Challenges in management of gastrointestinal cancers in pregnancies: A report of three cases

2021 ◽  
pp. 1753495X2098704
Author(s):  
Serene Thain ◽  
Jess McMicking ◽  
Julien de Naurois ◽  
Catherine Nelson-Piercy
Keyword(s):  
Disease Progression ◽  
Gastrointestinal Cancer ◽  
Gastrointestinal Cancers ◽  
Gastrointestinal Malignancies ◽  
Diagnosis And Management ◽  
Advanced Stages ◽  
Physiological Symptoms ◽  
The Impact ◽  
In Pregnancy ◽  
Diagnostic Investigations

Gastrointestinal cancer occurs in approximately 1 in 13,000 pregnancies, making up 4% of malignancies detected in pregnancy. It is a complex and challenging condition to diagnose and manage and is often only detected in its more advanced stages. This is partly due to symptoms of gastrointestinal cancer being incorrectly attributed to physiological symptoms of pregnancy, as well as concerns about the safety of diagnostic investigations in pregnancy, both of which may delay diagnosis and lead to disease progression. Challenges in management also arise from under-treatment in pregnancy due to concerns about the impact of surgery or chemotherapy on the pregnancy. We present here three cases of gastrointestinal cancer diagnosed in pregnancy in our centre and discuss the challenges and pitfalls one may encounter in the diagnosis and management of gastrointestinal malignancies in pregnancy.

scholarly journals CA 72-4 Compared with Cea and CA 19-9 as a Marker of Some Gastrointestinal Malignancies

1999 ◽  
Vol 14 (3) ◽  
pp. 172-177 ◽  
Author(s):  
J.B. Lopez ◽  
G.P Royan ◽  
M.N. Lakhwani ◽  
M. Mahadaven ◽  
J. Timor
Keyword(s):  
Colorectal Cancer ◽  
Esophageal Cancer ◽  
Colorectal Carcinoma ◽  
Gastrointestinal Cancer ◽  
Gastrointestinal Diseases ◽  
Gastrointestinal Cancers ◽  
Gastrointestinal Malignancies ◽  
Single Marker ◽  
The Individual ◽  
Esophageal Carcinomas

The objective of this study was to compare CA 72-4 with CEA and CA 19-9 in gastrointestinal malignancies. CA 72-4 was assayed by radioimmunoassay and CEA and CA 19-9 with the Abbott IMx analyser. The study included 52 patients with gastrointestinal cancer and 20 controls with benign gastrointestinal diseases. The 52 cases showed marker sensitivities of 39%, 49% and 35% for CA 72-4, CEA and CA 19-9, respectively, and 64% when the markers were combined. Marker expression in serum was highest in colorectal carcinoma followed by gastric and esophageal carcinoma. The sensitivities of the individual markers in colorectal, gastric and esophageal carcinomas, respectively, were: CA 72-4, 56%, 32% and 18%; CEA, 83%, 33% and 18%; CA 19-9, 53%, 25% and 18%. The sensitivity of the three markers in combination was 89%, 50% and 46% in colorectal, gastric and esophageal cancer, respectively. The specificity of CA72-4, CEA and CA 19-9 was 100%, 72% and 86%, respectively. However, CA 72-4 is not a useful a marker for gastrointestinal cancers because of its poor sensitivity. CEA, which had the best overall sensitivity and a reasonable specificity, was the most useful single marker, especially for colorectal cancer. Whereas the single markers were not useful in gastric and esophageal cancer, the combination of the three may be.

scholarly journals Longitudinal anterior-to-posterior shift of collateral channels in patients with moyamoya disease: an implication for its hemorrhagic onset

2019 ◽  
Vol 130 (3) ◽  
pp. 884-890 ◽  
Author(s):  
Shusuke Yamamoto ◽  
Satoshi Hori ◽  
Daina Kashiwazaki ◽  
Naoki Akioka ◽  
Naoya Kuwayama ◽  
...  
Keyword(s):  
Disease Progression ◽  
Moyamoya Disease ◽  
Staging System ◽  
Stage 4 ◽  
Advanced Stages ◽  
Lenticulostriate Artery ◽  
Moyamoya Vessel ◽  
Ischemic Attack ◽  
Adult Moyamoya Disease ◽  
The Impact

