Disclosure. Acknowledgement. What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Rectal cancer imaging. None

Size: px
Start display at page:

Download "Disclosure. Acknowledgement. What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Rectal cancer imaging. None"

Transcription

1 What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Zhen Jane Wang, MD Assistant Professor in Residence UC SF Department of Radiology Disclosure None Acknowledgement Hueylan Chern, MD, Department of Surgery, UCSF Rectal cancer imaging Message: Select patients for sphincter preserving surgery and for neoadjuvant therapy Endorectal US and MRI for local staging CT +/- PET for metastases EUS MRI PET 1

2 EUS Advantages Office Procedure Inexpensive Minimal preparation Mural depth of invasion Limitations Operator dependent Limited field of view EUS: Normal rectal wall Interface balloon & Mucosa Mucosa & Muscularis Mucosa Submucosa Muscularis Propria EUS staging T1: confined to submucosa EUS staging T1: confined to submucosa T2: invades muscularis propria Muscularis Propria 2

3 EUS staging EUS staging T1: confined to submucosa T2: invades muscularis propria T3: invades perirectal fat T1: confined to submucosa T2: invades muscularis propria T3: invades perirectal fat EUS staging Seminal vesicle T1: confined to submucosa T2: invades muscularis propria T3: invades perirectal fat T4: invades adjacent organ EUS staging T1: confined to submucosa T2: invades muscularis propria T3: invades perirectal fat T4: invades adjacent organ N1 : + node 3

4 EUS staging Rectal MRI T staging accuracy: 80-95% Superior in T1 vs. T2 staging Permits FNA of nodes Disadvantages: Limited field of view for lymph nodes and mesorectal fascia visualization Puli et al Ann Surg Oncol 2009;16(2):254 Advantages Improved visualization of anatomy, can see high nodal disease and past stenoses MERCURY trial: high res MRI predicts curative resection vs potential failure Limitation Expensive Limited T1 vs T2 staging Sagittal T2 weighted MRI Rectal MRI Technique Rectal MRI Technique Use a surface coil Endorectal coil not needed IV contrast not necessary Bowel preparation Rectal gel controversial No gel for low rectal cancer Include: Pelvic sidewalls Upper mesorectum Sagittal T2 weighted MRI High resolution (small field of view) T2 weighted images ~3mm slice thickness mm in plane resolution Axial /coronal planes orthogonal to the rectal wall To improve T2 vs T3 staging 4

5 Distance from anal verge T2 w sequence Mucosa/Submucos a Hyperintense Muscularis propria Iso to hypointense MRI T staging T1 from T2 difficult Goal is for T2 and above staging T2: tumor invades muscularis propria T3: tumor invades mesorectum T2 w sequence T2 w sequence 5

6 Advanced T3 disease (> 5mm invasion) Early T3 disease (< 5mm invasion) Advanced T3 disease (> 5mm invasion) MERCURY trial MR excellent for predicting depth of invasion into the mesorectum and CRM involvement by tumor or nodes Within 0.5mm between MR and histopathology MERCURY Study group, Radiology 2007, BMJ 2006 CRM within 1mm of mesorectal fascia MERCURY trial MR excellent for predicting depth of invasion into the mesorectum and CRM involvement by tumor or nodes Within 0.5mm between MR and histopathology MERCURY Study group, Radiology 2007, BMJ 2006 Coronal T2 image Assess relationship to the sphincter complex to determine feasibility Levator ani of sphincter preserving surgery IS puborectalis ES 6

7 Assess relationship to the sphincter complex to determine feasibility of sphincter preserving surgery Delineating relationship between anterior peritoneal reflection and tumor Invasion through the peritoneal reflection is T4 Coronal T2 image Sagittal T2 image : nodes T4: tumor invades bladder Axial T2 image Sagittal T2 image Coronal T2 image Size 5mm 68% sensitivity 78% specificity Morphology Spiculated margin Heterogenous signal intensity 85% sensitivity, 97% specificity 7

8 : nodes -Post CRT Size 5mm 68% sensitivity 78% specificity Morphology Spiculated margin Heterogenous signal intensity 85% sensitivity, 97% specificity MR 66% accurate in the prediction of CRM involvement post CRT Fibrosis difficult to differentiate from tumor infiltration 38% tumor over-staged MR findings of persistent potential CRM involvement associated with higher recurrence Chen et al. Dis Colon Rectum 2005;48: Sagittal T2 image Diffusion MRI Quantifies water molecule movement Many tumors with restricted diffusion (bright on DWI) Not for depth of extramural spread nor to differentiate between benign and malignant nodes Helpful for node localization and treatment response Rectal MRI Standardized Report 8

9 PET-CT No role in pre-operative primary tumor staging Helpful in M staging Detection of post-surgical recurrence Intravenous contrast for CT PET-CT: initial staging Brush et al. Health Technol Assess PET-CT: initial staging PET-CT: Post-treatment T2 weighted MRI PET 9

10 PET-CT: Post-treatment RF ablation site RF ablation site PET-CT: Post-treatment PET Patient with colon CA CT peri-rectal lymph node recurrence hepatic metastasis in dome (not seen on CT) Patient underwent radiation Post treatment CT PET-CT: Post-treatment No PET activity at site of recurrence c/w treated tumor new disease or treated disease? PET Fused PET-CT 10

