Pain management in gastrointestinal oncology

Abdominal cancer is commonly associated with pain needing medical attention. Effective pain management is available to control pain. Oral opioids are the foundation of analgesic therapy. With adequate implementation of therapeutic guidelines into clinical practice including the use of co-analgesics, adjuvants and non-pharmacological treatment options the quality of life of abdominal cancer patients can be considerably improved. Only in a minority of patients with refractory pain more sophisticated options of pain management will be necessary, e. g., epidural, intrathecal or neurolytic techniques. In this situation the consultation of a pain therapist is recommended.     

Alternative medicine in oncology

Unsolved medical key problems always gave and give way to outsider ideas and alternative-medical activities. This is normal and intellectually to be performed and often to be experienced in a humane respect. The problem of cancer with its great social relevance, but above all with its high moral claim to an early solution is particularly attractive for alternative-medical initiatives. These can be classified into the subjects of alternative diagnostics of cancer, immunotherapy, physiotherapy/homoepathy/organotherapy, anthroposophical cancer therapy, cancer diets and hypertherapy/multistep therapy. The analysis of these initiatives shows that the alternative medicine in oncology, and this is perhaps typical, not on a small scale is determined by personalities with philanthropic ideals, a superelevated consciousness of mission or lost self-criticism. Errors of famous scientists in the younger past are deplorable. Indeed, alternative medicine always means a scientifically devious subject, but on no account an offence against the scientific morality. Alternatively thinking personalities with their ideas may even stimulate, provoke and clarify scientific standpoints. But the analysis of initiatives given also shows that the alternative medicine in oncology may lead to deplorable commercial (iscador, carnivora) or medical doubts. Thus alternative medicine may become a disadvantage, a danger for science (lavished means) and society (misguidance of patients).     

Molecular target structures in oncology

Substantial progress has been made in recent years in understanding the molecular pathogenesis of malignant disorders, especially in identification of molecular targets for therapeutic interventions ("targeted therapies"). An important group of therapeutical targets are signaling cascades, e.g. protein tyrosine kinases (PTK) that are activated by mutations, translocations or overexpression. Small molecule inhibitors that compete with ATP and inhibit kinase activity have produced clinical impressive responses in chronic myeloid leukemia, gastrointestinal stroma tumors and non-small cell lung cancer. Another group of cellular targets is represented by tumor-selective cell surface proteins that can serve as target structures for antibodies. Therapeutical concepts using monoclonal antibodies have substantially improved response rates in patients with malignant lymphomas and are currently evaluated in other types of cancer. The definition of molecular target structures critical for the malignant phenotype is driving a new era of integrated diagnostics and therapeutics in the field of oncology.     

Internal medicine oncology in the aged

Advanced age represents a restriction for the possibilities of internal oncology. A limited function of the organs, as well as the patient's lack of cooperation must be expected, thus complicating the control of the therapy. However, despite these aspects, advanced age alone is no reason for rejecting chemotherapy. If there is a chance for therapeutical success, it will last just as long as with young patients. Malignant disease in older patients allows a curative therapy only in exceptional cases. Therefore, a very accurate cost/benefit analysis should be carried out for each patient in cases of palliative treatment.     

Internal medicine aspects of oncology

Internal oncology is described as an interdisciplinary field of internal medicine and its subspecialties for the diagnostics, therapy and care of patients with tumours. It is based on the close connection of various specialties at different levels of care. The consultation is the decisive instrument for the planning of diagnosis and therapy.     

Disseminated and circulating tumor cells in gastrointestinal oncology

Circulating (CTCs) and disseminated tumor cells (DTCs) are two different steps in the metastatic process. Several recent techniques have allowed detection of these cells in patients, and have generated many results using different isolation techniques in small cohorts. Herein, we review the detection results and their clinical consequence in esophageal, gastric, pancreatic, colorectal, and liver carcinomas, and discuss their possible applications as new biomarkers.