Tomáš Grega, Štěpán Suchánek, Miroslav Zavoral
Michal Voška, Tomáš Grega, Gabriela Vojtěchová, Ondřej Ngo, Ondřej Májek, Barbora Bučková, Ilja Tachecí, Marek Beneš, Jan Bureš, Julius Špičák, Miroslav Zavoral, Štěpán Suchánek
Peter Grell, Radka Obermannová
Igor Richter, Josef Dvořák, Jiří Bartoš
David Pavlišta, Lukáš Dostálek, Petra Šašková
Daniel Krejčí, Jana Krejčí, Norbert Pauk
Colorectal cancer screening is an effective tool for reducing the incidence and mortality of this disease. This is demonstrated by epidemiological data and microsimulation models too. Effective colorectal cancer screening can be achieved based on a population screening program where each individual is addressed and invited to the screening. Screening in the Czech Republic does not reach the minimum recommended coverage according to the international recommendation, where the target coverage by screening is at least 45 % of population. These results show that there is still space for improvement, especially there is needed to continue with address invitation to screening and continue in efforts to increase coverage by screening, for example by lowering the age limit for screening colonoscopy and introducing a central office for address invitations with a central evaluation of occult blood tests.
Background: Fecal immunochemical tests havebeen used as an initial test in colorectal cancer screening programs. However, majority of patients don't have advanced neoplasia on colonoscopy. Colon capsule endoscopy has the potential to reduce the need for optical colonoscopy. The main aim of the study was a negative predictive value of the second generation of colon capsule endoscopy for large polyps (? 10 mm). The secondary aims were: accuracy of detection of all polyps (polyps ? 6 mm and ? 10 mm) and cancers, the number of complications and target population acceptance of both methods (colon capsule endoscopy and optical colonoscopy).
Material and methods: In this multicentre (three gastroenterology units) feasibility study, the second generation of colon capsule endoscopy (CCE2) has been prospectively compared with OC in persons with positive semi-quantitative FIT with cut-off level 75 ng/ml. Colonoscopy was performed within 10 hours after capsule ingestion. CCE2 videos were viewed independently by a nurse and a physician, both blinded to the results of OC. Complications were assessed as severe (bleeding, perforation) or mild to moderate. The methods of acceptance were evaluated based on the questionnaire completed after both procedures (CCE2 and OC) were finished. The interim analysis of results is presented.
Results: From April 2016, 167 individuals have been enrolled; data from 95 persons have been analyzed. During the optical colonoscopy, polyps were diagnosed in 70 persons (74%), polyps ? 6 mm and ? 10 mm in 42 (44 %) and 26 (27 %) persons, respectively. The sensitivity of CCE2 for polyps ? 6 mm and ? 10 mm was 88 % (95% confidence interval [CI] 74-96 %) and 85 % (95% CI 65-96 %), respectively. The specificity for polyps ? 6 mm and ? 10 mm reached 85 % (95% CI 72-93 %) and 93 % (95% CI 84-98 %), respectively. The negative predictive value of CCE2 for polyps ? 10 mm was 94 % (95% CI 86-98 %). Nurses identified 36 polyps ? 6 mm of 42 (86 %) and 23 polyps ? 10 mm of 26 (88 %) found on OC. A total of 64 patients (68 %) preferred CCE2 as the primary screening method.
Conclusion: The second generation of colon capsule has appeared to have a high negative predictive value for the detection of clinically relevant colorectal neoplasia in a screening population. This method might be considered as an adequate tool for colorectal cancer screening.
Diagnosis and treatment of colorectal cancer is a typical example of interdisciplinary collaboration. Individualized treatment is based on well-established diagnostics, taking into account the extent of the disease, molecular predictors, general condition, and patient preferences. Patients with advanced disease should be presented at an interdisciplinary indication board.
Surgery is a basic, irreplaceable and yet the only curative way of oncotherapy of colon and rectum cancer. In the review, the important moments of the tumors of both two localities are mentioned - the extent of resection on the gut or the rectum, the extent of lymphadenectomy, the removal of the mesocolon or mesorectum, conventional and mini-invasive surgical approach, anastomosis, anastomotic complications and their prevention, some perioperative aspects such as intestinal preparation and antibiotic prophylaxis, solution of acute conditions and the position of surgery among other modalities of oncological treatment.
Gastric and gastro-oesophageal junction cancers are aggressive diseases, and only 25 % of patients with early stage disease achieve a long-term survival. The modern multimodal approach to treatment nearly doubled survival in these patients. The primary requirement for successful treatment is performing adequately radical resection in centers specialized in these challenging surgeries. In gastric cancer, the use of perioperative chemotherapy is recommended as a standard of care. The most effective regime in this approach is FLOT chemotherapy. In gastro-oesophageal junction carcinomas, in addition to perioperative therapy, neoadjuvant chemoradiotherapy appears to be appropriate strategy, mostly in cases with locally advanced carcinomas where tumor regression is required in order to perform an R0 resection.