11 PET false positive Inflammatory uptake of FDG mimicking tumor wait 4 weeks after surgery, 3 weeks after radiotherapy Physiologic uptake of FDG muscle, uterus, corpus luteum cyst correlative CT PET false positive Pre-operative MRI Tumor recurrence? PET false positive PET false positive Tumor recurrence? Seminal vesicle PET scan 11

12 PET false negative Diabetic patients High circulating glucose compete with FDG Small lesions Resolution limit 5-10mm Mucinous carcinoma Take home messages Ultrasound: T staging MR: T staging Depth of extramural spread, mesorectal involvement, predict CRM involvement Visualizing pelvic side wall / high nodes PET/CT Metastatic disease Recurrence Mucinous adenocarcinoma Thank you! 12

RECTAL CARCINOMA: A DISTANCE APPROACH. Stephanie Nougaret

RECTAL CARCINOMA: A DISTANCE APPROACH. Stephanie Nougaret RECTAL CARCINOMA: A DISTANCE APPROACH Stephanie Nougaret stephanienougaret@free.fr Despite the major improvements that have been made due to total mesorectal excision (TME) management of rectal cancer

More information

IMAGING GUIDELINES - COLORECTAL CANCER

IMAGING GUIDELINES - COLORECTAL CANCER IMAGING GUIDELINES - COLORECTAL CANCER DIAGNOSIS The majority of colorectal cancers are diagnosed on colonoscopy, with some being diagnosed on Ba enema, ultrasound or CT. STAGING CT chest, abdomen and

More information

COLORECTAL CANCER STAGING in 2010

COLORECTAL CANCER STAGING in 2010 COLORECTAL CANCER STAGING in 2010 Robert A. Halvorsen, MD, FACR MCV Hospitals / VCU Medical Center Richmond, Virginia I do not have any relevant financial relationships with any commercial interests COLON

More information

Colorectal Pathway Board (Clinical Subgroup): Imaging Guidelines September 2015

Colorectal Pathway Board (Clinical Subgroup): Imaging Guidelines September 2015 Colorectal Pathway Board (Clinical Subgroup): Imaging Guidelines September 2015 1 Contents Page No. 1. Objective 3 2. Imaging Techniques 3 3. Staging of Colorectal Cancer 5 4. Radiological Reporting 6

More information

L impatto dell imaging sulla definizione della strategia terapeutica

L impatto dell imaging sulla definizione della strategia terapeutica GISCoR L impatto dell imaging sulla definizione della strategia terapeutica M. Galeandro U.C. Radioterapia Oncologica ASMN-IRCCS Reggio Emilia 14 Novembre 2014 Rectal Cancer TNM AJCC-7 th edition 2010

More information

Role of MRI for Staging Rectal Cancer

Role of MRI for Staging Rectal Cancer Role of MRI for Staging Rectal Cancer High-resolution MRI has supplanted endoscopic ultrasound for staging rectal cancer. High-resolution MR images closely match histology and can show details such as

More information

Rectal cancer management: a team sport The role of radiology and the multidisciplinary conference

Rectal cancer management: a team sport The role of radiology and the multidisciplinary conference Rectal cancer management: a team sport The role of radiology and the multidisciplinary conference W. Donald Buie MD MSc FRCSC Professor of Surgery and Oncology Department of Surgery University of Calgary

More information

Staging Colorectal Cancer

Staging Colorectal Cancer Staging Colorectal Cancer CT is recommended as the initial staging scan for colorectal cancer to assess local extent of the disease and to look for metastases to the liver and/or lung Further imaging for

More information

Imaging in gastric cancer

Imaging in gastric cancer Imaging in gastric cancer Gastric cancer remains a deadly disease because of late diagnosis. Adenocarcinoma represents 90% of malignant tumors. Diagnosis is based on endoscopic examination with biopsies.

More information

Advances in Imaging Technology In The Management of Colorectal Cancer

Advances in Imaging Technology In The Management of Colorectal Cancer Advances in Imaging Technology In The Management of Colorectal Cancer Dushyant Sahani, M.D Director of CT Associate Professor Department of Radiology Massachusetts General Hospital Harvard Medical School

More information

8. The polyp in the illustration can be described as (circle all that apply) a. Exophytic b. Pedunculated c. Sessile d. Frank

8. The polyp in the illustration can be described as (circle all that apply) a. Exophytic b. Pedunculated c. Sessile d. Frank Quiz 1 Overview 1. Beginning with the cecum, which is the correct sequence of colon subsites? a. Cecum, ascending, splenic flexure, transverse, hepatic flexure, descending, sigmoid. b. Cecum, ascending,

More information

Alison Douglass Gillian Lieberman, MD. November. Colon Cancer. Alison Douglass, Harvard Medical School Year III Gillian Lieberman, MD

Alison Douglass Gillian Lieberman, MD. November. Colon Cancer. Alison Douglass, Harvard Medical School Year III Gillian Lieberman, MD November Colon Cancer Alison Douglass, Harvard Medical School Year III Our Patient Mr. K. is a 67 year old man with no prior medical problems other than hemorrhoids which have caused occasional rectal

More information

Staging of rectal cancer on MRI: What the surgeons want to know.

Staging of rectal cancer on MRI: What the surgeons want to know. Staging of rectal cancer on MRI: What the surgeons want to know. Poster No.: C-1108 Congress: ECR 2014 Type: Educational Exhibit Authors: G. Ayub, R. Chittal, A. Lowe, A. S. Punekar ; Leeds/, 1 2 1 2 2

More information

11/10/2015. Prostate cancer in the U.S. Multi-parametric MRI of Prostate Diagnosis and Treatment Planning. NIH estimates for 2015.

