Management

The management of colon cancer depends upon the stage at presentation. Patients can be divided into the following two categories: (1) patients with a tumor amenable to resection with curative intent and (2) patients in whom palliation is the goal. In patients with localized and potentially

TABLE 96-1. American Joint Commission on Cancer TNM Staging System for Colon Cancer (6th Edition, 2002)

Primary Tumor (T) TX Primary tumor cannot be assessed TO No evidence of primary tumor

Tis Carcinoma in situ: intraepithelial or invasion of lamina propria* T1 Tumor invades submucosa T2 Tumor invades muscularis propria

T3 Tumor invades through the muscularis propria into the subserosa, or into nonperitonealized pericolic or perirectal tissues T4 Tumor directly invades other organs or structures, and/or perforates visceral peritoneum**

Regional Lymph Nodes (N) NX Regional lymph nodes cannot be assessed NO No regional lymph node metastasis N1 Metastasis in 1 to 3 regional lymph nodes N2 Metastasis in 4 or more regional lymph nodes

Distant Metastasis (M) MX Distant metastasis cannot be assessed MO No distant metastasis M1 Distant metastasis

Stage Grouping

AJCC/UICC

Dukes

Stage 0

Tis

NO

MO

Stage I

T1

NO

MO

A

T2

NO

MO

Stage IIA

T3

NO

MO

B

Stage IIB

T4

NO

MO

B

Stage IIIA

T1-2

N1

MO

C

Stage IIIB

T3-4

N1

MO

C

Stage IIIC

Any T

N2

MO

C

Stage IV

Any T

Any N

M1

AJCC = American Joint Committee on Cancer; UICC = International Union Against Cancer.

AJCC = American Joint Committee on Cancer; UICC = International Union Against Cancer.

curable disease, surgical resection is generally the primary and initial therapy, followed by adjuvant chemotherapy in some cases. When patients present with advanced disease, chemotherapy is often the first line of therapy and palliative resection is reserved for cases of locally symptomatic disease.

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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