COLORECTAL CANCER STAGING in 2010

Size: px
Start display at page:

Download "COLORECTAL CANCER STAGING in 2010"

Transcription

1 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

2 COLON RECTUM Colon: local resection possible? Almost always if no metastases Rectum: local resection not possible if fixed Fixed then pre-op Rad Rx

3 RECTAL CANCER Higher recurrence rate than colon cancer Due to extensive lymphatic drainage of pelvis

4 SURGERY Only cure for colon cancer Surgery for all: palliation or attempted cure Palliation: colostomy

5 COLON RECTUM Colon cancer surgery Rectal cancer: surgery or pre op RAD Rx

6 SURGICAL PRINCIPLES Very low resections possible Anastomosis w/i 1cm dentate Proximal margin 2.5cm OK Limiting factor: Radial margin Males lower survival Prostate limits resection

7 AP RESECTION Operative mortality: 2-6% Permanent colostomy Complications: 23-75% Urinary retention Impotence Infection

8 TOTAL MESORECTAL EXCISION Resect rectum, meso-rectal fascia, perirectal fat, vessels & nodes Improves prognosis Replaces AP resections Protects sphincter function

9 MESORECTAL FASCIA Mesorectal compartment inside fascia contains: Rectum Mesorectal fat Blood vessels Lymphatic vessels and lymph nodes NOT the nerves to the rectal sphincter!

10 LUNG METS NO LIVER METS Think low rectal cancer Lymphatics follow venous drainage Drainage: internal hemorrhoidal vein to IVC, not portal vein Lung, not liver metastases

11 LOW RECTAL CANCER Search for metastases: Para-aortic nodes Lung metastases Abdominal/pelvic CT & Chest CT!

12 RECTUM COLON

13 STAGING OPTIONS: 2010 CT of abdomen and pelvis CT of chest, abdomen and pelvis PET/CT PET/CT Colonography MR: High-resolution MR with rectal coil 3T MR Trans-rectal ultrasound

14 STAGING CHOICE CT chest, abdomen and pelvis first Then PET or PET/CT Then? It depends Colon cancer: stop! Rectal cancer: local choice: EUS vs MRI

15 STAGING COLORECTAL CANCER T: Not important for colon cancer Local invasion is resectable T: Important for rectal cancer Select patients for neo adjuvant Rx Help determine surgical approach Laparotomy, laparoscopy trans-anal excision Veit-Haibach: JAMA 2006

16 MDCT: COLORECTAL CANCER Accuracy Improved Axial CT Axial & MPR T Staging 73% 83% N Staging 59% 80% (p<0.01) Fillipone: Radiology 2004

17 MPR: RECTAL CANCER USEFUL Rectal wall invasion Infiltration mesorectum Invasion adjacent vessels, organs

18 LIMITATIONS Trans-rectal ultrasound: Stenotic cancer: if probe cannot pass then TRUS inadequate Rectal probe: Disposable, expensive, uncomfortable and requires careful positioning

19 STAGING Colon cancer: CT good for metastases PET/CT good/better for mets Rectal cancer: CT & PET/CT EUS good for local invasion MRI great for meso-rectal invasion

20 COMPARISON STUDIES PET/CT > CT alone TRUS and MR with or without endorectal coil better than CT or MR for wall penetration or nodes

21 STAGING COLORECTAL CANCER Prospective trial [n = 47] Compared CT, PET/CT and PET/CT Colonography Veit-Haibach: JAMA 2006

22 STAGING COLORECTAL CANCER Results: 50 lesions in 47 patients TNM Staging: Better with PET/CT than CT alone Colonography improved T staging

23 PET: COLORECTAL CANCER LIMITATIONS Mucinous tumors: lower FDG uptake Limited value: T staging N staging reports: Sensitivity: 29-37% Specificity: 83-96%

24 PET/CT & COLORECTAL CANCER BENEFITS Very successful in detecting distant metastases, altering operative planning

25 PET/CT & COLORECTAL CANCER BENEFITS Liver mets: PET/CT & CT comparable CT has advantage of multiple phase scanning: hepatic arterial & portal venous phases PET disadvantage: mucinous or small tumors

26 PET/CT & COLORECTAL Peritoneal mets: CANCER 10-15% of patients at the time of diagnosis! CT sensitivity: 64% PET/CT sensitivity: 89% Selznen: Ann Surg 2004

27 PET and COLORECTAL CANCER PET promise: more lesions detected than CT alone 11 of 36 patients (31%) Changed Rx: 16% Kantorová: JNM 2003