11/10/2015. Prostate cancer in the U.S. Multi-parametric MRI of Prostate Diagnosis and Treatment Planning. NIH estimates for 2015. Multi-parametric MRI of Prostate Diagnosis and Treatment Planning Temel Tirkes, M.D. Associate Professor of Radiology Director, Genitourinary Radiology Indiana University School of Medicine Department

More information

MRI Rectal Staging Template Revision Summary

MRI Rectal Staging Template Revision Summary MRI Rectal Staging Template 2015 Revision Summary The following changes have been made since the June 2012 release. Formatting Standardized headings were added to the template. These headings are: Clinical

More information

MRI in staging of rectal carcinoma

MRI in staging of rectal carcinoma MRI in staging of rectal carcinoma Poster No.: C-0152 Congress: ECR 2015 Type: Scientific Exhibit Authors: J. R. Ramos Rodriguez, M. Atencia Ballesteros, M. D. M. Muñoz Ruiz, A. J. Márquez Moreno, M. D.

More information

Local staging of colon cancer: the current role of CT

Local staging of colon cancer: the current role of CT Local staging of colon cancer: the current role of CT Poster No.: C-2699 Congress: ECR 2018 Type: Authors: Keywords: DOI: Educational Exhibit A. P. Pissarra, R. R. Domingues Madaleno, C. Sanches, L. Curvo-

More information

Essentials of Clinical MR, 2 nd edition. 73. Urinary Bladder and Male Pelvis

Essentials of Clinical MR, 2 nd edition. 73. Urinary Bladder and Male Pelvis 73. Urinary Bladder and Male Pelvis Urinary bladder carcinoma is best locally staged with MRI. It is important however to note that a thickened wall (> 5 mm) is a non-specific finding seen in an underfilled

More information

Oncology Review article High-Resolution MRI in Rectal Cancer

Oncology Review article High-Resolution MRI in Rectal Cancer Oncology Review article High-Resolution MRI in Rectal Cancer Adriana Dieguez Department Of Magnetic Resonance And Computed Tomography In Oncologic Diseases, Diagnóstico Médico Junín 1023, C1113AAE. Buenos

More information

COLORECTAL CARCINOMA

COLORECTAL CARCINOMA QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF COLORECTAL CARCINOMA Ministry of Health Malaysia Malaysian Society of Colorectal Surgeons Malaysian Society of Gastroenterology & Hepatology Malaysian

More information

Cervical Cancer: 2018 FIGO Staging

Cervical Cancer: 2018 FIGO Staging Cervical Cancer: 2018 FIGO Staging Jonathan S. Berek, MD, MMS Laurie Kraus Lacob Professor Stanford University School of Medicine Director, Stanford Women s Cancer Center Senior Scientific Advisor, Stanford

More information

RECTAL CANCER CLINICAL CASE PRESENTATION

RECTAL CANCER CLINICAL CASE PRESENTATION RECTAL CANCER CLINICAL CASE PRESENTATION Francesco Sclafani Medical Oncologist, Clinical Research Fellow The Royal Marsden NHS Foundation Trust, London, UK esmo.org Disclosure I have nothing to declare

More information

PET/CT in Gynaecological Cancers. Stroobants Sigrid, MD, PhD Departement of Nuclear Medicine University Hospital,Antwerp

PET/CT in Gynaecological Cancers. Stroobants Sigrid, MD, PhD Departement of Nuclear Medicine University Hospital,Antwerp PET/CT in Gynaecological Cancers Stroobants Sigrid, MD, PhD Departement of Nuclear Medicine University Hospital,Antwerp Cervix cancer Outline of this talk Initial staging Treatment monitoring/guidance

More information

Rectal Cancer: Classic Hits

Rectal Cancer: Classic Hits Rectal Cancer: Classic Hits Charles M. Friel, MD Associate Professor of Surgery Section of Colon and Rectal Surgery University of Virginia September 28, 2016 None Disclosures 1 Objectives Review the Classic

More information

TME and autonomic nerve preservation techniques: based on Video and Cadaveric anatomy

TME and autonomic nerve preservation techniques: based on Video and Cadaveric anatomy TME and autonomic nerve preservation techniques: based on Video and Cadaveric anatomy Nam Kyu Kim M.D., Ph.D., FACS, FRCS, FASCRS Professor Department of Surgery Yonsei University College of Medicine Seoul,

More information

11/21/13 CEA: 1.7 WNL

11/21/13 CEA: 1.7 WNL Case Scenario 1 A 70 year-old white male presented to his primary care physician with a recent history of rectal bleeding. He was referred for imaging and a colonoscopy and was found to have adenocarcinoma.

More information

Imaging in rectal cancer with emphasis on local staging with MRI

Imaging in rectal cancer with emphasis on local staging with MRI Imaging in Oncology: Recent dvances Imaging in rectal cancer with emphasis on local staging with MRI Supreeta rya, Deepak Das, Reena Engineer 1, vanish Saklani 2 Departments of Radio Diagnosis, 1 Radiation

More information

LOINC. Clinical information. RCPA code. Record if different to report header Operating surgeon name and contact details. Absent.

