Management of stage Ⅳ rectal cancer - World Journal of ...

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MicroRNA epigenetic alterations in human cancer: one step forward in diagnosis and treatment. Int J Cancer 2008; 122: 963-968 S- Editor Sun H L- Editor Kerr C E- Editor Ma WH 827 February 21, 2011|Volume 17|Issue 7|
Online Submissions: http://www.wjgnet.com/1007-9327office wjg@wjgnet.com doi:10.3748/wjg.v17.i7.828 Imran Hassan, MD, Assistant Professor, Series Editor Current trends in staging rectal cancer Abdus Samee, Chelliah Ramachandran Selvasekar Abdus Samee, Department of Surgery, Princess Royal Hospital, Telford, Shropshire, United Kingdom Chelliah Ramachandran Selvasekar, Department of Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, United Kingdom Author contributions: Selvasekar CR designed the study; Samee A and Selvasekar CR were literature search and drafting the article; Samee A and Selvasekar CR revised the critically. Correspondence to: Chelliah Ramachandran Selvasekar, MD, FRCS, Consultant Colorectal Surgeon, Department of Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, United Kingdom. crselvasekar@aol.com Telephone: +44-1270-612046 Fax: +44-1270-612494 Received: August 30, 2010 Revised: November 12, 2010 Accepted: November 19, 2010 Published online: February 21, 2011 Abstract Management of rectal cancer has evolved over the years. In this condition preoperative investigations assist in deciding the optimal treatment. The relation of the tumor edge to the circumferential margin (CRM) is an important factor in deciding the need for neoadjuvant treatment and determines the prognosis. Those with threatened or involved margins are offered long course chemoradiation to enable R0 surgical resection. Endoanal ultrasound (EUS) is useful for tumor (T) staging; hence EUS is a useful imaging modality for early rectal cancer. Magnetic resonance imaging (MRI) is useful for assessing the mesorectum and the mesorectal fascia which has useful prognostic significance and for early identification of local recurrence. Computerized tomography (CT) of the chest, abdomen and pelvis is used to rule out distant metastasis. Identification of the malignant nodes using EUS, CT and MRI is based on the size, morphology and internal characteristics but has drawbacks. Most of the common imaging techniques are suboptimal for imaging following chemoradiation as they struggle to differentiate fibrotic changes and tumor. In this situation, EUS and MRI may provide complementary information to decide further treatment. Functional imaging using positron emission WJG|www.wjgnet.com 828 World J Gastroenterol 2011 February 21; 17(7): 828-834 ISSN 1007-9327 (print) ISSN 2219-2840 (online) © 2011 Baishideng. All rights reserved. tomography (PET) is useful, particularly PET/CT fusion scans to identify areas of the functionally hot spots. In the current state, imaging has enabled the multidisciplinary team of surgeons, oncologists, radiologists and pathologists to decide on the patient centered management of rectal cancer. In future, functional imaging may play an active role in identifying patients with lymph node metastasis and those with residual and recurrent disease following neoadjuvant chemoradiotherapy. © 2011 Baishideng. All rights reserved. Key words: Rectal cancer; Staging; Investigations; Magnetic resonance imaging; Ultrasound; Endoanal ultrasound; Positron emission tomography; Computerized tomography Peer reviewer: Christopher Mantyh, MD, Associate Professor, Department of Surgery, Duke University Medical Center, Box 3117, Durham, NC 2771, United States Samee A, Selvasekar CR. Current trends in staging rectal cancer. World J Gastroenterol 2011; 17(7): 828-834 Available from: URL: http://www.wjgnet.com/1007-9327/full/v17/i7/828.htm DOI: http://dx.doi.org/10.3748/wjg.v17.i7.828 INTRODUCTION TOPIC HIGHLIGHT Nearly one million patients are diagnosed with colorectal cancers (CRC) annually in the world [1] . The incidence of CRC is highest in the western world where it is the second commonest cause of cancer death and fourth commonest cause of death from cancer worldwide [2] . In the western world there is a life time risk of CRC of 5%. Overall the 5 year survival has improved in the UK (55% in males and 51% in females) but to a lesser extent than in the USA and Europe [3] . Around 30%-40% of colorectal cancer is defined to arise from the rectum which is defined as the distal margin of tumor within 15 cm of the anal verge [4,5] . Colonoscopy and biopsy is considered as the gold February 21, 2011|Volume 17|Issue 7|
Page 1 and 2: World Journal of Gastroenterology W
Page 3 and 4: Robert JL Fraser, Daw Park Jacob Ge
Page 5 and 6: Italy Donato F Altomare, Bari Piero
Page 7 and 8: Fernando Azpiroz, Barcelona Ramon B
Page 10 and 11: Contents BRIEF ARTICLE WJG|www.wjgn
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Page 16 and 17: expressed miRNAs including known on
Page 18 and 19: Oh et al [73] have shown that upreg
Page 20 and 21: 5 Bardeesy N, DePinho RA. Pancreati
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Page 26 and 27: proximity to a T3 tumor or nodules
Page 28 and 29: CONCLUSION Imaging in rectal cancer
Page 31: Ronnekleiv-Kelly SM et al . Palliat
Page 47: Popek S et al . Neoadjuvant vs adju
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Page 52 and 53: esection [19] . Conversely, approxi
Page 54 and 55: that option again, than patients wh
Page 56 and 57: Mulsow J et al . Treatment options
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Page 67 and 68: Sharma C et al . Clinical advances
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Table 10 Published results on lapar
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Sharma C et al . Clinical advances
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Table 2 Neuronal density and mean a
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A D tween ROS production and neutra
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troparesis. BMC Gastroenterol 2008;
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Table 2 Details of patients who nee
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Table 5 Lab data and performance st
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W168-W176 4 Slakey DP, Klein AS, Ve
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A BMI 28 26 24 22 20 18 40-49 50-59
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A Age (yr) 90 80 70 60 50 40 P < 0.
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Part1. Diagnosis and classification
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(25-OHD) and in the kidneys to form
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of osteomalacia with oral 25-hydrox
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patic parenchymal dissection as wel
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Table 1 Comparisons of three routes
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study demonstrated that the water-j
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It has been recently shown that CD1
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A B C Count Count 200 160 120 80 40
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and progenitor cells. Lgr5 (leucine
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J Gastroenterol 2011; 17(7): 938-94
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A SS 0 1023 ed into the abdominal c
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A B C D for more scientists. Cell t
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marrow as a potential source of hep
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INTRODUCTION Hepatocellular carcino
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A C Liu QY et al . Primary clear ce
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Liu QY et al . Primary clear cell c
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Instructions to authors Indexed and
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Instructions to authors uniform leg
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Instructions to authors Language ev
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