Gastrointestinal System Cancers
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Digestive and Gastrointestinal System cancers.

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General Resources for GI Cancer
Latest Research Publications

General Resources for GI Cancer (9 links)

Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Cunliffe S, Milosevic A
The clinical features and their impact on the prosthodontic management in a case of Gardner's syndrome.
Eur J Prosthodont Restor Dent. 2014; 22(1):7-10 [PubMed] Related Publications
Gardner's syndrome is a variant of Familial Adenomatous Polyposis (FAP), a condition that manifests as hundreds of colorectal polyps likely to undergo malignant change by the fourth decade. Early diagnosis of this condition has the potential to be life saving for individuals and due to its inherited nature other family members can often also be affected. Additional features of Gardner's Syndrome include multiple jaw osteomas with missing teeth that can make prosthodontic treatment a challenge. This case report highlights the presenting features and the prosthodontic problems faced when treating a patient with Gardner's syndrome.

Zhou J, Teng X
Primary extragastrointestinal stromal tumor of the prostate: a case report.
Anal Quant Cytol Histol. 2014; 36(1):55-60 [PubMed] Related Publications
BACKGROUND: The published literature on primary prostatic extragastrointestinal stromal tumor (EGIST) is limited to several isolated case reports. No long-term follow-up is currently available for these patients in order to determine if the biologic behavior of prostatic gastrointestinal stromal tumor is different from those occurring in other sites.
CASE: A 40-year-old man presented with symptoms of benign prostate hyperplasia. Magnetic resonance imaging revealed a huge prostatic mass restricted to the organ's capsule. After a complete resection and histopathologic study of the specimen, primary high-risk EGIST of the prostate was confirmed. The patient underwent adjuvant chemotherapy with imatinib. He has been observed for 32 months and is in good condition with no recurrence or metastasis.
CONCLUSION: Primary EGIST of the prostate is an extremely rare entity. It should be carefully distinguished from other spindle cell lesions. Complete surgical resection and chemotherapy with imatinib are important strategies of treatment.

Related: Gastrointestinal Stromal Tumors Prostate Cancer Imatinib (Glivec)

Greenberg A, Hershkovitz D, Sabo E
Correlation between the presence of KRAS mutation and the morphometric characteristics of colorectal carcinoma cell nuclei.
Anal Quant Cytol Histol. 2014; 36(1):23-31 [PubMed] Related Publications
OBJECTIVE: To determine whether there is an association between KRAS status and changes in nuclear morphometric properties.
STUDY DESIGN: A total of 60 cases were included in the analysis. Thirty cases carried a mutated KRAS oncogene, while 30 bore a wild-type KRAS gene. Computerized morphometry was used to measure various nuclear indices of size, shape, and texture.
RESULTS: Nuclear ellipticity (p = 0.02) and chromatin textural contrast (p = 0.02) were both significantly higher in the mutated KRAS group. However, chromatin contrast was the only independent predictor of KRAS status. A ROC analysis detected a best chromatin contrast cutoff point of 798, with a sensitivity of 89.7% and a specificity of 52%. Tumor grade was also associated with nuclear ellipticity (p = 0.001). Yet, no association was found between tumor grade and KRAS status.
CONCLUSION: Our results suggest that the presence of a KRAS mutation in colorectal carcinoma is associated with alterations in the nuclear morphometric properties of contrast and ellipticity.

Related: Colorectal (Bowel) Cancer KRAS gene

Li X, Cao B, Liu Y, et al.
Multivariate analysis of prognostic factors in 549 patients undergoing surgical treatment of gastric cancer.
Hepatogastroenterology. 2014 Mar-Apr; 61(130):535-42 [PubMed] Related Publications
BACKGROUND/AIMS: Gastric cancer is a common malignancy with high mortality rate, and surgical resection is the primary treatment.
METHODOLOGY: A retrospective analysis of patients who received surgical treatment for primary gastric cancer from January 2006 to December 2010 was performed. Cox univariate and multivariate analyses were performed to determine factors associated with decreased survival.
RESULTS: A total of 549 patients were included in the analysis (421 men and 128 women) with a mean age of 59.5 years (range, 21-81 years). Radical resection was performed in 496 patients, including D1 resection in 72 cases (14.5%), D2 resection in 380 cases (76.6%), and D3 resection in 44 cases (8.9%). The follow-up ranged from 3 to 67 months, during which 368 patients were alive or censored and 181 patients died. The overall 6-month and 1-, 3-, and 5-years survival rates were 89.8%, 80.8%, 58.9%, and 49.7% respectively. Multivariate analysis indicated that tumor size > 5 cm, increasing TNM stage, no resection, receiving perioperative blood transfusion, serum albumin <37 g/L, and not receiving postoperative comprehensive treatment (Chinese medicine, chemotherapy, immunotherapy) were associated with decreased survival.
CONCLUSIONS: Tumor size, TNM stage, extent of resection, serum albumin level, and comprehensive treatment were important prognostic factors.

