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Advanced gastric cancer remains a malignant tumor with poor prognosis, the majority of cases still diagnosed at an advanced stage. Apart from human epidermal growth factor receptor 2 (HER2) targeting, which only concerns 20% of advanced oesophageal adenocarcinomas, the treatment of advanced cases has been restricted, until recently, to cytotoxic chemotherapy and supportive care, leading to a poor median survival, barely reaching one year. Recently, however, major therapeutic changes have emerged with immune checkpoint inhibitor immunotherapies, leading to a definite improvement in results and a change in our practices. In addition, after many years of failure of non- HER2 targeted therapies in this disease, new therapeutic targets have emerged to broaden the therapeutic panel. [ABSTRACT FROM AUTHOR]

Non-colorectal MSI/dMMR (microsatellite instability/deficient MMR system) tumors are mostly represented by gastric and small bowel cancers. Nevertheless, their presence is ubiquitous, even if it is very rare in certain anatomical and histological locations. Their management has been revolutionized by the introduction of immune checkpoint inhibitors (ICI) (in particular anti-PD-1 and PD-L-1) which have shown interesting response rates, both in patients with advanced, metastatic disease, but also in a neoadjuvant setting with a localized tumor. Moreover, even if the treatment standards have not evolved in France concerning access to ICI partly due to the absence of randomized comparative study, the search for MSI/dMMR is recommended for any digestive tumor in localized or metastatic situation. In fact, the inclusion of patients in a clinical trial evaluating immunotherapy will be preferred over conventional chemotherapy treatment. [ABSTRACT FROM AUTHOR]

This article aimed to review third line therapeutic to review third line therapeutic options in patients with metastatic colorectal cancer, therapeutic strategies in the event of metastatic gastric cancer and first line treatments for metastatic pancreatic cancer. Following the results of the SUNLIGHT study, the trifluridine/tipiracil plus bévacizumab combination should become the new third line standard for metastatic colorectal cancers. Performing multiple tumor biopsies to assess several biomarkers (HER2, dMMR/pMMR, CPS, Claudine 18.2) essential for choosing the best first-line therapeutic combination is becoming essential in gastric cancers. In patients with metastatic pancreatic cancer, the NAPOLI-3 study is positive and positions the NALIRIFOX protocol as a new option of choice in 1st line. In these same patients, in the absence of a validated predictive biomarker, the interest of a sequential strategy with alternation of two chemotherapy protocols continues to be evaluated in ongoing phase 2 studies. [ABSTRACT FROM AUTHOR]

Rosine Guimbaud, MD, PHD, University Hospital of Toulouse, clarified the emerging role of immunotherapy in the management of resecable and metastatic oesopageal or gastric cancers and specified which biomarkers have to be search when using these new therapies in clinical practice. [ABSTRACT FROM AUTHOR]

Currently, gastric pre-neoplastic lesions (glandular atrophy, intestinal metaplasia, dysplasia) can only be detected during an upper GI endoscopy. Depending on their extent and severity, follow-up is proposed in order to detect the appearance of gastric adenocarcinoma as early as possible. When there is no indication for endoscopy, pre-neoplastic lesions may be present and evolve silently. In countries with a low risk of gastric cancer such as France, where there is no systematic endoscopic screening, patients not at high risk of gastric adenocarcinoma in whom pre-neoplastic lesions exist therefore have a loss of chance with a risk of developing gastric adenocarcinoma at a symptomatic stage, with a poor prognosis. Several serum biomarkers of pre-neoplastic lesions have been proposed, deriving from the histological characteristics of these lesions. The TFF3 peptide is a biomarker of intestinal metaplasia, and the pepsinogen I/II ratio of glandular atrophy. The place of these biomarkers in a national screening strategy remains to be clarified. [ABSTRACT FROM AUTHOR]

