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ASCO Educational Book; 2009
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Dilemmas in Upper Gastrointestinal Cancers: Focus on Symptom Improvement

Milind Javle, MD, Amy Abernethy, MD, Naifa L. Busaidy, MD, and Jeffrey H. Lee, MD

From the Department of Gastrointestinal Medical Oncology (Dr. Javle); Department of Endocrinology (Dr. Busaidy); Department of Gastroenterology, Hepatology and Nutrition (Dr. Lee), M. D. Anderson Cancer Center, Houston, TX; Division of Medical Oncology, Duke University Medical Center, Durham, NC (Dr. Abernethy)

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to Milind Javle, MD, Associate Professor, M.D. Anderson Cancer Center, 1515 Holcome Blvd, Houston, TX 77030; e-mail: mjavle{at}mdanderson.org

Overview: The burden of noncolorectal or upper gastrointestinal (including esophageal, gastric, small bowel, and pancreatobiliary) cancers continues to be significant worldwide. These malignancies are diagnosed at an advanced stage of disease and are often associated with poor survival. New and targeted therapies have marginally improved the prognosis of these cancers, particularly at early disease stage. The goal of therapy for advanced stages of these cancers continues to be palliation of symptoms toward an improvement in quality of life (QOL). We identified four clinical syndromes that occur commonly in this group of patients and lead to QOL impairment and, therefore, deserve further discussion and research: gastroparesis, ascites, hyperglycemia, and luminal obstruction. The pathophysiology, complications, and management of these syndromes are discussed below.