Curr. Oncol., Volume 13, Issue 1 (February 2006) – 5 articles

Since the early 1970s, a dramatic change has occurred in the epidemiology of esophageal malignancy in both North America and Europe: the incidence of adenocarcinomas of the lower esophagus and esophagogastric junction is increasing. Several lifestyle factors are implicated in this change, including gastroesophageal reflux disease (gerd). Primary esophageal adenocarcinomas are thought to arise from Barrett esophagus, an acquired condition in which the normal esophageal squamous epithelium is replaced by a specialized metaplastic columnar-cell-lined epithelium. Today, gerd is recognized as an important risk factor in Barrett esophagus. Progression of Barrett esophagus to invasive adenocarcinoma is reflected histologically by the metaplasia–dysplasia–carcinoma sequence. Although several molecular alterations associated with progression of Barrett esophagus to invasive adenocarcinoma have been identified, relatively few will ultimately have clinical application. Currently, the histologic finding of high-grade dysplasia remains the most reliable predictor of progression to invasive esophageal adenocarcinoma. However other promising molecular biomarkers include aneuploidy; 17p loss of heterozygosity, which implicates the TP53 tumour suppressor gene; cyclin D1 protein overexpression; and p16 alterations. It is anticipated that models incorporating combinations of objective scores of sociodemographic and lifestyle risk factors (that is, age, sex, body mass index), severity of gerd, endoscopic and histologic findings, and a panel of biomarkers will be developed to better identify patients with Barrett esophagus at increased risk for malignant progression, leading to more rational endoscopic surveillance and screening programs. Full article

The Ottawa Rapid Palliative Radiotherapy Program (rprp) was established in 1999 with the goal of facilitating access by family physicians to radiotherapy services for patients with advanced symptomatic cancer. Two years later, an audit revealed that of the 148 patients treated by the program, only 19 had been referred by family physicians. We therefore assessed awareness of the rprp and perceptions of the effectiveness of palliative radiotherapy on the part of family physicians by surveying a random sample of family physicians in Eastern Ontario. Response rate was 50%. Only 18% of family physicians were aware of the rprp, although 56% had previously referred patients for palliative radiotherapy. Among responders, 80% regularly provided palliative care, and these physicians were much more likely to be aware of and to refer patients for palliative radiotherapy. Our survey confirms the key role that family physicians play in providing care to patients with advanced cancer. However, significant deficits in family physician awareness of palliative radiotherapy programs and in knowledge of the effectiveness of palliative radiotherapy should be addressed to improve patient care. Full article

An integrative approach for managing a patient with cancer should target the multiple biochemical and physiologic pathways that support tumour development and minimize normal-tissue toxicity. Angiogenesis is a key process in the promotion of cancer. Many natural health products that inhibit angiogenesis also manifest other anticancer activities. The present article focuses on products that have a high degree of anti-angiogenic activity, but it also describes some of the many other actions of these agents that can inhibit tumour progression and reduce the risk of metastasis. Natural health products target molecular pathways other than angiogenesis, including epidermal growth factor receptor, the HER2/neu gene, the cyclooxygenase-2 enzyme, the nuclear factor kappa-B transcription factor, the protein kinases, the Bcl-2 protein, and coagulation pathways. The herbs that are traditionally used for anticancer treatment and that are anti-angiogenic through multiple interdependent processes (including effects on gene expression, signal processing, and enzyme activities) include Artemisia annua (Chinese wormwood), Viscum album (European mistletoe), Curcuma longa (curcumin), Scutellaria baicalensis (Chinese skullcap), resveratrol and proanthocyanidin (grape seed extract), Magnolia officinalis (Chinese magnolia tree), Camellia sinensis (green tea), Ginkgo biloba, quercetin, Poria cocos, Zingiber officinalis (ginger), Panax ginseng, Rabdosia rubescens hora (Rabdosia), and Chinese destagnation herbs. Quality assurance of appropriate extracts is essential prior to embarking upon clinical trials. More data are required on dose–response, appropriate combinations, and potential toxicities. Given the multiple effects of these agents, their future use for cancer therapy probably lies in synergistic combinations. During active cancer therapy, they should generally be evaluated in combination with chemotherapy and radiation. In this role, they act as modifiers of biologic response or as adaptogens, potentially enhancing the efficacy of the conventional therapies. Full article

The major breast cancer story of 2005 was trastuzumab, a monoclonal antibody directed against the Her-2 oncoprotein, and how it greatly improves outcomes for women with HER2-positive early-stage breast cancer. With early results showing that use of the drug can prevent roughly one half of relapses, adjuvant trastuzumab has been approved, funded, and accepted as the standard of care in many Canadian jurisdictions. In the present brief report, we summarize the four major adjuvant trials, outline some key controversies, and suggest steps to provide more-effective and better-tolerated adjuvant systemic therapy for the relevant patient subgroup. Full article