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Medicine - Surgery | Modern Management of Cancer of the Rectum

Modern Management of Cancer of the Rectum

Audisio, Riccardo A., Geraghty, James G., Longo, Walter E. (Eds.)

2001, XXI, 234 p.


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  • Covers the recent advances in the understanding of aetiology and treatment (prognostic factors, pattern of spread, natural history)
  • Written by international experts with an emphasis of contributors from the US
Modern Management of Cancer of the Rectum is intended to provide a comprehensive overview of all aspects of rectal neoplasms. It addresses such topics as epidemiology, biology, screening and chemoprevention, the role of imaging in diagnosis, staging and prognosis, radiation therapy, medical and surgical treatment, as well as new modalities of therapy, including laparoscopy, and transanal endoscopic surgery. A greater understanding of prognostic factors, patterns of spread and natural history has occurred during the past decade; together with new diagnostic modalities this has led to significant changes in the management of patients with rectal cancer. This book will be invaluable for all those who treat rectal cancer.

Content Level » Professional/practitioner

Keywords » Staging - cancer - colectomy - colorectal cancer - endoscopy - genetics - imaging - laparoscopic surgery - laparoscopy - liver - morbidity - pathology - prevention - screening - surgery

Related subjects » Internal Medicine - Oncology & Hematology - Surgery

Table of contents 

1. Evolution of the Surgical Management of Rectal Cancer.- Perineal Approach.- Transanal Excision.- Transsacral Resection.- Abdominosacral Resection.- Abdominoperineal Resection.- Abdominoanal Approach.- Anterior Resection.- The Present.- References.- 2. Pathology and Staging.- Resection Specimen.- Total Mesorectal Excision.- Histological Features of Rectal Cancer and Their Prognostic Significance.- Histological Type.- Tumour Differentiation.- Invasive Growth Pattern and Peritumoral.- Lymphocytic Infiltration.- Completeness of Excision.- Serosal Involvement.- Lymph Node Metastases.- Extramural Vascular Invasion.- Surgical Resection Margins and Local Recurrence.- Local Recurrence.- Longitudinal Resection Margin.- Circumferential Resection Margin.- Staging of Rectal Cancer.- Staging Systems Currently in Existence.- Dukes’ Staging.- TNM Staging System.- Dukes’ Staging Versus TNM.- Role of Pathology in Assessing the Quality of Rectal Cancer Surgery.- Quality of Preoperative Imaging and Pathology Reporting, and the Use of Reporting Proformas.- Conclusions.- References.- 3. Genetics, Screening and Chemoprevention.- Genetics.- Tumor Suppressor Genes.- MMR Genes.- Oncogenes.- Screening.- Average Risk.- Moderate Risk.- Increased Risk.- Chemoprevention.- NSAIDs.- Calcium.- Antioxidant Vitamins.- Circumin.- Perillyl Alcohol.- Oltipraz.- Selenium.- References.- 4. The Role of Imaging in the Diagnosis and Staging of Primary and Recurrent Rectal Cancer.- Diagnostic Imaging in the Staging of Primary Rectal Cancer.- Clinical Evaluation.- Contrast Examinations.- Endorectal Ultrasound.- Computed Tomography.- Magnetic Resonance Imaging.- Positron Emission Tomography.- Radioimmunoscintigraphy.- Diagnostic Imaging in the Diagnosis and Staging of Recurrent Rectal Cancer.- Ultrasound Techniques.- Computed Tomography.- Magnetic Resonance Imaging.- Positron Emission Tomography and Immunoscintigraphy.- Conclusions.- References.- 5. Neo-adjuvant Therapy.- Preoperative Therapy.- Rationale.- Predictors of Response to Preoperative Therapy.- Results of Preoperative Therapy.- Intensive Short Course Preoperative Radiation.- Sphincter Preservation with Preoperative Radiation.- Is Adjuvant Therapy Necessary in Patients Undergoing a Total Mesorectal Resection?.- Investigational Approaches.- Altered Radiation Fractionation Schemes.- New Chemotherapeutic Agents.- Summary.- References.- 6. Restorative Procedures.- Relevant Anatomy of the Rectum and Perirectal Tissues.- Surgical Options in Restorative Procedures.- Preoperative Evaluation and Patient Preparation.- Oncologic Principles in Rectal Surgery.- Extent of Resection.- Radial Margin and Complete Mesorectal Resection.- Final Preparations for Restorative Procedures.- Technical Details.- Proctosigmoidectomy.- Low Anterior Resection.- Special Consideration: Coloanal Anastomosis.- Special Consideration: Colonic Reservoir (J-Pouch).- Outcome After Low Anterior Resection Versus Abdominoperineal resection.- Laparoscopic Rectal Cancer Surgery.- Conclusions.- References.- 7. Abdominoperineal Resection.- Selection Factors for Abdominoperineal Resection.- Tumor-Related Factors.- Patient Factors.- Intraoperative Considerations.- Preoperative Preparation.- Operative Technique.- Intraoperative and Postoperative Complications.- Bleeding.- Unhealed Perineal Wound.- Inadvertent Perforation of the Rectum.- Perineal Hernia.- Urogenital Complications.- Urethral Injury.