DIGESTIVE ENDOSCOPY, Issue 3 2010
Tsutomu Namikawa
We report a rare case of early gastric cancer confined to the mucosal layer with extensive duodenal invasion, curatively removed with distal gastrectomy. An 84-year-old Japanese woman was referred to our hospital with gastric cancer. A barium meal examination and esophagogastroduodenoscopy revealed an irregular nodulated lesion measuring 6.5 x 5.5 cm in the gastric antrum and an aggregation of small nodules in the duodenal bulb. A biopsy specimen showed well-differentiated adenocarcinoma. The patient underwent distal gastrectomy with partial resection of the duodenal region containing the tumor and regional lymph node dissection, with no complication. Histological examination of the resected tissue confirmed well-differentiated adenocarcinoma limited to the mucosal layer and without lymph node metastasis. The cancer extended into the duodenum as far as 38 mm distant from the pyloric ring, and the resected margins were free of cancer cells. Gastric cancer located adjacent to the pyloric ring thus has the potential for duodenal invasion, even when tumor invasion is confined to the mucosal layer. In such cases, care should be taken during examinations to detect duodenal invasion, and the distal surgical margin must be negative given sufficient duodenal resection. [source]

SUCCESSFUL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR MUCOSAL CANCER OF THE DUODENUM

DIGESTIVE ENDOSCOPY, Issue 1 2010
Masahiro Shinoda
We report a case of mucosal duodenal cancer in a 62-year-old woman, which was successfully removed en bloc by endoscopic submucosal dissection (ESD). The patient underwent an upper gastrointestinal endoscopy at our hospital, which revealed an elevated flat mucosal lesion (type IIa) measuring 10 mm in diameter in the second portion of the duodenum. Histopathological examination of a biopsy specimen revealed features suggestive of a tubulovillous adenoma with severe atypia. As the findings suggested that the lesion had an adenocarcinoma component but was confined to the mucosal layer, we decided to carry out ESD and successfully removed the tumor in one piece. The resected tumor was 20 × 15 mm in size. Histopathological examination revealed that the lesion was a well-differentiated mucosal adenocarcinoma with no lymphovascular invasion. Mucosal duodenal cancer is extremely rare, and ESD of a lesion in the duodenum requires a high level of skill. To the best of our knowledge, this case is the first report of successful ESD carried out in a case of mucosal duodenal cancer. [source]

EARLY DIAGNOSIS OF SMALL PANCREATIC CANCER: ROLE OF ENDOSCOPIC ULTRASONOGRAPHY

DIGESTIVE ENDOSCOPY, Issue 2009
Atsushi Irisawa
Advanced pancreatic cancer is a major cause of cancer-related death. However, if surgery achieves clear margins and negative lymph nodes, the prognosis for survival can be prolonged. Therefore, early diagnosis , as early as possible , is important for improving overall survival and quality of life in patients with pancreatic cancer. Because of higher imaging resolution near the pancreas through the gastroduodenal wall, endoscopic ultrasonography enables detection of subtle pancreatic abnormalities. In fact, many investigators have reported the high ability of EUS not only for detection of small lesions but also recognition of chronic pancreatitis, which is the risky status of pancreatic cancer. As a tool for early diagnosis of pancreatic cancer, EUS is a highly anticipated modality. [source]

ROLE OF ENDOSCOPY IN SCREENING OF EARLY PANCREATIC CANCER AND BILE DUCT CANCER

DIGESTIVE ENDOSCOPY, Issue 2009
Kiyohito Tanaka
In the screening of early pancreatic cancer and bile duct cancer, the first issue was ,what are the types of abnormality in laboratory data and symptoms in case of early pancreatic cancer and bile duct cancer?' Early cancer in the pancreaticobiliary region has almost no symptoms, however epigastralgia without abnormality in the gastrointestinal (GI) tract is a sign of early stage pancreaticobiliary cancer. Sudden onset and aggravation of diabetes mellitus is an important change in the case of pancreatic cancer. Extracorporeal ultrasonography is a very useful procedure of checking up changes of pancreatic and biliary lesions. As the role of endoscopy in screening, endoscopic ultrasonography (EUS) is the most effective means of cancer detection of the pancreas, and endoscopic retrograde cholangiopancreatography (ERCP) is most useful of diagnosis tool for abnormalities of the common bile duct. Endoscopic retrograde cholangiopancreatography is an important modality as the procedure of sampling of diagnostic materials. Endoscopic ultrasonography-fine needle aspiration (EUS-FNA) has the role of histological diagnosis of pancreatic mass lesion also. Especially, in the case of pancreas cancer without evidence of cancer by pancreatic juice cytology and brushing cytology, EUS-FNA is essential. Intra ductal ultrasonography (IUDS) and perotral cholangioscopy (POCS) are useful for determination of mucosal extent in extrahepatic bile duct cancer. Further improvements of endoscopical technology, endoscopic procedures are expected to be more useful modalities in detection and diagnosis of early pancreatic and bile duct cancers. [source]

