Distress can occur at any stage of the cancer continuum—from diagnosis through treatment and into survivorship—and can be attributed to various factors. This article examines the multifactorial causes of distress in patients with cancer and outlines current strategies for its screening and management. Particular focus is given to depression and anxiety, which are the most prevalent forms of psychological distress in this population.

Pancreatic cancer is among the most aggressive malignancies, with a 5-year overall survival rate of approximately 10%. Despite the establishment of gemcitabine- and fluoropyrimidine-based combination chemotherapy as the standard of care, therapeutic outcomes remain poor due to inherent and acquired resistance to chemotherapy. In recent years, the development of targeted therapies has emerged as a promising treatment modality, driven by advances in molecular biology and genomic profiling. Notably, mutations in the KRAS gene—detected in nearly 90% of pancreatic cancer cases—are recognized as key oncogenic drivers, contributing significantly to tumor initiation, progression, and therapeutic resistance. As such, KRAS has become a focal point for therapeutic intervention. Strategies aimed at targeting KRAS include (1) direct inhibitors of specific KRAS mutations, (2) inhibitors of upstream regulators such as SOS1 and SHP2, and (3) inhibitors of downstream effectors within the RAS signaling cascade. Given the challenges posed by compensatory signaling mechanisms that reduce the efficacy of direct KRAS inhibitors, ongoing research is exploring alternative approaches such as pan-KRAS inhibitors, combination regimens that pair KRAS inhibitors with cytotoxic chemotherapy, and dualtarget strategies involving upstream and downstream signaling components. For the subset of patients (approximately 10%) with wild-type KRAS, the U.S. Food and Drug Administration has approved targeted therapies for tumors harboring specific rare genetic alterations, including NTRK, BRAF, NRG1, ALK, ROS1, RET, and those with mismatch repair deficiency or microsatellite instability-high status. Furthermore, poly(ADP-ribose) polymerase inhibitors have shown clinical benefit in patients with germline or somatic mutations in DNA damage repair genes such as BRCA1, BRCA2, and PALB2.

Familial adenomatous polyposis (FAP) is an autosomal dominant genetic disorder caused by mutations in the adenomatous polyposis coli gene. FAP is characterized by the development of hundreds to thousands of adenomatous polyps in the colon. While initially the primary concern was colorectal cancer, recent advancements in surveillance and prophylactic colectomy have shifted the focus toward the management of upper gastrointestinal (GI) neoplasms, particularly duodenal and gastric lesions. This review focuses on the epidemiology, clinical features, treatment options, and surveillance strategies for treating upper GI neoplasms in patients suffering from FAP. A review of the risk assessment through the Spigelman classification system and current guidelines for both nonampullary and ampullary lesions was conducted for duodenal neoplasms. Regarding gastric neoplasms, the characteristics and management strategies for fundic gland polyps, gastric adenomas, and cancers were discussed. Overall, early screening and timely removal of suspicious lesions are crucial for the management of upper GI neoplasms in patients with FAP for effective cancer prevention.

Colorectal serrated polyps (SP) are precancerous lesions characterized by a saw-tooth appearance in the colonic epithelium that contribute to colorectal cancer (CRC) development via the serrated pathway. CRC is the third most common cancer worldwide and the second most prevalent in Korea. The 2019 World Health Organization classification categorizes SP into hyperplastic polyps, sessile serrated lesions (SSL), SSL with dysplasia, and traditional serrated adenomas. The prevalence of SP ranges from 9 to 21%, with no significant increase with age, particularly among individuals aged < 50 years. The prevalence of SSL is slightly higher than that of traditional adenomas in women. Pathologically, SP develop through BRAF and KRAS mutations and CpG island methylation, accounting for 15 to 30% of CRC cases. SSL-associated cancers can progress rapidly and have a higher risk of lymph node invasion than conventional adenomas, thereby complicating early detection during colonoscopy. These findings highlight the importance of accurate identification and monitoring, especially in younger populations where prevalence is increasing. Thus, further studies are needed to optimize the screening guidelines for SP in younger adults.

