Nora A Janjan John M Skibber Miguel A Rodriguez Bigas Christopher Crane Marc E Delclos Edward H Lin and Jaffer A Ajani

Chapter Overview Epidemiology Anatomy and Patterns of Disease Spread Pathology Clinical Presentation Staging Prognostic Factors Combined-Modality Therapy Regimens with Radiation plus 5-Fluorouracil and Mitomycin C Regimens with Radiation plus 5-Fluorouracil and Cisplatin Other Issues Special Treatment Issues Posttreatment Biopsy Treatment of the Elderly and Patients with Comorbid Conditions Treatment of HIV-Positive Patients Anal Margin Definitive Chemoradiation The M. D. Anderson Technique...

Clinical Presentations Requiring Palliative Management

There are many types of clinical presentation that necessitate palliative management for tumors involving the gastrointestinal region. Among the most common are symptoms caused by recurrent rectal cancer and biliary obstruction caused by pancreatic cancer. Nausea and vomiting due to gastrointestinal obstruction may require surgical decompression. Metastases from gastrointestinal malignancies can occur in any location, become symptomatic, and necessitate palliative care. Pelvic tumors that cause...

Requirements for Adequate Bowel Function

Adequate bowel function requires GI motility, mucosal transport, defecation reflexes, and intact anal sphincter muscles. GI motility requires muscle contraction secretions supplied by the salivary glands, stomach, biliary system, pancreas, and small intestine an adequate central nervous system and adequate nutrition and hydration. Mucosal transport promotes the absorption of nutrients, water, and electrolytes in the small bowel, leaving water resorption to take place in the large bowel. If the...

Therapeutic Procedures

As mentioned previously, the most commonly performed therapeutic laparoscopic procedure at M. D. Anderson has been laparoscopic colon resection. There has been considerable controversy surrounding the onco-logic safety as well as the quality-of-life benefits of laparoscopic colon resection. We began a prospective, nonrandomized trial of laparoscopic colon resection in 1992. This trial was open to any patient with colorectal carcinoma. At the time of evaluation for publication, laparoscopic...

Laxatives

Patients who are undergoing treatment for cancer need particular attention given to the type of laxative used for constipation. It is important to provide immediate relief in the most gentle way, even if an aggressive approach is needed to relieve severe constipation and prevent more severe problems. The patient's total physical condition and the presence of bulky disease in the abdomen must be considered, as addressed in the following paragraphs. Patients undergoing chemotherapy that may cause...

Annette K Bisanz

Chapter Overview Introduction Steps to Effective Bowel Management Assessment and Diagnosis of Bowel Dysfunction 316 Normalization of the Bowel Establishment of Expectations for Bowel-Movement Frequency Development of a Bowel Management Program 318 Assessment of Outcomes Adjustment of Bowel Management Program to Achieve the Desired Outcome Requirements for Adequate Bowel Function 318 Components of an Effective Bowel Management Program 319 Fluid Fiber Food Medications to Offset Bowel Side Effects...

Christopher I Amos Carol H Bosken Amr S Soliman and Marsha L Frazier

Chapter Identifying Epidemiologic and Genetic Risk Factors for Colorectal Cancer Cohort Studies Assessing Familiality and Segregation Analysis 70 Factors Associated with Risk for Colorectal Cancer 71 Inflammatory Bowel Disease Factors Related to a Western Calcium and Folate Supplementation Cigarette Smoking Nonsteroidal Anti-inflammatory Hormone Replacement Therapy Genetic Factors Hypermethylation and Colorectal Cancer Gene-Gene Environmental Factors Related to Hereditary and Familial...

Steps to Effective Bowel Management

There are 6 steps to good bowel management assessment and diagnosis of bowel dysfunction, normalization of the bowel, establishment of expectations for bowel-movement frequency, development of a bowel management program, assessment of outcomes, and adjustment of the bowel management program through problem-solving. Assessment and Diagnosis of Bowel Dysfunction Thoroughly assessing bowel function and obtaining a bowel history together constitute the most important step in bowel management....

Edward H Lin and Henry Q Xiong

Chapter Epidemiology Clinical Presentations Diagnosis and Tenets of Management Fluorouracil Targeted Bevacizumab Cetuximab Celecoxib Management of Colon Cancer by Stage Carcinoma In Situ Stage I Colon Stage II Colon Cancer Stage III Colon Stage IV Colon Management of Side Effects Diarrhea Hand-Foot Syndrome Neuropathy Surveillance after Treatment Future Key Practice Points Suggested For decades, 5-fluorouracil was the only chemotherapy agent known to be active against colorectal cancer. In...

Environmental Factors Related to Hereditary and Familial Colorectal Cancer

Familial colorectal cancer may reflect the influence of multiple genetic factors along with environmental cofactors. Fuchs et al (2002) found that women with high folate intake who had a first-degree relative with colo-rectal cancer were not at increased risk for colorectal cancer. However, women with low folate intake who had a relative with colorectal cancer had about a 2.5-fold increased relative risk for colorectal cancer compared with women with low folate intake and no family history of...

O

The hallmark side effects of irinotecan are watery diarrhea and a small increase in the risk of thrombotic complications Cunningham et al, 1998 Rougier et al, 1998 Douillard et al, 2000 Saltz et al, 2000 . Oxaliplatin is a water-soluble platinum derivative and is an inactive prodrug that requires in vivo biotransformation. There is no evidence of cytochrome P450 metabolism of the DACH ring in vitro. The route of elimination is predominantly 54 urinary fecal excretion accounts for 2 of...