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General Surgery
Perspective on Colonic Neoplasms (A)
Built from Maingot's Abdominal Operations
What’s inside
10 sections · 72 slides
Overview
- Scope of this perspective
- Disciplines behind the progress
- The large bowel from caecum to rectum
- Terms used throughout this topic
- Timing words used for cancer treatment
Inherited forms of colorectal neoplasm
Which syndromes exist, how they are diagnosed, and what follows
- Two families of inherited polyps
- Adenomatous polyposis syndromes
- Hamartomatous polyposis syndromes
- Lobulated adenomatous polyp of the colon
- Genetic testing and risk-reducing surgery
- When to suspect MUTYH-associated polyposis
- Inheritance pattern of MUTYH-associated polyposis
- Definition of familial colorectal cancer type X
- Amsterdam criteria II
- Cancer risk in FCC X compared with Lynch syndrome
- Surveillance in Lynch syndrome
- Surveillance in familial colorectal cancer type X
- Testing for mismatch repair gene mutations
- Immunohistochemistry as the preferred first test
- Immunohistochemical stain for a mismatch repair protein
- Routine testing of young colorectal cancer patients
- From Amsterdam criteria to a named diagnosis
Sessile serrated adenomas
A second route from bowel lining to cancer
- Features of a sessile serrated adenoma
- Saw-toothed crypts of a sessile serrated adenoma
- Adenoma next to normal colonic crypts
- Two routes from bowel lining to cancer
- Why the serrated pathway matters
PET-CT in colorectal cancer
What the combined scan adds, and where guidelines place it
- What PET-CT shows
- Combined PET and CT display of the whole body
- Where guidelines place PET-CT
- Where PET-CT is not recommended
Updated TNM staging of colorectal cancer
Finer subdivisions of T, N and M
- Structure of the TNM classification
- Subdivision of the T4 category
- Subdivision of the N categories
- Subdivision of the M category
- Updated TNM subdivisions at a glance
- Tumour growing through the wall of the colon
- Colonic adenocarcinoma deposit in a lymph node
- Expected effect of the staging update
Targeted drug therapy
Antibodies against growth signals, and who benefits
- Cetuximab and bevacizumab
- How a monoclonal antibody drug works
- Ribbon model of the cetuximab antibody protein
- K-ras mutation and response to cetuximab
Advances in radiation delivery
Image guidance and intensity modulation
- Image-guided radiation therapy
- Intensity-modulated radiation therapy
- Linear accelerator used to deliver radiation therapy
Treatment of rectal cancer
The established pathway and the deviations being tested
- Position of the rectum within the pelvis
- The German Rectal Cancer Trial
- Recommended management of locally advanced rectal cancer
- Pathologic complete response
- Nonoperative management after complete clinical response
- Neoadjuvant chemotherapy without radiation
- Reading the chemotherapy-only results
- Chemoradiation and local excision in stage I disease
- 44%
- Status of the ACOSOG Z6041 evidence
Laparoscopic and robotic surgery
Settled for colon cancer, still being tested for rectal cancer
- Laparoscopic surgery for colon cancer
- Abdominal wall after keyhole surgery
- Trials that settled laparoscopic colon surgery
- Laparoscopic surgery for rectal cancer
- Why robotic surgery was taken up in the pelvis
- Robotic-assisted total mesorectal excision series
- Development of minimally invasive colorectal surgery
Summary
What to carry away from this perspective
- Take-home points on genetics and pathology
- Take-home points on imaging, staging and drugs
- Take-home points on surgery
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- References
- References (continued)
- References (continued)
- References (continued)
- Maingot's Abdominal Operations, 12th Edition