Related: Stomach Cancer Gastric Cancer

Okubo M, Tahara T, Shibata T, et al.
Light blue crest and ridge/villous patterns in the uninvolved gastric antrum by magnifying NBI endoscopy correlate with serum pepsinogen and gastric cancer occurrence.
Hepatogastroenterology. 2014 Mar-Apr; 61(130):525-8 [PubMed] Related Publications
BACKGROUND/AIMS: Combining the magnifying endoscopy and the narrow-band imaging (NBI) system is an endoscopic imaging technique for the enhanced visualization of mucosal microscopic structure and capillaries of the superficial mucosal layer. Light blue crest (LBC) and, ridge/villous pattern have been thought to be suggestive signs for gastric intestinal metaplasia (IM) of magnifying NBI endoscopy. Since the IM is related to gastric cancer risk (GC), the prevalence of LBC and ridge/villous pattern in the nonneoplastic gastric antrum was examined in relation to gastric cancer (GC) risk and serological severity of gastritis.
METHODOLOGY: In 100 subjects including 13 GC patients, gastric mucosal pattern were examined using magnifying NBI. The mucosal patterns in the antrum were classified according to the presence of LBC or ridge/villous pattern. Serum pepsinogen (PG) levels were also examined.
RESULTS: The sensitivity and specificity for predicting IM was the best when LBC and ridge/villous patterns were combined (sensitivity 95.2%, specificity 98.7%). Both LBC and ridge/villous pattern showed lower serum PGI and PGI/II ratio than those without (P = 0.046, 0.0005, respectively.) In particular, PGI/II ratio was lowest in ridge/villous pattern. The LBC and ridge/villous pattern showed higher incidence of all GC and diffuse GC compared to those without (P = 0.002, 0.002, respectively).
CONCLUSIONS: LBC and ridge/villous pattern in uninvolved gastric antrum by magnifying NBI endoscopy are useful signs for predicting gastric atrophy in the entire stomach and GC risk.

Related: Stomach Cancer Gastric Cancer

Chen J, Chen LJ, Zhou HC, et al.
Prognostic value of matrix metalloproteinase-9 in gastric cancer: a meta-analysis.
Hepatogastroenterology. 2014 Mar-Apr; 61(130):518-24 [PubMed] Related Publications
BACKGROUND/AIMS: The purpose of this study was to evaluate the effect of matrix metalloproteinase-9 overexpression on clinical outcome of gastric cancer using a meta-analysis.
METHODOLOGY: Relevant studies concerning the association between Matrix metalloproteinase-9 expression and survival of patients with gastric cancer were collected from electronic databases. Hazard ratios (HRs) with 95% confidence intervals (Cls) were calculated to estimate the association. Subgroup analysis was calculated to evaluate potential sources of heterogeneity. Besides, we also assessed the relationship between Matrix metalloproteinase-9 level and relevant clinicopathological parameters by estimating the Odds ratios (ORs) with 95% Cls.
RESULTS: Ten studies with 1,478 patients were included to perform a meta-analysis of the survival results. Pooled HRs indicated that MMP-9 overexpression had a negative impact on the over survival (OS) of patients with gastric cancer (HR = 1.69, 95% Cl: 1.29-2.23, P = 0.00), without significant heterogeneity (chi2 = 14.17, I2 = 36.5%, P = 0.117). Similarly, high level of MMP-9 tended to be correlated with lymph node metastasis (OR = 1.91, 95% Cl: 1.40-2.59, P < 0.05) and presence of vascular invasion (OR = 2.64, 95% CI: 1.52-4.59, P <0.05).
CONCLUSIONS: This meta-analysis shows that Matrix metalloproteinase-9 overexpression is a poor prognostic factor in patients with gastric cancer. However, larger scale and randomized studies are needed to confirm its potential clinical value.

Related: MMP9: matrix metallopeptidase 9 Stomach Cancer Gastric Cancer

Yamashita K, Sakuramoto S, Katada N, et al.
Simple prognostic indicators using macroscopic features and age in advanced gastric cancer.
Hepatogastroenterology. 2014 Mar-Apr; 61(130):512-7 [PubMed] Related Publications
BACKGROUND/AIM: Macroscopic features and age may be important prognostic factors that discriminate survival among clinical conditions requiring different therapeutic strategies of advanced gastric cancer (AGC), and this study aimed to identify their clinical relevance.
METHODOLOGY: A total of 232 AGC patients who had Surgical T2b or beyond was enrolled to identify clinical indicators, including macroscopic features in combination with age.
RESULTS: Macroscopic features were divided into 3 categories (types I/II/V, III, and IV), which included stage IV in 24%, 53%, and 72% (P < 0.0001), respectively. Macroscopic features (P < 0.0001), histological features (P = 0.025), and pathological infiltration type (P = 0.0003) were all univariate prognostic factors, as well as stage (P < 0.0001) and age (P = 0.009). However, the multivariate proportional hazards model found that macroscopic features (P = 0.0013) and age (P = 0.0091) were the only factors independent of stage (P <0.0001). Both factors clearly classified the patients into 4 groups (young type 1/II/V (group 1), elderly type I/II/V (group 2), type III and young type IV (group 3), and elderly type IV (group 4) with different prognoses.
CONCLUSIONS: Macroscopic features and age were simple indicators of prognosis in AGC. Both factors may have great potential to develop prognostic categories that effectively classify AGC into categories requiring different therapeutic strategies.