Résumé: Helicobacter pylori (H. pylori) est un bacille gram négatif qui colonise exclusivement la muqueuse gastrique. La contamination se fait dans l'enfance. Une fois l'infection établie, elle persiste sans possibilité d'éradication spontanée. L'infection par H. pylori est répandue, atteignant près de la moitié de la population mondiale et 20-30 % de la population française. L'infection par H. pylori est le plus souvent asymptomatique bien qu'elle soit responsable d'une gastrite d'abord aiguë puis chronique. Son rôle pathogène a été clairement démontré concernant les ulcères gastro-duodénaux et le cancer de l'estomac. À ce titre, H. pylori est considéré comme une bactérie pathogène stricte et un carcinogène du groupe 1. Néanmoins, H. pylori peut coexister de façon prolongée avec son hôte sans être responsable d'évènement cliniquement significatif. Dans cette revue, nous proposons de revoir les indications formelles de recherche et d'éradication d' H. pylori au regard des données récentes de la littérature. Certaines indications restent indiscutables et indiscutées comme la maladie ulcéreuse gastro-duodénale, la prévention du cancer gastrique et le lymphome gastrique du MALT. D'autres nécessitent parfois une réflexion plus poussée. Helicobacter pylori (H. pylori) is a gram-negative bacillus that colonizes the gastric mucosa. Once H. pylori colonizes the gastric mucosa, it can persist for a lifetime without any spontaneous eradication. Although more than half of the world's population is infected by H. pylori, H. pylori prevalence ranges between 20% to 30% in France. Although infection is mostly asymptomatic, the early phase of H. pylori infection elicits an acute gastritis that evolve to a long-standing chronic gastritis. Helicobacter pylori infection is formally recognized as an infectious disease and a class 1 carcinogen responsible for gastroduodenal ulcer, gastric cancer, and gastric MALT lymphoma. However, H. pylori infection could be lifelong asymptomatic and, in some cases, maintain a symbiotic relationship with its host. The aims of this review were to present and discuss recommended indications of H. pylori eradication according to recent data. Some indications remain obvious while some others could be discussed on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Résumé: Nous rapportons un cas d'hydropneumothorax spontané chez un homme de 58 ans, porteur d'un adénocarcinome gastrique métastatique, présentant une embolie pulmonaire proximale à gauche. Cette association de pathologies graves, pouvant entraver la fonction respiratoire et hémodynamique, a été découverte lors d'un examen scanographique indiqué pour bilan d'extension de la tumeur gastrique chez un patient paucisymptomatique, malgré l'association de ces pathologies potentiellement graves. Le mécanisme pourrait s'expliquer par le passage direct de l'air des alvéoles dans la cavité pleurale, dû à un infarctus pulmonaire. We report a case of spontaneous hydropneumothorax in a 58-year-old man with metastatic gastric adenocarcinoma and left proximal pulmonary embolism. This association of serious pathologies, which could hamper respiratory and hemodynamic function, was discovered during a CT-scan indicated for an assessment of gastric tumor extension in a paucisymptomatic patient, despite the association of these potentially serious pathologies. The mechanism could be explained by the direct passage of air from the alveoli into the pleural cavity, due to a pulmonary infarction. [ABSTRACT FROM AUTHOR]

Résumé: L'incidence du cancer de l'estomac est en diminution depuis 50 ans dans les pays occidentaux, mais ce cancer reste fréquent et grave. Il représente la 3e cause de décès par cancer dans le monde et la 5e cause de cancer en termes d'incidence après le cancer du poumon, le cancer du sein, le cancer colorectal et le cancer prostatique. Les deux principaux sites topographiques, cancer du cardia et cancer gastrique non cardial, présentent des caractéristiques épidémiologiques et des facteurs de risque distincts. La distribution géographique de l'incidence du cancer gastrique est très hétérogène avec des zones de forte incidence : l'Asie, l'Amérique centrale et du Sud, et des zones de faible incidence : l'Europe de l'Ouest et l'Amérique du Nord. Les principaux facteurs de risque sont l'infection chronique à Helicobacter Pylori , des facteurs génétiques et environnementaux (dont la forte consommation de sel, de nitrates alimentaires utilisés comme agents de conservation, ou de tabac). L'adénocarcinome du cardia, initialement décrit par Siewert en 1996, a une incidence croissante, notamment dans les pays développés. Des facteurs de risque différents de ceux du cancer de l'estomac ont été identifiés notamment un index de masse corporelle (IMC) élevé > 25 kg/m2, un reflux gastro-œsophagien, des apports faibles en fruits et légumes, un niveau socio-économique bas. The incidence of stomach cancer decreases for 50 years in Western countries, but this cancer remains frequent and severe. It represents the 3rd leading cause of cancer deaths in the world and the 5th leading cause of cancer in terms of incidence after lung cancer, breast cancer, colorectal cancer and prostate cance. The two main topographic sites, cardia cancer and non-cardia gastric cancer, have distinct epidemiological characteristics and risk factors. The geographical distribution of the incidence of gastric cancer is very heterogeneous with areas of high incidence: Asia, Central and South America and areas of low incidence: Western Europe and North America. The main risk factors are chronic Helicobacter Pylori infection, genetic and environmental factors (including high consumption of salt, dietary nitrates used as preservatives, or tobacco). Cardia adenocarcinoma, initially described by Siewert in 1996, has an increasing incidence, particularly in developed countries. Risk factors different from those of stomach cancer have been identified including a body mass index (BMI) > 25 kg/m2, gastroesophageal reflux, low intakes of fruits and vegetables, a low socioeconomic level. [ABSTRACT FROM AUTHOR]