Pancreatic carcinoma is the second most common cancer of the gastrointestinal tract in the Czech Republic after the colorectal cancer and the sixth most common cancer. The 5-year survival rate of all stages of the pancreatic carcinoma is below 5 %. It is expected that in 10-15 years, mortality of pancreatic carcinoma will take the first place among other malignancies. Over the last period, survival has not changed significantly despite the improvement of imaging methods and surgical performance becoming more precise. The pancreatic carcinoma develops relatively slowly, approximately over a decade, and we cure it until its terminal phase. Diseases should be understood as systemic, not local and regional. Improving the quality of guidelines and their compliance is the way to improve the care of these patients at present and in the near future. This is not only a health-organizational problem but also a social and economic problem.
Merkel cell carcinoma (MCC) is a rare aggressive skin neuroendocrine cancer, metastatic disease is associated with poor prognosis and overal survival. The efficacy of avelumab in the JAVELIN Merkel 200 registration study in metastatic MCC refractory to chemotherapy patients and also in untreated chemotherapy naive patients with MCC resulted in its approval by the Food and Drug Administration (FDA) in the US in March 2017 and subsequently in Europe in September 2017. The administration of avelumab in advanced MCCs on both first and subsequent treatment lines has shown prolongation of the interval in both progression and overall survival and good safety profile with manageable side effects.
Metastatic colorectal cancer is one of the day-to-day diagnoses of oncology centers. In addition to chemotherapy, we also have the opportunity to receive targeted treatment. Bevacizumab is a monoclonal antibody against vascular endothelial factor and we have more than ten years of experience with it. The review article evaluates the current status of bevacizumab in the treatment of metastatic colorectal cancer, where its position in the treatment algorithm of the disease has recently been clarified without a clear predictive factor. Finally, there is a case report of the patient who responds well to chemotherapy in combination with bevacizumab in the first line, despite left-hand localization and the non-mutated RAS gene.
Neuroendocrine tumors are neoplasm that arise from cell of the endocrine and nervous systems. Pulmonary neuroendocrine tumors include a spectrum of tumors from the low-grade typical carcinoid and intermediate-grade atypical carcinoid to the high-grade large-cell neuroendocrine carcinoma and small-cell carcinoma. The most common neuroendocrine lung tumor is SCLC, which accounts for 15-20% of invasive lung malignancies. Immunotherapy has proved to be a promising therapeutic modality in lung cancer well. Treatment with the blockade of immune checkpoints involves monoclonal antibodies blocking CTLA-4 (cytotoxic T-lymphocyte antigen) and antibodies blocking the PD-1 receptor (programmed cell death membrane protein) and its ligand PD-L1.
Tumors of the head and neck are among the world's most incidences of cancer. In the last decade there has been an increase in tumors associated with HPV infection and a decrease in the incidence of tumors associated with smoking and alcohol abuse. Despite the awareness, there are still 60% of patients in locoregional advanced stages and 12 % of patients have distant metastasis at the time of diagnosis. The basis of treatment is a multidisciplinary approach. Thanks to new knowledge about tumor biology, which has brought new therapeutic options (antibodies, immunotherapy), generalized and relapsing cancers have improved survival.
Pain is one of the most common manifestations of oncological illness. Its basic treatment strategy is based on the World Health Organization's three-step ranking. Non-opioid analgetics, weak opioids and strong opioid medication are available for treatment. For the treatment of breakthrough pain, transmucosal fentanyls are now also available. In the treatment of oncological pain, non-invasive administration of analgesics is preferable to invasive, preferring retarded drugs or transdermal opioids, supplemented by fast-release forms for the treatment of acute pain worsening. Analgesic medication can be supplemented with additional comedications, especially from the group of anticonvulsants and antidepressants.
It has been shown that patients with non-small cell lung cancer with confirmed mutation of epidermal growth factor receptors significantly benefit from treatment by tyrosine kinase inhibitors. However, resistant mutations develop within approximately 10 months, of which 60 % are formed by T790M mutations. Multiple clinical trials showed that osimertinib is an efficient molecule in both patients with common epidermal growth factor receptor mutations as well as in those with T790M positivity. AURA III met its primary endpoint showing that the PFS was significantly prolonged in T790M positive patients being treated with osimertinib compared to standard chemotherapy in the second line. Clinical study FLAURA also showed significant prolongation PFS in comparison to standard first line treatment in epidermal growth factor receptor mutated patients. Osimertinib has favorable safety profile and good efficacy even in CNS. In the Czech Republic osimertinib is registered for the first line treatment of patients with activating epidermal growth factor receptor mutations and for patients with confirmed T790M mutations. At the time that this article was written, full reimbursement of osimertinib is not available in the Czech Republic.