Appendiceal adenocarcinoma
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This document summarizes information about appendiceal adenocarcinoma. It discusses how the majority of patients present with acute appendicitis and describes the intestinal and mucinous tumor types. It also covers tumor classification, including mucinous tumors of uncertain malignant potential. Prognosis depends on factors like histologic type, T stage, and tumor grade. Treatment recommendations include simple appendectomy for early stage disease and hemicolectomy for more advanced tumors. Adjuvant chemotherapy and intraperitoneal hyperthermic chemotherapy are discussed as additional treatment options. Cytoreductive surgery can help palliate patients with peritoneal carcinomatosis.
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Colorectal cancer, Colon, Rectum, Duke's staging, TNM staging, Astler-Coller classification, Hemicolectomy
Qworld Most Important ENT Topics Notes for PG Medical Entrance Exam
Qworld Most Important ENT Topics Notes for PG Medical Entrance Exams Like NEETPG , AIPGMEE , AIIMS
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Chronic obstructive pulmonary disease
Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is usually progressive and associated with an abnormal inflammatory response in the lungs. The diagnosis of COPD requires two spirometric measures: FEV1 and its ratio to FVC (FEV1/FVC), which must be less than 0.7. Treatment involves smoking cessation, vaccinations, bronchodilators, corticosteroids, pulmonary rehabilitation, and oxygen therapy or lung transplantation for advanced cases.
Acquired hemophilia a
Acquired hemophilia A is a rare bleeding disorder caused by autoantibodies against factor VIII. It most commonly presents in older patients as severe bleeding and has a high mortality rate if not properly treated. Evaluation involves testing for prolonged aPTT and ruling out an inhibitor through mixing studies. Treatment focuses on controlling bleeding with bypassing agents or factor VIII while also using immunosuppressants to eliminate the autoantibody inhibitor. Proper management can reduce bleeding and inhibitor levels, but monitoring is needed due to the slow response to therapy.
Colon cancer
Colon cancer is the fourth most common cancer in the US. Approximately 96,830 new cases of colon cancer and 40,000 cases of rectal cancer occur each year. While incidence rates have decreased, it remains the second leading cause of cancer deaths. Approximately 20% of colon cancer cases are associated with hereditary factors like Lynch syndrome and Familial Adenomatous Polyposis. Universal genetic testing of tumors is recommended to identify hereditary cases so that at-risk family members can be identified. First line treatments for metastatic colon cancer include FOLFOX, CapeOx, and FOLFIRI combinations, often with added targeted therapies like bevacizumab, cetuximab, or panitumumab
Lymphangioma
Lymphangiomas are benign tumors of lymphatic vessels that most commonly occur in the head and neck region, particularly the tongue. They can also occasionally be found in the oral cavity elsewhere like the palate, cheeks, or lips. Lymphangiomas are generally classified as simple, cavernous, cellular, or diffuse systemic and can be either cystic or microcystic/macrocystic. Treatment options include surgical excision, sclerotherapy, cryotherapy, laser therapy, and other conservative treatments. Complete surgical removal is often difficult due to the risk of damaging surrounding vital structures and high chance of recurrence.
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Bladder tumor
1. The majority (95%) of primary bladder tumors originate from the bladder epithelium and are transitional cell carcinoma (90%). Squamous cell carcinoma (5%) and adenocarcinoma (1-2%) can also occur.
2. Risk factors for bladder cancer include occupational exposures like chemicals, smoking, and infections like Schistosomiasis.
3. Evaluation involves urine cytology, cystoscopy, imaging and biopsy. Treatment depends on tumor stage and grade, ranging from transurethral resection for non-muscle invasive tumors to radical cystectomy for muscle-invasive tumors.
Bladder tumor
1. The majority (95%) of primary bladder tumors originate from the bladder epithelium and are transitional cell carcinoma (90%). Squamous cell carcinoma (5%) and adenocarcinoma (1-2%) can also occur.
2. Risk factors for bladder cancer include occupational exposures like chemicals, smoking, and infections like Schistosomiasis.
3. Evaluation involves urine cytology, cystoscopy, imaging and biopsy. Treatment depends on tumor stage and grade, ranging from transurethral resection for non-muscle invasive tumors to radical cystectomy for muscle-invasive tumors.
