NMS. Casos Clínicos

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Part II ♦ Specific Disorders

Table 8-4: Staging of Colorectal Cancer

Modified Astler‐Coller

TNM Stage

Dukes

Stage 0 Stage I

Tis T1 T2

N0 N0 N0 N0 N0 N1 N1 N2

M0 M0 M0 M0 M0 M0 M0 M0

N/A

N/A

Stage A Stage B1 Stage B2 Stage B3 Stage C1

A A B B C C

Stage IIA T3 Stage IIB T4

Stage IIIA T1, T2 Stage IIIB T3, T4 Stage IIIC Any T

Stages C2, C3

Stages C1, C2, C3 C

Stage IV

Any T

Any N M1

Stage D

N/A

Studies have shown that adjuvant chemotherapy for stage III (there are multiple options) is effective in reducing recurrence and improving survival. The patient wants to know your plans for follow-up for recurrence of the cancer. Q: What do you tell patient? A: It is necessary to follow a patient who has undergone a curative resection for local recur- rence at the anastomosis, metastasis to the liver, distant metastasis, and occurrence of a second primary colon cancer . Approximately 90% of recurrences become detectable by 4 years, respectively. Repeat colonoscopy at 6 months and then at 12-month intervals is necessary. More frequent monitoring of CXR, CEA, and liver function tests is essential. A rising CEA, which is 70% accurate in predicting recurrence, should prompt CT of the abdomen to examine for metastasis.

Case 8.22 Heme-Positive Stool with Suspected Colon Cancer You see a 62-year-old patient who has heme-positive stools. You suspect colon cancer. Q: How would the following additional findings change the evaluation of this patient? Case Variation 8.22.1. RLQ mass ◆ ◆ A mass palpable in the RLQ suggests a large tumor that may be invading local structures such as the ureter. CT would help assess involved structures. Case Variation 8.22.2. Intermittent constipation and diarrhea ◆ ◆ This common symptom of colon cancer suggests the existence of a higher grade obstructive lesion , which is perhaps more likely on the left side of the colon. Management may be more difficult preoperatively due to the urgency of the obstruction. Surgeons should attempt to perform a curative procedure, although the prognosis is worse for obstructive cancers. SAMPLE