Ca Stomach
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This document outlines objectives and information about gastric cancer including epidemiology, risk factors, pathology, clinical features, investigations, staging, treatment, and prognosis. It discusses that distal gastric cancer is more common in low socioeconomic countries while proximal cancer is more common in developed countries. Risk factors include H. pylori infection, smoking, diet, and family history. Staging involves the TNM system and Lauren classification divides gastric cancer into intestinal and diffuse types. Investigations include endoscopy, imaging, and biopsy. Treatment involves surgery such as total or subtotal gastrectomy as well as chemotherapy and radiation. Poor prognosis is associated with hematogenous or peritoneal metastasis, extensive nodal disease, and fixation to surrounding structures.
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Gastric Cancer ( stomach tumor )
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
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Left gastro-epiploic artery
Short gastric arteries
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Blood supply
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- It describes the anatomy of the anal canal and classifications of fistula types.
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Ca stomach treatment
This document discusses gastric cancer staging, prognosis, and treatment options. It outlines the TNM staging system used by the International Union Against Cancer, describing tumor size, lymph node involvement, and metastasis. Treatment may include surgery such as gastrectomy, chemotherapy, and radiotherapy. Palliative procedures are used for inoperable cases. Factors such as lymph node involvement and tumor depth impact prognosis.
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The document discusses the use of diagnostic algorithms and antibody panels to identify tumor types through immunohistochemistry (IHC). It provides examples of algorithms that use sequential testing of antibodies to differentiate between common tumor types like carcinoma vs sarcoma, or to identify the primary origin of a metastatic tumor. The algorithms aim to increase diagnostic accuracy and guide treatment by narrowing down the possible tumor types. Key details about specific antibodies, their targets, and staining patterns are also presented.
Carcinoma stomach
carcinoma stomach
associated with epigastric mass moving with respiration,
history, symptoms
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This document discusses stomach cancer incidence, risk factors, diagnosis, staging and survival rates. It notes that approximately 760,000 stomach cancer cases are diagnosed worldwide each year, with most cases occurring in Eastern Asia. Key risk factors include H. pylori infection, smoking, and diets high in smoked, salted foods and red meat. Stomach cancers are typically diagnosed via endoscopy with biopsy and staged based on tumor size, lymph node involvement and metastasis. Five-year survival ranges from 71% for early stage IA to 4% for late stage IV disease.
Gastric cancer presentation final
Gastric cancer is the second most common cancer worldwide. It is most common in elderly men over 65 years old. Risk factors include family history, diet high in salt/fat/nitrates, H. pylori infection, and atrophic gastritis. Premalignant conditions include polyps, intestinal metaplasia, and dysplasia. Symptoms include dyspepsia and pain induced by meat that does not respond to treatment. Staging systems include Bormann's classification and the Japanese classification. Histologically, Lauren's classification divides gastric cancer into intestinal and diffuse types based on cell morphology and growth pattern.
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This document discusses gastric cancer including epidemiology, risk factors, clinical features, staging, prognosis, investigations, and treatment options. Gastric cancer risk increases after age 50 and is more common in males, smokers, and those with low socioeconomic status or pernicious anemia. Symptoms depend on tumor location but may include dyspepsia, bloating, or weight loss. Treatment involves surgery like gastrectomy, with chemotherapy and radiation used for advanced cases. Prognosis depends on stage, with 5-year survival rates ranging from 71% for stage IA to 4% for stage IV disease.
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gastric adenocarcinoma
A 66-year-old man presented with dysphagia and weight loss. An endoscopy revealed adenocarcinoma of the stomach. Further workup with biopsy and CT scan confirmed moderately differentiated adenocarcinoma. The patient's cancer was staged and treatment options of surgery, chemotherapy, radiation or chemoradiation were discussed. Screening for stomach cancer remains controversial but may be recommended for high-risk groups in areas with high incidence.
Benign & Malignant Tumors of the Stomach
Benign & Malignant Tumors of the StomachKanyakumari Government Medical College, Nagercoil, Tamil Nadu, India
Malignancies of the StomachGit 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.
GIT malignancies
1. The document discusses several gastrointestinal malignancies including cancer of the stomach, pancreas, and esophagus.
2. It provides details on the types, risk factors, clinical features, diagnosis, staging, and treatment options for each cancer type.
3. The prognosis for pancreatic and esophageal cancers is generally poor, as they often present at late stages and have low 5-year survival rates, while treatments for stomach cancers include surgical resection and chemotherapy or radiation depending on the stage and location of cancer.