Related: Stomach Cancer Gastric Cancer

Nishiwada S, Ko S, Mukogawa T, et al.
Comparison between percutaneous radiofrequency ablation and surgical hepatectomy focusing on local disease control rate for colorectal liver metastases.
Hepatogastroenterology. 2014 Mar-Apr; 61(130):436-41 [PubMed] Related Publications
BACKGROUND/AIMS: Therapeutic efficacy of radiofrequency ablation (RFA) for colorectal liver metastases (CRLM) was compared with hepatic resection (HR), focusing on local disease control rate as well as risk factors of recurrence and patients survival.
METHODOLOGY: From April 2002 to March 2012, 32 patients underwent RFA and 60 patients underwent HR for CRLM. The rate of local recurrence along the ablated or resected margin was evaluated in these patients.
RESULTS: The local recurrence was seen in 8 patients (13.3%) after HR, and 15 (46.9%) after RFA. Multivariate analysis of all patients revealed that RFA as an initial therapy (P < 0.001), venous invasion liver metastases (P = 0.049) were independent risk factors for local recurrence. Subgroup analysis showed that local recurrence rate after RFA was significantly higher than that after HR in patients with tumors 20 mm or larger (P < 0.001), while there was no significant difference in local recurrence rate between RFA and HR in patients with tumors less than 20 mm (P = 0.676).
CONCLUSIONS: RFA showed a high risk of local recurrence in comparison to HR especially in patients with tumors larger than 20 mm. Indication of RFA should be restricted drastically considering the limitation of efficacy.

Related: Colorectal (Bowel) Cancer

Kashihara H, Shimada M, Kurita N, et al.
Comparisons of inflammatory cytokines expressions in drain after laparoscopic versus open surgery.
Hepatogastroenterology. 2014 Mar-Apr; 61(130):379-81 [PubMed] Related Publications
BACKGROUND/AIMS: Laparoscopic surgery reduces the risk of postoperative adhesion compared with open surgery. The aim of this study was to assess the advantage of laparoscopic surgery in terms of postoperative adhesion.
METHODOLOGY: Eleven patients participated in this study (laparoscopic surgery: 6 patients, open surgery: 5 patients). Body temperature, heart rate, the duration until the first postoperative flatus and the beginning of diet were investigated on postoperative day 0, 1, 3, and 5, respectively. Serum level of WBC and CRP, PAI-1 and IFN-gamma level in the drainage tube were also measured at the same time.
RESULTS: There is no significant difference between the two groups in body temperature. The laparoscopic group revealed significantly lower WBC on POD 0 and CRP on POD 1 compared with the open group. PAI-1 was significantly lower on POD 3 and 5 in the laparoscopic group. IFN-gamma in the laparoscopic group tended to be suppressed compared with the open group.
CONCLUSIONS: Laparoscopic surgery may decrease the risk of postoperative abdominal adhesion compared with open surgery by suppressing early postoperative inflammation.

Related: Cytokines Stomach Cancer Gastric Cancer

Yoshimatsu K, Yokomizo H, Matsumoto A, et al.
Liquid tissue adhesive, subcuticular suture and subcutaneous closed suction drain for wound closure as measures for wound infection in a colorectal cancer surgery with stoma creation.
Hepatogastroenterology. 2014 Mar-Apr; 61(130):363-6 [PubMed] Related Publications
BACKGROUND/AIMS: Stoma creation is one of the risk factors for the incisional surgical site infection (SSI) which can develop the patient's pain in a colorectal surgery.
METHODOLOGY: We performed the subcuticular suture with subcutaneous negative pressure drainage and sealing with liquid tissue adhesive for the prevention of wound infection at the stoma creation.
RESULTS: A total of 72 patients between January 2006 and December 2012 were retrospectively analyzed. Up to December 2008, the wound closure was performed by the percutaneous transdermal interrupted suture with monofilament nylon sutures (conventional procedure). From January 2009, the 10-Fr silastic flexible drains were placed at the subcutaneous space and subcuticular suture using a monofilament absorption string was performed. A liquid tissue adhesive was used to seal the skin wound (revised procedure). There was no difference between the conventional group and the revised group in age and gender. Risk factors in two groups were not found the significant difference except diabetes mellitus. Incisional SSI was observed in 23 patients out of 72 patients (31.9%). There was no significant difference in incidence in clinicopathological factors. Only the revised procedure of wound closure significantly decreased 13.8% of incisional SSI rate from 44.2% in the conventional procedure.
CONCLUSIONS: Our several changes of wound closure including tissue adhesive, subcuticular suture and subcuticular closed suction drainage reduced incisional SSI.

Related: Colorectal (Bowel) Cancer

Hibi K, Mizukami H, Saito M, et al.
p16 Methylation is frequently detected in the serum of metastatic colorectal cancer patients.
Hepatogastroenterology. 2014 Mar-Apr; 61(130):354-6 [PubMed] Related Publications
For the purpose of detection of colorectal cancers, we tried to detect p16 methylation in the serum of colorectal cancer patients using quantitative methylation-specific polymerase chain reaction (qMSP). Out of 211 serum samples derived from colorectal cancer patients, 14 (7%) exhibited p16 methylation in their serum DNA by qMSP. After completion of qMSP analysis in all specimens, clinicopathological data were correlated with the molecular analysis. Interestingly, a significant difference was observed in the presence of distant metastasis (P = 0.0420). Moreover, a trend was shown toward preferentially developing lymph node metastasis (P = 0.0547), thus suggesting that p16 methylation in serum could be detected more frequently in metastatic colorectal cancer patients. High sensitivity of qMSP makes it possible to detect smaller amounts of tumor DNA in the serum. In principle, the methylation status of a primary tumor is not required in advance to detect circulating tumor DNA, suggesting that qMSP can be used as a screening method for cancer.