Pseudomyxoma Peritonei, is it preventable? .pptx
Appendicular Mucinous Neoplasms are rare pathologies of the appendix that can lead to rupture and the development of Pseudomyxoma Peritonei. In this lecture we present the difference between 4 cases of appendicular Mucinous Neoplasm in which the proper management and early surgical intervention prevented the development of Pseudomyxoma Peritonei
CA STOMACH.pptx
This document provides information on gastric carcinoma, including:
1. It describes the classification, epidemiology, risk factors, pathogenesis, histology, staging, clinical features, investigations, and management of gastric adenocarcinoma.
2. The main risk factors include H. pylori infection, dietary nitrites, genetic mutations, and polyps. Gastric adenocarcinoma is classified based on cell type, location, depth of invasion, and metastasis.
3. Management involves endoscopic resection for early cancers, while advanced cancers are treated with surgery such as gastrectomy, with or without chemotherapy and radiotherapy. Complications and palliative care are also discussed.
Urology 5th year, 3rd lecture (Dr. Ali Kamal)
- Transitional cell carcinoma accounts for 90% of primary bladder tumors and arises from the bladder epithelium. Squamous cell carcinoma and adenocarcinoma make up the remaining cases.
- Risk factors for bladder cancer include occupational exposures to chemicals and dyes, smoking, and Schistosoma haematobium infection.
- Diagnosis involves cystoscopy to visualize the bladder. Treatment depends on tumor stage and grade, ranging from transurethral resection for noninvasive papillary tumors to radical cystectomy for invasive cancers.
Cancer of bladder
A 73-year-old male presented with hematuria and irritative voiding symptoms. Further testing revealed high-grade urothelial carcinoma of the bladder that had invaded the bladder muscle. The patient received neoadjuvant chemotherapy followed by robotic cystoprostatectomy and urinary diversion surgery. Bladder cancer is usually transitional cell carcinoma and risk factors include smoking, occupational exposures, and prior radiation. Treatment depends on stage and grade but may include surgery, chemotherapy, and radiation.
Surgical Management of Carcinoma Esophagus
In Depth review of the Surgical management of esophageal carcinoma including management overview, endoscopic management, Type of surgeries, Open, and minimally invasive, Extent of lymphadenectomy. Literature review of evidence for type of surgery and complications
Gastric carcinoma
This document summarizes information about gastric carcinoma (stomach cancer). It covers the epidemiology, anatomy, pathology, risk factors, clinical presentation, staging, and treatment of gastric cancer. Key points include:
- Gastric cancer was previously a leading cause of cancer death but now ranks fourth most common. Incidence is highest in China and Japan.
- The stomach has extensive lymphatic drainage involving 16 lymph node stations.
- 95% of gastric cancers are adenocarcinomas. Other rare types include squamous cell carcinoma and carcinoid tumors.
- Risk factors include smoking, obesity, and H. pylori infection. Symptoms are often vague but may include weight loss, abdominal pain,
Tumors of small bowel.pptx
The document discusses tumors of the small bowel, including both benign and malignant types. It provides details on the incidence, risk factors, presentations, diagnostic approaches, and treatment options for common tumors such as gastrointestinal stromal tumors (GISTs), adenomas, neuroendocrine tumors, and adenocarcinoma. The document emphasizes that small bowel tumors often present nonspecifically, making preoperative diagnosis challenging, and outlines various imaging modalities that can help in diagnosis. Surgical resection is typically the main treatment for localized tumors.
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Git 4th GC18.
1) Gastric carcinoma is the third leading cause of cancer death worldwide, with highest incidence in East Asia and parts of South America.
2) Risk factors include H. pylori infection, smoking, diet high in salted/preserved foods, and family history of gastric cancer.
3) Early detection through endoscopy in dyspeptic patients over 50 years old or with red flags can improve outcomes, as resection allows for potential cure in early gastric cancer confined to mucosa or submucosa.
Carcinoid tumours of the small intestine
1) Carcinoid tumors are rare neuroendocrine tumors that originate from enterochromaffin cells in the small intestine.
