Gastrointestinal Oncology - part 10 pptx

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384 Chapter 18

appendix A

Esophageal Cancer Staging

PRIMARYTUMOR(T)

TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

Tis Carcinoma in situ

T1 Tumor invades lamina propria or submucosa

T2 Tumor invades muscularis propria

T3 Tumor invades adventitia

T4 Tumor invades adjacent structures

REGIONALLYMPHNODES(N)

NX Regional lymph nodes cannot be assessed

N0 No regional lymph node metastasis

N1 Regional lymph node metastasis

DISTANTMETASTASIS (M)

MX Distant metastasis cannot be assessed

M0 No distant metastasis

M1 Distant metastasis

Tumors of the Lower Thoracic Esophagus

M1a Metastasis in celiac lymph nodes

M1b Other distant metastasis

Tumors of the Midthoracic Esophagus

M1a Not applicable

M1b Nonregional lymph nodes and/or other distant metastasis

Tumors of the Upper Thoracic Esophagus

M1a Metastasis in cervical nodes

M1b Other distant metastasis

Used with the permission of the American Joint Committee on Cancer (AJCC7), Chicago, Illinois

The original source for this material is the AJCC Cancer Staging Manual, 6th edition (2002).

Springer-Verlag: New York, Inc., New York, New York

386 Appendix A

appendix B

Gastric Cancer Staging

PRIMARYTUMOR(T)

TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

Tis Carcinoma in situ: intraepitheal tumor without invasion of the lamina

propriaT1 Tumor invades lamina propria or submucosa

T2 Tumor invades muscularis propria or subserosa*

T2a Tumor invades muscularis propria

T2b Tumor invades subserosa

T3 Tumor penetrates serosa (visceral peritoneum) without invasion of cent structures**, ***

adja-T4 Tumor invades adjacent structures**,***

*Note: A tumor may penetrate the muscularis propria with extension into the

gastro-colic or gastrohepatic ligaments, or into the greater or lesser omentum, without ration of the visceral peritoneum covering these structures In this case, the tumor isclassified as T2 If there is perforation of the visceral peritoneum covering the gastric lig-aments or the omentum, the tumor should be classified as T3

perfo-**Note: The adjacent structures of the stomach include the spleen, transverse colon,

liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine, andretroperitorneum

***Note: Intramural extension to the duodenum or esophagus is classified by the depth

of the greatest invasion in any of these sites, including the stomach

NX Regional lymph node(s) cannot be assessed

N0 No regional lymph node metastasis*

N1 Metastasis in 1 to 6 regional lymph nodes

N2 Metastasis in 7 to 15 regional lymph nodes

N3 Metastais in more than 15 regional lymph nodes

*Note: A designation of pN0 should be used if all examined lymph nodes are negative,

regardless of the total number removed and examined

Used with the permission of the American Joint Committee on Cancer (AJCC7), Chicago, Illinois

The original source for this material is the AJCC Cancer Staging Manual, 6th edition (2002).

Springer-Verlag: New York, Inc., New York, New York

388 Appendix B

appendix C

Pancreas Cancer Staging

PRIMARYTUMOR(T)

TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

Tis Carcinoma in situ*

T1 Tumor limited to the pancreas, 2 cm or less in greatest dimensionT2 Tumor limited to the pancreas, more than 2 cm in greatest dimensionT3 Tumor extends beyond the pancreas but without involvement of the celi-

ac axis or the superior mesenteric arteryT4 Tumor involves the celiac axis or the superior mesenteric artery (unre-sectable primary tumor)

*Note: This includes the “PainInIII” classification N3 “metastasis”

REGIONALLYMPHNODES(N)

NX Regional lymph node(s) cannot be assessed

N0 No regional lymph node metastasis

N1 Regional lymph node metastasis

DISTANTMETASTASIS (M)

MX Distant metastasis cannot be assessed

M0 No distant metastasis

M1 Distant metastasis

Used with the permission of the American Joint Committee on Cancer (AJCC7), Chicago, Illinois.

The original source for this material is the AJCC Cancer Staging Manual, 6th edition (2002).

