The endoscopic treatment of gastrointestinal symptoms.

Nearly all the digestive cancers are endocavitary and thus endoscopy is the most suitable approach for them, for diagnostic as well as for therapeutic purposes. Digestive cancers form about 20 percent of all diagnosed cancers; when these are advanced, most of them are poorly responsive to curative treatments; consequently, patients not responding to curative treatment will need symptomatic, palliative treatment. Flexible endoscopy continuously improves its therapeutic possibilities and is used to treat a variety of diseases traditionally managed by surgery. Palliation is the treatment of the symptoms of a disease. Palliative treatment is planned when it is impossible to treat a disease for cure. Palliation would be better defined by dividing it into palliative care, including the treatments required to bridge the patients with advanced tumors from a specific disease status to the terminal events, and control of symptoms, concerning a former phase in the natural history of the disease, when an acceptable disease-related quality of life is obtainable. In view of these distinctions, palliative treatments to control symptoms should start as soon as the disease is classified as being incurable. It could happen at the time of the diagnosis, if conditions preventing curative treatments already exist. Palliation must be undertaken if anticancer treatments are not advisable because of general or local reasons; in such cases, a therapeutic approach directed to treat the cancer would waste time, opportunities and biological resources that could be used for a more tolerable and profitable symptomatic approach. Diagnosis of a solid cancer must be followed by the staging, as therapeutic options and prognosis are strictly related to the stage. Staging procedures are based on sophisticated and precise diagnostic tools, so that the oncologist should be able to separate localized from diffused and curable from non-curable diseases in the majority of cases. In fact, the suitable diagnostic possibilities must be implemented, to single out non-curable patients as early as possible, avoiding to give them inefficacious, sometime toxic and always costly anticancer treatments, and managing them in order to the symptoms they are complaining. Palliative option has to be undertaken only after having considered the different curative potentialities of surgery and radio-, chemo-, immunotherapy, and of any other kind of certified treatments, as well as the risk conditions of a particular patient, the side effects of a treatment, the quality of the remaining life, and weigh up the real impact of the therapeutic procedures with regard to the expected benefits. Analysis of gene expression patterns may be useful in the future for predicting the response to an anticancer treatment. The availability of new prognostic indicators in the form of molecular, clinical, and pathologic testing might offer the possibility of selecting potentially curable from non-curable patients.