2) Symptoms can include flushing, diarrhea and heart disease due to secreted hormones.
3) Treatment involves surgical removal of the primary tumor and metastases. Octreotide can help control symptoms.
MANAGEMENT OF RECTAL CARCINOMA.pptx
1. Surgery is the main treatment for rectal carcinoma, with total mesorectal excision being the standard surgical approach. The main surgeries are abdominoperineal resection for low tumors and anterior resection for mid and upper tumors.
2. Preoperative radiotherapy with or without chemotherapy can downstage the cancer and reduce local recurrence. Adjuvant chemotherapy improves survival for node-positive cancers.
3. Other treatments include transanal total mesorectal excision, palliative procedures like Hartmann's operation, and chemotherapy and immunotherapy for metastatic disease. Prognosis depends on stage and tumor characteristics, with 5-year survival rates ranging from 90% for stage I to 5% for stage IV
Gall Bladder Carcinoma
GB cancer is the 5th most common GIT malignancy(worldwide).200 years later it is still considered to be a highly malignant disease with a poor survival rate
.Here is a brief description regarding
Rectal cancer alex
1. Rectal cancer is a common malignancy that arises in the rectum, usually within 15 cm of the anal verge.
2. Diagnostic workup includes physical exam, proctoscopy, biopsy of the primary tumor, and imaging. Blood tests like CEA are also done.
3. Treatment involves a multidisciplinary approach with surgery, often total mesorectal excision, along with pre- or post-operative chemoradiation to reduce the risk of recurrence. The type of surgery depends on how far the cancer has spread.
Chẩn đoán hình ảnh u cơ-mỡ-mạch (Angiomyolipoma)
Angiomyolipoma is the most common benign renal tumor, occurring more frequently in women. It consists of blood vessels, smooth muscle, and fat. Approximately 20-30% of angiomyolipomas are associated with tuberous sclerosis. Imaging such as CT or MRI can diagnose angiomyolipoma by detecting fat content. Treatment depends on tumor size, with embolization for large tumors and observation for small tumors. Surgical removal may be needed for symptomatic or growing tumors to prevent complications like hemorrhage.
pancreatic cas managementby bedrumoh.pptx
1. Pancreatic cancer is the 4th leading cause of cancer death and often presents with jaundice, abdominal pain, weight loss, or new-onset diabetes. Diagnosis involves blood tests, CT, MRI, EUS, and biopsy.
2. Surgical management includes Whipple procedure for head tumors or distal pancreatectomy for body/tail tumors. Palliative options relieve biliary/duodenal obstruction and pain via stenting, bypass, or celiac plexus block.
3. Adjuvant chemo-radiotherapy after surgery can increase survival compared to surgery alone. Neoadjuvant FOLFIRINOX increases resectability of borderline resect
Gastric ca
This document provides an overview of the management of gastric cancer. It discusses the epidemiology, risk factors, diagnosis, staging workup, treatment options and prognosis. The main points are: gastric cancer is the 4th most common cancer worldwide and incidence has decreased; risk factors include H. pylori infection and low socioeconomic status; diagnosis involves endoscopy, imaging and biopsy; surgery is the only curative treatment but most present with advanced staged disease.
Gastrointestinal carcinoids
- Gastrointestinal carcinoid tumors most commonly occur in the small bowel and appendix. They arise from enterochromaffin cells and can produce symptoms if they secrete excess serotonin.
- Diagnosis is usually achieved through complementary imaging techniques such as somatostatin receptor scintigraphy, CT, MRI, and ultrasound. Somatostatin receptor scintigraphy is particularly useful for detecting primary tumors and metastases.
- Imaging findings include well-defined bowel masses that can invade the mesentery, associated lymphadenopathy, and liver metastases appearing as hypoechoic lesions that enhance with contrast.
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Chẩn đoán hình ảnh u cơ-mỡ-mạch (Angiomyolipoma)
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Anal cancer
This document discusses anal carcinoma. It covers the overview, risk factors which include HPV and anal intercourse, and the strong association with HPV-16 and HPV-18. It also discusses risk reduction through treatment of high-grade anal intraepithelial neoplasia, a precursor to anal cancer. The anatomy of the anal region and canal is described. Sentinel nodes are the inguinal nodes. Primary treatment of non-metastatic anal cancer involves chemotherapy with radiotherapy to improve local control and reduce colostomies.