Related: Colorectal (Bowel) Cancer CDKN2A

Kondo Y, Nagasaka T, Kobayashi S, et al.
Management of peritoneal effusion by sealing with a self-assembling nanofiber polypeptide following pelvic surgery.
Hepatogastroenterology. 2014 Mar-Apr; 61(130):349-53 [PubMed] Related Publications
BACKGROUND/AIMS: PuraMatrix is a synthetic material consisting of 16-amino acid peptides that self-assemble into nanofibers, previously used as a scaffold for functional cell cultures. We conducted a clinical study to determine the safety and sealing properties of PuraMatrix in post-operative lymphorrhea following pelvic surgery in humans.
METHODOLOGY: A total of 20 patients who underwent rectal cancer resection were analyzed. The study group (n = 10) consisted of patients who received PuraMatrix, matched with a control group (n = 10) of patients operated on conventionally.
RESULTS: During the 2 to 3 month follow-up period, there were no abnormal findings or adverse events in any the patients who received PuraMatrix. We found that the patients who received PuraMatrix had significantly reduced post-operative drainage volumes compared with the patients in the control group.
CONCLUSIONS: PuraMatrix is a safe and effective bio-compatible sealing material for the management of post-operative peritoneal effusion following pelvic surgery.

Lee JH, Kim SC, Kim KH, et al.
Decreased cellular levels of palmitic amide are linked to 5-fluorouracil resistance in human colon cancer cells.
Hepatogastroenterology. 2014 Mar-Apr; 61(130):343-8 [PubMed] Related Publications
BACKGROUND/AIMS: The aim of this study was to investigate whether profiling metabolic compounds in human colon cancer cells with induced 5-florouracil resistance enables identification of predictive biomarkers for 5-florouracil resistance.
METHODOLOGY: 5-florouracil resistant and parental cells were extracted using methanol/chloroform solution, and analyzed by MALDI-TOF. Principal components analysis and discriminant analysis was performed to select low-mass ions with strong discriminating power between 5-florouracil resistant and parental cells. The correlation between the intensities of low-mass ions and intrinsic 5-florouracil resistance in 11 colon cancer cells was analyzed using the Spearman rank coefficient.
RESULTS: Eleven low-mass ions had strong discrimi-nating power between 5-florouracil-resistant and parental cells. Of these, the intensity of a low-mass ion with 256.29 m/z was negatively correlated with intrinsic 5-florouracil resistance in 11 colon cancer cells (r = -0.6545, P = 0.0338). By searching the H+ adduct with 0.05 m/z tolerance in the Human Metabolome Database, a low-mass ion of 256.29 m/z was identified as palmitic amide. Interestingly, extracellular treatment with palmitic amide reduced 5-florouracil resistance and invasiveness in 5-florouracil-resistant cells.
CONCLUSIONS: Palmitic amide showed potential not only as a predictor of 5-florouracil resistance, but also for reduction of 5-florouracil resistance in colon cancer cells.

Related: Fluorouracil Signal Transduction

Beştaş R, Kaplan MA, Işikdoğan A
The correlation between serum VEGF levels and known prognostic risk factors in colorectal carcinoma.
Hepatogastroenterology. 2014 Mar-Apr; 61(130):267-71 [PubMed] Related Publications
BACKGROUND/AIMS: In the present study, we analyzed serum vascular endothelial growth factor (VEGF) levels and its correlation with the other clinicopathological characteristics of patients with colorectal carcinoma (CRC).
METHODOLOGY: Seventy-one patients (F/M, 29/42; Mean age +/- SD, 53.3 +/- 13.1 years) were included. The results of serum VEGF were analysed with respect to stage, gender, age, CEA, metastases and topographical tumour localization.
RESULTS: Patients with stage 3-4 disease had significantly higher values of VEGF (253.41 pg/mL +/- 302.24) than patients with stage 1-2 (49.99 pg/L +/- 100.30) (P < 0.003). Patients with the primary tumour localized in the colon had no significantly higher levels of serum VEGF than patients with the primary tumour localized in the rectum (225.97 +/- 324.88 pg/mL vs. 153.76 +/- 205.66 pg/ mL, respectively, P = 0.269). The VEGF expression significantly correlated with serum CEA level (P < 0.01) and clinical stages of colorectal cancer (P < 0.01). The VEGF expression was not correlated with patients' age (P = 0.955) and gender (P = 0.740).
CONCLUSIONS: The VEGF expression significantly correlated with advanced stage, and metastases but not age, gender, and tumour localization. VEGF may play an important role in the invasion and metastasis of CRC. Therefore, VEGF could be applied as prognostic markers in CRC.

Related: Colorectal (Bowel) Cancer VEGFA

Falleni M, Bauer D, Opocher E, et al.
A rare case of transmural endometriosis in primary adenocarcinoma of the rectum.
Pathologica. 2014; 106(1):14-5 [PubMed] Related Publications
Intestinal endometriosis of the rectum and sigmoid colon, occurring in up to 34% of pelvic endometriosis, mimics a wide number of conditions that are difficult to differentiate from inflammatory or malignant diseases. Herein we report the first case of transmural endometriosis concomitant with advanced primary rectal adenocarcinoma, presenting with obstructive symptoms. Correct diagnosis based on morphological identification and immunohistochemical characterization of the two entities is crucial for treatment.

