A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Gall bladder carcinoma seen in Indian popluation most common in women and presents at a very late stage .Survival is in months hence palliative treatment is being preferred .
GB cancer is the 5th most common GIT malignancy(worldwide).200 years later it is still considered to be a highly malignant disease with a poor survival rate
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Carcinoma rectum the complete aproach to how to investigate and treat a case ...nikhilameerchetty
this is a complete guide to the understanding of the anatomy clinical features and the latest investigation to the most modern methods of treating the case of carcinoma rectum , all the latest journal published and the ongoing trials hav been searched and incorporated
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Gall bladder carcinoma seen in Indian popluation most common in women and presents at a very late stage .Survival is in months hence palliative treatment is being preferred .
GB cancer is the 5th most common GIT malignancy(worldwide).200 years later it is still considered to be a highly malignant disease with a poor survival rate
.Here is a brief description regarding
Carcinoma rectum the complete aproach to how to investigate and treat a case ...nikhilameerchetty
this is a complete guide to the understanding of the anatomy clinical features and the latest investigation to the most modern methods of treating the case of carcinoma rectum , all the latest journal published and the ongoing trials hav been searched and incorporated
Management of colon cancer(surgical).pptxtadehabte
Colon Cancer Surgical Management, update.
Dr. Tadesse Habteyohannes
AAU, CHS
Colon cancer is among the largest cancers in the world and current treatment options, especially cure intent are a must. This slide will update on the current surgical recommendation for colon cancer based on location and stage. It also includes prognostic discriminants on the outcome of the disease.
If you have any questions you can reach me at
tadesurgery@gmail.com or by phone +251911567541
In Depth review of the Surgical management of esophageal carcinoma including management overview, endoscopic management, Type of surgeries, Open, and minimally invasive, Extent of lymphadenectomy. Literature review of evidence for type of surgery and complications
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
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
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!
6. Colorectal cancer: Epidemiology
• 2nd most common malignancy globally; affecting more than a million people
every year.
• 150,000 new cases of large bowel cancer diagnosed annually in USA.
• 1/3rd of them arise from rectum.
• Mortality rate of 1.2% per year.
• 3rd most common cause of cancer deaths in the USA.
7. Risk factors
• Age
• Hereditary syndromes
• IBD
• Abdominopelvic radiation
• Renal transplantation
• Diabetes mellitus
• Red and processed meat
• Smoking and alcohol
Protective factors
a. Physical activity
b. Diet high in fruits and vegetables
c. High fibre diet
d. Folic acid, Vitamin B6
e. Coffee intake; garlic
f. NSAIDS and Aspirin
9. Types of Carcinoma spread
a. Local spread : Circumferentially rather than longitudinally.
b. Lymphatic spread : Mostly in an upward direction
c. Venous spread : Liver (34%), Lungs (22%)
10. Clinical presentation
1. Suspicious signs and symptoms.
2. Asymptomatic individuals are discovered by routine screening.
3. Emergency admission with intestinal obstruction, perforation, or rarely acute
GI bleed.
11. Symptoms from local tumor
Right sided tumor Left sided tumor
a. Iron deficiency anemia
b. Malena
a. Alteration in bowel habits
b. Hematochezia
c. Tenesmus
d. Pain with defecation
Abdominal pain
Weight loss
12. Examination
a. General and Systemic examination
b. Abdominal examination
Ascites and Hepatomegaly: signs of metastasis.
Signs of acute bowel obstruction.
13. Examination
Digital rectal examination
• 90% of rectal cancers can be felt by DRE.
Fixation of the lesion to the anal sphincter.
Relationship to anorectal ring.
Fixation to the rectal wall and pelvic wall
Correct and Incorrect method of DRE
14. Investigations
1. . Proctoscopy
• Can accurately determine the distance between
distal tumor margin, top of the anorectal ring, and
dentate line.
2. Flexible sigmoidoscopy
15. Investigations
C. Colonoscopy
Most patients are diagnosed by
colonoscopy after presenting with lower GI
bleeding.