28 PET and COLORECTAL CANCER PET problem: Small nodes Sensitivity = 29% Specificity = 88% Kantorová: JNM 2003

29 COMPARISON STUDIES Nodes are the problem CT, MR, TRUS false positive: 30% MR with endorectal coil false positive: 20%

30 LOCAL INVASION More dependent upon circumferential tumor spread than longitudinal Local recurrence: 83% of pts with circumferential positive margin developed local recurrence

31 MESORECTAL FASCIA Surrounds rectum Contains mesorectal fat Defines surgical margin Visible on MR

32 MR TECHNIQUE No endorectal coil necessary Use phased array surface coil Slices perpendicular to long axis Contrast not proven to be useful

33 MR RESULTS RECTAL CANCER Penetration through meso-rectal fascia Call positive if tumor within 1mm Accuracy: 95% Bissett: Dis Colon Rectum 2001

34 CONCLUSION Chest CT for rectal cancer MDCT first, use MPR PET if no mets on CT Predict local invasion for rectal, not colon cancer with TRUS or MRI

35 THANK YOU

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

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

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

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

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

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

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

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

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

Guidelines for Laparoscopic Resection of Curable Colon and Rectal Cancer

Guidelines for Laparoscopic Resection of Curable Colon and Rectal Cancer SAGES Society of American Gastrointestinal and Endoscopic Surgeons http://www.sages.org Guidelines for Laparoscopic Resection of Curable Colon and Rectal Cancer Author : SAGES Webmaster PREAMBLE The following

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

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

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

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

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

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

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

Radiotherapy for Rectal Cancer. Kevin Palumbo Adelaide Radiotherapy Centre

Radiotherapy for Rectal Cancer. Kevin Palumbo Adelaide Radiotherapy Centre Radiotherapy for Rectal Cancer Kevin Palumbo Adelaide Radiotherapy Centre Overview CRC are common (3 rd commonest cancer) rectal Ca approx 25-30% of all CRC. Presentation PR bleeding: beware attributing

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

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

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

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

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

Colorectal Surgery. Patient Care. Goals and Objectives

Colorectal Surgery. Patient Care. Goals and Objectives Colorectal Surgery Patient Care 1) Interpret the results of clinical evaluations (history, physical examination) performed on patients with a) Hemorrhoids b) Perianal abscess/fistula c) Anal fissure d)

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

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

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

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

STAGING AND FOLLOW-UP STRATEGIES

STAGING AND FOLLOW-UP STRATEGIES ATHENS 4-6 October 2018 European Society of Urogenital Radiology STAGING AND FOLLOW-UP STRATEGIES Ahmet Tuncay Turgut, MD Professor of Radiology Hacettepe University, Faculty of Medicine Ankara 2nd ESUR

More information

Physician Follow-Up and Guideline Adherence in Post- Treatment Surveillance of Colorectal Cancer

Physician Follow-Up and Guideline Adherence in Post- Treatment Surveillance of Colorectal Cancer Physician Follow-Up and Guideline Adherence in Post- Treatment Surveillance of Colorectal Cancer Gabriela M. Vargas, MD Kristin M. Sheffield, PhD, Abhishek Parmar, MD, Yimei Han, MS, Kimberly M. Brown,

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

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

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

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

editoriale Optimal lymph node dissection for T3-T4 lower rectal cancer, the so-called high risk group: the Japanese experience Introduction

editoriale Optimal lymph node dissection for T3-T4 lower rectal cancer, the so-called high risk group: the Japanese experience Introduction G Chir Vol. 30 - n. 10 - pp. 393-399 Ottobre 2009 editoriale Optimal lymph node dissection for T3-T4 lower rectal cancer, the so-called high risk group: the Japanese experience M. YASUNO Introduction The

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

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

Recommendations for cross-sectional imaging in cancer management, Second edition

Recommendations for cross-sectional imaging in cancer management, Second edition www.rcr.ac.uk Recommendations for cross-sectional imaging in cancer management, Second edition Renal and adrenal tumours Faculty of Clinical Radiology www.rcr.ac.uk Contents Renal cell carcinoma 3 Clinical

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

Case Conference. Craig Morgenthal Department of Surgery Long Island College Hospital

Case Conference. Craig Morgenthal Department of Surgery Long Island College Hospital Case Conference Craig Morgenthal Department of Surgery Long Island College Hospital Neoadjuvant versus Adjuvant Radiation Therapy in Rectal Carcinoma Epidemiology American Cancer Society statistics for