Cancer colon
Colon and rectal cancer are the 3rd leading cause of cancer death in men and women. Risk factors include genetic predisposition, inflammatory bowel disease, tobacco use, sedentary lifestyle, obesity, diet, and family history. Screening is recommended starting at age 50, or earlier for those with risk factors. Treatment depends on the cancer stage and may involve surgery, radiation, chemotherapy, or a combination. The prognosis depends on stage, extent of disease, and ability to completely remove the cancer.
Malignant Neoplasms of Stomach.pptx
This document discusses malignant neoplasms of the stomach. Some key points:
- Stomach cancer is the 5th most common cancer globally and the 3rd leading cause of cancer death. Outcomes are generally poor due to late stage at presentation.
- Risk factors include H. pylori infection, smoking, low fruit/vegetable diet, family history, and prior gastric surgery or conditions like pernicious anemia.
- Tumors are classified by location, histology (intestinal vs diffuse), and stage. Diagnosis involves endoscopy, biopsy, and imaging.
- Treatment depends on stage but commonly includes surgical resection with lymph node dissection, with or without adjuvant chemotherapy/radiation
Gastric cancer
This document discusses gastric cancer, including:
- Malignant gastric tumors are mostly adenocarcinoma while benign tumors are rare.
- Risk factors include H. pylori infection, low socioeconomic status, and genetic mutations.
- Symptoms often include weight loss, abdominal pain, nausea, and dysphagia.
- Treatment involves surgical resection if possible along with adjuvant therapy and lymph node dissection.
- Other gastric tumors such as lymphoma and gastrointestinal stromal tumors are also discussed.
Carcinoma stomach presentation from text
This document provides an overview of carcinoma of the stomach, including epidemiology, etiology, pathology, clinical features, diagnosis, and staging. Some key points:
- Adenocarcinoma accounts for 95% of stomach cancers. Risk factors include H. pylori infection, dietary factors, genetic predisposition, and premalignant conditions like atrophic gastritis and intestinal metaplasia.
- Clinical features are often vague in advanced cases, presenting with epigastric pain, weight loss, obstruction, or metastases. Diagnosis involves endoscopy with biopsy for histology. Staging includes endoscopic ultrasound, CT, PET, and sometimes laparoscopy.
- Prognosis depends on
Gastric cancer
The document summarizes information about gastric cancer including its location in the stomach, classification, risk factors, diagnosis, staging, and management. Some key points are:
- Gastric cancer develops through a sequence of changes called the Correa cascade triggered by H. pylori infection and other environmental factors.
- Classification includes anatomical staging, histological subtypes, and molecular markers which guide treatment and prognosis.
- Risk increases with age, smoking, diet, and genetic conditions. Screening occurs in high-risk areas like Japan.
- Diagnosis is by endoscopy and biopsy. Staging involves blood tests, imaging, and endoscopic ultrasound.
- Treatment depends on stage but may include surgery,
Carcinoma stomach
This document discusses gastric cancer, including its incidence, risk factors, pathogenesis, clinical presentation, diagnostic evaluation, staging, and treatment approaches. Some key points include:
- Gastric cancer has a poor prognosis with only 20% 5-year survival. Early diagnosis is key.
- Risk factors include H. pylori infection, smoking, low socioeconomic status, and diets high in salt/preserved foods.
- Diagnosis involves endoscopy with biopsy. Staging evaluates tumor invasion and metastasis using CT, PET, and laparoscopy.
- Surgery offering total or subtotal gastrectomy is the only curative option, while chemotherapy and radiation are palliative.
Colorectal ca
1. Colorectal cancer is the second most common malignancy in females and third most common in males. It is also the fourth most common cause of cancer death.
2. Risk factors include red meat, obesity, smoking, alcohol, family history, and inflammatory bowel disease. Most cases are sporadic but some are hereditary.
3. Symptoms depend on the location of the cancer in the colon but may include blood in stool, changes in bowel habits, abdominal pain, weight loss, and anemia.
4. Treatment involves surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy depending on the stage and characteristics of the cancer. The type of surgery performed also depends on the location and
Carcinoma stomach- A Brief Overview- Part 1
Carcinoma of the stomach is the 14th most common cancer in the US and the 4th most common worldwide. Risk factors include H. pylori infection, low socioeconomic status, smoking, and diets high in salted/smoked foods and nitrates. Premalignant conditions include polyps, atrophic gastritis, intestinal metaplasia, and dysplasia. Presentation includes dyspepsia unresponsive to treatment, epigastric pain worsened by eating but not relieved by vomiting, and nausea. Endoscopic biopsy is needed for diagnosis.
Cancergastri2008
The document discusses various types of stomach tumors including gastric adenocarcinoma, GIST tumors, and lymphomas. It covers the epidemiology, risk factors, staging, diagnostic evaluations, surgical and non-surgical treatment options, and outcomes for gastric cancer and other stomach tumors. Guidelines for referral for endoscopy based on dyspepsia symptoms are also summarized.