Springer-Verlag: New York, Inc., New York, New York

390 Appendix C

TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

Tis Carcinoma in situ: intraepitheal or invasion of the 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 ceral peritoneum**,***

vis-*Note: Tis includes cancer cells confined within the gladular basement membrane

(intraepithelial) or lamina propria (intramucosal) with no extension through the cularis mucosae into the submucosa

mus-**Note: Direct invasion in T4 includes invasion of other segments of the colorectum by

way of the serosa; for example, invasion of the sigmoid colon by a carcinoma of thececum

***Note: Tumor that is adherent to other organs or structures, macroscopically, is

fied as T4 However, if no tumor is present in the adhesion, microscopically, the fication should be pT3 The V and L substaging should be used to identify the presence

classi-or absence of vascular classi-or lymphatic invasion

NX Regional lymph node(s) cannot be assessed

N0 No regional lymph node metastasis

N1 Metastasis in 1 to 3 regional lymph nodes

N2 Metastasis in 4 or more regional lymph nodes

Note: A tumor nodule in the pericolorectal adipose tissue of a primary carcinoma

with-out histologic evidence of residual lymph node in the nodule is classified in the pN egory as a regional lymph node metastasis if the nodule has the form and smooth con-tour of a lymph node If the nodule has an irregular contour, it should be classified inthe T category and also coded as V1 (microscopic venous invasion) or as V2 (if it wasgrossly evident), because there is a strong likelihood that it represents venous invasion

Note: The y prefix is to be used for those cancers that are classified after

pretreat-ment, whereas the r prefix is to be used for those cancers that have recurred

Used with the permission of the American Joint Committee on Cancer (AJCC7), Chicago, Illinois

The original source for this material is the AJCC Cancer Staging Manual, 6th edition (2002).

Springer-Verlag: New York, Inc., New York, New York

392 Appendix D

5-aminolevulinic acid (ALA), 370–372

5-fluorouracil, 27–30, 32, 36–39, 57, 62,

107–112, 116–129, 186, 187,

188, 189, 190, 191abdominoperineal resection, 170–171

abscess drainage, percutaneous, 265–266

acetic acid, percutaneous, 262

colon and rectal cancer, 168–169, 391–392

esophageal cancer, 385–386gastric cancer, 387–388pancreas cancer, 389–390aminotransferases, 317ampulla of Vater, 131analgesia, 203–204, 210epidural, 206–207intravenous patient-controlled, 204– 205

neuraxial, 214–215patient-controlled, 211–214Analgesic Step Ladder, WHO, 211angioplasty, pre-stent, 271animal model systems, 328antiangiogenesis inhibitors, 32–33, 39anti-AP-I retinoids, 329

antioxidants, 58, 339, 341, –343, 346, 349

APC 11307K mutation, 177appetite stimulants, 310–312argon plasma coagulation (APC), 287–

288, 299ascites, 264–265ascorbic acid, 339, 346Asian cholangiohepatitis, 255

Index

Astler-Coller staging system, 183–184

esophageal cancer risk with, 2, 34, 54

screening and surveillance for, 2–3, 4,

7–8treatment of, 5, 7–8

basal cell nevus, 333

endoscopic palliation in, 137–138

percutaneous procedures for, 245–254

body mass index (BMI), 308

bone cement injection, 218

bony metastasis, 208

Bortezomib, 329

bowel obstruction, 314

BRCA2 mutations, 70–72, 80

breast cancer, hereditary, 333

Brief Pain Inventory (BPI), 201, 202

CA-125, 178

CA 19-9, 90cachexia, 310–312CagA, 24–25calcium, 331, 342–343, 347cancer pain syndromes, 195, 207, 215assessment and management of, 195– 219

neuropathic, 209somatic, 208treatment-related, 207–208visceral, 208–209

cancer risk, heritable, 332cancer staging, 168–169, 223–238, 385– 392

cancer syndromes, segregate mutations associated with, 74–75

cannabinoids, 310capecitabine, 108, 116, 186, 189carboplatin, 27–30, 37

carcinoembryonic antigen (CEA), 163,

164, 184carcinogenesis, 335caretaker genes, 159carotenoid, 331case-control studies, 328cathepsin B, 378–379catheterization, central venous, 269–271catheters, 265

biliary drainage, 248–254occlusion of, 318tunneled, 270, 278CDDP, 32, 36, 37, 38–39CDKN2A mutations, 69, 72celecoxib, 191, 330celiac plexus block, 216–217cell culture experiments, 328cell signaling pathway, 113–114cetuximab, 112, 115

chemical carcinogens, 328chemical pleurodesis, 278chemoembolization, 256–260chemoprevention, 327, 328–335chemoprevention agents, 328, 329–331, 336–352

