

-in carefully selected operable patients with localized

tumors(T1-2 N0-1 M0)-Transthoracic
- No standard treatment can be identified for
carcinomas of the cervical
survival does not exceed 25% if regional lymph nodes are
involved
• Treatment of extensive disease (T3-4 N0-1 MO or T1-4 NO-1
Ml)
• squamous cell carcinoma MO
neoadjuvant chemo(radio)therapy (40-50 Gy)
Followed by:
early salvage surgery .
• adenocarcinoma MO
Perioperative chemotherapy with cisplatin and 5-FU
•  
metastatic disease
• Single-dose brachytherapy may be a preferred option.
• Chemotherapy
0• Gastroesopheal junction tumors
GEJ
Gastric cancer
• Epidemiology
• Gastric cancer is the fourth most common malignancy
world wide
• Decrease in incidence in non-cardial site, while the GEJ
are stable or even more.
• Eradication of Heliobacter pylori (HP), decrease in
smoking habits, more healthy food are the possible
explanation
• Risk factors related to GEJ tumors include: gatro-
esophageal reflux disease (GRD), male gender, obesity and
smoking
• Additional risk factors : atrophic gastritis, familial
clustering, genetic syndromes as HNPCC, and in families with >
2 cases
• Diffuse gastric carcinoma has a genetic background
Staging
• Tumor markers: CEA levels are elevated in 28.8% of the
cases. Patients with > 10ng/ml have a worse prognosis
• Systemic review of the T staging by different diagnostic
tools showed a similar accuracy between them. The
comparison included :
• EUS/CT/MRI/PDG-PET ( 65-93%).
• CT remains the imaging method of choice for evaluation
of local extension and distal metastases
 • EUS may be useful in superficial lesions or linitis plastica
• PDG-PET is negative in one third of met. Gastric cancer,
staging laparoscopy is not routinely recommended

Treatment
• Resectable disease
• Adjuvant and neo-adjuvant
• Radiotherapy
• Metastatic disease
• First line
• Second line
• New drugs
•
• CONCLUSIONS
• management of GC enquires a multidisyplin
approach,
including Gastroenterologist, pathologist, medical,
surgical
oncologist and radiotherapist
• Neo-adjuvant and adjuvant chemotherapy
improve the survival
of properly resected cases
• Surgery should be done in high caseload centers
aiming for D2
resection and reduced operative morbidity
• Post-operative chemo-radiotherapy should be
considered in cases
 with Inadequate primary treatment
• The choice of drugs in advanced disease should
be tailored for the
demand of individual patients for 1st and 2nd lines

THANK YOU