MANAGEMENT OF OESOPHAGEAL CANCER - Revista Galenus
UMF Tg. Mures Rezumat Aceas articol este o trecere in revista a datelor din literatura de specialitate privind gastric cancer staging evaluarii cancerului esofagian si gastric si stadializarea. Toti pacientii care sunt luati in evidenta pentru interventia chirurgicala trebuie sa fie supusi unei evaluari a statusului fizic in principal a capacitatii performante si a functiei respiratorii. Pentru pacientii cu cancer gastric sau esofagian,stadializarea tumorilor la diagnostic este principalul factor determinant al supravietuirii.
Gastric cancer staging ganglionilor limfatici este cel mai important si singurul factor,urmat de stadiul T. Cuvinte cheie:cancer esofagian,stadiu tumoral,ganglioni limfatici Abstract This article is a review of the literature data on management of oesophageal gastric cancer assesement and staging.
All patients being considered for surgery should undergo careful assessment of fitness with emphasis on performance status and respiratory function.
For patients with gastric or oesophageal cancer, tumour stage at diagnosis is the main determinant of survival. Lymph node involvement is the most important single factor, followed by T stage.
Key words:oesophageal cancer,tumor stage,lymph node Introduction For patients with gastric or oesophageal cancer, tumour stage at diagnosis is the main determinant of survival.
Конечно, в основном это иллюзия, - проговорил Майкл. - Но очень хорошая. Если не приглядываться, можно подумать, что ты находишься в Массачусетсе или в южной части Вермонта.
- Весь этот обед показался мне сном, - сказала Николь. - Я как-то еще не осознала, что наша встреча реальна.
The presence of more than four involved nodes or M1a node involvement is associated with significantly reduced survival, although it does not necessarily preclude long term survival following resection.
Long term survival is not seen in patients with junctional cancers who have cervical nodal disease or nodal metastases in three body compartments neck, mediastinum and abdomen .
In patients with gastric cancer both the number of involved nodes and the ratio of involved to uninvolved nodes significantly influence long term outcome. T stage is the most significant factor in node negative cases. In patients with oesophageal cancer preoperative identification of lymph node involvement by EUS is associated with a poor prognosis.
Впрочем, стараясь быть объективными, все четверо взрослых признали, что, поскольку сами они решили отложить половую зрелость, то не могут дать совет, основанный на собственном опыте.
Не сомневаюсь, что тебя в особенности заинтересует первая экспозиция.
Selected patients with T4 gastric cancer in the absence of extensive lymph gastric cancer staging involvement can have long term survival five years and over following surgical resection[7,8]. The patients most likely to benefit from curative treatment are those without distant metastases and with limited lymph node involvement.
Long gastric cancer staging survival is possible in highly selected patients with more advanced disease but the majority of patients in this category will survive for less than two years following resection.
Oesophageal cancer should undergo careful preoperative staging to enable targeting of potentially curative treatment to those likely to benefit. B Patients with oesophageal cancer who have distant metastases or patients with oesophageal cancer who have metastatic lymph nodes in gastric cancer staging compartments neck, mediastinum and abdomen on preoperative staging are not candidates for curative treatment.
C When M1a nodal involvement in oesophageal cancer, or extensive lymphadenopathy in any cancer, is identified on preoperative staging, the anticipated poor prognosis should be carefully considered when discussing treatment options. Where there is clear evidence of incurable disease following staging, attempts at resection should be avoided. Tumor stage and gastric cancer staging of life There is no evidence directly addressing the influence of tumour stage on quality of life in patients with oesophageal cancer.
Surgery results in a reduction in quality of life which gastric cancer staging returns to preoperative levels in patients surviving more than two years. In these patients quality of life improves after three to four months and approaches preoperative levels at around nine months.
D The possibility of reduction in quality of life after surgery should be considered when discussing treatment options, particularly when preoperative staging suggests that surgery would be unlikely to be curative.
Complications can be reduced by removing those patients at greatest risk from the surgical cohort.
Пожалуйста, снимите всю одежду и драгоценности. - Что. - спросила Кэти. - И трусы. - Все, - ответила другая женщина.
This is most frequently achieved by exercising clinical judgement and there is evidence that this is predictive of in-hospital mortality. The more objective POSSUM physiological and operative severity score for the enumeration of mortality and morbidity scoring system is also predictive of in-hospital death.
The primary gastric lymphoma: definition
Scoring systems for risk prediction specifically for patients with oesophageal cancer have been developed. Use of a composite scoring system based on general performance status as well as cardiac, hepatic and respiratory function has been shown to reduce postoperative mortality from 9. A simpler but unvalidated scoring system based on age, spirometry and performance status predicted an incrementally increasing risk of respiratory and cardiac complications although it did not predict postoperative mortality.
This measure of cardiopulmonary reserve is not gastric cancer staging available.
In an American study of high-risk surgical patients, symptom-limited stair climbing predicted postoperative complications. Gastric cancer staging cancer staging role of dynamic testing of cardiac function has not been addressed in patients with oesophageal cancers. B All patients being considered for surgery should undergo careful assessment of fitness with emphasis on performance status gastric cancer staging respiratory function.
Accurate completion of pathology reports is essential to ensure accurate pathological staging for comparison with clinical staging gastric cancer staging, to inform assessment of prognosis, to indicate the completeness and adequacy of resection and to assist in audit.
Important pathological parameters Resection specimens need to be dissected carefully for accurate tumour staging. Tumour stage correlates with prognosis. The RCP standards also give information on the gastric cancer staging preparation and dissection methods for resection specimens and the information which oxiuri tratament tpu be recorded for each resection.
The following parameters have gastric cancer staging identified as important in the RCP standards: Oesophageal, and junctional type I and II cancers — extent within the wall, gastric cancer staging margins, vascular invasion and gastric cancer staging number of lymph nodes and number and sites in which there is metastatic tumour.
The latter is important to identify M1 nodes as these are associated with a poor prognosis.
MANAGEMENT OF OESOPHAGEAL CANCER
Management of oesophageal and gastric cancer Treatment principles The choice of treatment for patients with oesophageal or gastric cancer depends on the gastric cancer staging of the disease, and on the condition and wishes of the patient.
Patients with resectable lesions may be unfit for surgery or potentially curative chemoradiotherapy by virtue of significant comorbid disease. The management of all patients should be discussed in an appropriate multidisciplinary meeting MDM where all staging and other relevant information is available to all members of the team. Patients should be informed of the treatment options available surgery, chemotherapy or radiotherapyand these should be evaluated in terms of risks and benefits.
The management of all patients gastric cancer staging are diagnosed with gastric or oesophageal cancer, should parazitii scandal politie discussed within a multidisciplinary forum. Stress associated with the diagnosis and treatment of cancer can cause significant psychological morbidity.
Conclusion Health professionals providing care and treatment for patients with oesophageal or gastric cancer should seek appropriate training in communication skills. D Information relating to local and national support services should be made available to both patients and carers.
Blog aimed at residents in surgery URL : www. Romeo Giuli MD, resident. School of General and Emergency Surgery. University of Siena. October
Patients should be given clear information relating to the potential risks and benefits of treatment.