Oncogastroenterology — a new direction in the development of multidisciplinary clinical medicine

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Abstract

Due to the high prevalence and increasing mortality from cancer, including gastrointestinal tumors, numerous challenges arise in the diagnosis, treatment, and management of patients, often requiring the intervention of doctors in related specialties. One such pressing issue is multidisciplinary collaboration between oncologists and gastroenterologists in clinical practice. The aim of this review is to systematize ideas about the multidisciplinary interaction of oncologists and gastroenterologists within the framework of the concept of oncogastroenterology from the standpoint of modern clinical recommendations, guidelines and consensus documents. This review also aims to attract the attention of medical specialists, increase scientific interest in this topic, and encourage multidisciplinary collaboration between oncologists and gastroenterologists. A search of relevant publications in PubMed/Medline, Google Scholar, Scopus / Web of Science, and eLibrary.ru databases, as well as Russian specialized journals related to gastroenterology and oncology, was conducted over the past 10 years. A literature review revealed that cancer patients face numerous gastrointestinal barriers, which not only significantly impair their quality of life but can also impact treatment tolerability and the overall prognosis. The most common gastrointestinal toxicities associated with anticancer therapy include nausea and vomiting, mucositis, diarrhea, exocrine insufficiency, hepatotoxicity, as well as nutritional deficiencies and a high risk of sarcopenia. All these issues are successfully addressed in a close, multidisciplinary team of an oncologist and a gastroenterologist by selecting and prescribing an optimal protocol for managing adverse events. The uniqueness of this review lies in the opportunity to highlight the emerging subspecialty of oncogastroenterology, which may be the optimal step in addressing key issues arising at the intersection of these two specialties. This will help define the goals and objectives of specialists in this field and set the direction for multidisciplinary progress, thereby advancing both oncology and gastroenterology to a new level of medical development, not only to address current challenges but also to provide a protective perspective on the future through cancer prevention.

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About the authors

Igor V. Reshetov

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: reshetoviv@mail.ru
ORCID iD: 0000-0002-0909-6278
SPIN-code: 3845-6604

MD, PhD, Professor, Academician of the RAS

Russian Federation, Moscow

Igor V. Maev

Russian University of Medicine

Email: igormaev@rambler.ru
ORCID iD: 0000-0001-6114-564X
SPIN-code: 1994-0933

MD, PhD, Professor, Academician of the RAS

Russian Federation, Moscow

Dmitry N. Andreev

Russian University of Medicine

Email: dna-mit8@mail.ru
ORCID iD: 0000-0002-4007-7112
SPIN-code: 2980-3362

MD, PhD, Assistant Professor

Russian Federation, Moscow

Valeria V. Cherenkova

A.S. Loginov Moscow Clinical Scientific Center

Email: dr.star@internet.ru
ORCID iD: 0000-0002-4361-3216
SPIN-code: 7631-0596

MD

Russian Federation, Moscow

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3. Fig. 1. Common gastrointestinal comorbidities associated with anticancer drug therapy [7]

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4. Fig. 2. Algorithm for prescribing antiemetic prophylaxis, developed by the Russian Association of Supportive Therapy in Oncology (RASSC, 2024)

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5. Fig. 3. Algorithm of actions in cases of low efficacy of antiemetic prophylaxis, developed by the Russian Association of Specialists in Supportive Care in Oncology (RASSC, 2024)

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6. Fig. 4. Algorithm for the differential diagnosis of drug-induced liver injury according to the American College of Gastroenterology (ACG) guidelines. Note. Abdominal US — abdominal ultrasound; ALT — alanine aminotransferase; ALT ULN — ALT upper limit of normal; ALP — alkaline phosphatase; ALP ULN — ALP upper limit of normal; HCV — hepatitis C virus; HEV — hepatitis E virus; CMV — cytomegalovirus; EBV — Epstein-Barr virus.

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7. Fig. 5. Types of exocrine pancreatic insufficiency and causes of its development [34] Note. Pancreas — pancreas; Duodenum — duodenum.

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8. Fig. 6. Diagnostic algorithm for exocrine pancreatic insufficiency [34] Note. EPI — exocrine pancreatic insufficiency; BMI — body mass index; pancreas — pancreas; FE — fecal elastase.

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9. Fig. 7. Treatment algorithm for exocrine insufficiency in cancer patients [34]

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