This document discusses colorectal cancer. Some key points:
- Colorectal cancer is the second most common cause of cancer deaths in North America. It affects the colon and rectum.
- Risk factors include family history, age over 50, inflammatory bowel disease, poor diet, smoking, and diabetes. Genetic changes like mutations in APC and DNA repair genes contribute to colorectal cancer development.
- Screening tools include fecal occult blood tests, sigmoidoscopy, colonoscopy, and virtual colonoscopy. Screening guidelines vary but generally recommend annual fecal tests, sigmoidoscopy every 5 years, or colonoscopy every 10 years starting at age 50. Family history of colorectal cancer may
The stomach J-shaped. It has two surfaces (the anterior & posterior), two curvatures (the greater & lesser), two orifices (the cardia & pylorus). It has fundus, body and pyloric antrum.
Blood supply
The left gastric artery
Right gastric artery
Right gastro-epiploic artery
Left gastro-epiploic artery
Short gastric arteries
Stomach cancer begins when cancer cells form in the inner lining of your stomach. These cells can grow into a tumor. Also called gastric cancer, the disease usually grows slowly over many years.
It could be:
malignant or benign
primary or secondary
Breast cancer is cancer that forms in the cells of the breasts. After skin cancer, breast cancer is the most common cancer diagnosed in women in the United States. Breast cancer can occur in both men and women, but it's far more common in women.
cancer of breast , this slide cointains detailed information about the breast cancer that is definition, causes and risk factor, sign and symptoms, management of patient with cancer , giving psychological support .treatment
The stomach J-shaped. It has two surfaces (the anterior & posterior), two curvatures (the greater & lesser), two orifices (the cardia & pylorus). It has fundus, body and pyloric antrum.
Blood supply
The left gastric artery
Right gastric artery
Right gastro-epiploic artery
Left gastro-epiploic artery
Short gastric arteries
Stomach cancer begins when cancer cells form in the inner lining of your stomach. These cells can grow into a tumor. Also called gastric cancer, the disease usually grows slowly over many years.
It could be:
malignant or benign
primary or secondary
Breast cancer is cancer that forms in the cells of the breasts. After skin cancer, breast cancer is the most common cancer diagnosed in women in the United States. Breast cancer can occur in both men and women, but it's far more common in women.
cancer of breast , this slide cointains detailed information about the breast cancer that is definition, causes and risk factor, sign and symptoms, management of patient with cancer , giving psychological support .treatment
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
3. Definition
Colorectal Cancer is
the cancer affecting
caecum, colon and
rectum
Anal canal and
Appendix are not
considered in the
definition, and are
treated as a separate
entities
4. Incidence
SECOND most common cause of Cancer
related deaths in North America
Estimated new cases and deaths from
colon and rectal cancer in the United
States in 2009*
New cases: 106,100 (colon); 40,870 (rectal)
Deaths: 49,920 (colon and rectal combined)
*Source – National Cancer Institute
6. High Risk Factors
Familial Adenomatous Polyposis
Hereditary Non Poliposis Colon Cancer
Family history of Colo Rectal Carcinoma
Previous Colorectal CA, Ovarian, Endometrial, Breast CA*
Age >50
Inflammatory Bowel Disease (UC > CD)
Poor Diet (increased fat, red meat, decreased fibre)
Smoking
Diabetes mellitus & Acromegaly
Streptococcus Bovis Bacteremia*
Ureterosigmoidostomy*
* Harrisons
7. Familial Factors – Risks for CRC
Syndrome Distrubution Histology Malignant Other
potential Lesions
Familial Large Intestine Adenoma Common none
Adenomatous
Polyposis
Gardner Large and Adenoma Common Multiple
Syndrome Small Intestine Malignancies
Turcot Large Intestine Adenoma Common Brain Tumors
Syndrome
Nonpolyposis Large Intestine Adenoma Common Endometrial
Syndrome and Ovarian
Tumors
Peutz Jeghers Small, Large Hamartoma Rare Multiple
Syndrome Intestine, Malignancies
Stomach
Juvenile Large and Hamartoma Rare Congenital
Polyposis Small Intestine Anomalies
8. Genetic Changes in CRC
GENETIC CHANGES MECHANISM - the
Activation of proto- mutational activation
oncogenes (K-ras) of an oncogene
Loss of tumour-
followed by and
suppressor gene coupled with the loss
activity (APC, DCC) of genes that
normally suppress
Abnormalities in
tumorigenesis
DNA repair genes
(hMSH2, hMLH1),
especially HNPCC
syndromes
11. Prevention
Increase fibre in diet
Decrease animal fat
and red meat,
Decrease smoking and
EtOH
Increase exercise and
decrease BMI
Secondary prevention
with screening
12. Canadian Task Force on Preventive Health Care
grading of health promotion actions
A: Good evidence to D: Fair evidence to
recommend the recommend against the
preventive health preventive health
measure measure
B: Fair evidence to E: Good evidence to
recommend the recommend against the
preventive health preventive health
measure measure
C: Existing evidence is I: Insufficient evidence (in
conflicting and does not quantity and/or quality)
allow making a to make a
recommendation for or recommendation,
against use of the clinical however other factors
preventive action, may influence decision-
