OPEN RIGHT HEMICOLECTOMY- STEP BY STEP OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openrighthemicolectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Open Right Hemicolectomy .
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch all my teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
esophageal carcinoma is one of the common gastrointestinal malignancy. Its usually present at advanced stage. Its management requires diagnosis as early as possible and staging followed by proper planning of treatment. Its treatment include endoscopic, surgical, adjuvant chemotherapy and palliative management.
The stomach J-shaped. It has two surfaces (the anterior & posterior), two curvatures (the greater & lesser), two orifices (the cardia & pylorus). It has fundus, body and pyloric antrum.
Blood supply
The left gastric artery
Right gastric artery
Right gastro-epiploic artery
Left gastro-epiploic artery
Short gastric arteries
Stomach cancer begins when cancer cells form in the inner lining of your stomach. These cells can grow into a tumor. Also called gastric cancer, the disease usually grows slowly over many years.
It could be:
malignant or benign
primary or secondary
OPEN RIGHT HEMICOLECTOMY- STEP BY STEP OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openrighthemicolectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Open Right Hemicolectomy .
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch all my teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
esophageal carcinoma is one of the common gastrointestinal malignancy. Its usually present at advanced stage. Its management requires diagnosis as early as possible and staging followed by proper planning of treatment. Its treatment include endoscopic, surgical, adjuvant chemotherapy and palliative management.
The stomach J-shaped. It has two surfaces (the anterior & posterior), two curvatures (the greater & lesser), two orifices (the cardia & pylorus). It has fundus, body and pyloric antrum.
Blood supply
The left gastric artery
Right gastric artery
Right gastro-epiploic artery
Left gastro-epiploic artery
Short gastric arteries
Stomach cancer begins when cancer cells form in the inner lining of your stomach. These cells can grow into a tumor. Also called gastric cancer, the disease usually grows slowly over many years.
It could be:
malignant or benign
primary or secondary
There are marked variations in the incidence of gastric cancer worldwide.
The UK it is approximately 15 per 100000 per year
The USA 10 per 100000 per year
Eastern Europe 40 per 100 000 per year.
It is more common in Japan—70 per 1,00,000 population.
Common in males 2:1.
Decrease incidence in western world (Western Europe and US)—last four decades.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
6. EPIDEMIOLOGY
• Generally-- Disease of the elderly
• Lower socioeconomic status
• Blacks 2 times > whites
Younger patients-- more of the diffuse variety
• Large
• Aggressive,
• Poorly differentiated,
• Sometimes infiltrating the entire stomach
(linitis plastic)
7. ETIOLOGY
Common in
- Pernicious anemia
- Blood group A
-A family history of gastric cancer
- Environmental factors appear more related
to the intestinal form
8. Factors Increasing or Decreasing the
Risk of Gastric Cancer
Increase risk Decrease risk
• Family history • Aspirin
• Diet (high in nitrates, salt, fat) • Diet (high fresh fruit and
• Familial polyposis vegetable intake)
• Gastric adenomas • Vitamin C
• Hereditary nonpolyposis
colorectal cancer
• Helicobacter pylori infection
• Atrophic gastritis, intestinal
metaplasia, dysplasia
• Previous gastrectomy or
gastrojejunostomy (>10 y ago)
• Tobacco use
• Ménétrier's disease
11. Early Gastric Cancer
Mucosa and submucosa, regardless of lymph
node status
• 10% have lymph node metastases
70% well differentiated
30% poorly differentiated
Cure rate with adequate gastric resection and
lymphadenectomy - 95%
12. Types/SubTypes(Early Gastric Cancer)
• Type I Exophytic lesion extending into the gastric lumen
• Type II Superficial variant
IIA Elevated lesions with a height no more than the
thickness of the adjacent mucosa
IIB Flat lesions
IIC Depressed lesions with an eroded but not deeply
ulcerated appearance
• Type III Excavated lesions that may extend into the
muscularis propria without invasion of this layer by actual
cancer cells
18. First two, tumor mass is intraluminal---
• Polypoid tumors are not ulcerated
• Fungating tumors are elevated intraluminally,
but also ulcerated
Latter two , tumor mass is in the wall of the
stomach---
• Ulcerative tumors are self-descriptive;
• Scirrhous infiltrate the entire thickness of the
stomach (linitis plastica) poor prognosis, involve
entire stomach
19. Important Prognostic Indicators
• Lymph node involvement
• Depth of tumor invasion
• Tumor grade (degree of differentiation: well,
moderately, poorly)
21. Lauren classification
• Intestinal type (53%),
• Diffuse type (33%),
• Unclassified (14%).
The Intestinal type associated with
chronic atrophic gastritis, severe intestinal
metaplasia, and dysplasia, less aggressive than the
diffuse type
The Diffuse type of gastric cancer associated with
younger patients and proximal tumors, poorly
differentiated
23. World Health Organization Histologic
Typing
• Adenocarcinoma
• Papillary adenocarcinoma
• Tubular adenocarcinoma
• Mucinous adenocarcinoma
• ---------------------------------------
• Signet-ring cell carcinoma
• Adenosquamous carcinoma
• Squamous cell carcinoma
• Small cell carcinoma
• ---------------------------------------
• Undifferentiated carcinoma
• Others
The Japanese classification(more detailed)
24. Spread
Various modes
Distant spread unusual before the disease
spreads locally
Distant metastases uncommon in the
absence of lymph node metastases
26. Lymphatic spread
1- Permeation
2- Emboli
Supraclavicular nodes (Troisier’s sign).