COMPARISON OF ENDOSCOPIC DETECTION RATE OF EARLY GASTRIC CANCER AND GASTRIC ADENOMA USING TRANSNASAL EGD WITH THAT OF TRANSORAL EGD

DIGESTIVE ENDOSCOPY, Issue 4 2008
Yukiya Yoshida
Background:, To investigate the influence of the reduced image quality of transnasal esophagogastroduodenoscopy (EGD) with the ultrathin endoscope (transnasal EGD) on endoscopic diagnoses, we compared the detection rate (DR) of early gastric cancer and gastric adenoma by transnasal EGD with that of transoral EGD using a standard endoscope. Methods:, Transnasal EGD was carried out in 2791 examinations for the purposes of screening or other reasons. Controls were examined by transoral EGD and numbered 3591 examinations. The transnasal endoscope used was an EG530N. Lesions graded C-3 or higher by Kimura-Takemoto's classification were regarded as endoscopic atrophy. Results:, (i) DR in all subjects and those with atrophy were not different between transnasal and transoral EGD. (ii) Multivariate analysis of DR in subjects with atrophy was carried out using five variables: gender, age, purposes of endoscopy, endoscopic insertion route and the four endoscopists. DR was significantly higher in males or subjects ,60 years. No difference was noted between the endoscopic insertion routes (transnasal vs transoral). (iii) The subjects analyzed in (ii) were divided into the transnasal and transoral groups, and multivariate analysis of DR was carried out using four variables. DR was not different among the endoscopists in the transoral group. However, in the transnasal group, DR increased as the years of endoscopic experience was prolonged. Conclusions:, Multivariate analysis detected no significant difference in DR between transnasal and transoral EGD. However, a significant difference in DR by transnasal EGD among the endoscopists is detected. Transnasal EGD should be carefully carried out by experienced endoscopists. [source]

ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER USING MAGNIFYING ENDOSCOPY WITH A COMBINATION OF NARROW BAND IMAGING AND ACETIC ACID INSTILLATION

DIGESTIVE ENDOSCOPY, Issue 3 2008
Kyosuke Tanaka
Demarcation of early gastric cancers is sometimes unclear. Enhanced-magnification endoscopy with acetic acid instillation and magnifying endoscopy with a narrow band imaging (NBI) system have been useful for recognition of demarcation of early gastric cancers. We report a patient with early gastric cancer who underwent a successful endoscopic submucosal dissection (ESD) by magnifying endoscopy with the combined use of NBI and acetic acid instillation. A 72-year-old man with early gastric cancer underwent ESD. Demarcation of the lesion was not clear, but magnifying endoscopy using the combination of NBI and acetic acid clearly revealed the demarcation. ESD was carried out after spots were marked circumferentially. We identified the positional relation between the demarcation and all markings. Resection of the lesion was on the outside of the markings. Histopathologically, the lesion was diagnosed as a well-differentiated adenocarcinoma limited to the mucosa. The margins were carcinoma free. Magnifying endoscopy combining the use of NBI with acetic acid instillation is simple and helpful for identifying the demarcation of early gastric cancer. This method may be useful in increasing the rate of complete resection by ESD for early gastric cancer. [source]

EX VIVO CASE STUDY OF ENDOCYTOSCOPY IN SUPERFICIAL ESOPHAGEAL CANCER

DIGESTIVE ENDOSCOPY, Issue 2007
Mototsugu Kato
Microscopic observation at the cellular level using endocytoscopy was obtained in surface mucosa of the gastrointestinal tract. This paper describes ex vivo images for endoscopically resected specimens of superficial esophageal cancer using endocytoscopy with methylene blue staining. The endocytoscopy images of cancerous and non-cancerous sites corresponded generally with horizontal histological images. The pattern of the cellular arrangement and the size and shape of cells were similar between endocytoscopy and horizontal histological imaging. Endocytoscopy is an effective tool for diagnosis of esophageal cancer. [source]

