The document discusses carcinoma of the rectum, including its incidence, risk factors, anatomy, staging, and treatment options. It notes that rectal cancer is the third most common cancer in men worldwide and the second most common in women. Treatment depends on the stage of the cancer, with more advanced or lower tumors typically requiring removal of part of the rectum and sphincter muscles via procedures like abdominoperineal resection or low anterior resection.
This document discusses carcinoma of the rectum. It begins by explaining the anatomy of the rectum and its blood supply, lymphatic drainage and innervation. It then discusses the epidemiology, risk factors, staging systems including Dukes and TNM classification. Signs and symptoms, diagnostic workup including endoscopic, radiological and biopsy evaluation are explained. Principles of surgical treatment including resection margins are outlined. The goal of surgery is eradication of the primary tumor along with adjacent mesorectal tissue.
Bladder cancer begins in the cells lining the bladder. It is most common in the urothelial cells. The main types are urothelial carcinoma, squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. Risk factors include smoking, chemical exposure, infections, and genetic factors. Symptoms include blood in the urine, pain during urination, and frequent urges to urinate. Diagnosis involves cystoscopy, urine tests, imaging, and biopsy. Treatment depends on cancer stage and invasiveness, and may include surgery, chemotherapy, immunotherapy, and radiation. Side effects vary by treatment but can include incontinence, infertility, fatigue, and pain.
The document discusses retroperitoneal masses, which can be classified as solid or cystic, neoplastic or non-neoplastic. Common solid neoplastic masses include liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Neurogenic tumors and lymphomas also occur. Presentation is usually nonspecific symptoms or a large abdominal mass. Investigation involves blood tests, imaging like CT, and biopsy. Wide surgical resection is the standard treatment when possible.
This document discusses rectal prolapse, including its anatomy, causes, types, clinical features, investigations, and management. It begins with the anatomy of the rectum and its blood supply. It then describes the causes of rectal prolapse as being related to decreased pelvic floor muscle tone. It outlines the types of rectal prolapse as partial, complete, or internal. Management involves dietary changes and injections for partial prolapse or surgery like rectopexy or STARR procedure for complete prolapse.
This document discusses colorectal malignancies and provides an overview of their embryology, anatomy, clinical features, investigations, staging, and treatment. It begins with the embryological development of the colon and rectum from the primitive gut. It then covers the anatomy of the colon, rectum, and anal canal before discussing the blood supply, lymphatic drainage, and nerve supply. The document outlines the epidemiology and risk factors for colorectal cancer. It also summarizes the pathogenesis, clinical presentation, investigations including endoscopic exams, and guidelines for screening. Lastly, it briefly discusses staging of disease and types of cancer spread.
Gallbladder carcinoma is the 5th most common gastrointestinal malignancy worldwide. It has a high incidence in India and Pakistan of 18-23 per 100,000 people. Risk factors include gallstones, gallbladder polyps larger than 1 cm, typhoid infection, and certain drugs. Gallbladder carcinoma commonly spreads locally and via lymphatics. Staging involves ultrasound, CT scan, and MRCP. Early stage 0 and 1 cancers can be managed with watchful cholecystectomy to ensure negative margins.
1. Management of carcinoma of the anal canal involves multimodality treatment with chemoradiation rather than surgery as the primary treatment. Surgery is reserved for patients who do not respond to chemoradiation or have recurrence.
2. Staging of anal canal cancer uses the TNM system and is based on tumor size rather than depth of invasion.
3. Chemoradiation involves concurrent radiation therapy and chemotherapy such as 5-FU and mitomycin-C over several weeks to treat both the primary tumor and regional lymph nodes.
This document discusses carcinoma of the rectum. It begins by explaining the anatomy of the rectum and its blood supply, lymphatic drainage and innervation. It then discusses the epidemiology, risk factors, staging systems including Dukes and TNM classification. Signs and symptoms, diagnostic workup including endoscopic, radiological and biopsy evaluation are explained. Principles of surgical treatment including resection margins are outlined. The goal of surgery is eradication of the primary tumor along with adjacent mesorectal tissue.
Bladder cancer begins in the cells lining the bladder. It is most common in the urothelial cells. The main types are urothelial carcinoma, squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. Risk factors include smoking, chemical exposure, infections, and genetic factors. Symptoms include blood in the urine, pain during urination, and frequent urges to urinate. Diagnosis involves cystoscopy, urine tests, imaging, and biopsy. Treatment depends on cancer stage and invasiveness, and may include surgery, chemotherapy, immunotherapy, and radiation. Side effects vary by treatment but can include incontinence, infertility, fatigue, and pain.
The document discusses retroperitoneal masses, which can be classified as solid or cystic, neoplastic or non-neoplastic. Common solid neoplastic masses include liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Neurogenic tumors and lymphomas also occur. Presentation is usually nonspecific symptoms or a large abdominal mass. Investigation involves blood tests, imaging like CT, and biopsy. Wide surgical resection is the standard treatment when possible.
This document discusses rectal prolapse, including its anatomy, causes, types, clinical features, investigations, and management. It begins with the anatomy of the rectum and its blood supply. It then describes the causes of rectal prolapse as being related to decreased pelvic floor muscle tone. It outlines the types of rectal prolapse as partial, complete, or internal. Management involves dietary changes and injections for partial prolapse or surgery like rectopexy or STARR procedure for complete prolapse.
This document discusses colorectal malignancies and provides an overview of their embryology, anatomy, clinical features, investigations, staging, and treatment. It begins with the embryological development of the colon and rectum from the primitive gut. It then covers the anatomy of the colon, rectum, and anal canal before discussing the blood supply, lymphatic drainage, and nerve supply. The document outlines the epidemiology and risk factors for colorectal cancer. It also summarizes the pathogenesis, clinical presentation, investigations including endoscopic exams, and guidelines for screening. Lastly, it briefly discusses staging of disease and types of cancer spread.