Megakaryopoiesis and Thrombopoiesis
Megakaryopoiesis and thrombopoiesis involve the production of megakaryocytes and platelets from hematopoietic stem cells in the bone marrow. Megakaryoblasts are early stage megakaryocytes that are 8-24 μm in size with minimal nuclear lobulation and scant cytoplasm. They express surface adhesion molecules like integrin αIIbβ3 and glycoprotein Ib-IX complex. Megakaryoblasts undergo endomitosis, replicating their DNA without cell division to become polyploid. Cytokines such as thrombopoietin are critical for megakaryoblast survival and proliferation.
Pembrolizumab in advanced melanoma
This document summarizes the results of a clinical trial investigating the efficacy and safety of pembrolizumab (anti-PD-1 antibody) in patients with advanced melanoma that progressed after treatment with ipilimumab. The overall response rate was 26% in the 2 mg/kg group and 10% in the 10 mg/kg group, with responses ongoing after 1 year. Pembrolizumab demonstrated a manageable safety profile, with grade 3-4 drug-related adverse events occurring in 12% of patients. This trial provides evidence that pembrolizumab is an effective treatment option for patients with advanced melanoma who have progressed on ipilimumab.
Bone tumors
The document discusses several types of primary bone cancers. It focuses on chondrosarcoma, which arises from cartilage and most commonly affects the pelvis and femur in older adults. The document outlines diagnostic evaluation, staging, histologic grading, and treatment approaches including wide local excision and adjuvant therapies for chondrosarcoma. Prognosis depends on tumor grade and location. Ewing's sarcoma and osteosarcoma are also discussed as well as giant cell tumor of bone.
Hodgkin lymphoma
Hodgkin's lymphoma, also known as Hodgkin's disease, is a cancer that originates in the lymphatic system. It is characterized by the presence of Reed-Sternberg cells in the lymph nodes and other tissues. The disease has four main subtypes - nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte rich - which are distinguished based on the type of cells in the tissue around the Reed-Sternberg cells. The nodular sclerosis subtype, which involves bands of fibrosis dividing the lymph node tissue into nodules, accounts for about 40-70% of cases. Hodgkin's lymphoma most commonly presents with painless swelling of lymph nodes in the neck,
Chronic Lymphocytic Leukemia
Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults. It has an average incidence of 2.7 per 100,000 people in the US and is more common in older men. CLL accounts for about 0.8% of all cancers and 30% of leukemias. The neoplastic cells are typically B-cell lymphocytes. Farming exposure and hepatitis C may play a role in etiology. CLL has various genetic abnormalities that affect prognosis. Clinical features include lymphadenopathy, fatigue, infections. Diagnosis requires a sustained lymphocytosis above 5000/uL. Treatment is indicated for symptomatic disease, doubling time under 6 months, or disease complications. Prognostic factors
Tumor board locally advanced rectal cancer
The document summarizes evidence and guidelines for managing locally advanced rectal cancer. It discusses that neoadjuvant chemoradiation is preferred over postoperative chemoradiation based on trials showing lower local recurrence rates and less toxicity. Long-course neoadjuvant chemoradiation followed by surgery 6-8 weeks later is the standard approach. Post-treatment assessment of tumor response helps predict outcomes, with complete response indicating a good prognosis. Adjuvant chemotherapy after surgery may further improve survival based on meta-analyses of trials. Guidelines recommend a multidisciplinary, tailored approach incorporating staging, treatment response, and patient factors.
Central venous catheter complications
1. Most common cardiac conduction abnormalities during CVC insertion are right bundle branch blocks and new left anterior and posterior fascicular blocks which result from overzealous advancement of the guide wire.
2. The most common site of catheter-related deep vein thrombosis is the internal jugular vein. Risk factors include history of DVT, subclavian insertion site, and improper catheter tip positioning.