Gastric cancer
Gastric cancer is most commonly adenocarcinoma (95%), while lymphomas account for 4% and gastrointestinal stromal tumors (GIST) 1%. Common symptoms include weight loss (62%), abdominal pain (52%), and nausea (34%). Physical examination may reveal signs of metastasis to the liver, peritoneum, or lymph nodes. Gastric cancers are classified as intestinal or diffuse types based on cell morphology and adhesion molecule expression, with intestinal types more commonly associated with Helicobacter pylori infection. Staging evaluates tumor invasion depth, lymph node involvement, and distant metastasis.
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vascular & ortho.pptx
The document provides an outline for a class on final proficiency examinations covering vascular disease and orthopedics. The vascular disease section includes topics like peripheral vascular disease, arterial diseases like acute and chronic limb ischemia, venous diseases like varicose veins and deep vein thrombosis. The orthopedics section covers fractures, their classification, diagnosis and management. Key investigations discussed are Doppler ultrasound, angiography and management includes nonsurgical options like medications and interventional procedures like angioplasty as well as surgical treatments.
Preoperative preparation of high risk patients.pptx
The document discusses preoperative preparation and management of common high-risk surgical patients, outlining evaluation, correction of medical issues, prophylaxis needed, and specific considerations and protocols for patients with diabetes, deep vein thrombosis risk, use of anticoagulants, history of myocardial infarction, hypertension, COPD, steroid use, thyroid abnormalities, adrenal insufficiency, and pheochromocytoma. Precautions and protocols are provided to optimize patient health and safety prior to and following surgery.
diagnostic evaluation for malignent disease.pptx
Physical assessment, lab tests, imaging studies, and tissue diagnosis are used to evaluate patients for possible malignant disease. Lab tests may include blood tests, urine tests, and tumor marker tests. Imaging studies like x-ray, ultrasound, CT, MRI, and nuclear scans provide images of internal organs and tissues. Tissue is obtained through non-invasive or invasive procedures like biopsy and endoscopy and is examined histologically with immunohistochemistry and molecular pathology to make a final diagnosis of cancer.
common investigations for pelvic floor.pptx
This document discusses various investigations used for morphological and functional assessment of pelvic floor disorders like prolapse and incontinence. It describes defecography, ultrasound, anorectal manometry, balloon expulsion test, electromyography, pudendal nerve latency test, and urodynamic studies. These tests evaluate the anatomical structure and functional integrity of the pelvic floor to diagnose and characterize pelvic floor disorders.
Wound infection
This document discusses wound infection and classification of surgical site infections. It defines wound infection as invasion of organisms into tissues following a breakdown of defenses, leading to cellulitis, lymphangitis or abscess. Surgical site infections are classified as major if associated with significant pus, systemic illness or delayed return home, and minor if only associated with discharge but not other symptoms. Prevention focuses on preoperative preparation including skin antisepsis and appropriate use of prophylactic antibiotics. Treatment involves drainage, debridement and targeted antibiotics based on culture results.
Ospe..for mbbs
The document outlines topics covered in an OSPE guide including imaging techniques like X-rays and CT scans, surgical appliances and specimens, incision and suture materials, instruments, scenario-based questions, procedures, and imaging specifics. Imaging techniques covered are X-ray, contrast X-ray to detect stones or other issues in the abdomen or other areas, and orthopedic X-rays. Surgical procedures outlined include surgical washing, gowning and gloving, assembling and disassembling blades and needle holders, suturing techniques, making incisions, catheterization, and inserting tubes.
Post op pyrexia
1. The document discusses postoperative pyrexia (fever), its causes, evaluation, and treatment.
2. Causes of postoperative fever include infectious factors like pneumonia, UTI, and wound infections, as well as non-infectious factors like atelectasis, drug reactions, and thromboembolic events.
3. Evaluation of the patient and fever involves considering timing of onset, surgical and medical history, examination of surgical sites and body systems, and diagnostic tests tailored to suspected causes. Proper diagnosis guides management, which may include antibiotics, source control, or treating underlying conditions.
Thoracic surgical emergencies
The document discusses various chest conditions including chest trauma, pneumothorax, haemothorax, flail chest, and pericardial tamponade. It describes the classification, clinical features, and management of these conditions. Specifically, it covers tension pneumothorax diagnosis and the need for immediate decompression. It also outlines procedures for inserting and managing chest drains.
Shock and its management
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2. Shock is classified based on its underlying etiology as hypovolemic, cardiogenic, obstructive, distributive, or endocrine shock. Septic shock is a type of distributive shock caused by infection.
