Gastric cancer in the elderly: an overview.

AIMS: Gastric cancer in the elderly represents a distinct entity with specific clinicopathological characteristics and the majority of affected patients belong to this age group. Subtotal or total gastrectomy with radical lymph node dissection, adjuvant chemoradiotherapy or perioperative chemotherapy represent the only potentially curative treatment options and seem to be performed with acceptable morbidity and mortality rates in selected elderly patients. Published research is very limited due to the strict selection and under-representation of elderly patients in clinical trials. A review of current recommendations and practice was performed. METHODS: A comprehensive literature review was performed searching Medline for articles published since 1974, using "gastric cancer", "elderly" and "treatment" as keywords. OBSERVATIONS: The data suggest that elderly patients that fulfill the inclusion criteria of clinical trials experience the same advantages and toxicities from chemotherapy as younger patients. Fit elderly patients with operable gastric cancer should be candidates for the standard surgical resection provided that preoperative comorbidities are taken into account. Perioperative chemotherapy or postoperative chemoradiotherapy should be added in case of locally advanced disease. Palliative systemic chemotherapy seems to prolong survival in recurrent and metastatic disease. CONCLUSIONS: Chronological age alone is not sufficient reason to withhold curative or palliative treatment from an elderly gastric cancer patient. Performance status does not suffice in order to estimate the general condition of elderly patients and cofactors regarding their functional, social and mental status have to be considered.

Gastrointestinal bleeding as initial presentation of melanoma of unknown primary origin: report of a case and review of the literature.

The case of an 81-year-old patient, initially presenting with gastrointestinal (GI) bleeding, including melena and hematemesis is reported. Endoscopy revealed an ulcerated mass of the stomach corpus with immunohistochemistry stains consistent with metastatic melanoma. The thorough physical and paraclinical examination did not reveal any lesions or nodules as a primary site of the disease. The literature concerning this rare presentation of melanoma is also reviewed.

Targeted therapy for oesophageal cancer: an overview.

Oesophageal cancer (OC), is an aggressive cancer constituting a major cause of cancer-related deaths worldwide. Recent advances in surgical techniques, incorporation of new therapeutic approaches -- adjuvant/neoadjuvant chemoradiotherapy -- and integration of new cytotoxic drugs into the management of oesophageal cancer have increased the response rate percentages to 40-50%, with minor impact on the overall survival. The need for an efficacious therapy with minimal toxicity along with a better understanding of molecular pathways of oesophageal carcinogenesis has led to the development of novel anticancer agents. These agents have targeted mechanisms of action such as: (1) inhibitors of the ErbB receptor family, (2) vascular endothelial growth factor (VEGF) inhibitors, (3) selective inhibitors of cycloxygenase-2, (4) matrix metalloproteinase inhibitors, (5) cell-cycle regulators, and (6) promoters of apoptosis. The incorporation of these agents into combined modality treatment schedules for advanced and early stage tumors together with the identification of patients who will most likely benefit will provide novel opportunities in the treatment of oesophageal cancer.