Modern Management of Cancer of the Rectum

Front Cover
Springer Science & Business Media, 2001 - Medical - 234 pages
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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.
 

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Contents

1 Evolution of the Surgical Management of Rectal Cancer
1
Transanal Excision
2
Abdominosacral Resection
3
Anterior Resection
4
The Present
5
2 Pathology and Staging
7
Histological Features of Rectal Cancer and Their Prognostic Significance
8
Tumour Differentiation
9
Patient Selection for Local Treatment
116
Depth
117
Margin of Excision
118
Contact Radiotherapy
120
Electrocoagulation
121
Adjuvant Therapy after Local Treatment
122
Salvage Treatment
123
References
124

Surgical Resection Margins and Local Recurrence
10
The Staging of Rectal Cancer
11
Dukes Staging
12
Dukes Staging Versus TNM
14
Quality of Preoperative Imaging and Pathology Reporting and the Use of Reporting Proformas
16
Conclusions
18
3 Genetics Screening and Chemoprevention
21
Tumor Suppressor Genes
22
MMR Genes
24
Screening
25
Average Risk
26
Chemoprevention
28
Calcium
29
Antioxidant Vitamins
30
References
31
4 The Role of Imaging in the Diagnosis and Staging of Primary and Recurrent Rectal Cancer
33
Contrast Examinations
34
Endorectal Ultrasound
35
Computed Tomography
36
Magnetic Resonance Imaging
38
Positron Emission Tomography
41
Radioimmunoscintigraphy
43
Ultrasound Techniques
44
Positron Emission Tomography and Immunoscintigraphy
45
References
46
5 Neoadjuvant Therapy
51
Results of Preoperative Therapy
52
Intensive Short Course Preoperative Radiation
53
Sphincter Preservation with Preoperative Radiation
54
Is Adjuvant Therapy Necessary in Patients Undergoing a Total Mesorectal Resection?
57
Investigational Approaches
58
References
59
6 Restorative Procedures
63
Surgical Options in Restorative Procedures
65
Preoperative Evaluation and Patient Preparation
66
Oncologic Principles in Rectal Surgery
67
Radial Margin and Complete Mesorectal Resection
69
Final Preparations for the Restorative Procedures
70
Technical Details
71
Low Anterior Resection
73
Coloanal Anastomosis
74
Colonic Reservoir JPouch
75
Laparoscopic Rectal Cancer Surgery
76
7 Abdominoperineal Resection
79
TumorRelated Factors
80
Operative Technique
81
Intraoperative and Postoperative Complications
85
Inadvertent Perforation of the Rectum
86
Urethral Injury
87
Optimized Surgery
89
Technique of Total Mesorectal Excision with Autonomic Nerve Preservation
91
Outcome of Total Mesorectal Excision
93
Morbidity of Total Mesorectal Excision
96
Extended Lateral Lymphadenectomy
97
Role of Total Mesorectal Excision in Upper Rectal Cancer
98
Laparoscopic Colectomy
101
Physiologic Aspects of Laparoscopic Surgery
102
Laparoscopic Surgery for Benign Colonic Disease
103
Laparoscopic Surgery for Malignant Colonic Disease
106
Summary
108
Procedures of Laparoscopic Proctosigmoidectomy
109
Conclusion
112
10 Minimal Access Surgery for Rectal Cancer
115
11 Postoperative Adjuvant Combined Modality Therapy
127
Functional Results with Postoperative Therapy
129
Is Adjuvant Therapy Necessary after Total Mesorectal Excision?
130
Investigational Approaches
131
12 Followup After Potentially Curative Therapy for Rectal Cancer
135
Background
136
Methods of Recurrence Detection
137
Endoscopy
139
Issues Specifically Regarding Rectal Cancer
142
Conclusion
143
13 Surgical Approach to Locally Recurrent Disease
147
Diagnostic Evaluation
148
Preoperative Therapies
149
Preoperative Planning
150
Intraoperative Radiation
153
Intraoperative HighDose Brachytherapy
154
Future Directions
155
14 Metastatic Rectal Cancer
157
Surgical Resection of Lung Metastases
158
5Fluorouracil
159
Modulation of 5Fluorouracil with Leucovorin
160
Modulation of 5Fluorouracil with Methotrexate
161
Other Continuous Infusional 5Fluorouracil Schedules
163
Chronomodulated Chemotherapy
164
5Fluorouracil and Mitomycin C
165
Capecitabine
166
Eniluracil
167
Raltitrexed
170
Oxaliplatin
171
IntraArterial Hepatic Chemotherapy for Isolated Liver Metastases
172
Cytokines
173
References
174
15 Rare Histiotypes
179
Clinical Presentation and Diagnosis
180
Lymphoma of the Rectum
182
Secondary Lymphoma of the Rectum
183
Treatment and Prognosis
184
Pathology
185
Vascular Lesions
186
Lymphangiomas
187
Adenosquamous Carcinoma of the Rectum
188
Sarcomas of the Rectum
189
References
190
16 Quality of Life and Palliative Care in Rectal Cancer Patients
193
Multidimensional Quality of Life Questionnaires
194
A Brief Historical Review
195
Bowel Dysfunction
196
Quality of Life Studies
197
Radiotherapy
198
Rehabilitation Needs
199
Pain
200
CachexiaAnorexia
203
Ascites
205
Nausea and Vomiting
206
Dyspnea
207
References
208
17 Costs of Rectal Cancer Patient Management
215
Methods
216
Results
217
Continuing Care Phase
223
Conclusion
228
Index
231
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