Demir G, Unsal D, Zengin N, et al.
Analysis of resected gastric cancer in Turkish population.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):259-66 [PubMed] Related Publications
BACKGROUND/AIMS: Gastric cancer is still an important health issue in Eastern Europe and Middle East, including Turkey, although its prevalence is decreasing in the western world.
METHODOLOGY: In order to define the profiles of the patients operated with a diagnosis of gastric cancer in Turkey, a multicenter retrospective study was conducted.
RESULTS: Six hundred and forty-eight of the 840 patients with complete data in all parameters were included in the analysis. The median follow-up time was 17.16 months (range, 6-143.63 months). Mean age was 57 +/- 11.7 (19-85). There was a recurrent disease in 42% of the tumors located at cardia, corpus or antrum, and 86% of diffuse tumors (p < 0.0001). The ratio of patients with recurrent disease was greater in stage III and IV tumors There were also greater recurrence ratios in patients with node positive (pN1-3) patients than pN0 tumors, and pT3-4 tumors than pT1 or pT2 tumors. Any recurrence was found in 48% of the tumors with lymphovascular invasion, while in 39% without lymphovascular invasion (p = 0.026). A statistically significant difference was found in the recurrence status of patients with positive/dissected node ratio of < 10% and > or = 10% (p < 0.0001).
CONCLUSIONS: Gastric cancer cases in Turkey are seen at a younger age, and at a higher stage. Proximal gastric cancer is seen much less than the western series. Prognostic significance of lymphovascular invasion in both univariate, and multivariate analyses is noteworthy.

Related: Stomach Cancer Gastric Cancer

Yun L, Bin Z, Guangqi G, et al.
Clinical significance in combined detection of serum pepsinogen I, pepsinogen II and carbohydrate antigen 242 in gastric cancer.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):255-8 [PubMed] Related Publications
BACKGROUND/AIMS: To explore the diagnosis value and clinical significance of combined detection of serum pepsinogen I (PG I), pepsinogen II (PG II), PG I/II and CA242 in patients with stomach diseases.
METHODOLOGY: Serum PG I, PG II and CA242 were detected with time-resolved fluoroimmunoassay (TRFIA) method. Serum levers of the four markers in gastric carcinoma were compared with that in chronic superficial gastritis, chronic atrophic gastritis, gastric ulcer and normal controls. The four indices were analyzed to judge their diagnosis value and the relationship with the biology behavior of gastric carcinoma.
RESULTS: The serum concentration of PG I in gastric carcinoma and in chronic atrophic gastritis were remarkably lower than that in controls (P < 0.05). The serum concentration of CA242 in gastric carcinoma was significantly higher than that in controls (P < 0.05).
CONCLUSIONS: To detect the levers of serum PG I, PG II, PG I/II would help to judge the metastasis and prognosis of gastric carcinoma. Combined detection of the four indices could increase the positive rate of diagnosis in gastric carcinoma.

Related: Stomach Cancer Gastric Cancer

Sasaki K, Fujiwara Y, Kishi K, et al.
Pathological findings of gastric mucosa in patients with gastric remnant cancer.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):251-4 [PubMed] Related Publications
BACKGROUND/AIMS: The mechanism of remnant gastric cancer development has not yet been well established. In this study, we compared the background gastric mucosa of remnant gastric cancer with that of upper lesion-restricted gastric cancer to determine the difference in the pathogenesis of naive gastric cancer and remnant gastric cancer.
METHODOLOGY: Twenty-five patients with gastric remnant cancer after distal gastrectomy and a control group of 29 patients with naive gastric cancer restricted to the upper part of the stomach who underwent gastrectomy were enrolled in this study. We evaluated the gastric mucosa adjacent to cancerous tissues using the updated Sydney score system.
RESULTS: The surrounding gastric mucosa in the remnant gastric cancer group was significantly less atrophic than that of the group with gastric cancer restricted to the upper part of the stomach. In remnant gastric cancer, patients who underwent Billroth II (B-II) reconstruction at first gastrectomy developed cancer at the anastomotic site more frequently than those with Billroth I (B-I) reconstruction.
CONCLUSIONS: The surrounding gastric mucosa was significantly less atrophic in remnant gastric cancer than naïve gastric cancer, which indicates that remnant gastric cancer might possess a different pathogenesis.

Related: Stomach Cancer Gastric Cancer

Hu WQ, Wang LW, Yuan JP, et al.
High expression of transform growth factor beta 1 in gastric cancer confers worse outcome: results of a cohort study on 184 patients.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):245-50 [PubMed] Related Publications
BACKGROUND/AIMS: Transform growth factors beta (TGFbeta) plays different roles at different stages of tumor development. TGFbeta1 is one isoform of TGFbeta, with complex secretion mechanism and bidirectional functions. This study was to investigate TGFbeta1 expression and its clinical significance in different clinicopathological subgroups of gastric cancer (GC) patients.
METHODOLOGY: Tumor and peritumoral tissues from 184 GC patients were constructed into three tumor tissue microarrays. The expression of TGFbeta1 was analyzed by immunohistochemistry methods.
RESULTS: TGFbeta1 was mainly expressed in the cytoplasm and membrane of GC cells. Low TGFbeta1 expression was observed in 82 (44.6%) tumor and 28 (68.3%) peritumoral tissues, and high expression was observed in 102 (55.4%) tumor and 13 (31.7%) peritumoral tissues. TGFbeta1 expression was significantly higher in tumor than peritumoral tissues (chi2 = 7.554, P = 0.006). The high expression of TGFbeta1 was related to worse overall survival (OS) (P = 0.040). TGFbeta1 expression was higher in the old and intestinal type GC than in the young (P = 0.017) and in diffuse type GC (P = 0.015), respectively. Patients with high TGFbeta1 expression had a worse survival in young people, female, diffuse type GC, poor differentiation, and lymph nodes metastasis. Multivariate Cox proportional hazards analysis showed that age, pathological grading, serosal invasion and TGFbeta1 expression were independent risk factors.
CONCLUSIONS: High TGFbeta1 expression may indicate poor prognosis of GC patients and warrant more active treatment against TGFbeta1.