PEUTZ-JEGHERS SYNDROME ASSOCIATED WITH RENAL AND GASTRIC CANCER THAT DEMONSTRATED AN STK11 MISSENSE MUTATION

DIGESTIVE ENDOSCOPY, Issue 4 2006
Hiromi Kataoka
A 75-year-old male was admitted to the gastroenterology unit of Nagoya City University Hospital due to epigastralgia after surgical treatment for right renal cancer. Endoscopy revealed advanced type 1 gastric cancer in the corpus of the stomach and multiple polypoid lesions in the stomach and duodenum. X-ray examination of the small intestine using barium showed multiple polyps in the upper jejunum. Faint pigmentation on the palm was also detected. Peutz-Jeghers syndrome (PJS) was diagnosed, despite a lack of family history. Total gastrectomy, resection of part of the upper jejunum and intraoperative endoscopic polypectomy of duodenal polyps was performed. This is the second reported case of PJS associated with renal cancer. We also detected a missense mutation in the tumor suppressor gene STK11 that, when mutated, is causative for PJS. [source]

MAGNIFICATION ENDOSCOPIC VIEW OF AN EARLY GASTRIC CANCER USING ACETIC ACID AND NARROW-BAND IMAGING SYSTEM

DIGESTIVE ENDOSCOPY, Issue 2006
Hideki Toyoda
A 62-year-old woman was referred to Mie University Hospital, Tsu, Japan, for examination of upper gastrointestinal tract. The conventional endoscopy showed a slightly depressed lesion on the greater curvature at the gastric body. The surface of surrounding non-neoplastic mucosa using magnification endoscopy with acetic acid was gyrus-villous pattern whereas the surface of the lesion was rough. Furthermore, magnification endoscopy using acetic acid and narrow-band imaging system visualized clearer fine surface pattern of carcinoma. The lesion had a rough mucosa with irregularly arranged small pits. The lesion was resected completely by endoscopic mucosal resection with insulated-tip electrosurgical knife. Narrow-band imaging system with acetic acid may be able to visualize not only the capillary pattern but also the fine surface pattern of gastric carcinoma. [source]

NODULAR GASTRITIS AND GASTRIC CANCER

DIGESTIVE ENDOSCOPY, Issue 2 2006
Tomoari Kamada
Nodular gastritis is defined as antral gastritis usually characterized endoscopically by a miliary pattern resembling gooseflesh and pathologically by prominent lymphoid follicles and infiltration of mononuclear cells. This physiological phenomenon was once considered particular to young women. Recent studies have shown that nodular gastritis is strongly associated with Helicobacter pylori infection and may be associated with gastric cancer. Reported cases of gastric cancer with nodular gastritis showed some features in common: all gastric cancers were diagnosed histologically as the diffuse-type, and all were located in the corpus with Helicobacter pylori infection. Because nodular gastritis may be a risk factor for diffuse-type gastric cancer, Helicobacter pylori may need to be eradicated to prevent gastric cancer in patients with nodular gastritis. [source]

ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER: TECHNICAL FEASIBILITY, OPERATION TIME AND COMPLICATIONS FROM A LARGE CONSECUTIVE SERIES

DIGESTIVE ENDOSCOPY, Issue 1 2005
Ichiro Oda
Background:, Endoscopic mucosal resection (EMR) is a recognized treatment for early gastric cancer (EGC). One-piece resection is considered to be a gold standard of EMR, as it provides accurate histological assessment and reduces the risk of local recurrence. Endoscopic submucosal dissection (ESD) is a new technique developed to obtain one-piece resection even for large and ulcerative lesions. The present study aims to identify the technical feasibility, operation time and complications from a large consecutive series. Methods:, We reviewed all patients with EGC who underwent ESD using the IT knife at National Cancer Center Hospital in the period between January 2000 and December 2003. Results:, During the study period of 4 years we identified a total of 1033 EGC lesions in 945 consecutive patients who underwent ESD using the IT knife. We found a one-piece resection rate (OPRR) of 98% (1008/1033). Our OPRR with tumor-free margins was 93% (957/1033). On subgroup analysis it was found to be 86% (271/314) among large lesions (, 21 mm) and 89% (216/243) among ulcerative lesions. The overall non-evaluable resection rate was 1.8% (19/1033). The median operation time was 60 min (range; 10,540 min). Evidence of immediate bleeding was found in 7%. Delayed bleeding after ESD was seen in 6% and perforation in 4% of the cases. All cases with complications except one were successfully treated by endoscopic treatment. Conclusion:, The present study shows the technical feasibility of ESD, which provides one-piece resections even in large and ulcerative EGC. [source]