OBJECTIVEThis study aimed to assess longitudinal changes in the collateral channels originating from the lenticulostriate artery (LSA), posterior communicating artery (PCoA), and anterior and posterior choroidal arteries (AChA and PChA, respectively) during disease progression and/or aging. The impact of collateral channels on onset type was also examined.METHODSThis study included 71 involved hemispheres in 41 patients with moyamoya disease. The disease was categorized into 6 stages according to Suzuki’s angiographic staging system. The degree of development of each moyamoya vessel was categorized into 3 grades.RESULTSThe LSA started to dilate in stage 2, showed the most prominent development in stage 3, and decreased in more advanced stages (p < 0.001). The AChA most notably developed in stage 3 and gradually shrank (p = 0.04). The PCoA started to dilate in stage 3 and showed the most prominent development in stage 4 (p = 0.03). The PChA started to dilate in stage 3 and showed the most prominent development in stages 4 to 5 (p < 0.001). Patient age was negatively related to LSA development (p = 0.01, R = 0.30) and was positively associated with the abnormal dilation and extension of the PCoA (p = 0.02, R = 0.28) and PChA (p < 0.001, R = 0.45). The PCoA, AChA, and PChA more distinctly developed in hemispheres with intracerebral or intraventricular hemorrhage than in hemispheres with ischemic stroke or transient ischemic attack (p < 0.001, p = 0.03, and p = 0.03, respectively).CONCLUSIONSThis study suggests that the collateral channels through moyamoya vessels longitudinally shift from the anterior to posterior component during disease progression and aging, which may be closely related to the onset of hemorrhagic stroke in adult moyamoya disease.

scholarly journals Scope of Artificial Intelligence in Gastrointestinal Oncology

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5494
Author(s):  
Hemant Goyal ◽  
Syed A. A. Sherazi ◽  
Rupinder Mann ◽  
Zainab Gandhi ◽  
Abhilash Perisetti ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Gastrointestinal Cancer ◽  
Prediction Models ◽  
Tumor Staging ◽  
Metastatic Potential ◽  
Modern Medicine ◽  
Treatment Modalities ◽  
Gastrointestinal Cancers ◽  
Radiographic Images ◽  
The Impact

Gastrointestinal cancers are among the leading causes of death worldwide, with over 2.8 million deaths annually. Over the last few decades, advancements in artificial intelligence technologies have led to their application in medicine. The use of artificial intelligence in endoscopic procedures is a significant breakthrough in modern medicine. Currently, the diagnosis of various gastrointestinal cancer relies on the manual interpretation of radiographic images by radiologists and various endoscopic images by endoscopists. This can lead to diagnostic variabilities as it requires concentration and clinical experience in the field. Artificial intelligence using machine or deep learning algorithms can provide automatic and accurate image analysis and thus assist in diagnosis. In the field of gastroenterology, the application of artificial intelligence can be vast from diagnosis, predicting tumor histology, polyp characterization, metastatic potential, prognosis, and treatment response. It can also provide accurate prediction models to determine the need for intervention with computer-aided diagnosis. The number of research studies on artificial intelligence in gastrointestinal cancer has been increasing rapidly over the last decade due to immense interest in the field. This review aims to review the impact, limitations, and future potentials of artificial intelligence in screening, diagnosis, tumor staging, treatment modalities, and prediction models for the prognosis of various gastrointestinal cancers.

Does use of total parenteral nutrition in patients with metastatic gastrointestinal cancer impact hospice length of stay?

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 58-58
Author(s):  
Jessica J Bian ◽  
Rachel S Rome ◽  
Angela Marie Taber
Keyword(s):  
Length Of Stay ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Cancer Patients ◽  
Gastrointestinal Cancer ◽  
The United States ◽  
Gastrointestinal Cancers ◽  
Single Institution ◽  
Median Length ◽  
The Impact

58 Background: The use of total parenteral nutrition (TPN) in metastatic cancer patients is controversial. The impact of TPN use on length of hospice stay in advanced cancer patients is unknown. We hypothesize that patients with metastatic gastrointestinal cancers who receive TPN have a shorter median length of hospice stay as compared to the median hospice length of stay for cancer patients in the United States in 2014 (18 days). The primary objective of our retrospective, single-institution study is to determine the median hospice length of stay in patients with metastatic gastrointestinal cancers who received TPN. Methods: Records of all adult patients with metastatic gastrointestinal cancers who received TPN at The Lifespan Cancer Institute from 2005 through 2014 were reviewed. The primary outcome was median hospice length of stay. Data analysis was conducted using Stata (Version 15.0, StataCorp, College station, Texas). Results: Seventy-nine patients were identified as having received TPN for metastatic gastrointestinal cancer. Forty-eight patients had documented referrals to hospice and 40 patients had assessable durations of hospice admission. Hospice length of stay ranged from one to 196 days with a median of 9.5 days, mean of 24.3 days, and interquartile range of 5.5 to 54 days. Conclusions: Hospice care has been shown to improve quality of life for patients and caregivers. In our retrospective, single-institution study of patients with metastatic gastrointestinal cancer who received TPN, the median hospice length of stay was shorter than the national median length of hospice stay for cancer patients in 2014 (9.5 days versus 18 days). This should be taken into consideration when weighing the risks and benefits of initiating TPN in metastatic gastrointestinal cancer patients. [Table: see text]

scholarly journals Metastatic Colorectal Cancer Resembling Severe Preeclampsia in Pregnancy

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Raminder Kaur Khangura ◽  
Charanpreet Kaur Khangura ◽  
Anagha Desai ◽  
Gregory Goyert ◽  
Roopina Sangha
Keyword(s):  
Colorectal Cancer ◽  
Abdominal Mass ◽  
Warning Signs ◽  
The Third ◽  
Common Cancer ◽  
Advanced Stages ◽  
Physiological Symptoms ◽  
Rare Malignancy ◽  
Atypical Presentations ◽  
In Pregnancy