Related: Stomach Cancer Gastric Cancer TGFB1

Nishizawa M, Seshimo A, Miyake K, et al.
Usefulness of the TRC method in the peritoneal washing cytology for gastric cancer.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):240-4 [PubMed] Related Publications
BACKGROUND: Peritoneal dissemination from gastric cancer is the most frequent metastasis of advanced gastric cancer. Detection of cancer micrometastasis is required for improvement of cancer therapy. A method that can detect micrometastases more sensitively is desired. Against this background, for the purposes of making the genetic diagnosis of micrometastasis simple and rapid, TRC (transcription reverse transcription concerted reaction) was developed.
METHODOLOGY: 69 patients with gastric cancer in those diagnosed with deeper than mp. At the time of surgery, peritoneal washing with saline was extracted. Having extracted the RNA therein, It was blended with a reagent responsive to CEAmRNA and was put into TRC. The cytology and TRC were compared and studied.
RESULTS: The concordance rate between TRC and cytology was K=0.6552. The patients whom there was a discrepancy between the cytology and TRC are clinically validate the TRC results. In the study of prognosis, TRC obtained a sensitivity of 90.9% and a specificity of 98.3%.
CONCLUSION: The measurement of CEAmRNA in peritoneal washing specimens by the TRC method is superior to Cytology. That is also equal to or superior to the RT-PCR method with respect to sensitivity and specificity, and superior with respect to simplicity and rapidity.

Related: Stomach Cancer Gastric Cancer

Xu Q, Gu L, Jiang C, et al.
The selection of surgical treatment for gastric cancer patients with cirrhosis and hypersplenism.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):232-5 [PubMed] Related Publications
BACKGROUND/AIMS: This study is to find the changes of hypersplenism, the leukocyte, platelets count, blood loss and operative time, hospitalization days in gastric cancer patients with cirrhosis and hypersplenism after splenectomy or splenic artery ligation.
METHODOLOGY: 32 gastric cancer patients with cirrhosis and hypersplenism were divided into two groups performed radical gastrectomy combined with splenectomy (Group A, n = 17) or splenic artery ligation (Group B, n = 15), 16 gastric cancer patients performed radical gastrectomy were selected as control group (Group C). Then, statistical analyzed.
RESULTS: There were no significant differences of the leukocyteand platelets between Group A and B (p > 0.05), but significant compared with Group C (p < 0.01). After 6 chemotherapy, the differences of the leukocyteand platelets were obvious between Group A and C (p < 0.05), but not between Group B and C (p > 0.05). There were significant differences on the grading of hyperhepatia between Group A and B. Except the operative time of Group B and C (p > 0.05), there were significant differences on the blood loss, the operative time and hospitalization days among three groups (p < 0.05).
CONCLUSIONS: The splenic artery ligation method was much more rational than splenectomy and it was preferred for the gastric cancer patients with cirrhosis and hypersplenism.

Related: Fluorouracil Leucovorin Stomach Cancer Gastric Cancer

Yajima H, Omura N, Matai K, et al.
Clinicopathological features of CA19-9-producing gastric cancer.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):221-5 [PubMed] Related Publications
BACKGROUND/AIMS: The aims of this study were to define CA19-9-producing gastric cancer and investigate its clinicopathological features.
METHODOLOGY: Twenty-three patients showing high preoperative serum CA19-9 levels (> or = 38 U/mL) were enrolled in this retrospective cohort study. The CA19-9 cut-off level was determined on the basis of receiver operating characteristic analysis of CA19-9 levels obtained from patients having survived for 3 years after surgery. Patients in whom the CA19-9 level was the cut-off level or higher were defined as having CA19-9-producing gastric cancer (Group A), and their clinicopathological features were compared with those of patients showing CA19-9 levels less than the cut-off level (Group B).
RESULTS: The preoperative serum CA19-9 cut-off level was set at 77 U/mL. In Group A, lymph node metastasis was seen in all 11 patients, with the incidence being higher than that in Group B (p <0.001). The number of patients with stage III or greater disease was 10 in Group A, compared with only 3 in Group B (p < 0.001). The independent prognostic factors were preoperative serum CA19-9 levels, venous invasion and tumor stage.
CONCLUSIONS: CA19-9-producing gastric cancer is a type of gastric cancer with poor prognosis and characterized by preoperative serum CA19-9 > or = 77 U/mL.

Related: Stomach Cancer Gastric Cancer

Schuld J, Richter S, Kollmar O
The role of cryosurgery in the treatment of colorectal liver metastases: a matched-pair analysis of cryotherapy vs. liver resection.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):192-6 [PubMed] Related Publications
BACKGROUND/AIMS: Although liver resection is the gold standard for patients with colorectal liver metastases (CRLM), only 15-20% of the patients are candidates for surgery. As ablative therapies may extend this low rate of curative option, the aim of the present study was to analyze the impact of cryosurgery (cryo) on survival of patients with CRLM compared to liver resection (Phx).
METHODOLOGY: In a matched-pair analysis, patients undergoing Phx or cryo were compared (n = 39 each). Analysis included pre-, peri-and postoperative data and follow-up for tumor-free and overall survival. Survival was estimated by Kaplan-Meier method.
RESULTS: Out of 124 patients undergoing 143 cryosurgical procedures, 39 patients could be identified undergoing single liver cryo procedure for CRLM with a curative approach. Matching of these patients with a Phx cohort, patients undergoing Phx revealed better overall (20 vs. 46 months) and tumor-free survival (7.8 vs. 33.6 months) than patients with cryo.
CONCLUSIONS: Liver resection is strongly recommended for patients with CRLM compared to cryosurgery.