CLINICAL USEFULNESS OF COLONOSCOPIC INSERTION OF A DECOMPRESSION TUBE FOR OBSTRUCTIVE COLORECTAL CANCER

DIGESTIVE ENDOSCOPY, Issue 2004
Kiyonori Kobayashi
ABSTRACT We evaluated the clinical usefulness of colonoscopic insertion of a decompression tube (decompression method) for the treatment of ileus associated with left-sided colorectal cancer. Decompression method was done in 48 patients with colorectal cancer (38 primary cancer, 10 metastatic cancer). A decompression tube was successfully inserted in all but 10 patients who had primary cancer with severe strictures. The overall insertion rate was 79%. Decompression method improved obstructive symptoms and decreased intestinal gas as evaluated on plain X-ray films of the abdomen. Emergency operation was unnecessary in 96% of the patients with primary cancers, in whom the decompression tube was successfully inserted. We conclude that decompression method can improve abdominal symptoms caused by obstructive colorectal cancer and reduce the need for emergency operation. [source]

EARLY GASTRIC CANCER: USEFULNESS OF INDEX OF HEMOGLOBIN ENHANCED IMAGING FOR THE DIAGNOSIS OF POORLY DIFFERENTIATED ADENOCARCINOMA

DIGESTIVE ENDOSCOPY, Issue 2002
Junko Fujisaki
No abstract is available for this article. [source]

MAGNIFYING ENDOSCOPY FOR THE DIAGNOSIS OF EARLY GASTRIC CANCER

DIGESTIVE ENDOSCOPY, Issue 2002
Yasumasa Niwa
Magnifying endoscopy of stomach cancer requires observation of minute structure and minute vessel patterns of the mucosal surface. The small pits, various-sized pits, irregularly branched pits and irregular vessels were found to be characteristics as the surface structure of early gastric cancer. Small pits were commonly observed on the differentiated type of early gastric cancer (88%) compared with the undifferentiated type (50%). We found it important to analyze not only the minute vessel patterns, but also the minute surface structure to ensure magnifying endoscopic observation using 0.1% indigo-carmine and the binarized images would be effective in determining the margin of the lesion. The relationship between the findings of magnifying endoscopy in cancer and the histology should now be investigated. Applying the techniques mentioned above, more delicate observation in the regular endoscopy and prudent photographing to obtain clear images might be promoted. Thus, this would contribute to endoscopy with a concept similar to optical biopsy, and which can depend on the usual biopsy methods. [source]

CHARACTERISTIC OF GASTRIC CANCER IN INDONESIA: THE ROLE OF HELICOBACTER PYLORI INFECTION

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2000
Murdani Abdullah
Background Gastric cancer is the second most common fatal malignancy in the world. In 1996, approximately one million new cases of gastric cancer were found. It is generally agreed that the pathogenesis is multifactorial which may include, dietary factors, environmental factors, bacterial and viral infections. Aim to evaluate the frequent of gastric cancer in Indonesia and itís relating factors. Methods A sample size of 7902 subjects were determined based on hospital data of dyspeptic patients following gastroduodenoscopy procedure from January 1997 to September 1999. Patients were recruited from 9 endoscopic centers located in 5 cities in Indonesia. Endoscopic biopsy specimens were taken 2 specimens from the antrum (2 cm from pylorus) and 2 specimens from the corpus. Helicobacter pylori infections were determined by serology (ELISA), rapid urea test (CLO test), or histopathology examination using Haematoxyline Eosin and Giemsa staining. The criteria used to diagnose Helicobacter pylori infection were a positive result either from one of these tests and/or in combination. Results The frequent of proximal gastric cancer and distal gastric cancer finding were 0.63 % and 0.54 %, consecutively. In the proximal and distal gastric cancer groups the present of Helicobacter pylori were 55.77 % and 85.36 %, consecutively (p>0.05). The finding of gastric cancer among ethnic groups were 0.65 % for Chinese ethnicity and 0.81 % for Non-Chinese ethnicity, statistically has no significant different (p=0,9514). The distal-to-proximal gastric cancer ratio was 0.85. The proximal gastric cancer more frequent to be found in the age group of 41-60 years old (47.83%), while the distal gastric cancer in the age group of 51-70 years old (61.54%). Conclusion The distal-to-proximal gastric cancer ratio was 0.85. The present of Helicobacter pylori were lower in proximal gastric cancer rather than distal gastric cancer, but statistically has of no significant. [source]

PATHOLOGICAL AND BIOLOGICAL CHARACTERISTICS OF INTERVAL BREAST CANCER

PATHOLOGY INTERNATIONAL, Issue 12 2001
Lee ES
No abstract is available for this article. [source]