Most tumors appear as an endoluminal
mass arising from mucosa and protruding
in lumen.
The mass may be exophytic or polypoid.
If the mass is noted, a biopsy is taken.
16. Synchronous lesions
• Present in 3-5 % of patients.
• Two or more distinct primary tumors
separated by normal bowel and not
due to direct extension or metastasis.
17. Tumor markers
• Carcinoembryonic antigen (CEA)
Sensitivity: 46%
Specificity: 89%
• Not used as a screening or diagnostic test.
• Preoperative CEA > 5ng/ml has a worse prognosis.
• Elevated preoperative CEA that doesn’t normalize after resection implies
persistent disease.
20. Imaging evaluation
• MRI of pelvis (3mm)
Preferred imaging for evaluating the
extent of primary tumor.
Provide information on depth of
transmural invasion, presence of
suspicious regional lymph nodes,
status of CRM, and invasion of other
organs.
• Transrectal endoscopic USG
Alternative for early-stage tumors (T1-
2,N0).
For advanced disease, may be limited
by the bulkiness of tumor and lack of
depth to assess invasion of other
organs.
21. Other imaging modalities
• CT scan
Helpful for evaluating distant
metastatic spread and for tumor-
related complications.
Provides limited local tumor and
nodal staging information.
Performed for chest, abdomen, and
pelvis.
• PET scan
Not been shown to add significant
information to conventional imaging
for initial locoregional staging of rectal
cancer.
22. Colorectal cancer staging: AJCC 8th edition
Primary tumor (T)
Tx Tumor cannot be assessed.
T0 No evidence of primary tumor.
Tis Carcinoma insitu(Intramucosal carcinoma).
T1 Tumor invades submucosa.
T2 Tumor invades muscularis propria.
T3 Tumor invades into pericolorectal tissues.
T4a Invades through visceral peritoneum
T4b Invades or adheres to adjacent organs
23.
24. Colorectal cancer staging: AJCC 8th edition
Regional lymph node (N)
Nx Regional LN couldn’t be assessed.
N0 No regional LN metastasis.
N1a One regional LN positive.
N1b Two to 3 regional LN positive.
N1c Tumor deposits in subserosa, mesentery, perirectal
tissue.
N2a Four to six regional LN positive.
N2b Seven or more regional LN positive.
25.
26. Colorectal cancer staging: AJCC 8th edition
Distant metastasis
M0 No distant metastasis.
M1a Mets to one organ without peritoneal mets.
M1b Mets to 2 or more organs w/o peritoneal mets.
M1c Mets to peritoneal surface.
29. Neoadjuvant therapy: Indications
Patients with clinical T3-T4 tumors: preoperative CRT or rt followed by adjuvant
therapy.
Patients with node (+) disease regardless of primary tumor stage.
The tumor appears to invade the mesorectal fascia.
Poor surgical candidate or decline APR for distal T1-2, N0 tumor.
30. Management of complete clinical responders
• If no evidence of residual tumor on DRE, rectal MRI, and direct endoscopic
evaluation, may be considered for the initial nonoperative approach.
• If nonoperative management is chosen, repeat above mentioned examinations
every 3 months for 2 years; then every 6 months for 5 years.
31. Surgical treatment
• A cornerstone for curative therapy for rectal adenocarcinoma.
• Depending upon the stage, size and location can be treated with local or radical
excision.
• Local excision: Transanally
• Radical excision: Transabdominally
a. Sphincter sparing procedure (e.g. Low anterior resection)
b. Abdominoperineal resection
32. Preoperative preparation
• Counseling and siting of stoma.
• Correction of anemia and electrolyte disorders.
• Arranging and cross-matching blood.
• Bowel preparation.
• DVT prophylaxis.
• Prophylactic antibiotics.
33. Selecting surgical treatment
Distance of cancer from the anal verge.
Presence of invasion into lateral pelvic walls/other organs.
Size of cancer.
Presence of regional lymph node metastasis.
Patient’s pelvic anatomy.