More information

Update on RECIST and Staging of Common Pediatric Tumors Ethan A. Smith, MD

Update on RECIST and Staging of Common Pediatric Tumors Ethan A. Smith, MD Update on RECIST and Staging of Common Pediatric Tumors Ethan A. Smith, MD Section of Pediatric Radiology C.S. Mott Children s Hospital University of Michigan ethans@med.umich.edu Disclosures No relevant

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

Navigators Lead the Way

Navigators Lead the Way RN Navigators Their Role in patients with Cancers of the GI tract Navigators Lead the Way Nurse Navigator Defined Nurse Navigator A clinically trained individual responsible for the identification and

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

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

NUMERATOR: Reports that include the pt category, the pn category and the histologic grade

NUMERATOR: Reports that include the pt category, the pn category and the histologic grade Quality ID #100 (NQF 0392): Colorectal Cancer Resection Pathology Reporting: pt Category (Primary Tumor) and pn Category (Regional Lymph Nodes) with Histologic Grade National Quality Strategy Domain: Effective

More information

STAGING, BIOPSY AND NATURAL HISTORY OF TUMORS SCOTT D WEINER MD

STAGING, BIOPSY AND NATURAL HISTORY OF TUMORS SCOTT D WEINER MD STAGING, BIOPSY AND NATURAL HISTORY OF TUMORS SCOTT D WEINER MD WHAT DO YOU DO WHEN THIS SHOWS UP IN YOUR OFFICE? besides panicking KEY PRINCIPLE!!! Reactive zone is the edema, neovascularity and inflammation

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

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

NUMERATOR: Reports that include the pt category, the pn category and the histologic grade

NUMERATOR: Reports that include the pt category, the pn category and the histologic grade Quality ID #100 (NQF 0392): Colorectal Cancer Resection Pathology Reporting: pt Category (Primary Tumor) and pn Category (Regional Lymph Nodes) with Histologic Grade National Quality Strategy Domain: Effective

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

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

Cervical Cancer 3/25/2019. Abnormal vaginal bleeding

Cervical Cancer 3/25/2019. Abnormal vaginal bleeding Cervical Cancer Abnormal vaginal bleeding Postcoital, intermenstrual or postmenopausal Vaginal discharge Pelvic pain or pressure Asymptomatic In most patients who are not sexually active due to symptoms

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

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

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

Colorectal Cancer Treatment

Colorectal Cancer Treatment Scan for mobile link. Colorectal Cancer Treatment Colorectal cancer overview Colorectal cancer, also called large bowel cancer, is the term used to describe malignant tumors found in the colon and rectum.

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

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 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

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

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

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

OFCCR CLINICAL DIAGNOSIS AND TREATMENT FORM

OFCCR CLINICAL DIAGNOSIS AND TREATMENT FORM OFCCR CLINICAL DIAGNOSIS AND TREATMENT FORM Name: _, OFCCR # _ OCGN # _ OCR Group # _ HIN# Sex: MALE FEMALE UNKNOWN Date of Birth: DD MMM YYYY BASELINE DIAGNOSIS & TREATMENT 1. Place of Diagnosis: Name

More information

Transanal Excision of Rectal Cancer : What Next?

Transanal Excision of Rectal Cancer : What Next? Transanal Excision of Rectal Cancer : What Next? November 10 th 2017 Meagan Costedio MD FACS FASCRS Medical Director Colorectal Surgery University Hospitals Ahuja Medical Center Associate Professor - Division

More information

COLON CANCER FOLLOW UP GUIDELINES

COLON CANCER FOLLOW UP GUIDELINES COLON CANCER FOLLOW UP GUIDELINES CAGPO Dr. Raziya Mia October 1, 2016 1 DISCLOSURES NONE 2 MITIGATING POTENTIAL BIAS Recommendations are consistent with published guidelines American Society of Clinical

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

Advanced Pelvic Malignancy: Defining Resectability Be Aggressive. Lloyd A. Mack September 19, 2015

Advanced Pelvic Malignancy: Defining Resectability Be Aggressive. Lloyd A. Mack September 19, 2015 Advanced Pelvic Malignancy: Defining Resectability Be Aggressive Lloyd A. Mack September 19, 2015 CONFLICT OF INTEREST DECLARATION I have no conflicts of interest Advanced Pelvic Malignancies Locally Advanced

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

performed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management.

performed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management. Hello, I am Maura Polansky at the University of Texas MD Anderson Cancer Center. I am a Physician Assistant in the Department of Gastrointestinal Medical Oncology and the Program Director for Physician