LOSS OF ESTROGEN RECEPTOR- , (ER,) IN PROSTATE CANCER

PATHOLOGY INTERNATIONAL, Issue 12 2001
Horvath LG
No abstract is available for this article. [source]

DEFICIENCIES IN PATHOLOGICAL REPORTING OF COLORECTAL CANCER IN VICTORIA

ANZ JOURNAL OF SURGERY, Issue 9 2008
Robert D. Winn
Background: Colorectal cancer (CRC) pathological reporting deficiencies have been shown to be common, with deviations from the suggested minimum dataset. Information from both surgeon and pathologist is necessary for a complete report. These deficiencies have been shown to be correctable with the use of synoptic reporting. We carried out an audit on a random sample of CRC pathological reports from the first 6 months of 2004 in Victoria, Australia, with the aim of documenting current CRC pathological reporting deficiencies. Methods: A random sample of pathological reports for CRC was obtained from the Cancer Council of Victoria. One hundred and sixteen of these reports were reviewed by a team of surgical and pathology trainees. Presence or absence of the various fields of the 1999 National Health and Medical Research Council minimum dataset for CRC reporting was recorded. Results: There were deviations from the minimal dataset. Most notable was the absence of the information on the apical node, the presence of distant metastasis and perineural invasion. Conclusions: The opportunity exists for improvement in the pathological reporting of CRC in Victoria through the uniform introduction of synoptic reporting. [source]

INTEGRATION OF PROSPECTIVE QUALITY OF LIFE AND NUTRITIONAL ASSESSMENT AS ROUTINE COMPONENTS OF MULTIDISCIPLINARY CARE OF PATIENTS WITH HEAD AND NECK CANCER

ANZ JOURNAL OF SURGERY, Issue 1-2 2008
Justine Oates
Background: Quality of life (QOL) and nutritional assessment of patients with head and neck cancer can provide additional information about the effects of treatment beyond the standard measures of disease control and survival. Integrating a prospective evaluation program into a multidisciplinary service may ensure that a more holistic model of care is developed. Methods: Prospective evaluation of QOL and nutrition before and after treatment for head and neck cancer was implemented in 2001. All patients enrolled in the program were treated with curative intent. Patients completed the European Organisation for Research and Treatment of Cancer Core QOL Questionnaire and Head and Neck Specific Module before treatment and at 3, 6 and 12 months after completion of therapy. In conjunction, patients underwent nutritional assessment by body mass index, biochemical parameters and the patient-generated subjective global assessment tool. Results: Among 288 patients who consented to participate in this study, 134 patients completed the QOL assessment criteria and were eligible for evaluation. Examples of QOL and nutritional data for patients with cancers of the oral cavity, oropharynx, nasopharynx, larynx, hypopharynx, parotid gland and paranasal sinus, and also unknown primary cancers are given. Implementation of this prospective assessment program required appropriate resources and was hampered by time constraints, logistics with blood tests and patient compliance. Conclusions: Despite difficulties with implementation, the information concerning QOL and nutritional status obtained in this study provided an appreciation of the long-term functional effects of treatment for head and neck cancer. Prospective QOL assessment and nutritional evaluation should become integral components of the care of patients with cancers of the head and neck. [source]

OPTIMIZING THE APPROACH TO PATIENTS WITH POTENTIALLY RESECTABLE LIVER METASTASES FROM COLORECTAL CANCER

ANZ JOURNAL OF SURGERY, Issue 11 2007
Elgene Lim
Liver metastases are a common event in colorectal carcinoma. Significant advances have been made in managing these patients in the last decade, including improvements in staging and surgical techniques, an increasing armamentarium of chemotherapeutics and multiple local ablative techniques. While combination chemotherapy significantly improves median patient survival, surgical resection provides the only prospect of cure and is the focus of this review. Interpretation of published work in this field is challenging, particularly as there is no consensus to what is resectable disease. Of particular interest recently has been the use of neoadjuvant treatment for downstaging and downsizing disease in patients with initially unresectable liver metastases, in the hope of response leading to potentially curative surgery. This review summarizes the recent developments and consensus guidelines in the areas of staging, chemotherapy, local ablative techniques, radiation therapy and surgery, emphasizing the multidisciplinary approach to this disease and ongoing controversies in this field and examines the changing paradigms in the management of colorectal hepatic metastases. [source]

