Pancreatic cancer is an aggressive malignancy in which early detection is critical but challenging. Because population-wide screening is not feasible, surveillance efforts have increasingly focused on individuals with hereditary susceptibility or a strong family history, who carry a substantially elevated lifetime risk. Evidence from recent prospective cohorts demonstrates that structured surveillance enables detection at earlier stages, improving resectability and survival in selected high-risk groups. Magnetic resonance imaging and endoscopic ultrasonography currently serve as complementary modalities. However, limitations remain, including reduced sensitivity for subtle lesions, variability in risk criteria and surveillance protocols, and uncertainties regarding the economic feasibility. Emerging approaches―including liquid biopsybased biomarkers, artificial intelligence-assisted imaging, and integrated risk stratification models―show promise for enhancing the precision and sustainability of future programs. This review summarizes the current recommendations for pancreatic cancer surveillance in highrisk individuals and highlights evidence from recent studies.

Duodenal invasion by ascending colon cancer is an uncommon and challenging manifestation of locally advanced right-sided colon cancer. Its optimal management remains debatable, particularly regarding the use of neoadjuvant concurrent chemoradiotherapy (CCRT). We retrospectively reviewed seven patients (aged 63–80 years) with ascending colon adenocarcinoma with duodenal invasion who were treated with neoadjuvant CCRT between 2012 and 2025 at a single tertiary center. Clinical staging ranged from stage IIC to IVB. Treatment strategies included neoadjuvant CCRT followed by curative-intent surgery when feasible and palliative chemotherapy and/or radiotherapy in advanced or inoperable cases. Among the seven patients, five underwent curative surgery following CCRT. Of these, four achieved long-term, recurrencefree survival for 99 months or more (average 102.5 months). One experienced recurrence after initial treatment and died of progressive disease. The remaining two patients did not undergo surgery because of disease progression or poor response to initial therapy, resulting in death or loss to follow-up. Histology revealed moderately to poorly differentiated adenocarcinoma and signet ring cell carcinoma. Neoadjuvant CCRT is feasible and effective in some patients with ascending colon cancer and duodenal invasion, supporting en bloc resection while minimizing surgical morbidity. Prospective studies are warranted to establish optimal treatment protocols.

Background/Aims: The benefits of adjuvant therapy after curative resection (CR) have been demonstrated for bile duct cancer with lymph node (LN) metastasis. However, the putative benefits of adjuvant treatment for bile duct cancer without LN metastasis remain controversial.We aimed to identify recurrence risk factors for distal bile duct cancer (DBC) without LN metastasis following CR and high-risk groups that may benefit from adjuvant treatment. Methods: We retrospectively analyzed recurrence-related factors of patients who underwent surgical resection for DBC at Yonsei University Severance Hospital from January 2010 to June 2019. Results: Of 380 DBC cases receiving CR, 248 (62.8%) were pathologically confirmed as free from LN metastasis. The recurrence rates of all cases and LN metastasis-free cases were similar at 52.4% and 46.8%, respectively. Further, distant metastasis and local recurrence were about equally frequent. Involvement of adjacent organs, the presence of an R1 resection margin (cancer cells present microscopically), lymphovascular invasion (LVI), and perineural invasion (PNI) were identified as risk factors for recurrence (R1 margin OR: 1.642, 95% CI: 1.045–2.578, p = 0.031; LVI OR: 2.049, 95% CI: 1.347–3.115, p = 0.001; PNI OR: 1.901, 95% CI: 1.170–3.088, p = 0.009). Overall survival was also significantly reduced in patients with R1 resection margins (p = 0.018), LVI (p < 0.001), or PNI (p = 0.002). Conclusions The overall risk of LN-negative DBC recurrence remains high after CR. Aggressive systemic adjuvant treatment and active surveillance are required for patients with R1 resection margins, LVI, or PNI.

Endoscopic resection (ER) is widely employed for early colorectal cancer. However, post-ER management of T1 colorectal cancer requires careful risk stratification for lymph node metastasis (LNM). Current European Society of Gastrointestinal Endoscopy (ESGE) guidelines and US Multi-Society Task Force (USMSTF) recommendations consider ER curative when adverse histopathologic features are absent, whereas additional oncologic surgery is recommended following noncurative ER. Recent data indicate that adverse features do not carry equal prognostic weight and should be interpreted in combination with resection quality and specimen accessibility. Deep submucosal invasion (DSI, ≥ 1,000 μm) remains a criterion for noncurative ER in contemporary recommendations; however, emerging evidence suggests that DSI alone confers a relatively lower absolute risk of LNM compared with DSI accompanied by other high-risk histology. This review summarizes ESGE and USMSTF recommendations, integrates updated evidence on DSI and other adverse histologic predictors (lymphovascular invasion, poor differentiation, and tumor budding), and outlines a practical post-ER approach incorporating pathology, resection quality, patient surgical risk, and shared decision-making.

The optimal management of T1 colorectal cancer with suspected submucosal (SM) invasion remains controversial. Although deep SM invasion (≥ 1,000 μm) is traditionally regarded as an indication for radical surgery owing to the risk of lymph node metastasis, emerging evidence suggests that invasion depth alone is insufficient for treatment decision-making. This review aimed to evaluate the role of endoscopic SM dissection (ESD) in colorectal cancer with suspected SM invasion, focusing on indications, limitations, and oncologic outcomes. A narrative review of current guidelines and published literature was conducted to evaluate pathologic risk factors, surgical and organ-preservation strategies, and technical outcomes of ESD in lesions with suspected deep SM invasion. Institutional cohort data were also summarized to illustrate real-world clinical application. Recent evidence highlights the importance of composite pathologic risk factors, such as lymphovascular invasion, tumor budding, and resection margin status, over invasion depth alone in predicting lymph node metastasis. ESD enables en bloc resection and precise histopathologic assessment, which facilitates stepwise treatment planning. However, achieving vertical margin clearance may be technically challenging in lesions with deep SM invasion. Accumulating data from surgical and organ-preservation approaches support a risk-adapted strategy rather than routine radical resection, particularly in selected patients with high surgical risk. In colorectal cancer with suspected SM invasion, ESD serves as a valuable diagnostic and therapeutic modality that informs individualized treatment decisions. Management should be based on comprehensive pathologic risk assessment and patientspecific factors rather on than invasion depth alone.