however other factors making
may influence decision-
making
13. Screening Tools
Digital rectal exam (DRE): most common exam, but not recommended as a screening tool
Fecal occult blood test (FOBT):
- proper test requires 3 samples of stool
- still recommended annually by the World Health Organization (WHO)
- results in 16-33% reduction in mortality in RCTs
- Minnesota Colon Cancer Study: RCT showed that annual FOBT can decrease mortality rate by
1/3 in patients 50-80 years old
Sigmoidoscopy:
- can identify 30-60% of lesions
- sigmoidoscopy + FOBT misses 24% of colonic neoplasms
Colonoscopy:
can remove or biopsy lesions during procedure
can identify proximal lesions missed by sigmoidoscopy
used as follow-up to other tests if lesions found
disadvantages: expensive, not always available, poor compliance, requires sedation, risk of
perforation (0.2%
Virtual colonoscopy: 91% sensitive, 17% false positive rate
Air contrast barium enema: 50% sensitive for large (>1 cm) adenomas, 39% for polyps
Carcinogenic embryonic antigen (CEA): to monitor for recurrence q3 months
14. Screening for Colorectal Cancer
Average risk individuals, at age 50
(incl. those with <2 relatives with Family Hx (>2 relatives with
CRC) – recommendations are CRC/adenoma, one being a 1st
variable: degree relative): start screening
• American Gastroenterology 10 years prior to the age of the
Society and American Cancer relative’s age with the earliest
Society - Yearly fecal occult
blood test (FOBT), flexible onset of carcinoma
sigmoidoscopy q5y, colonoscopy • FAP genetic testing +ve:
q10y
• Canadian Task Force on • yearly sigmoidoscopy starting
Preventative Health Care: at puberty (“B”
• yearly FOBT (“A” recommendation)
recommendation) • HNPCC genetic testing +ve:
• Sigmoidoscopy (“B” • yearly colonoscopy starting at
recommendation)
age 20 years (“B”
• whether to use one or both
of FOBT or Sigmoidoscopy (“C” recommendation)
recommendation)
• colonoscopy (“C”
recommendation d/t lack of good
RCT’s)
16. Investigations
Colonoscopy (best), look for synchronous
lesions - Alternative: air contrast barium
enema (“apple core” lesion) +
sigmoidoscopy
If a patient is FOBT +ve, microcytic anemia
or has a change in bowel habits, do
colonoscopy
Metastatic workup: CXR, abdominal
CT/ultrasound
Bone scan, CT head only if lesions suspected
Labs: CBC, urinalysis, liver function tests,
CEA (before surgery baseline)
27. Clinical Features
Often asymptomatic
Hematochezia / melena, abdominal pain, change
in bowel habits
Weakness, anemia, weight loss, palpable mass,
obstruction
Spread
Direct extension, lymphatic, hematogenous (liver
most common, lung, rarely bone and brain)
Peritoneal seeding: ovary, Blumer’s shelf (pelvic
cul-de-sac)
Intraluminal
28. Clinical Presentation
Right Colon Left Colon Rectum
Frequency 25% 35% 30%
Pathology Exophytic lesions Annular invasive Ulcerating lesions
with occult lesions
bleeding
Symptoms Weight loss, Constipation, Obstruction,
weakness, rarely alternating bowel tenesmus,
obstruction patterns, bleeding
abdominal pain,
decreased stool
caliber, rectal
bleeding
Signs Fe-Deficiency Bright Red Blood Palpable mass on
Anemia Per Rectum, Large rectal exam.
Bowel Bright Red Blood
Obstruction Per Rectum
29. TNM Classification
Primary Tumor Regional Lymph Distant Metastasis
Nodes
T0 No Primary Tumor N0 No Regional LN M0 No Metastasis
Tis CA in situ N1 Metastasis in 1-3 M1 Distant Metastasis
pericolic nodes
T1 Invasion into N2 Metastasis into 4 or
submucosa more pericolic nodes
T2 Invasion into N3 Metastasis into any
muscularis propria nodes along the course
of named vascular trunks
T3 Invasion into serosa
T4 Invasion into adjacent
structures
32. Treatment
SURGERY (indicated in potentially curable or symptomatic cases - not always in stage IV)
Curative: wide resection of lesion (5 cm margins) with nodes and mesentery
Palliative: if distant spread, then local control for hemorrhage or obstruction
80% of recurrences occur within 2 years of resection
Improved survival if metastasis consists of solitary hepatic mass that is resected
Colectomy:
- most patients get primary anastomosis (e.g. hemicolectomy, low anterior resection (LAR)-
- if cancer is below levators in rectum, patient may require an abdominal perineal resection
(APR) with a permanent end colostomy, especially if lesion involves the sphincter complex
- complications: anastomotic leak or stricture, recurrent disease, pelvic abscess,
enterocutaneous fistula
RADIOTHERAPY & CHEMOTHERAPY
Chemotherapy (5 FU based regimens): for patients with node-positive disease
Radiation: for patients with node-positive or transmural rectal cancer (pre ± post-op),
not effective in treatment of colon cancer
Adjuvant therapy – chemotherapy (colon) and radiation (rectum)
Palliative chemotherapy/radiation therapy for improvement in symptoms and survival
35. Case Finding
Case finding for colorectal cancer
(symptomatic or history of UC, polyps, or
CRC)
Surveillance (when polyps are found):
colonoscopy within 3 years after initial
finding
Patients with past CRC: colonoscopy every
3-5 years, or more frequently
IBD: some recommend colonoscopy every
1-2 years after 8 years of disease (especially
UC)
36. Follow up
Intensive follow up improves overall
survival in good risk patients
Currently there is no data suggesting
optimal follow up
Combination of periodic CT
chest/abdo/pelvis, CEA and colonoscopy
is recommended