Related: Colorectal (Bowel) Cancer

Chai TH, Jin XF, Li SH, et al.
A tandem trial of HD-NBI versus HD-WL to compare neoplasia miss rates in esophageal squamous cell carcinoma.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):120-4 [PubMed] Related Publications
BACKGROUND/AIMS: To determine whether the use of narrow-band imaging (NBI) system could enhance the detection rate of esophageal squamous cell carcinoma and precancerous lesions during endoscopic examination of the esophagus.
METHODOLOGY: 113 patients were randomized to undergo endoscopic examination using high definition television (HDTV) narrow band imaging (NBI) endoscopy or HDTV WL endoscopy. The primary endpoint was the difference in the neoplasm miss rate, and secondary outcome was the neoplasm detection rate.
RESULTS: The number of esophageal cancer and high grade intraepithelial neoplasia lesions detected by HD-NBI and HD-WL was 45 and 21, respectively. The neoplasm miss rate per lesion and per patient with HD-NBI showed significant difference compared with that of HD-WL (P <0.05). Characteristics of lesions missed by use of HD-NBI were similar to those missed by use of HD-WL; all missed lesions were high grade intraepithelial neoplasia lesions. Significant difference was observed between NBI and WL in adenoma detection rate (70.2% vs. 35.7%, P < 0.01).
CONCLUSIONS: Endoscopy with HD-NBI seems to improve the detection of esophageal cancer and precancerous lesions, high definition may be tested for its effect on detection of esophageal cancer and precancerous lesions in the future. These results indicate that endoscopy routinely using the NBI system for the surveillance of esophageal cancer and precancerous lesions may be recommended.

Related: Cancer Screening and Early Detection Cancer of the Esophagus Esophageal Cancer

Alldinger I, Schmitt MM, Dreesbach J, Knoefel WT
Endoscopic treatment of anastomotic leakage after esophagectomy or gastrectomy for carcinoma with self-expanding removable stents.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):111-4 [PubMed] Related Publications
BACKGROUND/AIMS: Anastomotic leakage is a feared complication after gastrectomy and esophagectomy. We report our experience in the treatment with endoscopic stent placement.
METHODOLOGY: Seventeen patients with anastomotic leakage after resection of a malignant tumor of the stomach or the distal esophagus have been long-term followed-up.
RESULTS: In 10 patients the implanted stent did successfully close the leakage in the first attempt. In 3 out of 7 patients with unsuccessfully sealed leakage a stent-in-stent-manoeuvre did successfully seal the leakage. We had no major complications upon implantation of the stents. We did have no recurrence of a once sealed leakage.
CONCLUSIONS: Endoscopic stent placement is a safe procedure in the treatment of anastomotic leakage after gastrectomy and esophagectomy. It should be performed in any clinically relevant leakage if possible. In cases where stent placement is not successful at first, correction of position, stent replacement or a stent-in-stent manoeuvre can be performed, with promising results.

Related: Cancer of the Esophagus Esophageal Cancer Stomach Cancer Gastric Cancer

Sato T, Nakamura T, Ota M, et al.
Improvement in the postoperative course of salvage esophagectomy after definitive chemoradiotherapy.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):105-10 [PubMed] Related Publications
BACKGROUND/AIMS: The aim of this study was to assess the outcome of salvage esophagectomy with less extensive lymphadenectomy, which we have performed since 2003 to improve high mortality and morbidity of standard salvage esophagectomy.
METHODOLOGY: We retrospectively compared the surgical outcome of 15 patients who underwent standard salvage esophagectomy via right thoracotomy for thoracic esophageal cancer between 1993 and 2002 (earlier period) with the results of 11 patients between 2003 and 2011 (later period).
RESULTS: There were two mortalities in the earlier period, whereas no patient died in the later period, and there was a lower rate of morbidity. In the later period, there was a significantly shorter SIRS duration, lower CRP on postoperative days 1-5, and higher lymphocyte count on postoperative days 2-4. Long-term survival showed no significant difference between the two periods.
CONCLUSIONS: Salvage esophagectomy with less extensive lymphadenectomy might improve the surgical outcome while maintaining long-term survival.

Related: Cancer of the Esophagus Esophageal Cancer

Funahashi K, Koike J, Shiokawa H, et al.
Phase I trial of preoperative chemoradiation therapy with S-1 for low rectal cancer.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):99-104 [PubMed] Related Publications
BACKGROUND/AIMS: A phase I study was performed to evaluate the dose-limiting toxicity and the recommended dose of the oral fluoropyrimidine S-1 when administered concurrently with radiation therapy to 9 Japanese patients with low rectal cancer.
METHODOLOGY: S-1 was given orally for a total of 9 weeks (4 weeks alone and 5 weeks during radiation therapy) at oral doses of 65 mg/m2/day (n = 3 patients) or 80 mg/m2/day (n = 6 patients). Radiation therapy was administered in 1.5 gray fractions five times weekly (Monday to Friday) for a total dose of 45 gray.
RESULTS: All patients achieved the planned 45 gray of radiation therapy. There was no grade > or = 3 toxicity. The recommended dose of S-1 was determined to be 80 mg/m2/ day. The dose intensity of S-1 was well maintained, and the combination of S-1 plus radiation therapy was well tolerated by all patients. Sphincter-preserving procedures were possible in all but one (89%) patient. High rates of tumor shrinkage and nodular downstaging were achieved. The histological response rate was 78%, including one complete response.
CONCLUSIONS: The recommended dose of S-1 with concurrent radiation therapy was 80 mg/m2/day. Pre-operative chemoradiation therapy with S-1 was feasible and well tolerated by patients with low rectal cancer.