Influenza causes substantial, yet preventable, morbidity and mortality and poses a particularly high risk to patients with cancer, in whom both the disease itself and systemic anticancer therapies can lead to immunosuppression. This review summarizes key updates in influenza prevention and management in these patients. Considering the apparent disappearance of the B/Yamagata lineage globally, influenza vaccines have transitioned from quadrivalent to trivalent formulations, while high-dose, adjuvanted, and cell culture-based vaccines have been developed to improve responses in older and immunocompromised hosts. Although patients with cancer demonstrate reduced vaccine immunogenicity, evidence shows that vaccination significantly decreases influenza-related complications, thereby justifying strong recommendations for routine vaccination. In diagnostics, real-time polymerase chain reaction and multiplex respiratory virus panels have replaced low-sensitivity rapid antigen tests, enabling earlier and more reliable diagnosis and timely antiviral use. Neuraminidase inhibitors remain the first-line therapy, with baloxavir marboxil, a cap-dependent endonuclease inhibitor, serving as a single-dose oral alternative. However, atypical presentations, prolonged viral shedding, and antiviral resistance can occur in this group. Therefore, combining optimized vaccination, proactive molecular testing, and prompt, individualized antiviral therapy is essential to reduce influenza-associated morbidity and mortality in patients undergoing anticancer treatment.

Crawling-type adenocarcinoma (CTAC) is being increasingly recognized as a distinct histological subtype of early gastric cancer (EGC), characterized by irregularly fused glands with superficially bland cytologic atypia and a propensity for extensive lateral intramucosal spread.Although CTAC often mimics nonneoplastic lesions such as intestinal metaplasia, its biological behavior differs substantially from other differentiated-type adenocarcinomas. Notably, when CTAC invades the submucosa, the invasive component often exhibits a poorly differentiated or poorly cohesive carcinoma morphology. Thus, CTAC poses substantial challenges in accurate preoperative diagnosis, margin delineation, and complete removal during endoscopic submucosal dissection. This review synthesizes available evidence regarding the morphological, molecular, and clinical features of CTAC, emphasizing diagnostic challenges and the clinical implications of its “crawling” lateral growth pattern. It also highlights future directions, including the need for standardized diagnostic criteria and the development of CTAC-specific risk prediction tools for optimizing endoscopic resection.

Hepatocellular carcinoma (HCC) is a highly invasive tumor with a strong tendency for metastasis. The most common sites of metastasis are the lungs, followed by lymph nodes, adrenal glands, and bones. However, metastasis of HCC to the small bowel is extremely rare. A 42-yearold female with HCC secondary to chronic hepatitis B and lung metastasis underwent a right hepatic lobectomy, followed by two wedge resections performed via video-assisted thoracic surgery, four sessions of transcatheter arterial chemoembolization, and stereotactic body radiation therapy. She was under regular follow-up for HCC, during which her alpha-fetoprotein level increased to 722.2 IU/ml. Abdominal computed tomography (CT) revealed segmental wall thickening and aneurysmal dilatation of the small bowel loops. An 18 F-fluorodeoxyglucose positron emission tomography/CT scan demonstrated a 3.3-cm hypermetabolic mass-like lesion (standardized uptake value: 11.3) in the small bowel. Surgical resection of the affected small bowel segment was performed. Histopathological examination of the specimen confirmed metastatic HCC, with immunohistochemical positivity for hepatocyte-specific antigen. The patient has remained cancer-free for 60 months post-operatively. Surgical intervention may offer favorable long-term outcomes in patients with small bowel metastasis from HCC.

Endoscopic submucosal dissection (ESD) has become the standard treatment for early gastric neoplasms owing to its high en bloc resection rate and low recurrence. However, ESD inevitably creates large artificial ulcers, which differ markedly from conventional peptic ulcers in etiology, morphology, and healing behavior. Post-ESD ulcers develop rapidly through thermal injury, leaving extensive mucosal and submucosal defects while preserving the muscularis propria.Healing is characterized by early ulcer contraction followed by epithelial regeneration, typically achieving over 90% closure within 4 weeks and complete reepithelialization by 8 weeks.Despite this, delayed healing occurs in 5–20% of patients. Major risk factors include Helicobacter pylori infection, large ulcer size, antral location, and high-grade dysplasia or early gastric cancer. Acid suppression remains the cornerstone of therapy. Proton pump inhibitors promote healing through potent acid inhibition and cyclooxygenase-2-mediated mucosal regeneration, whereas potassium-competitive acid blockers provide faster, stronger, and cytochrome P450 2C19-independent acid suppression, offering advantages during the early high-risk period.Mucoprotective agents, such as rebamipide and sucralfate, further enhance epithelial repair and reduce mechanical or chemical irritation. Endoscopic closure techniques―including clipping, use of over-the-scope devices, loop-clip methods, and the application of polyglycolic acid sheets with fibrin glue―offer additional protection and help reduce delayed bleeding. Emerging advances include artificial intelligence-based prediction models for delayed bleeding, biomaterialassisted tissue regeneration, and precision treatment tailored to genetics, ulcer characteristics, and patient-specific risk factors. Collectively, these developments are reshaping post-ESD ulcer management toward more individualized and proactive care.