GI / Colorectal / Pancreatic Cancer

The types of screening tests are discussed for detection of early colorectal cancer using fecal tests and blood tests. Colonoscopy remains the gold standard for detection of precancerous lesions and early colorectal cancer. Individuals at increased risk for colon cancer who should be considered for prevention intervention, including those with multiple colorectal polyps, inflammatory bowel disease, and those who have inherited genetic risk, the Lynch Syndrome (hereditary nonpolyposis colorectal cancer).

Esophagogastric cancer had different histology and natural history in different geographic regions, and strategies for prevention and treatment are tailored to the histology and previous history of GI disorders. Asian countries with widespread screening have survival rates double that of countries without population screening. Individuals with ALDH2-deficient genotypes have increased risk for esophageal cancers from drinking alcohol. Minimally invasive surgical techniques are discussed.

Obesity is a major risk factor for 13 cancers, especially colorectal cancer (CRC) and has surpassed the cancer risk of tobacco. CRC is increasing in younger individuals under 45 years of age. There is a multitude of biological mechanisms linking energy balance and obesity as a driver for cancer, also to survival. The gut microbiome is also associated with survival in early-stage CRC.

Gastroesophageal and colorectal cancers are a major life-threatening disease and often present at advanced stages. Discussions about selecting high-immunogenecity subtypes (such as MSI hi; high TMB) to optimize chemoimmunotherapy combinations and facilitate organ-sparing operations, and to propose new strategies for improving immunotherapy efficiency in GI cancers by reversing immunotherapy resistance with drugs that induce immunogenic tumor cell death and to modulate the immune microenvironment.

Screening should be considered for individuals with inherited pancreatic cancer predisposition, including those with a strong family history, high-grade intraductal papillary mucinous neoplasm (IPMN), or known genetic syndromes such as Peutz-Jeghers syndrome or hereditary pancreatitis. Particular attention should be given to individuals harboring germline pathogenic variants in genes such as BRCA1/2, PALB2, ATM, or mismatch repair genes associated with Lynch syndrome. Early detection through routine screening in these high-risk individuals has been associated with significantly improved outcomes. For select high-risk patients, prophylactic organ-preserving pancreatic surgery can be safely performed to reduce cancer incidence. A video demonstration of robotic pancreatectomy for this indication is included.