Nodal involvement does not imply systemic
dissemination
27. Blood-Borne
Liver
Other organs including lung and bone
Uncommon in the absence of nodal disease
28. Transperitoneal
Indicates Incurability
- Ascites
- Advanced palpated either abdominally or
rectally as a tumour ‘shelf ’
- Ovaries (Krukenberg’s tumours)
- Umbilicus (Sister Joseph’s nodule)
Laparoscopy and cytology
29. TNM Staging (AJCC &IUCC)
• T: Primary tumor
• Tis Carcinoma in situ; intraepithelial tumor without
invasion of lamina propria
• T1 Tumor invades lamina propria or submucosa
• T2 Tumor invades muscularis propria or subserosa
• T3 Tumor penetrates serosa (visceral peritoneum)
without invasion of adjacent structures
• T4 Tumor invades adjacent structures
30. N: Regional lymph node
N0 No regional lymph node metastasis
N1 Metastasis in 1 to 6 regional lymph nodes
N2 Metastasis in 7 to 15 lymph nodes
N3 Metastasis in more than 15 regional lymph
nodes
32. Staging
------IA T1 N0 M0
------IB T1 N1 M0
T2 N0 M0
------II T1 N2 M0
T2 N1 M0
T3 N0 M0
------IIIA T2 N2 M0
T3 N1 M0
T4 N0 M0
------- IIIB T3 N2 M0
--------IV T4 N1–3 M0
T1–3 N3 M0
Any T Any N M1
33. CLINICAL MANIFESTATIONS
- Weight loss
- Anorexia / early satiety
- Abdominal pain
- Nausea, vomiting, bloating
- Acute GI bleeding (5%)
- Chronic occult blood loss is common ( iron
deficiency anemia and heme-positive stool)
- Dysphagia (cardia)
36. • Cervical
• supraclavicular (on the left referred to as
Virchow's node)
• axillary lymph nodes may be enlarged
FNAC
37. - Metastatic pleural effusion
- Aspiration pneumonitis
- An abdominal mass indicate a large primary
tumor
- Liver metastases
- Carcinomatosis - Krukenberg's tumor
- Palpable umbilical nodule (Sister Joseph's
nodule) malignant ascites
38. Rectal exam
• Heme-positive stool
• Hard nodularity extraluminally and
anteriorly
Drop metastases, or rectal shelf of Blumer in
the pouch of Douglas
39. DIAGNOSTIC EVALUATION
Peptic ulcer / Gastric cancer clinical grounds
impossible
• age 45 years Endoscopy and biopsy
• new onset dyspepsia
• alarm symptoms Double-contrast barium
• family history
40. Preoperative staging
• Abdominal/Pelvic CT scanning ( contrast)
• MRI
• Locally EUS - enlarged (>5 mm) perigastric and
celiac lymph nodes
• EUS- early gastric cancer (T1) from more
advanced tumors
• Positron Emission Tomography Scanning(+CT)
• Staging Laparoscopy and Peritoneal Cytology
42. Goal
• R0 resection / adequate lymphadenectomy
• Negative margin of at least 5 cm required
• In diffuse variety, beyond 5 cm desirable
• Frozen section confirmation
43. Gastrectomy
Curative - Primary tumor resected en bloc
with adjacent involved organs (distal
pancreas, transverse colon, or spleen)
Palliative - indicated in incurable disease
44. Subtotal gastric resection
- ligation of the left and right gastric and
gastroepiploic arteries at origin
- en bloc removal of the distal 75% of the stomach, 2
cm of duodenum
- the greater and lesser omentum, associated
lymphatic tissue
• Reconstruction - Billroth II gastrojejunostomy
• the spleen and pancreatic tail not removed In
absence of involvement
• operative mortality - 2 to 5%
45.
46.
47. Total gastrectomy
• with Roux-en-Y esophagojejunostomy in
proximal gastric adenocarcinoma
• Total gastrectomy - superior functional, not
oncologic, results for proximal gastric cancer
48.
49. Extent of Lymphadenectomy
• The Japanese Research Society for Gastric Cancer
numbered the lymph node stations that potentially
drain the stomach
Generally these are grouped into
• level D1 ( stations 3 to 6),
• level D2 ( stations 1, 2, 7, 8, and 11) &
• level D3 ( stations 9, 10, and 12) nodes
D1 nodes are perigastric
D2 nodes are along the hepatic and splenic arteries
D3 nodes are the most distant
50. The standard operation for gastric cancer is
the D2 gastrectomy, which involves a more
extensive lymphadenectomy (removal of the
D1 and D2 nodes)
51. Other treatment modalities
Radiotherapy
Role is controversial
Number of radiosensitive tissues in the
region of the gastric bed - limits the dose
Role in the palliative treatment of painful
bony metastases
52. Chemotherapy
Improves the outcome
Should have chemotherapy before surgery
Number of regimes / currently used
Epirubicin,
Cis-platinum &
infusional 5-Fluorouracil (5-FU) or an oral
analogue such as Capecitabine
53. • First line in inoperable disease
• Oxaliplatin substituted for Cis-platinum (
fewer side-effects)
• Second-line treatment combinations
including Taxotere ↑
• Chemotherapy in advanced disease is
palliative
