Colorectal cancer(CRC)is a significant global health burden,being the third leading cancer globally.Its incidence has been observed to be higher in developed regions such as North America and Europe with geographical ...Colorectal cancer(CRC)is a significant global health burden,being the third leading cancer globally.Its incidence has been observed to be higher in developed regions such as North America and Europe with geographical variations in mortality rates.Efforts to address this disease burden include promoting early detection through screening and implementing treatment strategies to improve patient outcomes.With the growing and aging population,the incidence of CRC will undoubtedly increase.These epidemiological trends will mean that healthcare professionals will increasingly encounter CRC in more complex patients.Hence,it becomes imperative to have a deeper appreciation of the pathophysiology of CRC and understand the intricate interplay between a patient’s physiology and their goals of care before offering treatment.This review article will aim to encapsulate the important nuances and perspectives of managing this disease in the context of an elderly patient.展开更多
Colorectal cancer(CRC)is the third most prevalent cancer globally.There is a concerning increase in its incidence among younger individuals.Colonoscopy remains the gold standard for CRC diagnosis.With the introduction...Colorectal cancer(CRC)is the third most prevalent cancer globally.There is a concerning increase in its incidence among younger individuals.Colonoscopy remains the gold standard for CRC diagnosis.With the introduction of population-based bowel screening and increased public awareness,there has been a significant rise in referrals for colonoscopy.Healthcare providers worldwide will need to strategically evaluate how to allocate resources to adequately train the next generation of colonoscopists who will need to provide accurate endoscopic assessment and treatment for premalignant polyps and early CRC.This review outlines the current workload challenges faced by colonoscopists whilst exploring emerging technologies such as artificial intelligence for adenoma detection.Additionally,advanced endoscopic surgical techniques like endoscopic submucosal dissection are discussed.展开更多
Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and have gained considerable research and treatment interest,especially in the last two decades. GISTs are dr...Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and have gained considerable research and treatment interest,especially in the last two decades. GISTs are driven by mutations commonly found in the KIT gene and less commonly in the platelet-derived growth factor receptor alpha gene,BRAF gene and succinate dehydrogenase gene. GISTs behave in a spectrum of malignant potential,and both the tumor size and mitotic index are the most commonly used prognostic criteria. Whilst surgical resection can offer the best cure,targeted therapy in the form of tyrosine kinase inhibitors(TKIs) has revolutionized the management options. As the first-line TKI,imatinib offers treatment for advanced and metastatic GISTs,adjuvant therapy in high-risk GISTs and as a neoadjuvant agent to downsize large tumors prior to resection. The emergence of drug resistance has altered some treatment options,including prolonging the first-line TKI from 1 to 3 years,increasing the dose of TKI or switching to second-line TKI. Other newer TKIs,such as sunitinib and regorafenib,may offer some treatment options for imatinib-resistant GISTs. New molecular targeted therapies are being evaluated,such as inhibitors of BRAF,heat shock protein 90,glutamine and mitogenactivated protein kinase signaling,as well as inhibitors of apoptosis proteins antagonist and even immunotherapy. This editorial review summarizes the recent research trials and potential treatment targets that may influence our future patient-specific management of GISTs. The current guidelines in GIST management from Europe,North America and Asia are highlighted.展开更多
文摘Colorectal cancer(CRC)is a significant global health burden,being the third leading cancer globally.Its incidence has been observed to be higher in developed regions such as North America and Europe with geographical variations in mortality rates.Efforts to address this disease burden include promoting early detection through screening and implementing treatment strategies to improve patient outcomes.With the growing and aging population,the incidence of CRC will undoubtedly increase.These epidemiological trends will mean that healthcare professionals will increasingly encounter CRC in more complex patients.Hence,it becomes imperative to have a deeper appreciation of the pathophysiology of CRC and understand the intricate interplay between a patient’s physiology and their goals of care before offering treatment.This review article will aim to encapsulate the important nuances and perspectives of managing this disease in the context of an elderly patient.
文摘Colorectal cancer(CRC)is the third most prevalent cancer globally.There is a concerning increase in its incidence among younger individuals.Colonoscopy remains the gold standard for CRC diagnosis.With the introduction of population-based bowel screening and increased public awareness,there has been a significant rise in referrals for colonoscopy.Healthcare providers worldwide will need to strategically evaluate how to allocate resources to adequately train the next generation of colonoscopists who will need to provide accurate endoscopic assessment and treatment for premalignant polyps and early CRC.This review outlines the current workload challenges faced by colonoscopists whilst exploring emerging technologies such as artificial intelligence for adenoma detection.Additionally,advanced endoscopic surgical techniques like endoscopic submucosal dissection are discussed.
文摘Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and have gained considerable research and treatment interest,especially in the last two decades. GISTs are driven by mutations commonly found in the KIT gene and less commonly in the platelet-derived growth factor receptor alpha gene,BRAF gene and succinate dehydrogenase gene. GISTs behave in a spectrum of malignant potential,and both the tumor size and mitotic index are the most commonly used prognostic criteria. Whilst surgical resection can offer the best cure,targeted therapy in the form of tyrosine kinase inhibitors(TKIs) has revolutionized the management options. As the first-line TKI,imatinib offers treatment for advanced and metastatic GISTs,adjuvant therapy in high-risk GISTs and as a neoadjuvant agent to downsize large tumors prior to resection. The emergence of drug resistance has altered some treatment options,including prolonging the first-line TKI from 1 to 3 years,increasing the dose of TKI or switching to second-line TKI. Other newer TKIs,such as sunitinib and regorafenib,may offer some treatment options for imatinib-resistant GISTs. New molecular targeted therapies are being evaluated,such as inhibitors of BRAF,heat shock protein 90,glutamine and mitogenactivated protein kinase signaling,as well as inhibitors of apoptosis proteins antagonist and even immunotherapy. This editorial review summarizes the recent research trials and potential treatment targets that may influence our future patient-specific management of GISTs. The current guidelines in GIST management from Europe,North America and Asia are highlighted.