3. Management of shock involves initial resuscitation with oxygen, airway control, and fluid resuscitation. Ongoing resuscitation may require vasopressors and inotropes depending on the type of shock, along with monitoring of cardiovascular and perfusion parameters.
Hernia examination
This document discusses the examination of inguinal-scrotal swelling. It outlines the prerequisite steps, including asking questions about symptoms and medical history. It describes examining the swelling through inspection, palpation, percussion, and auscultation. Inspection focuses on the shape, size, skin condition and position of the swelling and penis. Palpation evaluates temperature, tenderness, consistency, cough impulse, and reducibility of the swelling. The examination aims to determine the cause of the swelling.
Interventional radiology
Interventional radiology (IR) is a medical subspecialty that performs minimally invasive procedures using medical imaging guidance. IR can be used for both diagnostic and therapeutic procedures. Some common IR procedures include angioplasty to unblock arteries, stent placement to treat aneurysms, tumor ablation, drainage catheter placement, and pain management injections. IR treatments can avoid the need for open surgery and allow many patients to be treated as outpatients. IR utilizes imaging technologies like fluoroscopy, CT, MRI, and ultrasound to guide small catheters and wires to access the inside of the body for both diagnostic testing and treatments.
Abdominal examina
The document provides instructions for performing an abdominal examination, including inspection from both sides of the patient to observe the shape, umbilicus, flanks, stria, scars, engorged veins, visible peristalsis, and lumps or bruises. During palpation, the examiner should feel the abdomen through superficial and deep touches and palpate individual organs. The examination involves inspection, palpation, percussion, and auscultation of the abdomen to check for any abnormalities.
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Ca rectum
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Initial mx of trauma
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Uroflowmetry
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Obstructive defecation syndrome
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Metabolic respons to injury
The document discusses the metabolic response to injury, which aims to restore tissue function and eradicate microorganisms. It covers homeostasis, the components and mediators of the injury response, and its phases. The response involves increased cardiac output, ventilation, and membrane transport. It is graded based on injury severity. Mediators include neuroendocrine hormones and cytokines. The response has catabolic and anabolic phases to mobilize and replace lost resources. Factors like immobilization, sepsis, and hypothermia can exacerbate it, while avoiding continuing hemorrhage, hypothermia, and tissue issues can reduce its negative impacts.
peripheral vascular disease
Peripheral vascular disease (PVD) refers to narrowed, blocked, or spasming blood vessels outside the heart and brain. It is commonly caused by atherosclerosis which leads to the buildup of fatty plaques in the arteries (atherosclerotic plaques). Symptoms range from mild intermittent leg pain with walking (intermittent claudication) to severe leg or foot pain at rest or skin ulcers/gangrene of the lower leg or foot. Treatment involves lifestyle changes, medications to reduce pain, plaque, or blood clotting, and potentially minimally invasive or open surgical procedures to restore blood flow if more conservative options are ineffective.
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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).
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Physiology of Special Chemical Sensation of Taste
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeProf. Marcus Renato de Carvalho
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Ca Stomach
- 2. Objectives: Anatomy & Physiology Epidemiology Aetiologic factors Pathology Clinical features Investigations Treatment
- 5. •Distal carcinoma is common in low socio-economic society & developing countries •Proximal carcinoma is common in high society & developed countries
- 6. H. pylori infection Smoking Pernicious anaemia Gastric atrophy Gastric polyp Post gastric surgery Diet Familial & genetic factor
- 8. Lauren classification: 1. Intestinal 2. Diffuse Other classification: 1. Early gastric cancer 2. Advanced gastric cancer
- 9. TNM Staging M 0: No metastesis M 1 : Distant metastesis
- 10. G1: Well differentiated G2: Moderately differentiated G3: Poorly differentiated G4: Undifferentiated Spread 1. Direct 2. Lymphatic 3. Blood born 4. Trans peritonial
- 11. Early gastric cancer: Dyspepsia Advanced gastric cancer: Dyspepsia after 40 yrs Blotting Early satiety Distention Features of inlet obstruction Features of outlet obstruction Metastatic features Non Metastatic features
- 12. Trousseau’s syndrome (thrombophlebitis) Syster Joseph nodule krukenberg tumour
- 13. o Endoscopy of upper GIT o Contrast Radiology o Ultra sonography o CT Scanning o Laparoscopy o PET Scan
- 14. Surgery Total gastrectomy Subtotal gastrectomy Palliative surgery Chemo therapy Radiotherapy
- 16. Haematogenous metastasis Involvement of distant peritoneum N4 nodal disease and disease beyond N4 node Fixation to the surrounding structures