394 Index

adjuvant, 189–190

for colorectal neoplasia, 184–191

for esophageal cancer, 36–39, 57

for gastric cancer, 23, 26–32, 62

liposomes in, 280

nutritional support in, 313

for pancreatic cancer, 107–120

side effects of, 258

adjuvant chemotherapy for, 189–190

familial risk and, 159

chemoprevention agents in, 340–349

diagnosis and preoperative evaluation

of, 163–165familial, 157–158

high-risk, 174–181metastatic, 184–189stage system of, 183–184surgical approach to, 157–181colorectal obstruction, luminal patency in, 300–302

colorectal polyps, 161colostomy, temporary, 167–168, 172computed tomography (CT)

in abscess drainage, 266

in colorectal cancer diagnosis, 163– 165

contrast-enhanced chest, 271–272for gastric cancer, 59

for pancreatic cancer, 91–93, 95for pancreaticobiliary malignancy, 129–130, 135–136

thin-cut helical, 153cordotomy, 218coronary artery bypass grafting surgery, 280

corticosteroids, 310–312Courvoisier’s sign, 89–90CPT11, 30

Crohn’s colitis, screening and surveillance for, 147–148, 151

cross-sectional studies, 91–93, 328cyclooxygenase-2 (COX-2) inhibitors, 7–8, 335, 337, 339–340, 345, 347–349, 351, 352

cyprohepatidine hydrochloride, 312cytidine analogue, 119–129cytokines, host-derived, 310cytotoxic agents, 32–33, 191D-limonene, 351

dexamethasone, 312diagnostic technologies, 365–380dietary factors, 307–308, 310dietary guidelines, ACS, 308difluoromethylornithine, 330, 349dihematoporphyrin ether, 371dilation, esophageal, 286–287diverticulitis, 164

DNA adduct formation, 328

Index 395

DNA mutations, stool testing for, 153–

in diagnosis and staging, 223–238

instruments and technique in, 223–

224endoscopy

epirubicin, 30, 62erbstatin, 329ERCC-1 gene, 39erlotinib, 113esophageal cancer, 39–40, 289algorithm for evaluating, 225chemotherapy/radiotherapy for, 37– 39

clinical presentation, diagnosis, and preoperative evaluation, 54–55diet and nutritional factors in, 307, 313

endoscopic ultrasonography for, 224– 226

incidence and epidemiology of, 23, 33, 53–54, 285

prevention, surveillance, and tic indicators for, 34–35, 336– 340

prognos-radiotherapy for, 35–36risk factors and pathogenesis of, 33–

34, 54staging of, 54–55, 385–386surgical management of, 35, 55–56, 285

esophageal strictures, 286–287esophageal wall, mass through, 225esophagectomy, 18

minimally invasive, 20transhiatal (Orringer), 15–19, 55–56transthoracic, 19–20, 55–56esophagogastroduodenoscopy (EGD), 59esophagojejunostomy anastomosis, 8esophagus

adenocarcinoma of, 2, 5, 7, 33–34, 53–54, 377

argon plasma coagulation of, 287–288laser therapy for, 287–288

neoplasms ofbenign, 11–15malignant, 15–20obstruction of, 285–296photodynamic therapy in, 288–291premalignant diseases of, 1–8stenting, 244–245, 291–296ulceration of, 245