SIGNIFICANCE OF TUMOUR VOLUME MEASUREMENTS IN TONGUE CANCER: A NOVEL ROLE IN STAGING

ANZ JOURNAL OF SURGERY, Issue 8 2007
Min H. Chew
Background: Tongue cancers are staged by the American Joint Committee on Cancer and the Union Internationale Contre le Cancer TNM staging systems. Cancer, however, evolves in a 3-D plane. Hence, using the largest tumour diameter will not reflect total cancer volume. We aim to evaluate the use of tongue cancer tumour volume (Tv) as a prognostic predictor of disease recurrence and survival. Methods: The study is a retrospective analysis of patients in Singapore General Hospital who underwent complete resection for histologically proven tongue carcinoma from 2000 to 2002. The Tv was measured on staging T2 -weighted magnetic resonance imaging datasets by semiautomated methods. Results: Seventeen patients with a median follow-up duration of 57.9 months were studied. A wide range of volumes was noted in each T stage. The median time to relapse was 8.6 months for those with Tv , 13 cc but was not achieved for those with Tv < 13 cc. The hazard ratio comparing Tv ,13 cc versus <13 cc is 9.02 (95% confidence interval (CI) 1.70,47.94, P = 0.014). Of the seven deaths reported, five patients had Tv , 13 cc. The median overall survival was 15.8 months for those with Tv , 13 cc but was not achieved for those with Tv < 13 cc. The hazards of death for Tv , 13 cc was 3.91 times that of Tv < 13 cc (95%CI 0.86,17.86, P = 0.078). Conclusion: Tongue cancer Tv measurement allows a more refined and accurate assessment of tumour status. This can be a possible prognostic indicator and be used in a novel staging method for the future. [source]

ASCENDING AORTIC RUPTURE BEHIND A STERNAL RADIONECROSIS FOR BREAST CANCER

ANZ JOURNAL OF SURGERY, Issue 6 2007
Nicolas Venissac MD
No abstract is available for this article. [source]

CT14 PREDICTING ONE-YEAR SURVIVAL AFTER SURGERY FOR EARLY STAGE NON-SMALL CELL LUNG CANCER

ANZ JOURNAL OF SURGERY, Issue 2007
M. O'keefe
Introduction Post-operative survival after surgery for early stage non-small cell lung cancer (NSCLC) is influenced by factors such as stage of disease and co-morbidities. We sought to assess the performance of 2 models in predicting 1 year survival after resected NSCLC. Methods The Colinet Simplified Co-Morbidity Score (SCS) (1) and a prognostic model by Birim (2) were retrospectively applied to a cohort of patients with surgically resected NSCLC. End-point was 1 year survival obtained from clinical follow-up and data-linkage with the Cancer Council of Victoria. Results 216 patients were treated from Feb 1999 to Dec 2005. 52 patients were excluded due to missing data, leaving 164 patients for analysis. Mean patient age was 66.4 ± 10.3. Pathological stage was 1 in 61%, 2 in19% and 3 in 17%. Observed 1 year survival was 78.7%. SCS was predictive of 1 year survival: mean SCS 9.24 for survivors and 11.03 for non-survivors (p = 0.001 by t-test). Patient's with low SCS (0-9) had a higher 1-year survival than those with high SCS (>9); 87.2% vs 69.2% (p = 0.005 by chi-square test). SCS discriminated fairly for 1 year survival (area under ROC curve 0.66). The predicted survival using the Birim model (74.2%) was similar to the observed survival (p = 0.43). The model predicted survival well in both low (predicted 83% vs observed 88%, p = 0.51) and high (66 vs 70%, p = 0.74) risk groups. Birim model discriminated well for 1 year survival (area under ROC curve 0.70). Conclusion SCS and the Birim model can both be used to estimate 1-year survival. They may aid the clinician in deciding who should be considered for surgical resection. [source]

GS13P OUTCOME OF TRANS-ANAL EXCISION FOR RECTAL CANCER

ANZ JOURNAL OF SURGERY, Issue 2007
S. Banerjee
Aims The aim of this study is to assess the outcome of trans-anal excision of rectal cancer in a single Surgeon's practice and determine possible selection criteria for this procedure. Methods Retrospective review of hospital records, specimen histopathology and imaging of consecutive patients with rectal cancer undergoing trans-anal excision as the primary treatment. Results 25 patients had trans-anal excision of rectal cancer including 3 cases of carcinoid tumour and 1 case of gastro-intestinal stromal tumour (GIST). 5/25 proceeded to radical rectal resection because of the presence of adverse features including lympho-vascular and peri-neural invasion and poorly differentiated cell type; residual tumour was present in 4/5 cases, nodal metastases in 3/5 patients each of whom received pre-operative chemotherapy and radiotherapy. 2/25 patients developed recurrence at 12 and 48 months from excision. One of these patients had distant recurrence at 12 months having proceeded to radical rectal resection and the other patient (aged 99), managed with trans-anal excision alone, recurred locally at 48 months. Both cases of recurrence were T3 tumours. Overall, 19/20 cases managed with trans-anal excision alone had no recurrence with a follow-up period of 12,48 months. 16 of these patients had T1 malignancy. Conclusion T1 tumours may be treated with trans-excision alone in the absence of adverse pathological features. It is unclear from our study whether T2 should be managed in this way due to their small number in this study and T3 tumours are clearly at high risk of recurrence with this treatment alone. [source]