The aim was to analyze the results of the diagnostic and therapeutic management of stomach cancers at the Donka Oncology Surgery Unit. This was a retrospective study of the descriptive type from 2007 to 2016. The epidemiological profile, the anatomoclinical aspects, the diagnosis, the extension assessment and the therapeutic modalities were described and analyzed. We collected 41 patients with a mean age of 53.8 years. The sex ratio was 1.7. Patients had consulted for epigastralgia (85.4%), vomiting (75.6%) and anorexia (26.8%) with a consultation time of 15.8 months. An epigastric mass (61.0%), hepatomegaly (46.3%) and ascites (31.7%) were present. The endoscopic aspect was budding (37.5%) and in 50.0%, the seat was antral. These included adenocarcinoma (18 cases), gastric carcinomas (9 cases), high grade dysplasia (1 case) and gastrointestinal stromal tumors (GIST) (1 case). Metastases were present in 27 cases (65.8%). Surgical treatment was performed in 20 patients with a resectability rate of 55% (11 cases). Gastrectomy of 4/5 with D2- type dissection was performed in 18 cases (72.2%) and the operative mortality was 2 cases (7.4%). Ten patients (24.4%) received adjuvant therapy, 9 with chemotherapy and 1 with radiotherapy. Patients were followed after a mean delay of 43.8 ± 8.6 months [95% CI 27.0-60 , 0] in which 4 recurrences (9.7%) and 32 deaths (78.04%) were recorded. Stomach cancer is common and of late diagnosis in our context. Surgical treatment of early forms and perioperative chemotherapy could improve the prognosis of these cancers. [ABSTRACT FROM AUTHOR]

Several studies have shown an association between Epstein-Barr virus (EBV) infection and some human cancers such as a subgroup of gastric carcinomas. The oncogenic potential of EBV has been widely explored but the exact processes conducting carcinogenesis are not yet fully understood. EBV-encoded viral proteins are known to deregulate the DNA damage response (DDR) signaling pathways. DDR inactivation leads to genomic instability and promote cellular transformation to generate malignant cells. In a recently published article in Nature Medicine, a molecular characterization of tumor tissue and circulating tumor DNA (cDNA) from non-selected patients with metastatic gastric cancer treated with pembrolizumab was conducted. This work showed that a strong correlation between PD-L1 positivity, EBV(+) and MSI-H could be established in the studied cohort. These results suggest that EBV(+) gastric cancer might, similarly to MSI-H tumors, be a target of high-potential for getting a clinical benefit of immunotherapy. Together, these data suggest that EBV status might thus serve as a clinical biomarker to identify patients with gastric cancer who would benefit from immunotherapy. Beyond their clinical interest, these works also pave the way for additional fundamental researches that will allow better characterizing the underlying molecular mechanisms. [ABSTRACT FROM AUTHOR]

Copyright of Journal Africain D'Hépato-Gastroentérologie is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: In the following article, we will discuss general issues relating to acute and late gastric''s radiation toxicities. The tolerance of the stomach to complete or partial organ irradiation is more unappreciated than for most other organs. We consulted the Medline database via PubMed and used the key words gastric – radiotherapy – toxicity. Currently, 60 Gy or less is prescribed in gastric radiation therapy. Acute clinical toxicity symptoms are predominantly nausea and vomiting. Although there is a general agreement that the whole stomach tolerance is for doses of 40 to 45 Gy without unacceptable complication, it is well established that a stomach dose of 35 Gy increases the risk of ulcer complications. [Copyright &y& Elsevier]

