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Epidemiology, risk factors and current screening in rectal cancer. Incidence and survival data from the Francim Cancer Registry Network allowed an estimate of the national incidence of rectal cancer and its prognosis up to 20 years after diagnosis.In 2018, 13 744 new cases of rectal cancer were diagnosed in France. Its incidence slightly decreased since 1990. The M/F sex ratio has steadily decreased over time from 2.1 to 1.8. Forty-seven percent of cancers were diagnosed at a local extension stage, 20 % at a regional extension stage and 34 % at an advanced stage. Individuals of both sexes over 50 years of age are at medium risk for rectal cancer.Five-year net survival was 60 % in men and 59 % in women. At 10-year, it was 54 % for individuals aged 50 and 47 % for those aged 70 at time of diagnosis. Excess mortality related to cancer mostly occurred within the first year after diagnosis. It decreased up to 10 years after diagnosis and remained stable.The use of the immunological test for fecal occult bleeding in France is not efficient because of a participation too low, of the order of 30 %, well below the 45 % required to ensure the efficiency of the screening program., Competing Interests: Les auteurs déclarent n’avoir aucun lien d’intérêts.

The management of acute pancreatitis is now fairly codified, with specific recommendations developed by expert groups. These recommendations deal in particular with the minimum initial assessment, recognized severity scores, initial medical management with hyperhydration, preventive anticoagulation, early refeeding, delays in imaging and management of complications. In this work, we have tried to bring together the various recommendations, articles and studies dealing with this subject, based more particularly on European recommendations, in order to guide the management of acute pancreatitis in current practice., (Copyright © 2021 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Actually, pancreatic cancer is a major challenge in digestive oncology. Its prognosis remains very poor with a five-year net survival less than 10%. Although if pancreatic cancer incidence was low, data from French digestive cancer registries show a dramatic increase in recent years, more marked in women (annual variation of +3.6% between 1982 and 2012) than in men (+2.3%). The currently recognized risk factors like tobacco or obesity cannot explain this evolving epidemiology. Moreover, progress in understanding pancreatic carcinogenesis is still insufficient. Except for familial aggregation, systematic screening couldn't be proposed., (Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Population-based studies have shown that guaiac faecal occult blood testing followed by colonoscopy in case of positivity can reduce colorectal cancer mortality. However attention has been given for alternative tests in particular to immunochemical faecal occult blood tests. It is now clear from available data that immunochemical tests outperform guaiac tests. They should be preferred for CRC screening. The one sample strategy has been adopted in most screening programmes. Given the superior performance characteristics of immunochemical, it is reasonable to assume that an organized programme using this type of test would lead to a greater reduction in colorectal cancer mortality and possibly of colorectal cancer incidence. Epidemiological studies allow us to define subjects at very high risk (genetic origin) and high risk for colorectal cancer. Colonoscopy screening is recommended in first degree relatives of patients with colorectal cancer or large adenoma diagnosed before 60 years or with two affected first-degree relatives, in subjects with an extended inflammatory bowel disease, or with a personal history of large bowel cancer or large adenoma.

The diagnosis of an abdominal mass using imaging techniques is difficult for clinicians and radiologists. We report a case of an atypical peripancreatic mass, mimicking a carcinoma on abdominal computed tomography and which was only diagnosed after an echoendoscopic biopsy of the mass was performed. It is difficult to differentiate abdominal tuberculosis from a neoplasm, especially if there is no pulmonary tuberculosis. Usually, the diagnosis of abdominal tuberculosis is only confirmed histologically, after surgical resection of the mass. Echoendoscopic biopsy confirmed the infectious nature of the mass and prevented complicated and difficult surgery.

Hemoccult II is the only method of screening for colorectal cancer whose effectiveness in reducing specific mortality has been proved by randomized controlled trials. The first experience of French districts based on this strategy reproduced on a population scale the results of the experimental studies. Expanding screening in France to the general public is a public health priority. Large-scale media campaigns, which currently do not exist, could then be launched, and prevention opportunities seized. Immunological tests identifying the presence of blood in the stool have better sensitivity than the guaiac smear tests, especially for the diagnosis of adenomas and to a lesser extent, for that of cancers as a whole. These tests may constitute an alternative to guaiac tests, but are more expensive. Total colonoscopy, proposed every 10 years from the age of 50 years or once in a lifetime around the age of 60 years, is not a realistic method because of its cost and its risks. Sigmoidoscopies are under evaluation in several countries in randomized controlled trials but do not seem appropriate to either the epidemiologic trends of colorectal cancer or to the practice of endoscopy in France. Virtual colonoscopy is an attractive alternative to searching for blood in stool. The evaluation now underway should not interfere with the broad expansion of methods of proven efficacy. Virtual colonoscopy may face competition from numerous emerging techniques of endoscopic exploration of the colon, including the video-capsule. To obtain widespread participation in colorectal cancer screening, policy-makers must take the opinions of healthcare professionals and of the public into account. The medicoeconomic data will be a decisive factor in the choice between these new strategies.

Hepatic metastases from colorectal cancer represent a serious complication, often at the origin of death. Very few studies allow to know their epidemiological characteristics. From available data the proportion of colorectal cancer with synchronous liver metastases is 15% and the 5 year cumulative risk of metachronous metastases is 16%. According to Côte-d'Or data, it was 4.6% for TNM stage 1 cancer, 14.1% for stage 2 and 32.0% for stage 3. Taking into account incidence and prevalence of colorectal cancer it can be estimated that the number of synchronous hepatic metastases is 5,400 per year and the number of metachronous hepatic metastases 9,000 per year. In the Côte-d'Or area 6.5% of synchronous hepatic metastases, were resected for cure and 21% of metachronous hepatic metastases. The survival rates for synchronous hepatic metastases were 31% at 1 year and 2% at 5 year. The corresponding rates for metachronous metastases were 31% and 4%. After surgery for cure the 5 year survival rate was 11% for synchronous metastases and 16% for metachronous metastases. Population based data indicates that liver metastases from colorectal cancer represent a frequent problem and are more frequent that suggested by hospital-based data.

Dedicated studies to esophageal carcinomas are few. Surgical excision remains the treatment of choice for localised tumours. External beam radiation therapy could be used alone to obtain a quick palliation and to allow the recovery of normal eating. Currently, combined modality treatment demonstrated better results when compared to radiation alone. Efficiency of combined modality treatment of adenocarcinoma seems equivalent to epidermoid. Numerous phase II studies demonstrated the feasibility of combined radio-chemotherapy in a preoperative setting. However, phases III trials are criticised and actually no definitive conclusion can be drawn. Inclusion of patients with such a tumour should be encouraged.