Extracellular vesicles (EVs) are lipid bilayer-enclosed particles that contain diverse molecular components, such as proteins, nucleic acids, and lipids. EVs reflect the state of their cell of origin in intercellular communication. Such characteristics of EVs demonstrate their potential as biomarkers and therapeutic agents in basic and translational research. Research on EV biology and applications has progressed significantly. However, challenges remain in translating their potential into clinical applications because of issues in nomenclature, the separation of EVs from nonvesicular extracellular particles, and methods for characterization and functional analysis. The International Society for Extracellular Vesicles addresses the current standards and challenges in this rapidly evolving field through periodical updates of its Minimal Information for Studies of Extracellular Vesicles (MISEV), which was published in 2014 and revised in 2018. The latest revision, MISEV2023, provides an updated overview of the current methodologies, detailing their strengths and limitations in EV production, separation, and characterization from various sources, including cell cultures, body fluids, and solid tissues. In this review, we summarize the fundamental principles of EV research by referencing the guidelines on EVs published by the Ministry of Food and Drug Safety of the Republic of Korea. Furthermore, we elaborate on the key aspects of MISEV2023, providing information for domestic EV researchers in selecting or developing optimal research methodologies according to their specific objectives and applications.

Hepatocellular carcinoma (HCC), a leading cause of cancer-related mortality, is often diagnosed at an advanced stage. As a result, approximately half of patients with HCC received systemic therapy during the disease course. In recent years, the introduction of immune checkpoint inhibitors (ICIs)—notably, atezolizumab plus bevacizumab and tremelimumab plus durvalumab—has transformed the treatment paradigm for advanced HCC, making them a firstline treatment option. Considering the increasing use of ICIs, understanding the incidence and appropriate management of their adverse events (AEs) is necessary for patient care. Hence, this review summarizes the incidence and management strategies for key immune-related AEs, including liver injury (hepatitis), thyroiditis, colitis, skin rash, and pneumonitis. Additionally, we discuss AEs associated with vascular endothelial growth factor inhibitors, such as hypertension, proteinuria, and bleeding. By thoroughly understanding these treatment-related AEs, the clinical outcomes of patients with HCC undergoing ICI-based therapy may be improved.

Extracellular vesicles (EVs) have emerged as highly promising nanocarriers for drug delivery, due to their biocompatibility, stability, and natural cell-targeting capabilities. Among the various sources of EVs, milk-derived EVs (MDEVs) have gained considerable attention for their abundance, cost-effectiveness, and distinctive biological properties. This review offers an in-depth analysis of MDEVs as potential carriers for oral drug delivery and their therapeutic applications. The review begins with an overview of the characteristics of EVs, highlighting the unique attributes of MDEVs. It proceeds to explore the different methods of isolation and purification, emphasizing those that maintain structural integrity and preserve biological activity. Furthermore, the regenerative potential of MDEVs is examined across multiple domains, including dermatology (skin wound healing and cosmetic applications), hair regeneration, and treatment of inflammatory diseases. Particular focus is given to the suitability of MDEVs for oral drug delivery, stressing their remarkable stability within the gastrointestinal tract, their ability to enhance bioavailability, and their capacity to traverse the intestinal barrier. The review also analyzes case studies of MDEV-based oral delivery systems used for treating intestinal diseases and systemic conditions, such as cancer. Finally, the review addresses the current challenges in the field, offers perspectives on future directions, and evaluates the clinical potential of MDEVbased therapies. This study provides valuable insights into the evolving field of milk-derived EVs and their applications in oral drug delivery and regenerative medicine.

Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, is a chronic inflammatory disorder that significantly diminishes the quality of life of patients.Current pharmacological treatments are often limited by low therapeutic efficacy and severe side effects, restricting their long-term application. This necessitates the development of novel therapeutic strategies. Exosome-based therapies have recently emerged as promising candidates due to the therapeutic potential demonstrated by exosomes derived from mammalian cells and plant sources in IBD management. These exosomes exhibit antiinflammatory effects by downregulating proinflammatory cytokine expression, modulating macrophage polarization, and promoting mucosal regeneration. However, scalability challenges and high production costs hinder the clinical translation of mammalian cell-derived exosomes. In contrast, plant-derived exosomes offer distinct advantages, including cost-effective large-scale production, enhanced stability, and reduced immunogenicity, positioning them as a emerging next-generation therapeutic modality for IBD. However, there are still some hurdles in the standardization of largescale exosome production and the precise elucidation of their therapeutic mechanisms. Future research needs to focus on optimizing exosome manufacturing processes, conducting mechanistic studies, and combinatory approaches to accelerate clinical application.