Abstract: Purpose: Analysis of the feasibility and results of adjuvant chemotherapy followed by conformal chemoradiotherapy after surgery for gastric carcinoma. Patients and methods: Twenty-six patients (R0 or R1) were treated postoperatively by three cycles of 5-fluorouracil (5-FU) and cisplatin, followed by a concomitant association of LV5FU2 chemotherapy with a conformal radiotherapy of 45Gy. Results: The tumor was classified pT3-T4 in 77% of the patients and 92.5% had a nodal involvement (pN1: 54%; pN2: 31%). Feasibility: (1) Adjuvant chemotherapy: nausea/vomiting grade II/III: 12patients (48%); neutropenia grade III/IV: two patients; completed in all patients, except one. (2) Chemoradiotherapy: nausea/vomiting grade II/III: 10 patients; diarrhea grade II/3: two patients; oesophagitis grade II/III: two patients; myocardial infarction/pulmonary embolism: two patients. All patients except one received the planned dose of 45Gy. Radiotherapy was interrupted in six cases, with a median duration of 14days. Survival: with a median follow-up of 30months, 65% of the patients were alive without disease; median survival was 32 months. Conclusion: This postoperative schedule was judged feasible. It allowed the deliverance of a more intensified chemotherapy than the classical schedule. Its clinical benefit must be evaluated in a phase III trial. [Copyright &y& Elsevier]

Introduction. – The stomach is the most common site involved in primary gastrointestinal lymphoma. Gastric lymphoma originates from the mucosa-associated lymphoïd tissue so called MALT. It comprises a group of distinctive clinicopathological entities which are important to consider for clinical management.Current knowledge and key points. – In recent years, new diagnostic tools and new treatment strategies have improved the overall prognosis. One of the most exciting recent discoveries is the hypothesis that an infection by a bacterium, Helicobacter pylori has a decisive role in gastric lymphoma.Future prospects and projects. – Recent advances, essentially due to molecular biology and cytogenetic studies may emerge with the understanding of pathogenesis and new prognostic factors of these different types of gastric lymphomas. It is the aim of our oncoming studies together with the evaluation of the new therapeutic options such as radiotherapy and monoclonal antibodies in prospective studies. [Copyright &y& Elsevier]

Among men of similar ages in France, cancer mortality rose from 1950 to 1985, but has decreased since 1985. Mortality from stomach cancer has decreased since 1950, as has that from head and neck cancers since 1976 (these rates nevertheless remain the highest in Europe). Since 1980, there has also been a decrease in mortality from (but not incidence of) colorectal and prostate cancers among men. Since 1980, these favourable developments have no longer been counter-balanced by increased mortality from lung cancer. This latter has stabilised and is even decreasing. Despite this progress, cancer mortality among men remains one of the highest in the European Union. Among women, cancer mortality has diminished since 1970 due to a decrease in deaths from stomach cancer (as with men) and, since 1960, from cervical cancer. As among men but in a more marked fashion, there has also been a decrease in deaths from colorectal cancer since 1975, which appears to be linked to the improved quality of treatment. Breast cancer mortality has remained stable since 1985. However, unlike with men, mortality from lung cancer, which was very low, has rapidly increased since 1980. This explains why the overall decrease in cancer mortality among women has slowed and is currently less than among men. However, cancer mortality among women in France remains one of the lowest in the European Union. Analysis of available data and comparison with other EU countries allows us to draw some other conclusions: 1. more than half of cancer deaths can be avoided with increased prevention, notably in fighting against tobacco usage, alcohol consumption, obesity and sedentary lifestyles; 2. comparison with other European countries shows that it is necessary to increase the proportion of women screened for breast and cervical cancer and to improve the quality of screening procedures; 3. it is time to launch new pilot projects in other departments to screen for colorectal cancer; 4 treatment... [ABSTRACT FROM AUTHOR]

Copyright of EMC-Chirurgie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: We report a 74-year-old woman with acute heart failure and recurrent ischemic strokes as the presenting features of a nonbacterial thrombotic endocarditis complicating a gastric adenocarcinoma. The treatment only allowed a few months remission. Diagnosis of nonbacterial thrombotic endocarditis is rarely obtained while the patient is alive. Coagulation abnormalities due to the tumoral process are responsible of the valvular thrombotic process. Anticoagulation with heparin is recommended. Valvular surgery remains controversial. [Copyright &y& Elsevier]

Abstract: Introduction: Metastatic malignant tumors of the hand are unusual. We describe a patient with gastric cancer. Observation: A 64-year-old man in remission of a gastric adenocarcinoma treated surgically one year previously was admitted to hospital for a pain of the right hand associated with an edema. The radiography of the hand established an osteolysis of the third metacarpal. The surgical operation revealed an important inflammatory zone associated with a wide osseous destruction. It consisted of an osteosynthesis of the second and third metacarpal with destruction of lytic fabric. The anatomopathologic examination revealed an osseous metastasis of a gastric adenocarcinoma. The patient died five months after the diagnosis of acrometastasis. Discussion: The acrometastases are difficult to diagnose, a biopsy is often necessary. Evolution during acrometastasis of gastric cancer is the same one as in the other acrometastases. Their treatment is primarily palliative because of their very bad forecast. [Copyright &y& Elsevier]

