Gastroesophageal Cancers: Progress and Problems

Author: Jaffer A. Ajani MD
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Approximately 38,000 new patients will be diagnosed with gastroesophageal cancer in 2008.1 Although this number may be trivial compared with more common cancers, the incidence of esophageal and gastroesophageal junction adenocarcinoma has been steadily climbing over the past 20 years (www.cancer.org; accessed June 10, 2008). Although obesity, gastroesophageal reflux, and Barrett's metaplasia may contribute some or great extent to this alarming increase, some of the reasons for this increase remain elusive.2 The global health burden imposed by gastroesophageal cancer parallels that imposed by lung cancer, with approximately 1.4 million new cases and 1.1 million deaths per year.3 Furthermore, the mortality is likely to remain high because early detection of gastroesophageal cancer is not commonly practiced in most countries. Nevertheless, we have witnessed some definite progress in staging and therapy of patients with gastroesophageal cancer. For localized gastroesophageal cancer, progress has been made with the implementation of multidisciplinary approaches that lead to better selection of therapy for a specific patient, formulation of long-term strategies, and emergence of new standards.4–6 Multidisciplinary interactions can lead to new research strategies and improved understanding of the philosophies used by individual disciplines for treatment decisions. Progress in the treatment of early gastroesophageal carcinomas using endoscopic therapies is also worth mentioning.7-10 Endoscopic therapy of early cancer seems to be spreading in non-academic centers as well. In addition to these improvements, progress in imaging techniques can improve patient selection. Despite these improvements, considerably more progress must be made. To reduce mor-bidity and mortality, gastroesophageal surgeries should be performed...

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Jaffer A. Ajani, MD, an internationally recognized expert on gastrointestinal cancers, is Professor of Gastrointestinal Medical Oncology at M. D. Anderson Cancer Center and the Chair of the NCCN Clinical Practice Guidelines in Oncology Gastroesophageal Cancers Panel. He has participated over the past 20 years in numerous trials using innovative combined modality therapies for localized gastric and esophageal cancers, and some of his work led to the development of strategies of pre-operative therapy for resectable upper gastrointestinal cancers.

His current research focus is on developing programs to research the molecular markers for progression of Barrett's metaplasia to adenocarcinoma. These research efforts involve multi-institutional collaboration with investigators at the University of Chicago, University of Pennsylvania, Mayo Clinic, and Yonsei University, in Seoul, Korea.

In addition to his work with NCCN, Dr. Ajani participates actively in the International Society of Gastrointestinal Oncology is the editor of the Society's journal, Gastrointestinal Oncology Research.

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