Gallbladder carcinoma is the 5th most common gastrointestinal malignancy worldwide. It has a high incidence in India and Pakistan of 18-23 per 100,000 people. Risk factors include gallstones, gallbladder polyps larger than 1 cm, typhoid infection, and certain drugs. Gallbladder carcinoma commonly spreads locally and via lymphatics. Staging involves ultrasound, CT scan, and MRCP. Early stage 0 and 1 cancers can be managed with watchful cholecystectomy to ensure negative margins.
1. Management of carcinoma of the anal canal involves multimodality treatment with chemoradiation rather than surgery as the primary treatment. Surgery is reserved for patients who do not respond to chemoradiation or have recurrence.
2. Staging of anal canal cancer uses the TNM system and is based on tumor size rather than depth of invasion.
3. Chemoradiation involves concurrent radiation therapy and chemotherapy such as 5-FU and mitomycin-C over several weeks to treat both the primary tumor and regional lymph nodes.
The document discusses carcinoma of the gallbladder, including relevant anatomy, epidemiology, etiology, clinical presentation, workup including imaging and staging, treatment approaches depending on whether the cancer is preoperatively diagnosed, incidentally found during surgery, or incidentally found on pathology after cholecystectomy, as well as follow up considerations. The cancer often arises from chronic inflammation due to gallstones and commonly spreads through lymphatics, veins, and direct invasion into the liver requiring extensive surgical resection if detected before advancing to late stages.
The document discusses carcinoma of the rectum and anal canal. It covers anatomy, blood supply, lymphatic drainage, innervation, clinical features, investigations, staging, types of spread, treatment including surgeries like anterior resection and abdominoperineal resection. It discusses complications, results, local recurrence, radiotherapy and chemotherapy. The summary focuses on key details about anatomy, investigations, treatment options and outcomes.
This document summarizes the anatomy, staging, and risk factors of colon cancer. It describes the development of the colon from the midgut and hindgut. It outlines the layers of the colonic wall and discusses blood supply, lymph nodes, and staging systems including Duke's and TNM staging. Key risk factors discussed include diabetes, smoking, alcohol, and hereditary syndromes.
This document provides information on carcinoma of the rectum, including its anatomy, epidemiology, risk factors, clinical presentation, diagnostic workup, staging, treatment options of surgery, chemotherapy and radiotherapy, and prognosis. Key points include:
- The rectum is located in the pelvis and is about 12-15 cm long, divided into upper, middle, and lower thirds.
- Colorectal cancer is the third most common cancer globally and rectal cancer makes up about 28% of cases.
- Risk factors include age over 50, family history, smoking, obesity, and inflammatory bowel disease.
- Treatment involves total mesorectal excision surgery with or without neoadjuvant chemor
The document describes the anatomy and clinical aspects of the esophagus. It notes that the esophagus is a tubular structure about 25 cm long that begins at the pharynx and pierces the diaphragm to join the stomach. It discusses the relations of the esophagus in the neck, thorax, and abdomen. The document also summarizes the blood supply, lymphatic drainage, and innervation of the esophagus. Finally, it reviews esophageal cancer risk factors, staging, and treatment options including surgery, chemotherapy, and radiation therapy.
The document describes the anatomy, blood supply, innervation, and common cancers of the urinary bladder. It discusses the following key points:
- The bladder wall has four layers - serous, muscular, submucosal, and mucosal coats. The detrusor muscle in the muscular layer allows the bladder to expand and contract.
- The main arteries supplying the bladder are branches from the internal iliac arteries. Lymph drainage is to the external and internal iliac and sacral nodes.
- Over 90% of bladder cancers are transitional cell carcinomas. Risk factors include smoking, occupational exposures, schistosomiasis infection, and certain drugs.
-
The document provides information on colon cancer including:
1. The blood supply, lymphatic drainage, and innervation of the colon.
2. Risk factors for colon cancer development including familial syndromes.
3. Staging systems for colon cancer such as Dukes classification and TNM staging.
4. Clinical features, diagnosis, and screening guidelines for colon cancer.
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.
The document discusses the anatomy and diagnostic evaluation of prostate cancer. It describes the prostate as a walnut-sized gland located below the bladder and surrounding the urethra. The primary function is to produce seminal fluid. Diagnostic workup involves PSA levels, digital rectal exam, prostate biopsy and various imaging modalities like CT, MRI, bone scan and PSMA PET/CT to stage disease extent and metastasis. Gleason scoring is used to grade prostate cancer based on architectural patterns seen on biopsy.
This document discusses a case of a 60-year-old male diagnosed with rectal cancer. It provides details on his medical history, including a sigmoidoscopy that revealed adenocarcinoma of the rectum. He received neoadjuvant chemoradiation therapy. The document discusses the clinical anatomy of the rectum, risk factors for rectal cancer, staging systems, diagnostic workup, and treatment options like surgery. The main treatment is surgery, with the goal of total mesorectal excision to reduce local recurrence rates.
This document provides information on the anatomy, epidemiology, etiology, pathology, clinical manifestations, staging, diagnosis, Gleason scoring, and treatment of prostate cancer. It describes the prostate as a walnut-sized gland located in front of the rectum and below the bladder. It discusses the risk factors for prostate cancer such as family history and diet. The document outlines the staging system for prostate cancer and lists diagnostic tests including PSA levels, biopsy, and imaging. It also explains Gleason scoring and common treatment options such as surgery, radiation therapy, hormone therapy, and chemotherapy.
1) Transanal total mesorectal excision (TME) is a novel technique for resection of rectal cancers.
2) TME involves excising the rectum and the surrounding mesorectum in one block through the anus to minimize local recurrence.
3) This "down-to-up" transanal approach aims to improve on open TME by reducing morbidity and impairment of function compared to traditional surgery.