More information

[A RESEARCH COORDINATOR S GUIDE]

[A RESEARCH COORDINATOR S GUIDE] 2013 COLORECTAL SURGERY GROUP Dr. Carl J. Brown Dr. Ahmer A. Karimuddin Dr. P. Terry Phang Dr. Manoj J. Raval Authored by Jennifer Lee A cartoon about colonoscopies. 1 [A RESEARCH COORDINATOR S GUIDE]

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

NOVA SCOTIA RECTAL CANCER PROJECT: A POPULATION-BASED ASSESSMENT OF RECTAL CANCER CARE AND OUTCOMES. Devon Paula Richardson

NOVA SCOTIA RECTAL CANCER PROJECT: A POPULATION-BASED ASSESSMENT OF RECTAL CANCER CARE AND OUTCOMES. Devon Paula Richardson NOVA SCOTIA RECTAL CANCER PROJECT: A POPULATION-BASED ASSESSMENT OF RECTAL CANCER CARE AND OUTCOMES by Devon Paula Richardson Submitted in partial fulfilment of the requirements for the degree of Master

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

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

Glossary of Terms Primary Urethral Cancer

Glossary of Terms Primary Urethral Cancer Patient Information English Glossary of Terms Primary Urethral Cancer Advanced cancer A tumour that grows into deeper layers of tissue, adjacent organs, or surrounding muscles. Anaesthesia (general, spinal,

More information

THE ROLE OF CONTEMPORARY IMAGING AND HYBRID METHODS IN THE DIAGNOSIS OF CUTANEOUS MALIGNANT MELANOMA(CMM) AND MERKEL CELL CARCINOMA (MCC)

THE ROLE OF CONTEMPORARY IMAGING AND HYBRID METHODS IN THE DIAGNOSIS OF CUTANEOUS MALIGNANT MELANOMA(CMM) AND MERKEL CELL CARCINOMA (MCC) THE ROLE OF CONTEMPORARY IMAGING AND HYBRID METHODS IN THE DIAGNOSIS OF CUTANEOUS MALIGNANT MELANOMA(CMM) AND MERKEL CELL CARCINOMA (MCC) I.Kostadinova, Sofia, Bulgaria CMM some clinical facts The incidence

More information

Rectal Cancer. GI Practice Guideline

Rectal Cancer. GI Practice Guideline Rectal Cancer GI Practice Guideline Dr. Brian Dingle MSc, MD, FRCPC Dr. Francisco Perera MD, FRCPC (Radiation Oncologist) Dr. Jay Engel MD, FRCPC (Surgical Oncologist) Approval Date: 2006 This guideline

More information

A Review of Rectal Cancer. Tim Geiger, MD Assistant Professor of Surgery, Colon and Rectal Surgery Vanderbilt University Medical Center

A Review of Rectal Cancer. Tim Geiger, MD Assistant Professor of Surgery, Colon and Rectal Surgery Vanderbilt University Medical Center A Review of Rectal Cancer Tim Geiger, MD Assistant Professor of Surgery, Colon and Rectal Surgery Vanderbilt University Medical Center No disclosures Disclosures About me.. Grew up in Southern Illinois

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

Colon Cancer Surgery

Colon Cancer Surgery Colon Cancer Surgery Introduction Colon cancer is a life-threatening condition that affects thousands of people. Doctors usually recommend surgery for the removal of colon cancer. If your doctor recommends

More information

Colorectal cancer starts in the colon or rectum.

Colorectal cancer starts in the colon or rectum. The content of this booklet was adapted from content originally published by the National Cancer Institute. Colon Cancer Treatment (PDQ ) Patient Version. Updated December 7, 2017. https://www.cancer.gov/types/colorectal/patient/colon-treatment-pdq

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

HEPATIC METASTASES. We can state 3 types of metastases depending on their treatment options:

HEPATIC METASTASES. We can state 3 types of metastases depending on their treatment options: HEPATIC METASTASES 1. Definition Metastasis means the spread of cancer. Cancerous cells can separate from the primary tumor and enter the bloodstream or the lymphatic system (the one that produces, stores,

More information

Pre-operative assessment of patients for cytoreduction and HIPEC

Pre-operative assessment of patients for cytoreduction and HIPEC Pre-operative assessment of patients for cytoreduction and HIPEC Washington Hospital Center Washington, DC, USA Ovarian Cancer Surgery New Strategies Bergamo, Italy May 5, 2011 Background Cytoreductive