3. Symptoms of venous air embolism during CVC insertion include chest pain, dyspnea, headache, EKG changes, and decreased cardiac output. Treatment involves stopping air entry, placing the patient in Trendelenburg and left lateral position, and
Board review internal medicine
A 67-year-old woman with poorly controlled type 2 diabetes and hypertension presented with severe muscle weakness and was found to have hyperglycemia, hyperkalemia, and elevated creatinine. Examination revealed facial hirsutism and signs of Cushing's syndrome. Laboratory testing, including a C-peptide measurement, should be performed to determine the cause of her diabetes.
Journal club lung cancer screening
The guideline recommends annual low-dose CT screening for lung cancer until age 79 for high-risk groups based on results from the National Lung Screening Trial. It received moderate ratings in the AGREE assessment due to lack of stakeholder involvement, uncertainty around harms and costs, and need for further validation. While screening high-risk groups could reduce mortality, the high false positive rate and risk of overdiagnosis require careful consideration in implementation.
Anal gland carcinoma
The biopsy results showed poorly differentiated adenocarcinoma in the rectal biopsy and lymph nodes. Immunohistochemistry staining was positive for CK7 and CEA, and negative for CDX2 and other markers. This profile is consistent with anal gland carcinoma (AGC). For AGC lesions greater than 2 cm or not well differentiated, the treatment is neoadjuvant chemoradiation followed by surgery and adjuvant FOLFOX chemotherapy. Both squamous anal canal cancer and AGC are treated with approximately 5 weeks of chemoradiation, though the chemotherapies differ, and metastatic treatments also differ between the cancers.
Hypernatremia
This patient presented with altered mental status and hypernatremia. Initial workup found a serum sodium of 151 mEq/L, urine sodium of 20 mEq/L, and a urine osmolality less than 1%. A water deprivation test confirmed the diagnosis of central diabetes insipidus, as the patient continued to produce dilute urine despite becoming hypernatremic and hyperosmolar. Central diabetes insipidus was likely caused by damage to the hypothalamus preventing adequate release of antidiuretic hormone.
Blood transfusion
This document provides information about blood transfusion, including guidelines, components, and risks. It discusses:
1) Guidelines from 1988 and 2010 that multiple factors should be considered for red blood cell transfusion based on a patient's clinical status and oxygen needs.
2) Red blood cell transfusion is indicated for symptomatic anemia, life-threatening anemia, or restoring oxygen-carrying capacity after hemorrhage.
3) Potential transfusion reactions include febrile non-hemolytic reactions, acute hemolytic reactions, transfusion-related acute lung injury, and infections like HIV or hepatitis. Careful patient screening and component selection can reduce risks.
Acute promyelocytic leukemia
Acute Promyelocytic Leukemia (APL) is a subtype of AML characterized by the t(15;17) translocation resulting in the PML-RARA fusion gene. APL has a high cure rate with all-trans retinoic acid (ATRA) and chemotherapy due to its differentiation of promyelocytes. Complications include disseminated intravascular coagulation, ATRA syndrome, and pseudotumor cerebri. Modern treatment protocols using risk stratification and ATRA with chemotherapy have increased survival to over 80% for APL.
Superior vena cava syndrome
This document discusses Superior Vena Cava Syndrome (SVCS), which occurs when the Superior Vena Cava (SVC) is compressed, reducing blood flow from the head and upper body. The document covers the case presentation of a patient with SVCS, including symptoms, imaging findings, and treatment. It then provides details on the anatomy, etiologies, clinical features, imaging and classification of SVCS. Treatment options for malignant causes of SVCS such as radiation therapy, chemotherapy and stenting are described. A grading system and treatment algorithm for SVCS are also presented.
Multiple myeloma
- The patient presented with obstructive jaundice and was diagnosed with plasmacytoma and multiple myeloma based on tests. She received 2 cycles of chemotherapy but was then transferred due to a storm and taken off treatment.
- Multiple myeloma is a cancer of plasma cells characterized by proliferation of malignant plasma cells in the bone marrow. It accounts for 1% of cancers and treatment may include stem cell transplantation, thalidomide, lenalidomide, and bortezomib to extend survival.
- The document discusses diagnostic criteria, risk stratification, treatment including primary therapy and surveillance, stem cell transplantation criteria, and approaches to relapsed or refractory disease.