Pancreatic carcinoma arises from either the exocrine or endocrine tissues of the pancreas. It most commonly originates in the pancreatic ductal cells of the head or body of the pancreas. Risk factors include increasing age, male gender, smoking, family history, and genetic conditions. Symptoms depend on the location of the tumor but commonly include jaundice, abdominal or back pain, weight loss, and new-onset diabetes. Diagnosis involves blood tests, imaging like CT, MRI, ERCP, and biopsy. Staging uses the TNM system to describe tumor size and spread. Prognosis is generally poor due to late diagnosis but depends on tumor characteristics and treatment.
This document discusses bladder and kidney cancer. It notes that about 73,510 new cases of bladder cancer are diagnosed each year in the United States, mainly in older adults. Smoking, workplace exposures, and other factors can increase risk. Bladder cancers are usually transitional cell carcinomas or papillary carcinomas. Staging involves assessing tumor invasion depth and spread. Treatments include surgery, intravesical therapies like BCG immunotherapy, and chemotherapy. Surgical options involve removing all or part of the bladder, and reconstructive surgeries to create urinary diversions. Nursing care focuses on managing urinary diversions, providing education and monitoring for complications.
This document provides details on testicular neoplasm (cancer):
1. It describes the surgical anatomy of the testis and surrounding structures.
2. It discusses the various cell types that can cause testicular cancer, including germ cell tumors and sex cord stromal tumors.
3. It outlines the typical presentation of testicular cancer, including a painless testicular mass, and describes methods for clinical staging and investigation such as serum tumor markers, ultrasound, and MRI.
Colorectal carcinoma anatomy to managementDrAyush Garg
This document provides an overview of colorectal carcinoma, including its anatomy, epidemiology, risk factors, clinical features, screening, pathology, staging, and diagnostic workup. It begins with a description of the embryological development of the colon and rectum. It then discusses the risk factors for colorectal cancer, pre-invasive lesions, clinical presentation, screening guidelines, the adenoma-carcinoma sequence of tumor progression, staging system, and tests used to diagnose and stage colorectal cancer. The goal is to comprehensively cover colorectal carcinoma from anatomy to management.
This document provides an overview of rectal cancer, including:
- Anatomy and blood supply of the rectum.
- Epidemiology - It is the 3rd most common cancer in men and 2nd in women globally. Incidence rates in India are 4.1 per 100,000 in men and 3.5 in women.
- Risk factors include age, smoking, diet, obesity, diabetes, and inflammatory bowel disease.
- Presentation includes rectal bleeding, changes in bowel habits, and abdominal/pelvic pain. Advanced cases cause obstruction or perforation.
- Staging involves endoscopy, transrectal ultrasound, MRI, CT and PET scans to determine tumor depth
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,
This document discusses the anatomy, physiology, examination, and treatment of rectal prolapse. It describes the anatomy of the rectum including blood supply, drainage, and surrounding structures. Examination of the rectum and indications are outlined. Rectal prolapse is classified and risk factors, presentation, evaluation, and complications are covered. Both non-operative and surgical treatment options are summarized, including abdominal, laparoscopic, and perineal procedures.
This document discusses cervical cancer, including its causes, diagnosis, staging, and treatment. It begins with the histology and embryological development of the cervix. Precancerous lesions called cervical intraepithelial neoplasia can develop from persistent HPV infection and potentially progress to cancer over many years if left untreated. Diagnosis involves Pap smear, colposcopy, and biopsy. Staging uses the FIGO system and determines treatment, which may include surgery, radiation therapy, or chemoradiation depending on the stage. The choice of treatment also considers the patient's age and fitness.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
The document discusses carcinoma of the gallbladder, including relevant anatomy, epidemiology, etiology, clinical presentation, workup including imaging and staging, treatment approaches depending on whether the cancer is preoperatively diagnosed, incidentally found during surgery, or incidentally found on pathology after cholecystectomy, as well as follow up considerations. The cancer often arises from chronic inflammation due to gallstones and commonly spreads through lymphatics, veins, and direct invasion into the liver requiring extensive surgical resection if detected before advancing to late stages.
The document discusses carcinoma of the rectum and anal canal. It covers anatomy, blood supply, lymphatic drainage, innervation, clinical features, investigations, staging, types of spread, treatment including surgeries like anterior resection and abdominoperineal resection. It discusses complications, results, local recurrence, radiotherapy and chemotherapy. The summary focuses on key details about anatomy, investigations, treatment options and outcomes.
This document summarizes the anatomy, staging, and risk factors of colon cancer. It describes the development of the colon from the midgut and hindgut. It outlines the layers of the colonic wall and discusses blood supply, lymph nodes, and staging systems including Duke's and TNM staging. Key risk factors discussed include diabetes, smoking, alcohol, and hereditary syndromes.
This document provides information on carcinoma of the rectum, including its anatomy, epidemiology, risk factors, clinical presentation, diagnostic workup, staging, treatment options of surgery, chemotherapy and radiotherapy, and prognosis. Key points include:
- The rectum is located in the pelvis and is about 12-15 cm long, divided into upper, middle, and lower thirds.
- Colorectal cancer is the third most common cancer globally and rectal cancer makes up about 28% of cases.
- Risk factors include age over 50, family history, smoking, obesity, and inflammatory bowel disease.
- Treatment involves total mesorectal excision surgery with or without neoadjuvant chemor
The document describes the anatomy and clinical aspects of the esophagus. It notes that the esophagus is a tubular structure about 25 cm long that begins at the pharynx and pierces the diaphragm to join the stomach. It discusses the relations of the esophagus in the neck, thorax, and abdomen. The document also summarizes the blood supply, lymphatic drainage, and innervation of the esophagus. Finally, it reviews esophageal cancer risk factors, staging, and treatment options including surgery, chemotherapy, and radiation therapy.
