Aim. The present guidelines intended for primary care physicians are aimed at facilitating early diagnosis of malignant tumours of the digestive system, which can significantly improve the immediate and long-term results of their treatment.General provisions. The guidelines comprise sections devoted to esophageal adenocarcinoma, esophageal squamous cell carcinoma, gastric cancer, colorectal cancer, hepatocellular carcinoma and extrahepatic bile duct and gall bladder cancer, as well as pancreatic cancer. Each section contains information on risk factors and precancerous diseases, which allows a physician to identify whether a particular patient falls into the risk group of digestive system neoplasms. It is shown how digestive system cancers can be suspected on the basis of patients’ complaints and past medical history, as well as data obtained both from a direct examination and laboratory instrumental studies. Each section offers practical algorithms in cases of suspected esophageal adenocarcinoma, esophageal squamous cell carcinoma, gastric cancer, colorectal cancer, hepatocellular carcinoma and extrahepatic bile duct and gallbladder cancer, as well as pancreatic cancer.Conclusion. The knowledge of clinical manifestations and risk factors in the development of digestive system neoplasms allows a physician to suspect cancer and devise a timely and adequate diagnostic strategy, including laboratory and instrumental studies at specialised clinical centres.

Background. Preoperative biopsy is recommended for morphological verification of colorectal epithelial neoplasms prior to their endoscopic resection. However, histological reports for endoscopic biopsy and resected lesions are not reliably consistent.Aim. Assessment of sensitivity, specificity and accuracy of endoscopic biopsy in differential diagnosis of colorectal serrated adenomas and risk factors for variance between biopsy results and morphological examination of completely resected lesions.Materials and methods. The assay used data on 56 morphologically verified serrated adenomas diagnosed and resected in 50 patients (14 men, 36 women; average age 66.9 ± 10.5 years). Biopsy was taken from all tumours before endoscopic resection. Results of morphological examination of biopsy samples and resected tumours were analysed and compared. Sensitivity, specificity and accuracy of biopsy was assessed, with the tumour size and type and biopsy forceps system taken as criteria.Results. The identified cases included 22 (39.3%) right-colon, 21 (37.5%) left-colon and 13 (23.2%) rectal lesions of 28.5 ± 2.6 mm average size. Polypoid were 17 (30.3%), non-polypoid — 6 (10.7%) and spreading — 33 (59%) of the tumours. Full consistency of morphological examination was observed for 12 cases (21.4%). In 9 cases (16%), dysplasia was established as mild-graded with biopsy, whilst the eradicated tumours contained severe dysplastic foci. Foci of adenocarcinoma were detected in 10 tumours (including 2 with submucosal invasion), but only 2 cases were correctly diagnosed for malignant adenoma with biopsy. Tumour morphology was misidentified in 32 cases (57.1%).Conclusions. Preoperative forceps biopsy is shown to possess low sensitivity in differential diagnosis of serrated colorectal lesions and very low sensitivity to predict malignant serrated adenomas.

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(2 Ostryakova Ave. Vladivostok 690950 Russian Federation), 2 JSC Russian Railways hospital branch at the Vladivostok station (25 Verkhneportovaya St. Vladivostok 690063 Russian Federation) background. The study objective is to evaluate the role of endosonography and fine-needle puncture under the control of endoscopic ultrasonography (EUS) in the diagnosis and staging of pancreatic tumors. Methods. It was evaluated the results of EUS and the fine-needle puncture under the control of EUS with cytological examination on the material of 17 clinical observations. Results. In 13 patients EUS confirmed the data of magnetic resonance and computed tomography. In 7 cases it was diagnosed a highly differentiated adenocarcinoma in 3 cases-moderately differentiated adenocarcinoma, in 1 case-undifferentiated pancreatic cancer and in one case-metastasis of clear cell renal cancer. Conclusions. Endosonography is a minimally invasive, fairly safe and effective method of diagnosis of pancreas tumors, allowing in combination with fine-needle puncture and cytological study to evaluate the resectability and curable tumor as well as determine the future tactics of patients even at the stage of development of the methodology.