LOINC. Clinical information. RCPA code. Record if different to report header Operating surgeon name and contact details. Absent. Complete as narrative or use the structured format below 55752-0 17.02.28593 Clinical information 22027-7 17.02.30001 Record if different to report header Operating surgeon name and contact details 52101004

More information

Rectal Cancer Update 2008 The Last 5 cm. Consensus Building

Rectal Cancer Update 2008 The Last 5 cm. Consensus Building Rectal Cancer Update 2008 The Last 5 cm Consensus Building Case Distal Rectal Cancer 65 male physician Rectal mass: 5cm from anal verge, 1cm above sphincter? Imaging choice: CT vs MR vs ERUS? Adjuvant

More information

CT PET SCANNING for GIT Malignancies A clinician s perspective

CT PET SCANNING for GIT Malignancies A clinician s perspective CT PET SCANNING for GIT Malignancies A clinician s perspective Damon Bizos Head, Surgical Gastroenterology Charlotte Maxeke Johannesburg Academic Hospital Case presentation 54 year old with recent onset

More information

Handling & Grossing of Colo-rectal Specimens for Tumours. for Medical Officers in Pathology

Handling & Grossing of Colo-rectal Specimens for Tumours. for Medical Officers in Pathology Handling & Grossing of Colo-rectal Specimens for Tumours for Medical Officers in Pathology Dr Gayana Mahendra Department of Pathology Faculty of Medicine University of Kelaniya Your Role in handling colorectal

More information

Colorectal Cancer Structured Pathology Reporting Proforma DD MM YYYY

Colorectal Cancer Structured Pathology Reporting Proforma DD MM YYYY Colorectal Cancer Structured Pathology Reporting Proforma Mandatory questions (i.e. protocol standards) are in bold (e.g. S1.03). Family name Given name(s) Date of birth DD MM YYYY S1.02 Clinical details

More information

Carcinoma del retto: Highlights

Carcinoma del retto: Highlights Carcinoma del retto: Highlights Stefano Cordio Struttura Complessa di Oncologia Medica ARNAS Garibaldi Catania Roma 17 Febbraio 2018 Disclosures Advisory Committee, research funding and speakers bureau

More information

Pancreatic Adenocarcinoma: Everything You Need to Know From Cross-Sectional Imaging to Treatment

Pancreatic Adenocarcinoma: Everything You Need to Know From Cross-Sectional Imaging to Treatment Pancreatic Adenocarcinoma: Everything You Need to Know From Cross-Sectional Imaging to Treatment Andrew W. Bowman, MD PhD Assistant Professor of Radiology Mayo Clinic Florida SCBT-MR Annual Meeting Nashville,

More information

Rectal Cancer Cookbook Update. A. JOURET-MOURIN with the collaboration of A Hoorens,P Demetter, G De Hertogh,C Cuvelier and C Sempoux

Rectal Cancer Cookbook Update. A. JOURET-MOURIN with the collaboration of A Hoorens,P Demetter, G De Hertogh,C Cuvelier and C Sempoux Rectal Cancer Cookbook Update A. JOURET-MOURIN with the collaboration of A Hoorens,P Demetter, G De Hertogh,C Cuvelier and C Sempoux Prof Dr A Jouret-Mourin, Department of Pathology, UCL, St Luc, Brussels

More information

Colorectal Cancer and FDG PET/CT

Colorectal Cancer and FDG PET/CT Hybrid imaging in colorectal & esophageal cancer Emmanuel Deshayes IAEA WorkShop, November 2017 Colorectal Cancer and FDG PET/CT 1 Clinical background Cancer of the colon and rectum is one of the most

More information

COLON AND RECTAL CANCER

COLON AND RECTAL CANCER COLON AND RECTAL CANCER Mark Sun, MD Clinical Associate Professor of Surgery University of Minnesota No disclosures Objectives 1) Understand the epidemiology, management, and prognosis of colon and rectal

More information

Optimal Imaging Strategies for Rectal Cancer Staging and Ongoing Management

Optimal Imaging Strategies for Rectal Cancer Staging and Ongoing Management Curr. Treat. Options in Oncol. (2016) 17: 32 DOI 10.1007/s11864-016-0403-7 Lower Gastrointestinal Cancers (AB Benson, Section Editor) Optimal Imaging Strategies for Rectal Cancer Staging and Ongoing Management

More information

JMSCR Vol 05 Issue 06 Page June 2017

JMSCR Vol 05 Issue 06 Page June 2017 www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i6.29 MRI in Clinically Suspected Uterine and

More information

Local Excision of Rectal Cancer Techniques and Outcomes

Local Excision of Rectal Cancer Techniques and Outcomes Local Excision of Rectal Cancer Techniques and Outcomes Manoj J. Raval, MD, MSc, FRCSC Clinical Assistant Professor, UBC Rectal Cancer Update 2008 October 25, 2008 Overview Techniques & Description Patient

More information

PET in Rectal Carcinoma

PET in Rectal Carcinoma Case Report PET in Rectal Carcinoma Josefina Jofré M 1, Paulina Sierralta C 1, José Canessa G 1,2, Pamela Humeres A 3, Gabriel Castro M 4, Teresa Massardo V 1,4 1 Centro PET de Imágenes Moleculares, Hospital

More information

Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C.

Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C. Role of Whole-body Diffusion MR in Detection of Metastatic lesions Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C. Cancer is a potentially life-threatening disease,

More information

Dr. Anat Ravid Surgical Oncology Lead Erie St. Clair Regional Cancer Program May 1, 2014

Dr. Anat Ravid Surgical Oncology Lead Erie St. Clair Regional Cancer Program May 1, 2014 Preoperative Staging MRI in Rectal Cancer: Where Are We Going in the Pelvis? Dr. Anat Ravid Surgical Oncology Lead Erie St. Clair Regional Cancer Program May 1, 2014 Objectives: How are we looking? Who

More information

PET CT for Staging Lung Cancer

PET CT for Staging Lung Cancer PET CT for Staging Lung Cancer Rohit Kochhar Consultant Radiologist Disclosures Neither I nor my immediate family members have financial relationships with commercial organizations that may have a direct

More information

New Visions in PET: Surgical Decision Making and PET/CT

New Visions in PET: Surgical Decision Making and PET/CT New Visions in PET: Surgical Decision Making and PET/CT Stanley J. Goldsmith, MD Director, Nuclear Medicine Professor, Radiology & Medicine New York Presbyterian Hospital- Weill Cornell Medical Center

More information

COLON AND RECTAL CANCER

COLON AND RECTAL CANCER No disclosures COLON AND RECTAL CANCER Mark Sun, MD Clinical Assistant Professor of Surgery University of Minnesota Colon and Rectal Cancer Statistics Overall Incidence 2016 134,490 new cases 8.0% of all

More information

Application of Magnetic Resonance Images in Gastrointestinal Malignancies

Application of Magnetic Resonance Images in Gastrointestinal Malignancies Chin J Radiol 2003; 28: 269-275 269 Application of Magnetic Resonance Images in Gastrointestinal Malignancies SHENG-LAN YU 1 YUK-MING TSANG 1 PO-CHIN LIANG 1 HUNG-JUNG WANG 1 CHIEN-YAO HSU 1 TA-CHENG WEI

More information

Adjuvant Chemotherapy for Rectal Cancer: Are we making progress?

Adjuvant Chemotherapy for Rectal Cancer: Are we making progress? Adjuvant Chemotherapy for Rectal Cancer: Are we making progress? Hagen Kennecke, MD, MHA, FRCPC Division Of Medical Oncology British Columbia Cancer Agency October 25, 2008 Objectives Review milestones

More information

Gastric Cancer Staging AJCC eighth edition. Duncan McLeod Westmead Hospital, NSW

Gastric Cancer Staging AJCC eighth edition. Duncan McLeod Westmead Hospital, NSW Gastric Cancer Staging AJCC eighth edition Duncan McLeod Westmead Hospital, NSW Summary of changes New clinical stage prognostic groups, ctnm Postneoadjuvant therapy pathologic stage groupings, yptnm -

More information

objectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University

objectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University objectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University To determine the regions of physiologic activity To understand

More information

Accuracy of transvaginal ultrasound and magnetic resonance imaging in diagnosis and extension of pelvic endometriosis

Accuracy of transvaginal ultrasound and magnetic resonance imaging in diagnosis and extension of pelvic endometriosis Accuracy of transvaginal ultrasound and magnetic resonance imaging in diagnosis and extension of pelvic endometriosis A.Salem, Kh. Fakhfakh, S. Mehiri, Y. Ben Brahim, F. Ben Amara, H. Rajhi, R. Hamza,

More information

Exercise 15: CSv2 Data Item Coding Instructions ANSWERS

Exercise 15: CSv2 Data Item Coding Instructions ANSWERS Exercise 15: CSv2 Data Item Coding Instructions ANSWERS CS Tumor Size Tumor size is the diameter of the tumor, not the depth or thickness of the tumor. Chest x-ray shows 3.5 cm mass; the pathology report

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A Abdominoperineal excision, of rectal cancer, 93 111 current controversies in, 106 109 extent of perineal dissection and removal of pelvic floor,

More information

Esophageal Cancer. What is the value of performing PET scan routinely for staging of esophageal cancers

Esophageal Cancer. What is the value of performing PET scan routinely for staging of esophageal cancers Esophageal Cancer What is the value of performing PET scan routinely for staging of esophageal cancers What is the sensitivity and specificity of PET scan for metastatic lesions When should PET scan be

More information

THE ROLE OF HIGH RESOLUTION MAGNETIC RESONANCE IMAGING (MRI) IN DETECTING CIRCUMFERENTIAL RESECTION MARGIN (CRM) FOR THE PROGNOSIS OF RECTAL CANCER

THE ROLE OF HIGH RESOLUTION MAGNETIC RESONANCE IMAGING (MRI) IN DETECTING CIRCUMFERENTIAL RESECTION MARGIN (CRM) FOR THE PROGNOSIS OF RECTAL CANCER THE ROLE OF HIGH RESOLUTION MAGNETIC RESONANCE IMAGING (MRI) IN DETECTING CIRCUMFERENTIAL RESECTION MARGIN (CRM) FOR THE PROGNOSIS OF RECTAL CANCER Arpana Shrestha, Fu Tian and Jin-jian Xiang Department

More information

Imaging: When to get MRI, CT or PET-CT?

Imaging: When to get MRI, CT or PET-CT? Imaging: When to get MRI, CT or PET-CT? Alina Uzelac, D.O. Assistant Clinical Professor Neuroradiology UCSF Department of Radiology and Biomedical Imaging San Francisco General Hospital Overview CT MRI

More information

I have no financial relationships to disclose. I WILL NOT include discussion of investigational or off-label use of a product in my presentation.