The document describes the anatomy, blood supply, innervation, and common cancers of the urinary bladder. It discusses the following key points:
- The bladder wall has four layers - serous, muscular, submucosal, and mucosal coats. The detrusor muscle in the muscular layer allows the bladder to expand and contract.
- The main arteries supplying the bladder are branches from the internal iliac arteries. Lymph drainage is to the external and internal iliac and sacral nodes.
- Over 90% of bladder cancers are transitional cell carcinomas. Risk factors include smoking, occupational exposures, schistosomiasis infection, and certain drugs.
-
The document provides information on colon cancer including:
1. The blood supply, lymphatic drainage, and innervation of the colon.
2. Risk factors for colon cancer development including familial syndromes.
3. Staging systems for colon cancer such as Dukes classification and TNM staging.
4. Clinical features, diagnosis, and screening guidelines for colon cancer.
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.
The document discusses the anatomy and diagnostic evaluation of prostate cancer. It describes the prostate as a walnut-sized gland located below the bladder and surrounding the urethra. The primary function is to produce seminal fluid. Diagnostic workup involves PSA levels, digital rectal exam, prostate biopsy and various imaging modalities like CT, MRI, bone scan and PSMA PET/CT to stage disease extent and metastasis. Gleason scoring is used to grade prostate cancer based on architectural patterns seen on biopsy.
This document discusses a case of a 60-year-old male diagnosed with rectal cancer. It provides details on his medical history, including a sigmoidoscopy that revealed adenocarcinoma of the rectum. He received neoadjuvant chemoradiation therapy. The document discusses the clinical anatomy of the rectum, risk factors for rectal cancer, staging systems, diagnostic workup, and treatment options like surgery. The main treatment is surgery, with the goal of total mesorectal excision to reduce local recurrence rates.
This document provides information on the anatomy, epidemiology, etiology, pathology, clinical manifestations, staging, diagnosis, Gleason scoring, and treatment of prostate cancer. It describes the prostate as a walnut-sized gland located in front of the rectum and below the bladder. It discusses the risk factors for prostate cancer such as family history and diet. The document outlines the staging system for prostate cancer and lists diagnostic tests including PSA levels, biopsy, and imaging. It also explains Gleason scoring and common treatment options such as surgery, radiation therapy, hormone therapy, and chemotherapy.
1) Transanal total mesorectal excision (TME) is a novel technique for resection of rectal cancers.
2) TME involves excising the rectum and the surrounding mesorectum in one block through the anus to minimize local recurrence.
3) This "down-to-up" transanal approach aims to improve on open TME by reducing morbidity and impairment of function compared to traditional surgery.
Pancreatic carcinoma arises from either the exocrine or endocrine tissues of the pancreas. It most commonly originates in the pancreatic ductal cells of the head or body of the pancreas. Risk factors include increasing age, male gender, smoking, family history, and genetic conditions. Symptoms depend on the location of the tumor but commonly include jaundice, abdominal or back pain, weight loss, and new-onset diabetes. Diagnosis involves blood tests, imaging like CT, MRI, ERCP, and biopsy. Staging uses the TNM system to describe tumor size and spread. Prognosis is generally poor due to late diagnosis but depends on tumor characteristics and treatment.
This document discusses bladder and kidney cancer. It notes that about 73,510 new cases of bladder cancer are diagnosed each year in the United States, mainly in older adults. Smoking, workplace exposures, and other factors can increase risk. Bladder cancers are usually transitional cell carcinomas or papillary carcinomas. Staging involves assessing tumor invasion depth and spread. Treatments include surgery, intravesical therapies like BCG immunotherapy, and chemotherapy. Surgical options involve removing all or part of the bladder, and reconstructive surgeries to create urinary diversions. Nursing care focuses on managing urinary diversions, providing education and monitoring for complications.
This document provides details on testicular neoplasm (cancer):
1. It describes the surgical anatomy of the testis and surrounding structures.
2. It discusses the various cell types that can cause testicular cancer, including germ cell tumors and sex cord stromal tumors.
3. It outlines the typical presentation of testicular cancer, including a painless testicular mass, and describes methods for clinical staging and investigation such as serum tumor markers, ultrasound, and MRI.
Colorectal carcinoma anatomy to managementDrAyush Garg
This document provides an overview of colorectal carcinoma, including its anatomy, epidemiology, risk factors, clinical features, screening, pathology, staging, and diagnostic workup. It begins with a description of the embryological development of the colon and rectum. It then discusses the risk factors for colorectal cancer, pre-invasive lesions, clinical presentation, screening guidelines, the adenoma-carcinoma sequence of tumor progression, staging system, and tests used to diagnose and stage colorectal cancer. The goal is to comprehensively cover colorectal carcinoma from anatomy to management.
This document provides an overview of rectal cancer, including:
- Anatomy and blood supply of the rectum.
- Epidemiology - It is the 3rd most common cancer in men and 2nd in women globally. Incidence rates in India are 4.1 per 100,000 in men and 3.5 in women.
- Risk factors include age, smoking, diet, obesity, diabetes, and inflammatory bowel disease.
- Presentation includes rectal bleeding, changes in bowel habits, and abdominal/pelvic pain. Advanced cases cause obstruction or perforation.
- Staging involves endoscopy, transrectal ultrasound, MRI, CT and PET scans to determine tumor depth
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,
This document discusses the anatomy, physiology, examination, and treatment of rectal prolapse. It describes the anatomy of the rectum including blood supply, drainage, and surrounding structures. Examination of the rectum and indications are outlined. Rectal prolapse is classified and risk factors, presentation, evaluation, and complications are covered. Both non-operative and surgical treatment options are summarized, including abdominal, laparoscopic, and perineal procedures.
