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Colorectal Cancer

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ORLANDO-The National Initiative on Cancer Care Quality (NICCQ) has presented preliminary results from its ongoing survey of breast and colorectal cancer patients in five cities. The study, now in its second year, was prompted by a 1999 Institute of Medicine report that found serious gaps in the quality of care for many people.

A 75-year-old attorney presents with intermittent rectal bleeding. He had refused routine sigmoidoscopy in the past. His primary care physician was his friend, and he had convinced him to at least send in stool specimens for occult blood testing. Three years ago, his primary care physician informed him that "several" of the tests were positive and that he required evaluation. The patient refused and his doctor retired.

The US National Cancer Institute Gastrointestinal Intergroup has contributed to the development of chemotherapy and radiation regimens for the treatment of stage II and III rectal cancer. The first Intergroup trial demonstrated improvement in relapse-free and overall survival for patients who received protracted venous infusion fluorouracil (5-FU) with radiation compared to those treated with bolus 5-FU.

EAST MELBOURNE, Australia-A new prospective study has confirmed the usefulness of 18F-FDG PET in treatment planning for patients with confirmed or suspected colorectal cancer recurrence. In this study, 60% of planned surgeries were found to be unnecessary as the result of PET.

WESTBURY, New York-E-Z-Em, Inc. has begun marketing its InnerviewGI workstation for virtual colonoscopy procedures. The product is able to render three-dimensional (3D) images in just seconds and provides imaging professionals with multiple 3D view options (see figures below), as well as synchronized 2D and 3D views of the colon, the company said in a news release. InnerviewGI is powered by Vital Images’ Vitrea 2 software and features real-time navigation of 3D volume data.

The multistep process of carcinogenesis, which can take many years, provides many opportunities for intervention to inhibit disease progression. Effective chemoprevention agents may reduce the risk of cancer by inhibiting the initiation stage of carcinoma through induction of apoptosis or DNA repair in cells harboring mutations, or they may act to prevent promotion of tumor growth. Similarly, chemoprevention may entail blocking cancer progression to an invasive phenotype.

One of the most important prognostic factors in colorectal cancer is the presence or absence of regional lymph node metastases. In many instances, micrometastatic disease may not be found on routine pathologic analysis using hematoxylin and eosin staining, but may be discovered only with immunohistochemical methods or polymerase chain reaction assay.

BOSTON-Excessive sun exposure is a known risk factor for the development of skin cancer, but sun exposure appears to have a protective effect against a variety of other cancers, according to speakers at a symposium on sunlight at the 168th National Meeting of the American Association for the Advancement of Science (AAAS).

A 51-year-old man presents with iron deficiency anemia and occasional blood in his stool. He has no abdominal pain, no change in appetite, no diarrhea or constipation, no melena, and no loss of weight. The patient denies any nausea and vomiting.

Surgery is still the most important treatment for solid tumors, regardless of the age of the patient. In this article, we discuss the physiology of aging as it relates to risk assessment in the elderly surgical oncology patient. A brief review of the role of surgery in the treatment of breast, colorectal, pancreatic, and gastric cancer is provided, because these solid tumors primarily affect elderly patients.

A substantial body of evidence supports the conclusion that chronic inflammation can predispose an individual to cancer, as demonstrated by the association between chronic inflammatory bowel diseases and the increased risk of colon carcinoma. Chronic inflammation is caused by a variety of factors, including bacterial, viral, and parasitic infections, chemical irritants, and nondigestible particles.

A 49-year-old woman presents with increasing constipation. She has noted intermittent bright red blood on the toilet tissue. She denies abdominal pain, anorexia, weight loss, and fever. She has a long history of constipation treated with "natural, herbal remedies." Her medical history is unremarkable. She is taking no other medications. Her surgical history is positive for hysterectomy for fibroids. Her family history is positive for colon cancer in her maternal grandmother.

ROCKVILLE, Maryland-The FDA has approved a tiny ingestible video camera-the Given Diagnostic Imaging System (Given Imaging Ltd)-for use with other endoscopic and radiologic GI tract evaluations, to detect polyps, cancer, or causes of bleeding and anemia in the small intestine.

WASHINGTON-Sentinel lymph node (SLN) mapping has been used in gastrointestinal cancers to identify patients with occult micrometastases who might benefit from adjuvant chemotherapy. Because rectal lymph drainage is "less predictable" than colon lymph drainage, the technique had been considered less suitable for rectal than for colon cancers, said Sukamal Saha, MD, of the McLaren Regional Medical Center of Michigan State University, Flint.