Primary adenosquamous carcinoma of the stomach is extremely rare and accounts for less than 1% of gastric malignancies. It is particularly aggressive and generally results in a poorer outcome than other carcinomas. Microscopically, it consists of a mixture of two distinct components: adenocarcinoma and squarnous cell carcinoma. We present two cases of gastric adenosquamous carcinoma in two female patients, aged 63 and 70, and discuss the clinical and pathological characteristics of this unusual tumour. [ABSTRACT FROM AUTHOR]

Abstract: We report a case of intraductal papillary mucinous tumor of the pancreas (IPMT) degenerated and fistulized into the stomach, the duodenum and the colon. Diagnoses of malignancy and fistulization were proven preoperatively. Pancreaticoduodenectomy extended to the body was performed. Pathological examination revealed a malignant IPMT with an invasive component. Of the 3 fistulizations tracts, both gastric and duodenal ones were malignant. To our knowledge, this is the first reported case of IPMT with colonic fistulization. Twelve months later, the patient is alive without signs of recurrence. [Copyright &y& Elsevier]

This review reports 3 of recently published molecular classifications of the 3 main gastro-intestinal cancers: gastric, pancreatic and colorectal adenocarcinoma. In colorectal adenocarcinoma, 6 independent classifications were combined to finally hold 4 molecular sub-groups, Consensus Molecular Subtypes (CMS 1-4), linked to various clinical, molecular and survival data. CMS1 (14% MSI with immune activation); CMS2 (37%: canonical with epithelial differentiation and activation of the WNT/MYC pathway); CMS3 (13% metabolic with epithelial differentiation and RAS mutation); CMS4 (23%: mesenchymal with activation of TGFβ pathway and angiogenesis with stromal invasion). In gastric adenocarcinoma, 4 groups were established: subtype "EBV" (9%, high frequency of PIK3CA mutations, hypermetylation and amplification of JAK2, PD-L1 and PD-L2), subtype "MSI" (22%, high rate of mutation), subtype "genomically stable tumor" (20%, diffuse histology type and mutations of RAS and genes encoding integrins and adhesion proteins including CDH1) and subtype "tumors with chromosomal instability" (50%, intestinal type, aneuploidy and receptor tyrosine kinase amplification). In pancreatic adenocarcinomas, a classification in four sub-groups has been proposed, stable subtype (20%, aneuploidy), locally rearranged subtype (30%, focal event on one or two chromosoms), scattered subtype (36%,<200 structural variation events), and unstable subtype (14%,>200 structural variation events, defects in DNA maintenance). Although currently away from the care of patients, these classifications open the way to "à la carte" treatment depending on molecular biology., (Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Abstract: With 12,000 new cases each year in France, rectal cancers are a frequent entity. Concurrent fluoropyrimidin-based chemoradiation followed by a surgery including total mesorectal excision is the standard of care for locally advanced (T3-4) or node positive cancers of the mid and lower rectum. Modalities of irradiation depend on tumour location (mid versus lower rectum) and its local extension. Nevertheless, the clinical target volume (CTV) always encompasses the entire mesorectum, that goes from the peritoneal reflexion line (facing the third sacral vertebrae) to the levator ani muscles. The internal iliac lymph nodes are as well always included in the CTV. The aim of this article is to review the main epidemiological, anatomical, radiological and prognostic factors that are meaningful to define the optimal modalities of conformal radiation of rectal cancers. Definition of target volumes and organs at risk will be discussed, as well as doses and dose-constraints. A case report will be used to illustrate this article. [ABSTRACT FROM AUTHOR]

Abstract: Ocular metastasis is a rare presenting feature of gastric adenocarcinoma. We report a 48-year-old woman who presented with a decrease in visual acuity of the right eye leading to the discovery of an ocular metastasis. Diagnostic work-up identified a gastric adenocarcinoma with pulmonary metastases. She received four cycles of chemotherapy combining epirubicin, cisplatin and fluorouracil. The patient died 6 months after the diagnosis of respiratory failure. [ABSTRACT FROM AUTHOR]