396 Index

estrogen compounds, 345, 348

ethanol, percutaneous injection of (PEI),

261–262, 264etoposide, 27–30, 36

farnesyl transferase inhibitors, 113–114

fat emulsion, intravenous, 316

fecal occult blood testing, 142–145, 147

femoral stenosis, percutaneous dilation of,

279fentanyl, 206, 210

chemoprevention agents in, 349–350

classification and prognostic indicators

of, 24–25diet and, 58, 313

endpoints of, 349–350

epidemiology of, 23–24, 58multimodality therapy for, 32–33nonsurgical treatments of, 26–31, 62optical coherence tomography of, 377risk factors and pathogenesis of, 24, 58staging of, 59–60, 387–388

surgical management of, 25–26, 60– 62

gastric decompression, 320–321gastric interposition, 19gastric lymphoma, 227–228gastric outlet obstruction, 297gastric transposition, 15gastric tube, 18gastric wall, hypoechoic mass from, 232gastroesophageal junction tumors, 24, 292

gastroesophageal reflux disease (GERD),

2, 24, 34gastrointestinal bleeding, 164gastrointestinal malignancydiagnosis and staging of, 223–238diet and nutrition in, 307–322endpoint evaluation of, 335heritable syndromes associated with, 332–334

mortality rates for, 327gastrointestinal neoplasiachemoprevention for, 327–352technologies for detecting, 365–380gastrointestinal stromal tumors (GISTs), 229–232

Gastrointestinal Tumor Study Group (GITSG) trial, 116–120

gastrojejunostomy, 102, 243–244gastrostomy, 243–244

gatekeeper genes, 158G17DT, 114gemcitabine, 37, 100–115, 119–129gene therapy, 279–280

genetic counseling, 81, 151, 153genetic markers, 90, 91genetic mutations, 79–80genetics

of colorectal cancer, 158–162

of pancreatic carcinoma, 69–73genistein, 329

genitourinary procedures, 273–276

Index 397

glutamate release inhibitors, 208

hemorrhagic pericardial tamponade, 268

hepatic artery chemoembolization, 186

hepatic artery infusion, 186, 188

ideal body weight (IBW), 315–316

ileal pouch anal anastomosis, 175–176,

179–181

ileorectal anastomosis, 167–168ileosigmoid anastomosis, 167–168immune therapy, 114–115immunohistochemistry, 25inferior vena cava filters, 272–273inflammatory bowel disease, 147–148, 150–151

interleukin-6, 310intraductal papillary mucinous tumors (IPMTs), 87, 88–89, 135, 235intraepithelial neoplasia, 335irinotecan, 30, 32–33, 111, 186, 187, 188Ivor-Lewis technique, 35

J pouch, 172, 174jaundice, 89–90, 130, 136–138

K-ras mutations, 80, 91, 134, 184, 351 K-ras oncogene, 69

Karnofsky Performance Status (KPS) Scale, 201

Klatskin tumors, 136Kocher maneuver, 99Kraske’s procedure, 171laparoscopic gastric resection, 60laparoscopy, 32, 60, 95, 102–103, 135– 136

laparotomy, 35, 60laser therapy, 287–288, 300–301, 302leiomyoma, esophageal, 11–14leucovorin, 36, 108, 112, 189, 190levamisole, 189

levobupivacaine, 206–207Li-Fraumeni syndrome, 334light-scattering spectroscopy, 373, 380light-tissue interactions, 365–366limonene, 329

lipoma, esophageal, 14liposomes, 280liver, biopsy of, 268–269low anterior resection syndrome, 172luminal patency

in colorectal obstruction, 300–302esophageal, 285–296

in upper gastrointestinal obstruction, 296–300

lung biopsy, 267–268LV5FU2, 189–190

398 Index

135–136malnutrition, 313

marimastat, 111, 331

matrix metalloproteinase inhibitors, 30,

114McGill Pain Questionnaire (SF-MPQ),

201mechanical pleurodesis, 278

metastatic vertebral compression fractures,

217–218methotrexate, 27–30

methyl-CCNU, 31

microsatellite instability (MSI), 24, 70,

151, 159mismatch repair genes (MMR) mutations,

151, 158–160, 178, 332mitomycin C, 27–30

mitomycin C and streptozocin, 117

molecular beacons, 378–379, 380

molecular screening, 79–80

monoclonal antibodies, 39

morphine, 206, 209–210

mucinous duct ectasia, 135

mucosa-associated lymphoid tissue (MALT)

lymphoma, 227–228multimodal therapy, 57

multiple endocrine neoplasia I, 334myelotomy, 218

N-nitroso compounds, 307nasogastric feeding tube, 320–321National Comprehensive Cancer Network (NCCN) cancer pain guidelines, 211–213