This document discusses cervical cancer, including its causes, diagnosis, staging, and treatment. It begins with the histology and embryological development of the cervix. Precancerous lesions called cervical intraepithelial neoplasia can develop from persistent HPV infection and potentially progress to cancer over many years if left untreated. Diagnosis involves Pap smear, colposcopy, and biopsy. Staging uses the FIGO system and determines treatment, which may include surgery, radiation therapy, or chemoradiation depending on the stage. The choice of treatment also considers the patient's age and fitness.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
2. Incidence and Epidemiology
• In world- men-3rd (10.0% of all cancer cases)
women-2nd (9.4% of all cancer cases).
• 60% of cases -developed countries.
• The number of CRC-related deaths-accounting for 8% of all cancer deaths and making CRC the
fourth most common cause of death due to cancer.
• In India, the annual incidence rates (AARs) - colon and rectal cancer in men are 4.4 and 4.1 per
100000, respectively.
- women is 3.9 per 100000.
• Colon cancer ranks 8th and rectal cancer ranks 9th among men.
• women, rectal cancer does not figure in the top 10 cancers, whereas colon cancer ranks 9th.
• In the 2013 report, the highest AAR in india in men- Thiruvananthapuram (4.1) followed by Banglore
(3.9) and Mumbai (3.7) .
• The highest AAR in women for CRCs was recorded in Nagaland (5.2) followed by Aizwal (4.5)
3. Anatomy of rectum
• length-15 to 20 cm
• Extends from the rectosigmoid junction(fusion of the taenia coli into a completely
circumferential muscular layer) to the pelvic diaphragm-2-3 cm below and 4 cm in
front of the coccyx.
• Parts -Upper third-Intraperitoneal
-Middle third-retroperitoneal
-lower third- extraperitoneal
4. • Shape –
Variable in shape, the rectum follow the sacrococcygeal ligament
Widens below as ampulla, which is very distensible
• Three involutions or curves (valves of Houston)
-Proximal and distal valves- fold to the right
-Middle valve- folds to the left(Kohlrausch’s
valve)
• These valves are more properly called folds because they have no
specific function as impediments to flow.
• lost after full surgical mobilization of the rectum, a maneuver that may
provide approximately 5 cm of additional length to the rectum, greatly
facilitating the surgeon’s ability to fashion an anastomosis deep in the
pelvis.
6. • Peritoneal reflections at the middle third of
the rectum which is approx.
7-9 cm from the anal verge in
male
5-7.5 cm from the anal verge in
female
• Anteriorly form the pelvic cul-de-sac
(pouch of Douglas, rectouterine pouch)
serve as the site of drop metastatic
deposits(Blumer’s shelf) from visceral
tumors.
• Detected by a digital rectal examination.
• The rectum has two flexures-
• Sacral flexure(Dorsal bend) results from the
concave form of sacrum
• Perineal flexure(Ventral band)results from the
encirclement of the rectum by levator ani
muscle (puborectalis sling)
• Layers of the rectum-
7. Relations
• Anteriorly -Denonvilliers fascia(a fold of two layers of peritoneum)Separates the rectum
from
In males- Bladder, posterior prostate and seminal vesicles above and ductus
deference below
Female- the peritoneal fold form the pouch of Douglas-
back of cervix and vagina
• Posteriorly the rectum separated from the sacrum and coccyx by the
Mesorectum
Fascia propria
Presacral fascia
Waldeyer’s fascia
• laterally- the visceral fascia condenses to form the lateral ligament of the rectum
8.
9. Fascia
• Fascia propria- an extension of the endopelvic fascia, encloses the rectum and its
mesorectal fat, lymphatics, and vascular supply as a single unit;
-forms the lateral stalks of the rectum; and connects to the parietal
fascia on the pelvic sidewall.
• Presacral fascia is the parietal fascia that covers the sacrum and coccyx, presacral
plexus, pelvic autonomic nerves, and the middle sacral artery.
• Waldeyer’s fascia-Posterior thickening of presacral fascia, at the level of S4.
• Denonvilliers’ fascia -a fold of two layers of peritoneum separates the anterior rectal wall
from the prostate and seminal vesicles in the male and in female from the posterior wall of
vagina.
10. Lymphatic Drainage
• Upper and middle rectum- drains
into the inferior mesenteric nodes .
• lower rectum-drain into the
inferior mesenteric system(network
along the middle and inferior rectal
arteries, posteriorly along the
middle sacral artery, and anteriorly
through the channels to the retro-
vesical or rectovaginal septum) to
the iliac nodes, and ultimately, to
the periaortic nodes.
11. Nerve supply
• Pelvic autonomic nerves - paired
hypogastric (sympathetic), sacral
(parasympathetic), and Inferior
hypogastric nerves .
• Sympathetic nerves supply- originate
from L1 to L3, form the inferior mesenteric
plexus, travel through the superior
hypogastric plexus, and descend as the
hypogastric nerves to the pelvic plexus.
• Parasympathetic nerves, or nervi
erigentes, arise from S2 to S4 and join
the hypogastric nerves anterior and lateral
to the rectum to form the pelvic plexus
and ultimately the periprostatic plexus
• Fibers from this plexus innervate the
rectum as well as the bladder, ureter,
prostate, seminal vesicles, membranous
urethra, and corpora cavernosa.
• Injury to these autonomic nerves can lead
to impotence, bladder dysfunction, and
loss of normal defecatory mechanisms.
12. Risk factors for carcinoma Rectum
• History of a first-degree relative with colorectal cancer.
