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Review
. 2020 Sep;8(17):1106.
doi: 10.21037/atm-20-4143.

Narrative review of the role of gastroenterologist in the diagnosis, treatment and palliation in gastric and gastroesophageal cancer

Liege I Diaz  1 , Shruti Mony  2 , Jason Klapman  1
Affiliations
Review

Narrative review of the role of gastroenterologist in the diagnosis, treatment and palliation in gastric and gastroesophageal cancer

Liege I Diaz et al. Ann Transl Med. 2020 Sep.

Abstract

Esophageal cancer (EC) and gastric cancer (GC) carry a high mortality rate. Unfortunately, a majority of patients are asymptomatic and at the time of diagnosis, the disease may invariably be in its advanced stages with limited curative options. Thus, it is imperative to recognize certain risk factors including gastroesophageal reflux disease (GERD), male gender, pre-existing Barrett's esophagus, smoking history, obesity, Helicobacter pylori infection, atrophic gastritis among others for both EC and GC, intervene on time with screening and surveillance modalities if indicated and optimize treatment plans. With advances in endoscopic techniques, early neoplastic lesions are increasingly managed by gastroenterologists, offering an alternative to surgery. The gold standard for diagnosis of EC and GC is high definition endoscopy with adequate targeted biopsies. Endoscopic ultrasound (EUS) is a key in the staging of early cancers dictating the pathway for treatment options. We also play a key role in palliation cases with the aim to reduce the symptoms like nausea, vomiting and even when possible, restore oral intake and improve nutrition in both advanced GC and EC. This review article discusses the risk factors, diagnostic and endoscopic treatment modalities of early EC and GC and palliation of advanced cancer where gastroenterologists play a key role.

Keywords: Esophageal; cancer; endoscopic ultrasound (EUS); gastric.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-4143). The series “Gastroesophageal Cancer 2020” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
EUS depiction of esophageal layers. Layer 1: mucosa; layer 2: muscularis mucosa; layer 3 submucosal; layer 4: muscularis propia. EUS, endoscopic ultrasound.
Figure 2
Figure 2
EUS depiction of gastric layers. Layer 1: mucosa; layer 2: muscularis mucosa; layer 3 submucosal; layer 4: muscularis propia. EUS, endoscopic ultrasound.
Figure 3
Figure 3
EUS findings in Linitis plastica. All five-layer pattern is obliterated and replaced by a homogenous band. EUS, endoscopic ultrasound.
See this image and copyright information in PMC

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