HP37 PROGNOSTIC FACTORS IN OESOPHAGEAL CANCER: NUMBER OF LYMPH NODES AND EXTRACAPSULAR LYMPH NODE INVASION , AN INTERIM ANALYSIS

ANZ JOURNAL OF SURGERY, Issue 2007
S. K. Thompson
Purpose Controversy exists over the 2nd edition of the TNM staging system introduced by the American Joint Committee in Cancer in 1988, and revised in 2002. Prognostic pathological factors such as the number of positive lymph nodes and any extracapsular lymph node invasion may refine this current staging system and optimize patient treatment. Methodology All patients who underwent surgical resection for oesophageal cancer were identified in a prospectively-maintained database. Patients without invasive adenocarcinoma or squamous cell cancer were excluded. Pathology slides were reviewed by a single pathologist. Survival data was calculated using Kaplan-Meier curves, and prognostic factors were examined using the log rank test. Results 235 surgical specimens met inclusion criteria, and 95 specimens have been reviewed so far. The 5-yr overall survival rate was 43% (median 31.4 months). Subdividing pN-stage into 1,2 positive nodes and >2 positive nodes showed significant differences in 5-yr survival between both groups: 41% vs. 6.0%, respectively (P = 0.0003). Similarly, including absence and presence of extracapsular lymph node invasion into our pathology review showed significant differences in 5-yr survival: 40% vs. 7.8%, respectively (P < 0.01). A negative circumferential margin, and the absence of both vascular and perineural invasion were also found to significantly improve survival rates. Conclusions The number and characteristics of metastatic invasion of lymph nodes should be included in current oesophageal cancer staging systems. Clinicians will then have more accurate prognostic information, and treatment can be better tailored to patients' needs. [source]

POPULATION-BASED SCREENING FOR HEREDITARY NON-POLYPOSIS COLORECTAL CANCER (LYNCH SYNDROME): THE WESTERN AUSTRALIAN APPROACH

ANZ JOURNAL OF SURGERY, Issue 4 2007
Barry Iacopetta PhD
No abstract is available for this article. [source]

A PILOT STUDY OF PREOPERATIVE AND POSTOPERATIVE CHEMOTHERAPY IN PATIENTS WITH OPERABLE GASTRIC CANCER: AUSTRALASIAN GASTROINTESTINAL TRIALS GROUP STUDY 9601

ANZ JOURNAL OF SURGERY, Issue 4 2007
Michael Findlay
Background: With poor cure rates in gastric cancer using surgery alone, the safety, efficacy and feasibility of preoperative and postoperative chemotherapy was investigated. Methods: Patients with advanced but operable gastric or cardio-oesophageal adenocarcinoma were staged using endoscopy, computed tomography scan and laparoscopy. If considered potentially resectable, they received chemotherapy (epirubicin, cisplatin and 5-fluorouracil) for 9 weeks before and after surgery. Results: Of 59 participants entered, two were found to have metastatic disease and were excluded from the analysis. Of the participants, 10 were women and 47 men; their median age was 58 years (range 27,83 years) and median performance status 0 (range 0,1). Two of the 57 participants commencing chemotherapy did not undergo surgery (one sudden death, one new liver metastases). Grade 3 and 4 preoperative and postoperative toxicity rates were, respectively, neutropenia 22 and 18%, emesis 12 and 14% and other non-haematological toxicity <10 and <10%. Of the 55 who underwent surgery, 40 had apparently curative resections (clear or positive microscopic margins), 2 died after surgery (anastomotic leak, sepsis) and 16 had postoperative complications. Of these, 27 participants commenced postoperative chemotherapy and 21 completed it. Median progression-free survival and overall survival were 19.6 and 22 months, respectively. Conclusion: Epirubicin, cisplatin and protracted venous infusion of 5-fluorouracil chemotherapy was well-tolerated in the preoperative setting and did not appear to increase complication rates of surgery for advanced and operable stomach cancer. These findings demonstrate the feasibility of this strategy in the Australasian clinical setting and are in keeping with the results of a recently reported randomized trial, which demonstrated a significant survival advantage using this chemotherapy regimen. [source]

