Rectal Cancer

The clinical utility of EUS in staging rectal cancer is even greater than in EC. I say this because the treatment of rectal cancer has a number of surgical/presurgical approaches, and stratifying patients to the most optimal therapy can really only be done with very accurate local staging (ie, with EUS). Large tubulovillous adenomas in the rectum can often be treated with endoscopic mucosal resection (EMR). In these cases, EUS can play an important role in ruling out malignancy deep in the rectal wall, or more importantly, in surrounding lymph nodes. Small, early rectal cancers may be optimally managed by transanal full thickness resection followed by possible external beam radiation, thus avoiding a colostomy. Here, EUS is useful to rule out T3 or N1 disease, in which case the transanal approach would not be appropriate. For locally advanced rectal cancers (ie, T3N0 or T3N1), preoperative chemoradiation followed by resection offers the best long term survival. EUS and FNA are very helpful in providing accurate T and N staging to determine if neoadjuvant therapy is indicated. The overall T-stage accuracy of EUS is 80 to 95% and N-stage accuracy is

70 to 75% (Table 5-5). EUS is more sensitive and specific than CT for T and N staging, although CT is still needed to detect liver metastasis. MRI with pelvic surface coils is more accurate than CT for T staging and similar to EUS. However, MRI has a lower specificity for N stage and is more expensive (although less operator dependent) than EUS. A recent outcomes paper examining the role of EUS in rectal cancer staging showed that of 80 consecutive patients with rectal cancer, 66 patients would have gone directly to surgery based on CT alone (Figure 5-3) (Harewood et al, 2002). However, EUS/FNA was able to determine that 24 of the 66 patients (36%) had locally advanced diseased and more appropriately received neoadjuvant chemoradiation. There is a chapter on rectal carcinoma (see Chapter 98, "Rectal Cancer") and on rectal cancer palliation (see Chapter 99, "Rectal Cancer Palliation").

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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