More information

Manchester Cancer Colorectal Pathway Board: Guidelines for management of colorectal hepatic metastases

Manchester Cancer Colorectal Pathway Board: Guidelines for management of colorectal hepatic metastases Manchester Cancer Colorectal Pathway Board: Guidelines for management of colorectal hepatic metastases Date: April 2015 Date for review: April 2018 1. Principles The recognised specialist HPB MDT for Greater

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

Early colorectal cancer Quality and rules for a good pathology report Histoprognostic factors

Early colorectal cancer Quality and rules for a good pathology report Histoprognostic factors Early colorectal cancer Quality and rules for a good pathology report Histoprognostic factors Frédéric Bibeau, MD, PhD Pathology department Biopathology unit Institut du Cancer de Montpellier France Quality

More information

Audit Report. Colorectal Cancer Quality Performance Indicators. Patients diagnosed April 2014 March Published: July 2016

Audit Report. Colorectal Cancer Quality Performance Indicators. Patients diagnosed April 2014 March Published: July 2016 NORTH OF SCOTLAND PLANNING GROUP Colorectal Cancer Managed Clinical Network Audit Report Colorectal Cancer Quality Performance Indicators Patients diagnosed April 2014 March 2015 Published: July 2016 Mr

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

Abdominal Imaging Update. Tom Sutherland MBBS MMed FRANZCR

Abdominal Imaging Update. Tom Sutherland MBBS MMed FRANZCR Abdominal Imaging Update Tom Sutherland MBBS MMed FRANZCR Objectives Review selected radiological abdominal studies. CT Colonography Rectal MRI Small bowel Imaging Liver Imaging. Discuss limitations, advantages

More information

Colorectal Cancer Quality Performance Indicators

Colorectal Cancer Quality Performance Indicators Publication Report Colorectal Cancer Quality Performance Indicators Patients diagnosed between April 2013 and March 2016 Publication date 27th June 2017 An Official Statistics Publication for Scotland

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GASTROINTESTINAL RECTAL CANCER GI Site Group Rectal Cancer Authors: Dr. Jennifer Knox, Dr. Mairead McNamara 1. INTRODUCTION 3 2. SCREENING AND

More information

Early Rectal Cancer Surgical options Organ Preservation? Chinna Reddy Colorectal Surgeon Western General, Edinburgh

Early Rectal Cancer Surgical options Organ Preservation? Chinna Reddy Colorectal Surgeon Western General, Edinburgh Early Rectal Cancer Surgical options Organ Preservation? Chinna Reddy Colorectal Surgeon Western General, Edinburgh What is Early rectal cancer? pt1t2n0m0 Predictors for LN involvement Size Depth Intramural

More information

UPDATE IN THE MANAGEMENT AND TREATMENT OF COLORECTAL CANCER. Edwin A. Empaynado, MD Advocare Colon and Rectal Surgical Specialists

UPDATE IN THE MANAGEMENT AND TREATMENT OF COLORECTAL CANCER. Edwin A. Empaynado, MD Advocare Colon and Rectal Surgical Specialists UPDATE IN THE MANAGEMENT AND TREATMENT OF COLORECTAL CANCER Edwin A. Empaynado, MD Advocare Colon and Rectal Surgical Specialists WHAT IS COLON CANCER? WHAT CAUSES COLORECTAL CANCER? WHAT ARE THE RISK

More information

Transanal Endoscopic Microsurgery

Transanal Endoscopic Microsurgery Transanal Endoscopic Microsurgery Dana R. Sands, MD, FACS, FASCRS Director, Colorectal Physiology Center Staff Surgeon Department of Colorectal Surgery Cleveland Clinic Florida What is TEM? Minimally invasive

More information

ADJUVANT CHEMOTHERAPY...

ADJUVANT CHEMOTHERAPY... Colorectal Pathway Board: Non-Surgical Oncology Guidelines October 2015 Organization» Table of Contents ADJUVANT CHEMOTHERAPY... 2 DUKES C/ TNM STAGE 3... 2 DUKES B/ TNM STAGE 2... 3 LOCALLY ADVANCED

More information

PANCREATIC CANCER GUIDELINES

PANCREATIC CANCER GUIDELINES PANCREATIC CANCER GUIDELINES North-East London Cancer Network & Barts and the London HPB Centre PROTOCOL FOR MANAGEMENT OF PANCREATIC CANCER (SEPTEMBER 2010) I. PRE-REFERRAL GUIDELINES Screening 1. Offer

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