• Inflammatory bowel disease (IBD)
• Familial adenomatous polyposis (FAP)(autosomal dominant syndrome) defect in the APC
gene located on chromosome 5q21, Lynch syndrome, 5MYH genetic defect
• Dietary fats, especially red-meat fats, alcohol consumption
• Type, size, and number of polyps
• Sedentary lifestyle, high-fat diet
15. Adenoma-to carcinoma sequence
75% to 85% of adenomas-tubular, form a stalk
8% to 15% of adenomas -tubulovillous
5% to 10% of adenomas - villous. broad base, increased risk of cancer
16. Haggitt and colleagues classification
Polyps containing cancer according to the
depth of invasion
• Level 0: Carcinoma does not invade the
muscularis mucosae
(carcinoma in situ or intramucosal
carcinoma)
• Level 1: Carcinoma invades through the
muscularis mucosae into the submucosa
but is limited to the head of the polyp
• Level 2: Carcinoma invades the level of
the neck of the polyp
(junction between the head and
stalk)
• Level 3: Carcinoma invades any part of
the stalk
• Level 4: Carcinoma invades into the
submucosa of the bowel wall below the
17. Clinical Feature
• Hematochezia
• Tenesmus(sensation of incomplete defecation)
• Change in bowel habits or stool caliber
• Spurious diarrhoea(Early morning)
• Mucous discharge
• Sense of rectal “fullness”
• Feature of bowel obstruction
• Weight loss
• Nausea
• Vomiting
• Fatigue
• Anorexia
18. General Examination
Physical examination starts when the patient enters the clinic.
• Assessment of illness
• Mental state and intelligence
• Build
• State of nutrition
• Attitude
• Decubitus (position in bed)
• Colour of the skin, skin eruptions
• Pulse,blood pressure, respiration and temperature.
19. • Bimanual Examination- examination of the contents of the pelvis can be conveniently
examined during rectal examination by placing another hand on the abdomen.
This gives a better idea of the size, shape and nature of any pelvic mass.
Identification of bladder carcinoma
look at the examining finger for presence of faeces, blood, pus or mucus.
• Abdominal Examination- annular carcinoma at the upper part of the rectum an indistinct
lump may be felt at the left side of the abdomen.
Due to descending colon loaded with hard faeces(swelling pits on pressure)
Examine the liver for secondary metastasis.
Examine jaundice, hard subcutaneous nodules and free fluid.
• Lymph Nodes- hind gut will metastasize to the iliac groups of lymph nodes.
- lower part of the anal canal below the pectinate line commonly spreads
to
the inguinal group of lymph nodes and these are easily palpable.
20. Local Examination and Investigation
• Digital rectal examination (DRE)- any rectal growth.
-Assessment of tumor size.
-Mobility and fixation.
-Anterior or posterior location.
-Relationship to the sphincter mechanism.
-Identify Top of the anorectal ring.
-Distance from the anal verge.
• Rigid proctoscopy -Demonstrates the proximal and distal levels of the mass from anal
verge,
-Extent of circumferential involvement,
-Orientation within the lumen, and relationship to the vagina,
prostate, or
peritoneal reflection.
-Determining the feasibility of local excision
-To obtain an adequate tissue biopsy.
21. • Rigid sigmoidoscopy
• Flexible sigmoidoscopy – not used routinely
• flexibility of the instrument can give a false distance between the
tumor and the dentate line.
• Complete colonoscopy -to rule out synchronous cancers, which
occur 2% to 8% of the time.
• prefer colonoscopy over virtual colonoscopy so that we may not
only diagnose but also excise any amenable polyps.
• women should undergo a complete pelvic examination to determine
vaginal invasion.
22. • Abdominal and pelvic CT scans-
-Demonstrate regional tumor extension,lymphatic and distant
metastases, tumor related complications such as perforation or fistula
formation.
• CECT scan
-To assess the liver for metastatic disease,
-To evaluate the size and function of the kidneys.
-Assess the Ureteral involvement by the tumor and planning of ureteral
stent placement preoperatively.
-Invasion of contiguous structures such as the vagina, prostate, and
bladder lateral pelvic sidewall invasion.
24. Staging of rectal tumors on the basis of
endoscopic
Rectal Ultrasound
25. Indication of MRI
• For TNM staging
• Based on depth of tumor invasion as
well as presence of lymph node or
distant metastases
• To describe the anatomic extent of the
lesion.
• Aids in planning treatment
• Evaluating response to treatment
• Comparing the results of various
treatment regimens
• Determining prognosis.
29. Dukes’ Staging
A: limited to the rectal wall (15%). The prognosis is excellent (>90% 5-year
survival).
B: Extends to the extra rectal tissues, but without metastasis to the regional lymph
nodes (35%). The prognosis is reasonable (70% 5-year survival).
C: Secondary deposits in the regional lymph nodes (50%).
C1-local pararectal lymph nodes alone are involved
C2-Nodes accompanying the supplying blood vessels to their origin from the aorta stage
D-Presence of widespread metastases, usually hepatic
30. Astler- Coller modification of Duke’s
staging
• A- Tumor limited to the mucosa,
carcinoma in situ
• B1-Tumor grows through
submucosa but not through
muscularis propria
• B2-tumor grows beyond
muscularis propria
• C1-stage B1 with regional lymph
node metastases
• C2-stage B2 with regional lymph
node metastases
• D- Distant metastasis
31. Stage STAGE T N M Dukes MAC
0 Tis N0 M0 - -
1 T1 N0 M0 A A
T2 N0 M0 A B1
IIA T3 N0 M0 B B2
IIB T4a N0 M0 B B2
IIC T4b N0 M0 B B3
IIIA T1-T2 N1/N1c M0 C C1
T1 N2a M0 C C1
IIIB T3-T4a N1/N1c M0 C C2
T2-T3 N2a M0 C C1/C2
T1-T2 N2b M0 C C1
IIIC T4a N2a M0 C C2
T3-T4a N2b M0 C C2
T4b N1-N2 M0 C C3
IVA Any T Any N M1a - -
IVB Any T Any N M1b - -
32. Principles Of Treatment
• Depending on the stage of tumor
• location of the tumor within the rectum.
• Superficially invasive, small cancers -local excision.
• Deeply invasive tumors- require major surgery, such as low anterior
resection (LAR) or APR.
