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Guidelines

The European Society for Medical Oncology (ESMO), the European Society for Radiotherapy & Oncology (ESTRO) and the European Society of Surgical Oncology (ESSO) have come together to produce 2 sets of joint clinical practice guidelines, on anal cancer and on gastric cancer. These guidelines have been prepared and reviewed by leading experts from the relevant disciplines and aim at helping you provide cancer patients with the best treatment.
 

Anal cancer: ESMO-ESTRO- ESSO Clinical Practice Guidelines for diagnosis, treatment and follow-up


Squamous cell carcinoma of the anus (SCCA) is a rare cancer but its incidence is increasing throughout the world, and is particularly high in the human immunodeficiency virus positive (HIV+) population. A multidisciplinary approach is mandatory (involving radiation therapists, medical oncologists, surgeons, radiologists and pathologists). SCCA usually spreads in a loco-regional manner within and outside the anal canal. Lymph node involvement at diagnosis is observed in 30%–40% of cases while systemic spread is uncommon with distant extrapelvic metastases recorded in 5%-8% at onset, and rates of metastatic progression after primary treatment between 10 and 20%. SCCA is strongly associated with human papilloma virus (HPV, types 16–18) infection. The primary aim of treatment is to achieve cure with loco-regional control and preservation of anal function, with the best possible quality of life. Treatment dramatically differs from adenocarcinomas of the lower rectum. Combinations of 5FU-based chemoradiation and other cytotoxic agents (mitomycin C) have been established as the standard of care, leading to complete tumour regression in 80%-90% of patients with locoregional failures in the region of 15%. There is an accepted role for surgical salvage. Assessment and treatment should be carried out in specialised centres treating a high number of patients as early as possible in the clinical diagnosis. To date, the limited evidence from only 6 randomised trials [1,2,3,4,5,6,7], the rarity of the cancer, and the different behaviour/natural history depending on the predominant site of origin (the anal margin, anal canal or above the dentate line) provide scanty direction for any individual oncologist. Here we aim to provide guidelines which can assist medical, radiation and surgical oncologists in the practical management of this unusual cancer.

To read the full article:
European Journal of Surgical Oncology (EJSO), Volume 41, Issue 1, Pages 1-174, S1-S16 (January 2015)

 

Gastric cancer: ESMO-ESTRO- ESSO Clinical Practice Guidelines for diagnosis, treatment and follow-up

 

In 2012, there were ∼140 000 new cases of gastric cancer diagnosed across all European countries, making it the sixth commonest cancer diagnosis. Perhaps more importantly, it remains the fourth commonest cause of cancer-related death, being responsible for ∼107 000 deaths annually.1 Despite a gradual decline in the worldwide incidence of gastric cancers, there has been a relative increase in the incidence of tumours of the oesophago-gastric junction (OGJ) and gastric cardia. The peak incidence is in the 7th decade, and the disease is approximately twice as common in men as in women. There is marked geographic variation, with the highest rates in East Asia, South America and Eastern Europe and the lowest rates in the United States and Western Europe.

To read the full article: 
European Journal of Surgical Oncology (EJSO) Volume 41, Issue 1, Pages 1-174, S1-S16 (January 2015)

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