Although colorectal cancer (CRC) is the third most common cancer in women, it is a rare malignancy in pregnancy. Symptoms of CRC such as fatigue, malaise, nausea, vomiting, rectal bleeding, anemia, altered bowel habits, and abdominal mass are often considered typical symptoms of pregnancy. Many cases of CRC are diagnosed in advanced stages due to missed warning signs of CRC, which may be misinterpreted as normal symptoms related to pregnancy. This report reviews 2 cases of CRC diagnosed within a 4-month interval at our institution. Both cases were initially thought to be atypical presentations of preeclampsia. Prenatal history, hospital course, and postpartum course were reviewed for both patients. CRC is often diagnosed at advanced stages in pregnancy. Common physiological symptoms of pregnancy should be scrutinized carefully and worked up appropriately, especially if symptoms remain persistent or increase in intensity or severity.

scholarly journals Gastrointestinal cancers, ACE-2/TMPRSS2 expression and susceptibility to COVID-19

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sepehr Shafiee ◽  
Luca Cegolon ◽  
Mostafa Khafaei ◽  
Nasrin Gholami ◽  
Shi Zhao ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Serine Protease ◽  
Human Body ◽  
Gastrointestinal Cancer ◽  
Health Impact ◽  
Target Cells ◽  
Gastrointestinal Cancers ◽  
Gastrointestinal Malignancies ◽  
Screening Programs ◽  
Transmembrane Serine Protease

AbstractRecent studies on the pathophysiology of COVID-19 are indicating that the Angiotensin convertase enzyme 2 (ACE-2) and transmembrane serine protease 2 (TMPRSS2) can act as a major component in the fusion of SARS-Cov-2 with target cells. It has also been observed that the expression of ACE-2 and TMPRSS2 can be altered in malignancies. Shedding light on this matter could be crucial since the COVID-19 pandemic interfered with many gastrointestinal cancer screening programs. Herein we discuss the possibility of severe forms of COVID-19 in patients with gastrointestinal cancers due to the gastrointestinal entry route of SARS-CoV-2 into the human body. The disruption of cancer screening programs caused by the current COVID-19 pandemic could therefore have massive negative health impact on patients affected by gastrointestinal malignancies.

Adoptive Cell Therapy for Gastrointestinal Cancers

2020 ◽  
Vol 04 (04) ◽  
pp. 345-350
Author(s):  
Ryan J. Slovak ◽  
Hyun S. Kim
Keyword(s):  
Cell Therapy ◽  
Clinical Research ◽  
Solid Tumors ◽  
Immune Cells ◽  
Ex Vivo ◽  
Adoptive Cell Therapy ◽  
Hematologic Malignancies ◽  
Gastrointestinal Cancers ◽  
Gastrointestinal Malignancies ◽  
Specific Antigens

AbstractThe reinfusion of autologous or allogeneic immune cells that have been educated and/or engineered ex vivo to respond to tumor-specific antigens is termed “adoptive cell therapy.” While adoptive cell therapy has made tremendous strides in the treatment of hematologic malignancies, its utilization for solid tumors has lagged somewhat behind. The purpose of this article is to concisely review the clinical research that has been done to investigate adoptive cell therapy as a treatment for gastrointestinal malignancies.

Insulin Therapy in Pregnancy Hypertensive Diseases and its Effect on the Offspring and Mother Later in Life

2019 ◽  
Vol 17 (5) ◽  
pp. 455-464 ◽  
Author(s):  
Alfonso Mate ◽  
Antonio J. Blanca ◽  
Rocío Salsoso ◽  
Fernando Toledo ◽  
Pablo Stiefel ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Polycystic Ovary Syndrome ◽  
Insulin Therapy ◽  
Polycystic Ovary ◽  
Ovary Syndrome ◽  
Insulin Resistant ◽  
Hypertensive Disorders ◽  
The Impact ◽  
In Pregnancy

Pregnancy hypertensive disorders such as Preeclampsia (PE) are strongly correlated with insulin resistance, a condition in which the metabolic handling of D-glucose is deficient. In addition, the impact of preeclampsia is enhanced by other insulin-resistant disorders, including polycystic ovary syndrome and obesity. For this reason, there is a clear association between maternal insulin resistance, polycystic ovary syndrome, obesity and the development of PE. However, whether PE is a consequence or the cause of these disorders is still unclear. Insulin therapy is usually recommended to pregnant women with diabetes mellitus when dietary and lifestyle measures have failed. The advantage of insulin therapy for Gestational Diabetes Mellitus (GDM) patients with hypertension is still controversial; surprisingly, there are no studies in which insulin therapy has been used in patients with hypertension in pregnancy without or with an established GDM. This review is focused on the use of insulin therapy in hypertensive disorders in the pregnancy and its effect on offspring and mother later in life. PubMed and relevant medical databases have been screened for literature covering research in the field especially in the last 5-10 years.

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