I have no financial relationships to disclose. I WILL NOT include discussion of investigational or off-label use of a product in my presentation. Prostate t Cancer MR Report Disclosure Information Vikas Kundra, M.D, Ph.D. I have no financial relationships to disclose. I WILL NOT include discussion of investigational or off-label use of a g product

More information

Surgical Therapy of GEP-NET: An Overview

Surgical Therapy of GEP-NET: An Overview Surgical Therapy of GEP-NET: An Overview Pierce K.H Chow MBBS, MMed, FRCSE, FAMS, PhD Professor, Duke-NUS Graduate School of Medicine Senior Consultant Surgeon, Singapore General Hospital Visiting Senior

More information

Endobronchial Ultrasound in the Diagnosis & Staging of Lung Cancer

Endobronchial Ultrasound in the Diagnosis & Staging of Lung Cancer Endobronchial Ultrasound in the Diagnosis & Staging of Lung Cancer Dr Richard Booton PhD FRCP Lead Lung Cancer Clinician, Consultant Respiratory Physician & Speciality Director Manchester University NHS

More information

Mini J.Elnaggar M.D. Radiation Oncology Ochsner Medical Center 9/23/2016. Background

Mini J.Elnaggar M.D. Radiation Oncology Ochsner Medical Center 9/23/2016. Background Mini J.Elnaggar M.D. Radiation Oncology Ochsner Medical Center 9/23/2016 Background Mostly adenocarcinoma (scc possible, but treated like anal cancer) 39, 220 cases annually Primary treatment: surgery

More information

Colon and Rectum. Protocol revision date: January 2005 Based on AJCC/UICC TNM, 6th edition

Colon and Rectum. Protocol revision date: January 2005 Based on AJCC/UICC TNM, 6th edition Colon and Rectum Protocol applies to all invasive carcinomas of the colon and rectum. Carcinoid tumors, lymphomas, sarcomas, and tumors of the vermiform appendix are excluded. Protocol revision date: January

More information

Can MRI Improve Triage of Bladder Cancer Patients. John Chang, M.D., Ph.D. Banner MD Anderson Cancer Center

Can MRI Improve Triage of Bladder Cancer Patients. John Chang, M.D., Ph.D. Banner MD Anderson Cancer Center Can MRI Improve Triage of Bladder Cancer Patients John Chang, M.D., Ph.D. Banner MD Anderson Cancer Center None Financial Disclosures MRI for Bladder Cancer Background Bladder cancer staging and treatment

More information

FEMALE PELVIS Normal Tissue RTOG Consensus Contouring Guidelines

FEMALE PELVIS Normal Tissue RTOG Consensus Contouring Guidelines FEMALE PELVIS Normal Tissue RTOG Consensus Contouring Guidelines Hiram A. Gay, M.D., H. Joseph Barthold, M.D., Elizabeth O Meara, C.M.D., Walter R. Bosch, Ph.D., Issam El Naqa, Ph.D., Rawan Al-Lozi, Seth

More information

Local Excision for early rectal cancer

Local Excision for early rectal cancer Local Excision for early rectal cancer M. Trompetto, E. Ganio, G. Clerico, A. Realis Luc, RJ Nicholls Colorectal Eporediensis Centre Clinica S. Rita Vercelli Gruppo Policlinico di Monza Mortality Morbidity

More information

Esophageal Cancer: A Multimodality Approach to Detection and Staging

Esophageal Cancer: A Multimodality Approach to Detection and Staging Esophageal Cancer: A Multimodality Approach to Detection and Staging, MBA Topic: Esophageal Cancer Imaging: A multimodality approach Conference: Society of Thoracic Imaging Location: Date/Time: March 14,

More information

UCL. Rectum Adenocarcinoma. Quality of conformal radiotherapy Impact for the surgeon P. Scalliet & K. Haustermans

UCL. Rectum Adenocarcinoma. Quality of conformal radiotherapy Impact for the surgeon P. Scalliet & K. Haustermans Rectum Adenocarcinoma Quality of conformal radiotherapy Impact for the surgeon P. Scalliet & K. Haustermans Fifth Belgian Surgical Week May 6th, 2004, Oostende SOR rectum adenocarcinoma Indication of radiotherapy

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER CERVIX

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER CERVIX PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER CERVIX Site Group: Gynecology Cervix Author: Dr. Stephane Laframboise 1. INTRODUCTION 3 2. PREVENTION 3 3. SCREENING AND

More information

Laparoscopic Resection Of Colon & Rectal Cancers. R Sim Centre for Advanced Laparoscopic Surgery, TTSH

Laparoscopic Resection Of Colon & Rectal Cancers. R Sim Centre for Advanced Laparoscopic Surgery, TTSH Laparoscopic Resection Of Colon & Rectal Cancers R Sim Centre for Advanced Laparoscopic Surgery, TTSH Feasibility and safety Adequacy - same radical surgery as open op. Efficacy short term benefits and

More information

CHAPTER 7 Concluding remarks and implications for further research

CHAPTER 7 Concluding remarks and implications for further research CONCLUDING REMARKS AND IMPLICATIONS FOR FURTHER RESEARCH CHAPTER 7 Concluding remarks and implications for further research 111 CHAPTER 7 Molecular staging of large sessile rectal tumors In this thesis,

