Latest Updates

Small Intestine: Adenocarcinoma

Sudeep Banerjee, MD, Joel M Baumgartner, MD, MAS, Jason K Sicklick, MD
    • Genetic pathways implicated in small bowel adenocarcinoma (APC, TP53, β-catenin, SMAD4, microsatellite instability, K-ras) are similar to colorectal adenocarcinoma but less well understood.
    • Advanced endoscopy or enteroscopy can be used to obtain preoperative diagnosis.
    • Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy may offer improved survival for a subset of patients with peritoneal metastasis.

Small Intestine: Adenocarcinoma

Sudeep Banerjee, MD, Joel M Baumgartner, MD, MAS, Jason K Sicklick, MD
    • Genetic pathways implicated in small bowel adenocarcinoma (APC, TP53, β-catenin, SMAD4, microsatellite instability, K-ras) are similar to colorectal adenocarcinoma but less well understood.
    • Advanced endoscopy or enteroscopy can be used to obtain preoperative diagnosis.
    • Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy may offer improved survival for a subset of patients with peritoneal metastasis.

Small Intestine: Neuroendocrine and Miscellaneous Tumors

Sudeep Banerjee, MD, Joel M Baumgartner, MD, MAS, Jason K Sicklick, MD
    • Functional PET/CT with gallium-68 dotatate provides improved sensitivity and resolution compared with traditional imaging methods.
    • Hepatic transarterial embolizations can improve carcinoid-related symptoms in patients who are not surgical candidates or have unresectable disease.
    • Somatostatin analogues remain the mainstay of systemic therapy for carcinoid, whereas targeted agents and cytotoxic chemotherapy are areas of active investigation.

Management of Recurrent Retroperitoneal Sarcoma

Charles Catton, MD, FRCPC, Rebecca Gladdy, MD, PhD, FRCSC, Abha Gupta, MD, MSc, FRCPC, Armen Parsyan, MD, PhD, DSc, MPH, FRCSC
    • Better understanding of the patterns of failure such that patients at high risk for relapse are identified
    • Improved understanding of the molecular basis of sarcomas impacting our ability to diagnose and predict the biologic behavior and to further inform management algorithms
    • Successful completion of a randomized clinical trial to determine the effects of preoperative radiation therapy on local recurrence in primary resectable retroperitoneal sarcoma 

Small Intestine: Neuroendocrine and Miscellaneous Tumors

Sudeep Banerjee, MD, Joel M Baumgartner, MD, MAS, Jason K Sicklick, MD
    • Functional PET/CT with gallium-68 dotatate provides improved sensitivity and resolution compared with traditional imaging methods.
    • Hepatic transarterial embolizations can improve carcinoid-related symptoms in patients who are not surgical candidates or have unresectable disease.
    • Somatostatin analogues remain the mainstay of systemic therapy for carcinoid, whereas targeted agents and cytotoxic chemotherapy are areas of active investigation.

Management of Recurrent Retroperitoneal Sarcoma

Charles Catton, MD, FRCPC, Rebecca Gladdy, MD, PhD, FRCSC, Abha Gupta, MD, MSc, FRCPC, Armen Parsyan, MD, PhD, DSc, MPH, FRCSC
    • Better understanding of the patterns of failure such that patients at high risk for relapse are identified
    • Improved understanding of the molecular basis of sarcomas impacting our ability to diagnose and predict the biologic behavior and to further inform management algorithms
    • Successful completion of a randomized clinical trial to determine the effects of preoperative radiation therapy on local recurrence in primary resectable retroperitoneal sarcoma 

Endoscopic Management of Polyps and Early Malignancy

Tyler Berzin, MD, MS, Nadim Mahmud, MD, MS, MPH
    • Endoscopic full-thickness resection has been successfully performed for the treatment of gastric tumors invading deep into the gastric wall.
    • Endoscopic submucosal dissection is emerging as a consideration for colorectal polyps greater than 2 cm in size owing to higher en blocresection rates and fewer local recurrences than endoscopic mucosal resection.
    • Advanced endoscopic resection techniques, including endoscopic submucosal dissection, are becoming more widespread as global expertise develops.
    • A combination of endoscopic resection and radiofrequency ablation is effective for nodular high-grade esophageal dysplasia.

Endoscopic Management of Polyps and Early Malignancy

Tyler Berzin, MD, MS, Nadim Mahmud, MD, MS, MPH
    • Endoscopic full-thickness resection has been successfully performed for the treatment of gastric tumors invading deep into the gastric wall.
    • Endoscopic submucosal dissection is emerging as a consideration for colorectal polyps greater than 2 cm in size owing to higher en blocresection rates and fewer local recurrences than endoscopic mucosal resection.
    • Advanced endoscopic resection techniques, including endoscopic submucosal dissection, are becoming more widespread as global expertise develops.
    • A combination of endoscopic resection and radiofrequency ablation is effective for nodular high-grade esophageal dysplasia.
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