Related: Tegafur-uracil

Murata K, Yamamoto H, Fukunaga M, et al.
Survival benefit of oral tegafur/uracil and leucovorin as a first line therapy for elderly patients with advanced or metastatic colorectal cancer.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):94-8 [PubMed] Related Publications
BACKGROUND/AIMS: This phase II trial was performed to evaluate the efficacy and tolerability of tegafur/uracil (UFT) and oral leucovorin (LV) in elderly patients with advanced or metastatic colorectal cancer who had not received prior chemotherapy.
METHODOLOGY: Patients aged > or = 70 years were eligible. UFT and LV were taken orally on days 1-28 of the cycle at doses of 300 mg/m2/day and 75 mg/m2/day, respectively. Treatment was administered on an outpatient basis every 35 days and consisted of at least two cycles until disease progression.
RESULTS: A total of 30 patients were enrolled in this study. The median age of the patients was 81.5 years (range: 74-88 years). The observed overall response rate was 17.9%. The estimated median overall survival time was 23.5 months. Two patients (7%) experienced toxicities with a worst grade of 3, and one patient (4%) experienced toxicities with a worst grade of 4. There were no treatment-related deaths. No patients experienced grade 3 or 4 hematological adverse events.
CONCLUSIONS: Although the response rate to UFT/LV was moderate, a favorable survival time was observed. Lower hematological adverse event rate of UFT/LV may introduce second line therapy safely to elderly colorectal cancer patients and contribute longer survival.

Related: Colorectal (Bowel) Cancer Leucovorin Tegafur-uracil

Schouten SB, De Bruin AF, Gosselink MP, et al.
Is microvessel density correlated with anastomotic leakage after low anterior resection?
Hepatogastroenterology. 2014 Jan-Feb; 61(129):90-3 [PubMed] Related Publications
BACKGROUND/AIMS: Anastomotic leakage after low anterior resection may be the result of poor vascular supply from the proximal anastomotic loop. The purpose of this study was to investigate the correlation between colonic microvessel density and anastomotic breakdown.
METHODOLOGY: Between 2006 and 2009, a consecutive series of 81 patients underwent double-stapled low anterior resection followed by a colorectal anastomosis. Symptomatic anastomotic leakage occurred in 14 patients (17%). In these patients, microvascular density was determined by image analysis of CD-31-immunostained sections from the proximal resection site. The results were compared with a sample of the remaining 67 patients without anastomotic leakage closely matched for age, gender, ASA-classification, pathological stage and neoadjuvant treatment.
RESULTS: The mean percentage of anti-CD31 stained area, obtained from the proximal resection site was similar between patients with or without anastomotic leakage (4.0% +/- 1.8% versus 4.4% +/- 1.6% respectively, P = 0.53). With respect to neo-adjuvant therapy, no differences in the density of CD31 positive were observed (pre-operative radiotherapy = 4.3% +/- 1.8% versus pre-operative chemoradiotherapy 4.1% +/- 1.6%, P = 0.77). The mean vessel density reached borderline statistical significance in women (5.0% +/- 1.8%) compared to men (3.8% +/- 1.8%) (P = 0.06).
CONCLUSIONS: Microvessel density quantification with immunohistochemical analysis of CD31 expression of the proximal anastomotic region did not show any correlation with anastomotic leakage in the clinical setting.

Related: Colorectal (Bowel) Cancer

Yaegashi M, Otsuka K, Itabashi T, et al.
Daikenchuto stimulates colonic motility after laparoscopic-assisted colectomy.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):85-9 [PubMed] Related Publications
BACKGROUND/AIMS: Paralytic ileus after laparoscopic-assisted surgery often occurs. We investigated whether daikenchuto (DKT), a traditional Japanese herbal medicine, improves intestinal motility in patients undergoing laparoscopic-assisted colectomy for colon cancer.
METHODOLOGY: Fifty-four patients who underwent colectomy at Iwate Medical University Hospital between October 2010 and March 2012 were randomized to either the DKT group (7.5 g/day, p.o.) or the control group (lactobacillus preparation, 3g/day, p.o.). Primary endpoints included time to first flatus, bowel movement, and tolerance of diet after extubation. Secondary endpoints were WBC count, C-reactive protein (CRP) level, length of hospital stay, and postoperative ileus. Colonic transit time was measured using radiopaque markers and abdominal radiographs.
RESULTS: Fifty-one patients (DKT, 26 vs. control, 25) were included in the per-protocol analysis. The DKT group had significantly faster time until first flatus (67.5 +/- 13.6h vs. 77.9 +/- 11.8h, P < 0.01) and bowel movement (82.9 +/- 17.8h vs. 99.5 +/- 18.9h, P < 0.01) and colonic transit time (91.9 +/- 19.8h vs. 115.2 +/- 12.8 h, P < 0.05). There were no significant intergroup differences in secondary endpoints and adverse events.
CONCLUSIONS: DKT accelerates colonic motility in patients undergoing laparoscopic-assisted colectomy for colon cancer.

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