SURGICAL MANAGEMENT OF BREAST CANCER IN A SMALL PERIPHERAL NEW ZEALAND HOSPITAL

ANZ JOURNAL OF SURGERY, Issue 12 2006
Don Wai Gin Lee
Background: Peripheral hospitals are perceived to be at a disadvantage in providing treatment for breast cancer, especially with regard to breast conservative surgery (BCS) because of the requirement of adjuvant radiotherapy. Wairau Hospital is a 100-bed peripheral hospital in New Zealand with no on-site radiotherapy unit. Methods: A retrospective audit of the surgical management of breast cancer between 1998 and 2002 was carried out. Results: One hundred and fifty-seven presentations during the audit period. Despite the lack of tertiary resources, we report an overall BCS rate of 58.6%, consistent with the appropriate New Zealand guidelines. Of screen-detected cancers, 81.6% underwent BCS. Only five patients requested mastectomy and of those undergoing BCS, five patients refused subsequent adjuvant radiotherapy. This was because of frailty from age and comorbidities and the inconvenience of travel. Conclusion: High rates of BCS are possible in peripheral hospitals. We postulate that intensive support and a visiting outpatient oncological service help empower patients to seek BCS if appropriate. A strong partnership between surgical, radiological and oncological services is also vital. [source]

URBAN,RURAL DIFFERENCES IN THE MANAGEMENT OF SCREEN-DETECTED INVASIVE BREAST CANCER AND DUCTAL CARCINOMA IN SITU IN VICTORIA

ANZ JOURNAL OF SURGERY, Issue 11 2006
David L. Kok
Background: At least one-third of primary breast cancers in Australia are discovered by population-based mammographic screening. The aim of this study was to determine whether there were any differences in the surgical treatment of women diagnosed with breast cancer by BreastScreen Victoria between urban and rural populations and to investigate temporal changes in their pattern of care. Methods: An analysis of women diagnosed with breast cancer (invasive and non-invasive) by BreastScreen Victoria from 1993 to 2000 was conducted. Descriptive analyses of the proportion of women undergoing each surgical treatment type over time were carried out. Logistic regression was used to assess the effect of urban,rural residence on each treatment outcome while accounting for possible confounding factors. Results: Rural women with invasive breast cancer were less likely to undergo breast-conserving surgery (BCS) compared with urban women (odds ratio, 0.42; 95% confidence interval, 0.35,0.50). The same was also true for rural women with ductal carcinoma in situ (odds ratio, 0.53; 95% confidence interval, 0.29,0.96). This difference was independent of patient and tumour characteristics, including tumour size, surgeon caseload, patient's age and socioeconomic status. It also persisted over time despite a steady overall increase in use of BCS for both invasive and non-invasive cancers over the study period. Conclusions: Among Victorian women with screen-detected breast cancer, urban women consistently had higher rates of BCS compared with rural women despite increased overall adoption of BCS. Reasons for this disparity are still unclear and warrant further investigation. [source]

TUMOUR SIZE AS A PREDICTOR OF AXILLARY NODE METASTASES IN PATIENTS WITH BREAST CANCER

ANZ JOURNAL OF SURGERY, Issue 11 2006
Sharon Laura
Background: The ability to predict the behaviour of breast cancer from its dimensions allows the clinician to inform a woman about the absolute benefits of adjuvant therapies or further surgery to control her disease. Tumour size and grade are independent predictors of nodal disease. This study aims to generate a tool, using Australian data, allowing surgeons to calculate the probability of axillary lymph node involvement in a preoperative setting. Methods: The histological reports of patients with breast cancer treated in 1995 in New South Wales were examined and tumour size, grade and nodal status recorded. Univariate and multivariate analyses identified predictors of node positivity and, using linear regression analysis, a simple formula to predict nodal involvement was derived. Results: In a 6-month period, 754 women had non-metastatic, unifocal breast cancer treated with surgery and complete axillary dissection and 283 (37.5%) had positive nodes. Tumour size remained an independent predictor of node positivity and the probability (%), y, of nodal involvement may be predicted by the formula y = 1.5 × tumour size (mm) + 7, r = 0.939 and P = 0.001. Conclusions: This paper shows the need to assess the axilla in every patient because even patients with small tumours (0,5 mm) have the possibility of axillary involvement (7,14.5%). Use of this simple formula allows clinicians and patients to make informed decisions about the possible need for a full axillary dissection to reduce the chance of understaging and potentially undertreating a woman's breast cancer. [source]