Presurgical anorectal sphincter function.
Whether the patient can tolerate transabdominal surgery.
34. Local excision
Criteria
Superficial T0 or T1 tumor.
Tumor less than 3 cm in diameter.
Involves less than 30% of bowel
lumen circumference.
The tumor is mobile and nonfixed.
Able to achieve clear margins.
Favorable histological features.
No evidence of metastasis.
Compliant with postoperative
surveillance.
35. Local excision: Basis
• Involves full-thickness excision, ideally with a 10 cm grossly normal
circumferential margin.
37. Transcoccygeal excision
Used for larger or more proximal lesions within middle or distal 3rd of rectum.
Anterior lesion Posterior lesion
38. Transanal endoscopic microsurgery
• Useful for small lesions in the mid and proximal
rectum that are too high for traditional excision.
• Rigid operating proctoscope of diameter 40 mm,
length 12/20 cm used.
• Designed to provide exposure to a lesion that is
down relative to optic scope.
40. Low anterior resection (LAR)
Criteria
Invasive rectal cancer (T2-T4)
If a negative distal margin can be achieved.
Adequate presurgical anorectal sphincter function.
41. LAR: Basis
• Entails partial or total resection of the rectum
followed by colorectal or coloanal anastomosis.
• Total mesorectal excision
Involves sharp dissection in the avascular plane
between fascia propria which encompasses
mesorectum and parietal fascia overlying pelvic
wall structures.
Emphasizes autonomic nerve preservation, and
avoids violation of mesorectal envelope.
46. Special considerations
• Diverting loop ileostomy considered for low-lying anastomosis; a/w increased
rates of anastomotic leaks.
• Drain placement is recommended in extremely low resection.
• Anastomosis around the anorectal ring results in impaired QOL.
Colonic pouch
Transverse coloplasty
47. LAR: Outcomes
• The local recurrence rate of less than 10%.
• Lower recurrence a/w use of meticulous surgical techniques (achieving adequate
margins, performing TME and adjuvant chemo radiotherapy.
48. Abdominoperineal resection (APR)
Criteria
• Patients with T2-4 tumor:
A negative distal margin of 1 cm can’t be achieved by any other procedures.
Locally advanced low-lying rectal cancer.
Locally recurrent low-lying rectal cancer.
Poor presurgical anorectal function.
49. APR: Basis
• Entails en bloc resection of sigmoid colon, rectum and anus followed by
reconstruction of a permanent colostomy.
52. Postoperative care
• Not allowed to sit for 5 days.
• Perineum cleaned daily with hydrogen peroxide.
• Foley catheterization for 3 -5 days.
• Wound complications in up to 25% of cases.
• Stoma complications: Ischemia, retraction, hernia, stenosis, prolapse
• Operative mortality of APR: less than 2%
54. Multivisceral resection: Basis
• Involves resection of the rectum with one or more adjacent pelvic organs or bony
structures.
• Total pelvic exenteration removes all pelvic organs.
60. Adjuvant therapy
• Following resection, all patients who received neoadjuvant should receive 4
months of adjuvant chemotherapy.
• Those with stage 2/3; who directly underwent surgery: 4 months of chemo
followed by six weeks of chemoradiotherapy.
63. Post-treatment Surveillance: Stage wise
Stage II/III disease
F/u every 3-6 months first 3 years; then every 6 months during 4th to 5th year.
History and examination (incl. DRE) in each visit.
Serum CEA at each f/u for 1st two to three years.
Colonoscopy within few months after resection; then at 1st year.
Annua CT scan of chest and abdomen for at least 3 years.
64. Post-treatment Surveillance: Stage wise
Resected stage IV disease
No high evidence data for recommendation.
Surveillance strategy individualised.
66. References
• National Comprehensive Cancer Committee guidelines 2022.
• European Society of Medical Oncology guidelines 2022.
• Bailey and Love text book of the surgery 28th edition.
• Sabiston textbook of surgery.
• Maingot text book of abdominal operations.