More information

COLORECTAL CANCER FAISALGHANISIDDIQUI MBBS; FCPS; PGDIP-BIOETHICS; MCPS-HPE

COLORECTAL CANCER FAISALGHANISIDDIQUI MBBS; FCPS; PGDIP-BIOETHICS; MCPS-HPE COLORECTAL CANCER FAISALGHANISIDDIQUI MBBS; FCPS; PGDIP-BIOETHICS; MCPS-HPE PROFESSOR OF SURGERY & DIRECTOR, PROFESSIONAL DEVELOPMENT CENTRE J I N N A H S I N D H M E D I C A L U N I V E R S I T Y faisal.siddiqui@jsmu.edu.pk

More information

A916: rectum: adenocarcinoma

A916: rectum: adenocarcinoma General facts of colorectal cancer The colon has cecum, ascending, transverse, descending and sigmoid colon sections. Cancer can start in any of the r sections or in the rectum. The wall of each of these

More information

FDG PET/CT STAGING OF LUNG CANCER. Dr Shakher Ramdave

FDG PET/CT STAGING OF LUNG CANCER. Dr Shakher Ramdave FDG PET/CT STAGING OF LUNG CANCER Dr Shakher Ramdave FDG PET/CT STAGING OF LUNG CANCER FDG PET/CT is used in all patients with lung cancer who are considered for curative treatment to exclude occult disease.

More information

Radiology Pathology Conference

Radiology Pathology Conference Radiology Pathology Conference Sharlin Johnykutty,, MD, Cytopathology Fellow Sara Majewski, MD, Radiology Resident Friday, August 28, 2009 Presentation material is for education purposes only. All rights

More information

Pathohistological Assessment of the Circular Margin of Resection During Total Mesorectal Excision, Conducted on The Malignant Formations of the Rectum

Pathohistological Assessment of the Circular Margin of Resection During Total Mesorectal Excision, Conducted on The Malignant Formations of the Rectum International Journal of Research Studies in Science, Engineering and Technology Volume 4, Issue 5, 2017, PP 17-22 ISSN : 2349-476X http://dx.doi.org/10.22259/ijrsset.0405004 Pathohistological Assessment

More information

Mediastinal Staging. Samer Kanaan, M.D.

Mediastinal Staging. Samer Kanaan, M.D. Mediastinal Staging Samer Kanaan, M.D. Overview Importance of accurate nodal staging Accuracy of radiographic staging Mediastinoscopy EUS EBUS Staging TNM Definitions T Stage Size of the Primary Tumor

More information

MRI of Rectal Cancer

MRI of Rectal Cancer MRI of Rectal Cancer Arnd-Oliver Schäfer Mathias Langer MRI of Rectal Cancer Clinical Atlas Prof. Dr. Arnd-Oliver Schäfer Department of Diagnostic Radiology Freiburg University Hospital Hugstetter Straße

More information

A schematic of the rectal probe in contact with the prostate is show in this diagram.

A schematic of the rectal probe in contact with the prostate is show in this diagram. Hello. My name is William Osai. I am a nurse practitioner in the GU Medical Oncology Department at The University of Texas MD Anderson Cancer Center in Houston. Today s presentation is Part 2 of the Overview

More information

Staging and Treatment Update for Gynecologic Malignancies

Staging and Treatment Update for Gynecologic Malignancies Staging and Treatment Update for Gynecologic Malignancies Bunja Rungruang, MD Medical College of Georgia No disclosures 4 th most common new cases of cancer in women 5 th and 6 th leading cancer deaths

More information

Prostate MRI. Overview. Introduction 2/20/2015. Prostate cancer is most frequently diagnosed noncutaneous cancer in males (25%)

Prostate MRI. Overview. Introduction 2/20/2015. Prostate cancer is most frequently diagnosed noncutaneous cancer in males (25%) Prostate MRI John Bell, MD Introduction Prostate Cancer Screening Staging Anatomy Prostate MRI overview Functional MRI Multiparametric Approach Indications Example Cases Overview Introduction Prostate

More information

Dr Claire Smith, Consultant Radiologist St James University Hospital Leeds

Dr Claire Smith, Consultant Radiologist St James University Hospital Leeds Dr Claire Smith, Consultant Radiologist St James University Hospital Leeds Imaging in jaundice and 2ww pathway Image protocol Staging Limitations Pancreatic cancer 1.2.4 Refer people using a suspected

More information

Restaging Locally Advanced

Restaging Locally Advanced Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights. EDUCATION EXHIBITS

More information

Upper GI Malignancies Imaging Guidelines for the Management of Gastric, Oesophageal & Pancreatic Cancers 2012

Upper GI Malignancies Imaging Guidelines for the Management of Gastric, Oesophageal & Pancreatic Cancers 2012 Upper GI Malignancies Imaging Guidelines for the Management of Gastric, Oesophageal & Pancreatic Cancers 2012 Version Control This is a controlled document please destroy all previous versions on receipt

More information

State-of-the-art of surgery for resectable primary tumors

State-of-the-art of surgery for resectable primary tumors Early colorectal cancer State-of-the-art of surgery for resectable primary tumors (Special focus on rectal cancer surgery) Stefan Heinrich & Hauke Lang Department of General, Visceral and University Hospital

More information

Rectal Cancer. Madhulika G. Varma MD Associate Professor and Chief Section of Colorectal Surgery University of California, San Francisco

Rectal Cancer. Madhulika G. Varma MD Associate Professor and Chief Section of Colorectal Surgery University of California, San Francisco Rectal Cancer Madhulika G. Varma MD Associate Professor and Chief Section of Colorectal Surgery University of California, San Francisco Modern Treatment for Rectal Cancer Improve Local Control Improved

More information

Index. Surg Oncol Clin N Am 16 (2007) Note: Page numbers of article titles are in boldface type.