Approach to Hypokalemia
This document discusses the approach to hypokalemia. It begins by distinguishing between renal and extrarenal causes of hypokalemia based on urinary potassium levels and the transtubular potassium gradient. It then reviews various endocrine causes of hypokalemia related to the renin-angiotensin-aldosterone system. Primary aldosteronism is discussed in more detail, including criteria for diagnosis, screening methods such as the aldosterone-renin ratio, and distinctions between forms with and without an adrenal tumor. Tests for evaluating renal tubular function like the urine anion gap and methods for diagnosing renal tubular acidosis are also summarized.
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Appendiceal adenocarcinoma
- 1. Tumor Board-Appendiceal Adenocarcinoma Presented By - Ranjita Pallavi PGY-3 Department of Internal Medicine
- 3. Appendicular Adenocarcinoma • Majority of patients with adenocarcinomas present with acute appendicitis. • Other features include ascites, abdominal mass, or generalized abdominal pain. In less than 20 percent of cases, the cancer is found incidentally at surgery for other reasons. • Intestinal-type tumors typically manifest as a focal mass without mucocele formation. • Although they have a poorer prognosis, this is the case only if the disease is locoregionally advanced at presentation. • The mucinous type spreads more often throughout the peritoneal cavity.
- 4. UMP • Mucinous tumor of uncertain malignant potential (UMP) is used for neoplasms where the histological features do not allow distinction between a lesion that is benign from the one that has the potential to cause metastases. • There is loss of normal complement of lymphoid tissue in the wall adjacent to the neoplastic epithelium accompanied by fibrosis of submucosa and muscularis propria. • Appendix may be transformed into a cystic structure composed of a thin fibrous wall lined by neoplastic mucinous epithelium. • Calcification may occur in the fibrous wall. • Because of a different therapeutic management, confirming the diagnosis of mucinous tumor of UMP is important. • Right hemicolectomy should be considered for UMP considering the risk of 10% of residual disease and metastases.
- 6. Prognosis
- 7. TNM Staging
- 8. Long Term Outcomes • 36 patients were studied. • 88% presented with acute appendicitis. • 50% underwent curative resection • Overall 5 year survival 46% • 5 year survival after curative resection 61% vs 32% for palliative surgery. • Prognostic variables: Histologic type: colonic vs mucinous, T stage (T1,2 vs T3,4) and tumor grade. • T2 or greater should be treated with Hemicolectomy. • T1 would benefit from hemicolectomy.
- 9. Treatment – Appendiceal Adenocarcinoma Recommendations: • Simple appendectomy for adenocarcinomas that are confined to the mucosa or well-differentiated lesions that invade no deeper than the submucosa. • Hemicolectomy for more deeply invasive tumors. • Routine oophorectomy has been proposed at the time of colectomy because the ovaries are a common organ for metastases. • Resection of ovaries that are involved with metastatic spread is clearly beneficial. • However, no series has shown an improvement in survival with prophylactic oophorectomy, and this approach is not recommended. • Role of adjuvant chemotherapy/RT is unclear.
- 11. Intraperitoneal Hyperthermic Chemotherapy- IPHC • Ideal candidates: Asymptomatic patients with small volume peritoneal carcinomatosis who are likely to be successfully cytoreduced (leaving behind deposits <2.5 mm) with surgical debulking • Rapid recurrence of the peritoneal surface disease despite treatment, combined with progression of nodal or extraperitoneal systemic disease, interferes with long-term benefit. • CT scans may not distinguish between diffuse peritoneal adenomucinosis (DPAM) from mucinous peritoneal carcinomatosis, features like the presence of tumor implants >5 cm on the jejunum, proximal ileum, or adjacent mesentery is more consistent with mucinous adenocarcinoma with secondary peritoneal carcinomatosis than DPAM.
- 12. Cytoreductive Surgery • Presence of segmental obstruction of the small bowel raises suspicion for peritoneal adenocarcinomatosis. • It predicts a less favorable outcome from aggressive cytoreduction and intraperitoneal heated chemotherapy. • Total abdominal colectomy, pelvic peritonectomy, and end-ileostomy is a technically feasible procedure and is advocated for the palliation of patients with peritoneal carcinomatosis of appendiceal origin.
- 14. Thank You