Metastatic Carcinoma of Unknown Primary Origin

In most patients, the site of origin of a metastatic carcinoma of unknown primary origin cannot be reliably determined by light microscopy (Hammar, 1998). Almost 60 of metastatic carcinomas of unknown primary origin are adenocarcinomas. Some metastatic adenocarcinomas (e.g., colonic adenocarcinomas) have distinctive histologic features that allow for determination of their site of origin. For most other metastatic adenocarcinomas of unknown primary origin, immunohistochemical analysis can help...

Introduction

Over the past 50 years, there has been a shift in emphasis from tertiary to secondary to primary prevention of colorectal cancer. In this volume, other chapters will concentrate on surgical, chemotherapeutic, and radiothera-peutic measures to minimize the morbidity and mortality associated with the treatment of established malignancy, all of which can be thought of as tertiary prevention. In this chapter, initial attention will be devoted to a brief review of secondary prevention, which we can...

Gastric Cancer

Gastric adenocarcinoma is one of the most common human solid tumors worldwide. In the United States, approximately 25,000 people are diagnosed annually with gastric adenocarcinoma. We see approximately 300 patients with newly diagnosed gastric cancer yearly at M. D. Anderson. The symptoms related to gastric cancer are typically vague and longstanding in many patients. Thus, advanced-stage disease is diagnosed in a significant proportion of patients. Esophagogastroduodenoscopy is considered the...

Constipation

Definitions of constipation vary from one reference to another. At M. D. Anderson, we define constipation as the condition in which stool is hard and difficult to eliminate. Even if the frequency of bowel movements decreases, as long as the stool remains soft and formed, the patient is not constipated. Never Underestimate How Much Stool the Intestines Can Hold The average length of the colon is 4 to 5 feet, and the colon is 2 inches in diameter, which makes possible a large fecal-mass...

Dmi

Barium, as fecal impaction cause, 319, 343 screening, 114 Barium swallow for esophageal cancer diagnosis, 234, 243 for gastrointestinal stromal tumor diagnosis, 274, 275 Barrett's esophagus, 346-373 biomarkers of, 358-361 biopsy of, 348-350, 355 definition of, 346, 348-349 diagnosis of, 349-351 epidemiology of, 351-352 as esophageal adenocarcinoma cause, 348, 350, 351-352, 353, 353 , 355-356, 357 esophageal dysplasia associated with, 347, 348, 349, 356-358, 359 histopathology of, 347, 349-351...

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...

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...

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...