• Stage II and III rectal cancer, combined preoperative chemoradiotherapy.
• Stage IV- palliative therapy
33. Abdominoperineal resection
• Distal rectal cancers - abdominoperineal resection (APR)-first described by Miles, who noted high
failure rates after local excision.
• Involves the en bloc resection of the tumor as well as the surrounding lymph nodes and the anal
sphincters, resulting in a permanent end colostomy.
• Quite successful for early rectal cancers (stage I) in terms of survival,
• Significant morbidity of 61% and mortality ranging from 0% to 6.3%.
• Urinary complications - 50% and perineal wound infections 16%.
leaks from their stoma appliance sexual dysfunction
• The 5-year survival rates- 78% to 100% - stage I
45% to 73% - stage II
22% to 66% - stage III
34. • First phase of resection is abdominal approach.
• Patient lying in the supine position.
• Mobilisation of the distal sigmoid and rectum.
• Second phase of resection-perineal route.
• Dissect the anal canal cut the lesion and delivered by the perineal
route.
• Anal opening closed with the suture.
• Mature the colon with permanent end colostomy.
35. Perineal dissection: two-team synchronous approach. A. Projected lines of pelvic floor resection in the
vertical plane. B. Anal closure. C. Perineal incision. D. Incision line anterior to coccyx through anococcygeal
ligament through which scissors are used to gain entrance to the pelvis. E. Planes of pelvic dissection and
posterior plane of entry into pelvis through the pelvic floor. F. Projected lines of pelvic floor transection. G.
Lateral transection of levator ani muscle. H. Anterior transection of rectourethralis, puborectalis, and
pubococcygeus. I. Completion of anterior dissection and removal of rectum through perineal wound. J.
Pelvic floor closed with two drains in place.
36. Total Meso-rectal Excision
• Take out the tumor and mesorectal fat
also
• Done along with all type of resection
surgery
• Involves precise dissection and removal of
the entire rectal mesentery, including that
distal to the tumor, as an intact unit.
• Sharp dissection under direct vision in
the avascular, areolar plane between the
fascia propria of the rectum, which
encompasses the mesorectum, and the
parietal fascia overlying the pelvic wall
structures.
• Autonomic nerve preservation (ANP)
37. Low anterior resection
• Done in the mid and lower rectal
carcinoma.
• Resection done by dividing the
waldeyer’s fascia to enter into the
deep rectal space.
• Taken 2 cm safe margin from the
dentate line
Ultra-low anterior resection-
• Done only in distal rectal cancer.
• LAR with 0.5-1cm safe margin from
the dentate line.
Anterior resection
• Done in the proximal rectal cancer
• Safe margin 5 cm proximal and
distal to the tumor
• Stay above the waldeyer’s fascia
38. Local Excision
• Four approaches:-
-Transsphincteric
-Transanal
-Transcoccygeal
-TEM(Transanal endoscopic microsurgery)
• local recurrence rate of 7% to 33%
• Survival rates of 57% to 87%.
• Risk factors for local recurrence- positive surgical margins, transmural
extension, lymphovascular invasion, and
poorly differentiated/high grade histology.
39. Trans anal Excision
• Small distal rectal cancers
• lesion range from 6 to 8 cm above the anal verge,3 to 4 cm above the
anorectal ring.
40. Transcoccygeal Excision
• Originally popularized by Kraske
• Used for larger or more proximal lesions within the middle or distal third of
the rectum
• Approximately 4.8 cm from the dentate line.
• Useful for lesions on the posterior wall of the rectum but can be used for
anterior lesions.
• Bowel preparation and thrombosis precautions
• Placed in the prone jack knife position.
• Complication-fecal fistula(The incidence is 5% to 20%)
41. Transanal Endoscopic Microsurgery (TEM)
First described by Gerhard Buess of Tubingen, Germany, in 1980.
• Useful for small benign and malignant lesions in the mid and proximal
rectum that are too high for a traditional transanal excision.
• Anterior lesion-placed in the prone jack knife position.
• Posterior lesion- placed in a modified lithotomy position.
• lateral lesions, the patient can be placed on the appropriate side so that
the lesion is at the inferior quadrant of the visual field.
• The rectum is distended with carbon dioxide anywhere from 15- to 26-cm
water pressure so that the tumor can be visualized and the resection and
closure of the rectum can be completed.
43. • LAPAROSCOPIC SURGERY
Preservation of the autonomic nerves is also possible during laparoscopic
TME.
Early results confirmed complete resection of the mesorectum with intact
visceral fascia in all patients.
• ROBOTIC SURGERY
The main obstacles to robotic rectal cancer surgery (and even laparoscopic
when compared to open technique) - High learning curve
- Time constraints
- High cost of the procedure
-Operative time is longer
44. Pre operative bowel preparation
• Includes a clear-liquid diet 24 hours prior to surgery,
• laxatives and/or enemas,
• Oral antibiotics (erythromycin base and neomycin base)
• gastrointestinal tract irrigation with a solution of polyethylene glycol
electrolyte lavage (GoLYTELY or Miralax).
• Nichols/Condon preparation: neomycin 1 g and erythromycin base 1 g,
both non-absorbable antibiotics, by mouth at 5:00 pm and 10:00 pm on the
day prior to surgery.
• Perioperative systemic antibiotics should be given prior to incision time.
• Cover both aerobic and anaerobic intestinal bacteria is a second- or third
generation cephalosporin in combination with metronidazole.
45. Complications of surgical management
Early complications
• Infection
• Bleeding
• Wound problems
• Postoperative fever, tachycardia,
arrhythmias, tachypnea
• Urinary incontinence
Late complications
• Deep venous thrombosis
• Pulmonary embolism
• Myocardial infarction, Pneumonia, Renal
failure.