Nd:YAG laser therapy, 296–297, 299– 302

Nd:YAG probe, 287near-infrared light, 373nedaplatin, 37nephrostomy catheter, 273–274, 276nephroureteral catheter, 275nephroureterostomy, 274nerve blocks, 215–217neuroendocrine liver metastasis, 259neurofibroma, esophageal, 14neurolytic blocks, 216neuromodulation, 218neuropathic pain, 200, 209neurosurgical palliative techniques, 218nitric oxide synthetase inhibitors, 208nitrogen balance, 319

nocturnal jejunal feeding, 313nonpancreatic periampullary cancer, 87nonsteroidal anti-inflammatory drugs (NSAIDs), 204–205, 339–340, 344–345, 347–348

nutritional factors, 307–308nutritional status assessment, 308–310, 311

nutritional support, 312, 313–314obesity, 307–308

Olomoucine, 330oncogenes, 158–160opioids

chronic use of, 209–210continuous infusion of, 211–214optical coherence tomography, 374–378organ dysfunction biopsy, 269

osteoclast inhibitors, 208ovarian cancer, hereditary, 333oxaliplatin, 30, 37, 111, 112–113, 115,

186, 191oxycodone, 209–210oxygen radicals, 288

Index 399

cystic neoplasms of, 135

hypoechoic mass in head of, 234

familial, 74–75, 333

epidemiology and incidence of,

67–69genetics of, 73

risk factors in, 68, 73–74

screening for, 76–80

family history of, 68–69, 80–83

genetic syndrome associated with, 71

immune therapy for, 114–115

locally advanced, 115–118

metastatic, 107–113

palliative intervention for, 101–102

postoperative care for, 102

preoperative evaluation of, 89–95

69, 76–77, 80–81pancreatic neoplasia, classification of, 87pancreatic neuroendocrine tumors, 236pancreaticobiliary malignancy, 232–237pancreaticobiliary neoplasia, 125–139pancreaticoduodenectomy, 89, 95, 136–137Whipple vs pylorus-preserving, 97–99pancreatico-jejunal reconstruction, 100pancreatic periampullary cancer, 88pancreatitis, 70–73, 74–75, 238papilloma, esophageal, 14paracentesis, large volume, 264parenteral nutrition, 314–315central, 315

complications of, 317–318home, 319–320

monitoring, 316–319prescription for, 315–316safety and efficacy of, 316–317, 319total (TPN), 312–316

PEG tube, 322pelvic biopsy, 269pemetrexed, 111Penrose drain, 16, 17pentoxifylline, 310percutaneous biopsy, 267adrenal, 268liver, 268–269lung/mediastinal, 267–268pancreas, 269

retroperitoneal and pelvic, 269percutaneous drainage techniques, image-guided, 265–266

percutaneous tumor ablation, 260–261acetic acid, 262

chemical, 261–262

in combination therapy, 264thermal, 263–264

periampullary duodenal tumors, 87

400 Index

postoperative pain management, 203–207

premalignant disease, esophageal, 1–8

prevention, in Barrett’s esophagus, 7–8

proton pump inhibitors, 340

proto-oncogenes, mutations in, 159–160

in abscess drainage, 265–266

for ascites, 264–265

in biliary disease treatment, 245–256

in central venous access, 269–271

in chest interventions, 277–279

in emerging therapies, 279–280

in gastrointestinal procedures, 243– 245

radiotherapyfor colorectal neoplasia, 184–191for esophageal cancer, 35–36, 38–39, 57

for gastric cancer, 30–32, 62for locally advanced pancreatic cancer, 115–117

nutritional support in, 313, 314for rectal cancer, 191

Raman spectroscopy, 373–374, 380

ras mutations, 160 Ras pathway, 113–114

rectal canceradjuvant therapy for, 190–191algorithm for evaluating, 228preoperative assessment for, 164surgical management of, 169–174rectal mass, 228–229

mucosal-based, 230polypoid, 230refecoxib, 330refeeding syndrome, 317reflectance spectroscopy, 374rescue medication, 210resection surgerycolorectal, 149–150esophageal, 5, 7–8, 15–20retinoid acids, 330

retinol, 339retroperitoneal biopsy, 269reverse-transcriptase polymerase chainreaction analysis, 60

RhuMab, 329robotics, 280ropivacaine, 206–207Roscovitine, 330

Index 401