Oncology/Hematology

Epidemiology & Etiology: Aspirin and other nonsteroidal anti-inflammatory agent use has been associated with a lower risk for cancer of the gastroesophageal junction and other gastrointestinal tumors.41 Cigarette smoking, H. pylori infection, Epstein-Barr virus, radiation exposure, and prior gastric surgery for benign ulcer disease also have been implicated as risk factors. Diagnosis: Staging includes chest x-ray, chest CT scans, and abdominal imaging to rule out metastasis and to determine surgical resectability. PET scans are not (yet) recommended as standard diagnostic procedure in view of limited sensitivity, but can be helpful to determine the resectability of gastric cancers in select cases.48 The role of EUS is less clear in gastric cancer than in esophageal and gastroesophageal junction cancers. Treatment: D2 lymphadenectomy was associated with lower locoregional recurrence (12% vs. 22%) and gastric cancer–related death rates (37% vs.

Epidemiology & Etiology: Approximately 60% of cases of distal esophageal or gastroesophageal adenocarcinomas have evidence of Barrett’s esophagus. High-grade dysplasia is an indication for more aggressive management, including surgical resection. Tumor markers, such as TP53, may be predictors of potential progression to malignant disease. There is an inverse association between Helicobacter pylori (H. pylori) infection and adenocarcinomas of the lower esophagus, presumably a result of the reduced acidity associated with atrophic gastritis.9   Infection with human papillomavirus (HPV) has been correlated with an increased incidence of squamous cell cancers of the upper esophagus.10 Diagnosis: endoscopic ultrasound (EUS), have become more important in the evaluation and staging of esophageal cancer.11 EUS, in the hands of a skillful sonographer, can accurately assess the depth of penetration in as many as 90% of tumors and determine involvement o

Epidemiology & Etiology: Data regarding coffee and excess alcohol consumptions are conflicting; therefore, they cannot be considered true etiologic factors. There is an association between pancreatic cancer and diabetes; however, it is more likely that diabetes is an early manifestation of cancer and not necessarily a predisposing factor. Selective mutations of BRCA2, and, to a lesser degree, BRCA1 have been associated with familial pancreatic cancer. Approximately 10% to 20% of patients are thought to have a familial predisposition. Pancreatic adenocarcinomas arise from ductal epithelial cells. Pancreas cancer has the highest lethality of all the gastrointestinal malignancies. Diagnosis: Diagnostic tests used for pancreas cancer are CT scan, MRI, EUS, and endoscopic retrograde cholangiopancreatography. Diagnostic tests, such as PET and EUS, may play a role in distinguishing cancer from other abnormalities and most importantly are used to adequate