Clinical Evaluation

After the initial diagnosis of rectal cancer is made, further workup should determine if the patient is a candidate for different palliative therapy regimens and what aspect of the patient's disease is likely to cause symptoms. This diagnostic workup is initially based on physical findings and symptoms. if these first data suggest the presence of advanced disease, then further workup should be minimized. in other words, patients who have clear evidence for disseminated rectal cancer or who are in frail health often do not require further computed tomography (CT) or magnetic resonance imaging (MRI) scans. In every case of incurable rectal cancer, the extent of the workup must assure that the potential treatment morbidity is justified by the anticipated outcome. in patients who are candidates for surgery, a CT of the abdomen/pelvis is performed to determine resectability and extent of abdominal metastases. Endorectal ultrasound or pelvic MRI can be used if findings on CT are unable to determine resectability. If the rectal cancer appears resectable, then CT of the upper abdomen and chest and positron emission tomography scanning are done to exclude distant metastases. In addition, diagnostic laparoscopy can be used to identify widespread disease prior to laparotomy in patients with an otherwise negative workup. Despite recent advances in imaging technologies and intensive investigations, the surgeon often finds that the preoperative workup underestimated the full extent of the disease. The true extent of local involvement and distant spread, and thus the need for palliative treatment, only become evident at examination of the abdomen in the operating room.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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