Index. Surg Oncol Clin N Am 16 (2007) Note: Page numbers of article titles are in boldface type. Surg Oncol Clin N Am 16 (2007) 465 469 Index Note: Page numbers of article titles are in boldface type. A Adjuvant therapy, preoperative for gastric cancer, staging and, 339 B Breast cancer, metabolic

More information

Imaging techniques in the diagnosis, staging and follow up of GI cancers. Moderators: Banke Agarwal, MD and Paul Schultz, MD

Imaging techniques in the diagnosis, staging and follow up of GI cancers. Moderators: Banke Agarwal, MD and Paul Schultz, MD Imaging techniques in the diagnosis, staging and follow up of GI cancers Moderators: Banke Agarwal, MD and Paul Schultz, MD Panelists Axel Grothey, MD Professor of Oncology Division of Medical Oncology

More information

Preoperative diagnosis and staging of rectal cancer using diffusion weighted and water imaging combined with dynamic contrast enhanced scanning

Preoperative diagnosis and staging of rectal cancer using diffusion weighted and water imaging combined with dynamic contrast enhanced scanning 2734 Preoperative diagnosis and staging of rectal cancer using diffusion weighted and water imaging combined with dynamic contrast enhanced scanning QILI ZHAO 1, LIJIAN LIU 1, QIUYAN WANG 1, ZEXIA LIANG

More information

Cover Page. The handle holds various files of this Leiden University dissertation.

Cover Page. The handle   holds various files of this Leiden University dissertation. Cover Page The handle http://hdl.handle.net/887/22038 holds various files of this Leiden University dissertation. Author: Swellengrebel, H.A.M. Title: Challenges in the multimodality treatment of rectal

More information

Proposed All Wales Vulval Cancer Guidelines. Dr Amanda Tristram

Proposed All Wales Vulval Cancer Guidelines. Dr Amanda Tristram Proposed All Wales Vulval Cancer Guidelines Dr Amanda Tristram Previous FIGO staging FIGO Stage Features TNM Ia Lesion confined to vulva with

More information

MUSCLE - INVASIVE AND METASTATIC BLADDER CANCER

MUSCLE - INVASIVE AND METASTATIC BLADDER CANCER 10 MUSCLE - INVASIVE AND METASTATIC BLADDER CANCER Recommendations from the EAU Working Party on Muscle Invasive and Metastatic Bladder Cancer G. Jakse (chairman), F. Algaba, S. Fossa, A. Stenzl, C. Sternberg

More information

INTRAUTERINE DEVICE = IUD INTRAUTERINE DEVICE = IUD CONGENITAL DISORDERS Pyometra = pyometrea is a uterine infection, it is accumulation of purulent material in the uterine cavity. Ultrasound is usually

More information

Pelvic Angiogram - Male

Pelvic Angiogram - Male Pelvic Angiogram - Male Common iliac artery Internal iliac artery Lateral sacral artery Iliolumbar artery Posterior trunk of internal iliac artery Superior gluteal artery Internal pudendal artery External

More information

is time consuming and expensive. An intra-operative assessment is not going to be helpful if there is no more tissue that can be taken to improve the

is time consuming and expensive. An intra-operative assessment is not going to be helpful if there is no more tissue that can be taken to improve the My name is Barry Feig. I am a Professor of Surgical Oncology at The University of Texas MD Anderson Cancer Center in Houston, Texas. I am going to talk to you today about the role for surgery in the treatment

More information

S1.04 PRINCIPAL CLINICIAN G1.01 COMMENTS S2.01 SPECIMEN LABELLED AS G2.01 *SPECIMEN DIMENSIONS (PROSTATE) S2.03 *SEMINAL VESICLES

S1.04 PRINCIPAL CLINICIAN G1.01 COMMENTS S2.01 SPECIMEN LABELLED AS G2.01 *SPECIMEN DIMENSIONS (PROSTATE) S2.03 *SEMINAL VESICLES Prostate Cancer Histopathology Reporting Proforma (Radical Prostatectomy) Includes the International Collaboration on Cancer reporting dataset denoted by * Family name Given name(s) Date of birth Indigenous

More information

Disorders of Cell Growth & Neoplasia. Histopathology Lab

Disorders of Cell Growth & Neoplasia. Histopathology Lab Disorders of Cell Growth & Neoplasia Histopathology Lab Paul Hanna April 2010 Case #84 Clinical History: 5 yr-old, West Highland White terrier. skin mass from axillary region. has been present for the

More information

Index. Surg Oncol Clin N Am 14 (2005) Note: Page numbers of article titles are in boldface type.

Index. Surg Oncol Clin N Am 14 (2005) Note: Page numbers of article titles are in boldface type. Surg Oncol Clin N Am 14 (2005) 433 439 Index Note: Page numbers of article titles are in boldface type. A Abdominosacral resection, of recurrent rectal cancer, 202 215 Ablative techniques, image-guided,

More information

Restaging after neoadjuvant chemoradiation in rectal cancers: is histology the key in patient selection?

Restaging after neoadjuvant chemoradiation in rectal cancers: is histology the key in patient selection? Original Article Restaging after neoadjuvant chemoradiation in rectal cancers: is histology the key in patient selection? Nitin Singhal 1, Karthik Vallam 1, Reena Engineer 2, Vikas Ostwal 3, Supreeta Arya

More information