• Impaired sexual function
• Enterocutaneous fistula, or diffuse
peritonitis
• Anastomotic leaks between 4 and 7 days
• Stoma complications- ischemia,
retraction, hernia, stenosis, and prolapse.
46. Management Of Stage IV Disease-
• Palliative resection-depends on the degree of symptoms present.
-Bleeding, localized perforation, and obstruction
• Management options
1.Permanent diversion followed by chemotherapy (± radiotherapy
depending on local symptoms)
2. Palliative resection with a permanent colostomy followed by chemotherapy and
radiotherapy
3.Palliative resection with restoration of GI continuity followed by chemotherapy ±
radiation therapy.
Extend the median life expectancy of patients with stage IV disease from
approximately 8 months to nearly 2 years.
48. Neoadjuvent and Adjuvent chemotherapy
Tis; pT1N0, pT2N0 Observation
pT3–4N0, pT1–3N1–2,
pT4N1–2
5-FU±LV or FOLFOX or capecitabine ± oxaliplatin followed by
infusional
5-FU/radiotherapy (RT)or capecitabine + RT followed by 5-
FU±LV
OR FOLFOX or capecitabine ±oxaliplatin or infusional5-FU/RT
OR
capecitabine + RT followed by 5-FU±LV or FOLFOX or
capecitabine ±
oxaliplatin
cT3N0, any TN1–2 Preoperative infusional 5-FU/RT or capecitabine + RT
followed by surgery
and then 5-FU±LV or FOLFOX or capecitabine ± oxaliplatin
cT4 and/or locally unresectable Infusional 5-FU/RT or capecitabine + RT followed by surgical
resection
if possible and then 5-FU±LV or FOLFOX or capecitabine ±
49. Regimen of chemotherapeutic drugs
1-FOLFOX (2-weekly regimen)
Day 1 Oxaliplatin 85mg/m2 ,infusion over 2h
Folinic acid 350mg, infusion over 2 h
5-FU 400mg/m2 , bolus
5-FU 1200mg/m2 , continuous infusion over 24 h
Day 2 5-FU 1200mg/m2 ,continuous infusion over 24 h
2-CAPOX (3-weekly regimen)
Day 1 Oxaliplatin 130mg/m2 , intravenous infusion over 2h
Days 1–14 Capecitabine 1700 mg/m2 , oral in 2 divided doses Age >75 years: reduced starting
dose; oxaliplatin 100mg/m2 andcapecitabine 1300mg·m-2day-1 for 14 days followed by a 7-day rest
period Capecitabine (3-weekly regimen)
Capecitabine: 2000mg/m-2day-1 in 2 divided doses for 14 days followed by a 1-week break.
50. 3-FOLFIRI (2-weekly regimen)
Day 1 Irinotecan 180mg/m2 ,intravenous infusion over 1 h
Folinic acid 350mg,intravenous infusion over 2 h
5-FU 400mg/m2 ,intravenous bolus 5-FU 1200mg/m2 ,
continuous
intravenous infusion over 24 h Day 2 5-FU 1200mg/m2 ,
continuous
intravenous infusion over 24 h
4-CAPIRI (3-weekly regimen)
Day 1 Irinotecan 200mg/m2 ,intravenous infusion over 60
min
Days 1–14 Capecitabine 1700mg,oral in 2 divided doses
followed by a 1-week break.
51. Management of obstructing, metastatic, and
recurrent
rectal cancer
• Obstructing Cancer- a loop ileostomy is constructed for diversion.
• Metastatic Rectal Cancer- Presented with incurable metastatic disease and
life expectancy is greater than 6 months
Palliative rectal resection.
Neoadjuvant chemoradiation-staged T3 or N1
Rectal stents or laser destruction of the tumor- to
maintain an adequate lumen.
52. • Recurrent Rectal Cancer-
Developed at the distal margin of the anastomosis
Mostly develop from residual cancer on the pelvic sidewall
or
inadequate TME with mesorectal nodes that are not
excised as
part of the endopelvic envelope
• Performed in an operating room–radiation therapy suite.(Intra
Operative Radiation Therapy)
• Resection with negative microscopic margins and absence of
vascular invasion - predicts improved local control and survival after
resection and IORT.
• Morbidities of IORT -peripheral neuropathy and ureteral stenosis.
53. Surveillance
• After curative resection, long-term follow-up includes routine screening for rectal recurrence and
metachronous colorectal neoplasms.
• 60% to 84% of recurrences-in the first 24 months
90% within 48 months.
• Median time to recurrence -11 to 22 months.
• Local recurrence rates- between 4% and 50%.
• Median survival after recurrences-40 months.
• Survival rate in different stages
54. Follow-up
• Patients are seen postoperatively at 2 weeks and then every 3 months for
2 years.
• At each visit, the patient undergoes DRE and sigmoidoscopy, and a CEA
level is obtained.
• As per the National Comprehensive Cancer Network (NCCN) guidelines,
we recommend at 1 year post-resection a colonoscopy and CT scans of
the chest, abdomen, and pelvis.
• A CT scan is performed annually until 3 to 5 years postoperatively.
• Colonoscopy frequency is determined by the findings at 1 year.
• If there are no polyps and no recurrence, the follow-up interval
colonoscopy can be lengthened to 3 years, and then if normal even up to a
5-year interval after that.
55. • Certainly, in patients who have polyps, Lynch syndrome, or are
younger at the initial age of diagnosis, a shorter interval such as
every 3 years is recommended.
• After the initial 2 years of surveillance, patients continue to be
followed every 6 months with CEA levels and physical examinations
until 5 years after the surgery.
• At 5 years, if the patient has had no recurrence, he or she may be
followed yearly with clinic visits and may undergo colonoscopy
every 3 to 5 years as outlined above.
• Of course, closer observation is indicated for patients at high risk
for subsequent cancer formation, such as patients with IBD,
polyposis syndromes, or a strong family history of colorectal cancer.