- Colostomy Complications.- Other complaints.- Concluding Remarks.- References.- 8. Total Mesorectal Excision with Autonomic Nerve Preservation: “Optimized Surgery”.- Rationale of Total Mesorectal Excision and its Relationship to the Anatomy of Spread of Rectal Cancer.- Technique of Total Mesorectal Excision with Autonomic Nerve Preservation.- Outcome of Total Mesorectal Excision.- Morbidity of Total Mesorectal Excision.- Sexual and Urinary Function After Total Mesorectal Excision.- Extended Lateral Lymphadenectomy.- Role of the Colonic J-Pouch.- Role of Total Mesorectal Excision in Upper Rectal Cancer.- Summary.- References.- 9. Laparoscopic Resections for Large Bowel Malignancy: Laparoscopic Colectomy.- Laparoscopic Colectomy.- Physiologic Aspects of Laparoscopic Surgery.- Laparoscopic Surgery for Benign Colonic Disease.- Laparoscopic Surgery for Malignant Colonic Disease.- Summary.- Laparoscopic Rectal Cancer Surgery.- Laparoscopic Surgery for Rectal Carcinoma.- Procedures of Laparoscopic Proctosigmoidectomy.- Conclusion.- References.- 10. Minimal Access Surgery for Rectal Cancer.- Preoperative Assessment.- Tumor Invasion.- Patient Selection for Local Treatment.- Size.- Exophytic Lesions.- Mobile Lesions.- Depth.- Favorable Histology.- Margin of Excision.- Therapeutic Modalities for Local Treatment.- Local Excision.- Contact Radiotherapy.- Electrocoagulation.- Adjuvant Therapy after Local Treatment.- Salvage Treatment.- Palliative Local Surgery.- Summary.- References.- 11. Postoperative Adjuvant Combined Modality Therapy.- Postoperative Therapy.- Rationale of Postoperative Combined Modality Therapy.- Results of Postoperative Therapy.- Functional Results with Postoperative Therapy.- Decreasing the Toxicity of Pelvic Radiation Therapy.- Is Adjuvant Therapy Necessary after Total Mesorectal Excision?.- Investigational Approaches.- Altered Radiation Fractionation Schemes.- New Chemotherapeutic Agents.- Summary.- References.- 12. Follow-up After Potentially Curative Therapy for Rectal Cancer.- Background.- Methods of Recurrence Detection.- History and Physical Examination.- Laboratory Investigations.- Endoscopy.- Issues Specifically Regarding Rectal Cancer.- Recommendations.- Conclusions.- References.- 13. Surgical Approach to Locally Recurrent Disease.- Clinical Presentation.- Diagnostic Evaluation.- Preoperative Therapies.- Preoperative Planning.- Operative Strategy.- Intraoperative Radiation.- Intraoperative Electron Radiation Therapy.- Intraoperative High-Dose Brachytherapy.- Results.- Extended Resection.- Future Directions.- Novel Therapeutics.- References.- 14. Metastatic Rectal Cancer.- Surgery for Metastatic Rectal Cancer.- Surgical Resection of Liver Metastases.- Surgical Resection ofLung Metastases.- Surgical Resection of Brain Metastases.- Chemotherapy Versus Best Supportive Care for Patients with Advanced Colorectal Cancer.- 5-Fluorouracil.- Mechanism of Action.- Modulation of 5-Fluorouracil with Leucovorin.- Modulation of 5-Fluorouracil with Methotrexate.- Protracted Venous Infusional 5-Fluorouracil.- Other Continuous Infusional 5-Fluorouracil Schedu1es.- Chronomodulated Chemotherapy.- 5-Fluorouracil and Mitomycin C.- Oral Fluoropyrimidimes.- Uracil-Tegafur and Oral Leucovorin.- Capecitabine.- Eniluracil.- S-1.- Irinotecan.- Raltitrexed.- Oxaliplatin.- Intra-Arterial Hepatic Chemotherapy for Isolated Liver Metastases.- Biological Therapy.- Immunotherapy.- Cytokines.- Gene Therapy.- Conclusion.- References.- 15. Rare Histiotypes.- Carcinoid Tumors of the Rectum.- Clinical Presentation and Diagnosis.- Treatment and Prognosis.- Lymphoma ofthe Rectum.- Primary Lymphoma of the Rectum.- Secondary Lymphoma ofthe Rectum.- Anorectal Melanoma.- Clinical Presentation and Diagnosis.- Treatment and Prognosis.- Neuroendocrine Carcinoma of the Rectum.- Pathology.- Clinical Presentation and Diagnosis.- Treatment and Prognosis.- Vascular Lesions.- Diffuse Cavernous Hemangioma.- Lymphangiomas.- Hemangiopericytoma.- Squamous Cell and Adenosquamous Carcinoma of the Rectum.- Squamous Cell Carcinoma of the Rectum.- Adenosquamous Carcinoma of the Rectum.- Sarcoma of the Rectum.- Leiomyosarcoma.- Kaposi’s Sarcoma.- References.- 16. Quality of Life and Palliative Care in Rectal Cancer Patients.- Quality of Life: Defining and Measurement Issues.- Multidimensional Quality of Life Questionnaires.- Psychosocial Aspects of Rectal Cancer: A Brief Historical Review.- Symptoms Associated with Rectal Surgery.- Sexual and Urological Dysfunction.- Bowel Dysfunction.- Mood and Social Life.- Quality of Life Studies.- Chemotherapy.- Radiotherapy.- Surgery.- Rehabilitation Needs.- Palliative Care in Rectal Cancer Patients.- Evaluation.- Pain.- Cachexia-Anorexia.- Ascites.- Nausea and Vomiting.- Dyspnea.- Conclusions.- References.- 17. Costs of Rectal Cancer Patient Management.- Methods.- Literature Review.- Cost Analyses.- Results.- Initial Care Phase.- Continuing Care Phase.- Conclusion.- References.

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