Introduction: Digestive System Cancer – General Information
Gastrointestinal (GI) cancer is a collective term covering malignant neoplasms affecting various organs of the digestive system, including the stomach, small and large intestines, and the rectum. Early diagnosis and adequate therapy play a decisive role in the outcome of the disease, yet significant difficulties can arise on the path to an accurate diagnosis [1, 8]. Understanding these nuances is critically important for both patients and physicians.
Symptoms and Diagnostic Challenges of GI Cancer
Symptoms of GI cancer are often nonspecific, which hinders timely diagnosis. Patients may complain of abdominal pain, unexplained weight loss, and changes in bowel habits, such as watery diarrhea [8]. Malignant neoplasms can mimic other diseases, leading to diagnostic errors. For example, gastric adenocarcinoma with a signet-ring cell component can manifest with symptoms very similar to Crohn's disease, including multiple colonic strictures and ascites [8]. This requires high clinical suspicion from physicians and a broad differential diagnosis, especially in young patients with atypical strictures and systemic manifestations [8].
Complexity also lies in obtaining a sufficient tissue sample for histological examination. In one case of primary gastric squamous cell carcinoma, the initial biopsy, due to limited material, indicated adenocarcinoma. Only a subsequent deep biopsy with full immunohistochemical analysis allowed for the correct diagnosis to be established [1]. This underscores the importance of adequate sampling.
Sometimes, Sarcina ventriculi bacteria are found in the stomachs of patients with carcinoma, especially in cases of delayed gastric emptying [6]. Their presence may indicate a serious underlying disease, such as poorly differentiated gastric carcinoma, accompanied by anemia and an inflammatory response [6]. The persistence of upper GI symptoms after Helicobacter pylori eradication may also be a sign of the development of a more serious disease, such as malignant lymphoma, manifesting as ulcers or "chicken skin-like" mucosa in the stomach [7].
Modern Diagnostic Methods
The foundation of GI cancer diagnosis is endoscopic examination with biopsy [1, 6, 7]. During endoscopy, the physician visually assesses the condition of the mucosa, identifies pathological changes, and takes tissue samples for analysis [1, 6, 7].
After obtaining biopsy material, a histological examination is performed, supplemented by immunohistochemical analysis. Immunohistochemistry identifies specific markers in tumor cells, which is critical for accurate cancer classification. For example, gastric squamous cell carcinoma is characterized by the presence of CK5/6, P40, and P63 markers, while adenocarcinoma is characterized by CKpan, CK7, and MUC5AC [1]. Accurate tumor classification influences the choice of treatment tactics.
In some cases, biomarkers are used to assess the risk of developing multiple tumors. For example, the expression of the KK-LC-1 antigen in primary gastric tumors can serve as a predictor for the development of multiple gastric cancers [4].
Treatment Approaches: Surgery, Chemotherapy, and Personalized Strategies
Treatment for GI cancer often involves a combination of methods: surgery, chemotherapy, radiation therapy, and targeted therapy. The choice of tactics depends on the type of cancer, its stage, the patient's general condition, and comorbidities.
Surgical removal of the tumor is the primary treatment method for many types of GI cancer, including rectal cancer [2]. After surgery, adjuvant chemotherapy is often prescribed to destroy remaining cancer cells and reduce the risk of recurrence [2].
Chemotherapy, such as the XELOX regimen (including oxaliplatin), is widely used for rectal cancer [2]. However, it is important to be aware of potential side effects. Oxaliplatin can cause rhabdomyolysis — the breakdown of muscle tissue, manifesting as involuntary muscle twitching, weakness in the limbs, decreased urine output, and changes in urine color, as well as a significant increase in creatine kinase levels [2]. Such complications require immediate discontinuation of the drug, careful monitoring, and symptomatic treatment [2].
In cases where radical treatment is impossible or impractical (for example, in elderly patients with poor physical condition or if surgery is refused), palliative therapy is used [1]. Its goal is to alleviate symptoms and improve quality of life [1].
The Importance of an Individualized Approach and a Multidisciplinary Team
Given the complexity of GI diseases, an individualized approach to each patient is crucial. This is especially relevant for the elderly, who often have comorbidities that affect treatment tolerance [1]. Developing a personalized treatment plan requires a careful assessment of all factors, including age, general health status, disease stage, and patient preferences [1].
A multidisciplinary board, including oncologists, surgeons, gastroenterologists, pathologists, and other specialists, is the key to successfully managing such patients [2]. Joint discussion allows for the selection of the most effective and safe diagnostic and treatment strategy, as well as the ability to respond promptly to emerging complications, as in the case of chemotherapy-induced rhabdomyolysis [2]. Such a comprehensive approach ensures the best possible outcomes for patients with gastrointestinal cancer.
References
- [1] Overcoming diagnostic pitfalls in primary gastric squamous cell carcinoma: the imperative of adequate sampling in an elderly female patient, case report. https://pubmed.ncbi.nlm.nih.gov/41333217/
- [2] Oxaliplatin-induced rhabdomyolysis in a postoperative rectal cancer patient: a case report and literature review. https://pubmed.ncbi.nlm.nih.gov/42712673/
- [3] Preclinical and First-in-Human Study of Carbonic Anhydrase IX-Targeting Theranostic Pair, [68Ga]Ga/[177Lu]Lu-NYM096, in Clear Cell Renal Cell Carcinoma. https://pubmed.ncbi.nlm.nih.gov/41991341/
- [4] Kita-Kyushu lung cancer antigen-1 expression in initial gastric tumors predicts multiple cancer development: A pilot study. https://pubmed.ncbi.nlm.nih.gov/41608347/
- [5] Renal Function During and After 177Lu-PSMA-617 Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer. https://pubmed.ncbi.nlm.nih.gov/42481178/
- [6] Sarcina ventriculi: An incidental finding or a byproduct of a more concerning underlying disease? https://pubmed.ncbi.nlm.nih.gov/42437153/
- [7] Persistent upper gastrointestinal symptoms after Helicobacter pylori eradication: malignant lymphoma following "chicken skin-like" gastritis. https://pubmed.ncbi.nlm.nih.gov/38989877/
- [8] Signet-Ring Cell Carcinoma Masquerading as Crohn's Disease: A Diagnostic Challenge in Multifocal Colonic Strictures with Ascites. https://pubmed.ncbi.nlm.nih.gov/41940216/
Disclaimer: The information presented in this article is for reference purposes only and cannot replace professional medical advice. All decisions regarding diagnosis and treatment should be made only after consultation with a qualified medical specialist.