Inoperable rectal tumour, no metastases: A radio-chemotherapy with a favourable response surgery B radio-chemotherapy with a non-favourable response chemotherapy Operable rectal tumour, with metastases: radical surgery rectal cancer lung metastasis treatment the tumour with resection of the hepatic or lung metastasis radio-chemotherapy radio-chemotherapy followed by surgical treatment. Non-operable rectal tumour with metastases: chemotherapy and radiotherapy.
Metastatic colorectal cancer to the lungs
We must remember that the rectum is a fix organ, that represents an advantage for the irradiation process. The preoperative irradiation has the advantage of preventing the excessive irradiation of other cavity organs, as in the case of the postoperative irradiation, when the small bowel loops drop in the pelvis. This protocol has been established starting from the actual knowledge regarding the genetics of rectal cancer, and also the studies of fundamental and clinical research which analyzed the response of the rectal cancer to different treatment methods.
The oncogenesis is determined by the alternation of the rectal cancer lung metastasis treatment cycle, and initiates the appearance of angiogenesis. Citokines such as the fibroblastic growth factor, the endothelial growth factor, angiogenin and interleukin 8 mediate and are the promoters of angiogenesis. Those are produced by the tumor cells, T lymphocytes and by other stromal cells.
Probleme actuale privind aplicarea protocolului de tratament în cancerul de rect
Also, the macrophages and the tumor cells produce urokinase plasminogen activatorwhich favours angiogenesis. The tumour angiogenesis is responsible for the tumour behaviour, lymphatic metastases and the distant metastases. The genetic studies have shown that mutations in the p53 suppressor gene may determine the cell rectal cancer lung metastasis treatment of inhibitors of the apoptosis, which make the tumour cells resistant to chemo-radiotherapy.
The evaluation of the status of the p53 gene might allow the appreciation of the tumour aggressiveness in case of a partially located lesion, the response to PCT 5FUthe survival after curative resection, and of the prognostic 2. It is a known fact that the tissue response to irradiation depends of: The cellular apoptosis through disruptions at the DNA level and through the production of free rectal cancer lung metastasis treatment radicals.
The cellular destructions that affect tumour proliferation. The fibrosis and the densification of the rectal wall. The obliterating arteritis through hyalinisation process. The blockage of the cells which block the apoptosis. The destruction of the micro-angiogenesis network.
It must be remembered that hypoxia decreases the destruction of the tumour cells.
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- Virus del papiloma humano on
The different response to radiotherapy is rectal cancer lung metastasis treatment by several factors: The tumour dimensions The cellular phenotype The tumour angiogenesis. The type of the peri-tumour inflammatory infiltrate - the tumours with mixt infiltrate have a better prognosis. The intra-tumour microvascular density the greatest number of vascular lumen without a muscular wall in an objective field 40X.
The response to radio-chemotherapy may be appreciated: Macroscopic: The decrease of the tumour dimensions Conversions to a more inferior stage.
The post-radiotherapy regression reaction was quantified by Bazzetti inwho established 5 degrees of regression of the rectal tumour after radiotherapy. R5 - the absence of the regression. A good response to R2 radiotherapy almost complete regression was achieved in nearly Therefore, we can say that the radiotherapy response was correlated directly with the initial stage of the disease, being favourable for patients in stage II of evolution and weak for those in stage III 3.
Under these conditions, a very important problem is the identification of the degree of response to radiotherapy of the tumour and also to the metastases potential, as long-term radiotherapy lasts approximately 4 weeks, to which one may add around a minimum of weeks until the moment in which the papilloma excision eyelid cpt code will be operated on, a total of weeks.
If the tumour has a low potential for the radiotherapy response, but a high potential for metastases, the benefit of radiotherapy will be decreased and the risk of metastasis will increase exponentially, taking into account the fact that radiotherapy is a form of local treatment and does not prevent metastases. It is to be noticed that the rectal cancer lung metastasis treatment of the genetic studies are inconstant and have not allowed so far the identification of a genetic marker rectal cancer lung metastasis treatment predisposition of the rectal tumours to radio-chemotherapy.
Another problem that we would like to analyze is regarded to the attitude rectal cancer lung metastasis treatment the patients with an R1 response in the Bazetti classification.
In the treatment guide of the Ministry of Health for colorectal carcinoma in stage I TNM TN0M0it is rectal cancer lung metastasis treatment that, in carefully selected cases which are correctly staged preoperatively, in centres with experience, one might choose local transanal resection, exclusive radiotherapy or a combination between radiotherapy and limited surgery.
The post-radiotherapy regression R0 and its follow-up wait-and-see has the advantage that the patients are spared the complications of surgery and there are two studies mentioned Habr-Gama et al. Nevertheless, we must state the fact that the surgical treatment in rectal cancer rectal cancer lung metastasis treatment assume the following complications: Abdominal perineal resection: Impair of the sexual activity Decrease rectal cancer lung metastasis treatment the quality of life Para-stomal hernia.
One must remember that the physiologic mechanisms of defecation are the more affected as the resection descends at the level of the rectum, so that in the case of ultralow resections and in those with colo-anal anastomosis, they are completely disappeared.
Some of these potential complications induce a big discomfort for the patient and produce a degree of invalidity. They may represent reasons for accusation of malpraxis in the case of a patient in which the anatomical specimen does no longer contain tumour tissue after radiotherapy, and which in the postoperative period remains one of the downfalls of the surgery of the rectum.
It is a reason why the studies regarding this conservative approach have continued. Therefore, a study from Maas et al. In batch II - 20 patients who completely responded from another batch had resection.
Actual problems regarding the implementation of the treatment protocol in rectal cancer
Only one patient in batch I presented with local relapse after 25 months, being resolved through surgical treatment. After complete information of the patient regarding the protocol and rectal cancer lung metastasis treatment surgical complications of the abdominal perineal resection rectal rectal cancer lung metastasis treatment lung metastasis treatment of the low and ultralow rectal resections, the 4 patients without rectal cancer lung metastasis treatment lesions and without identifiable nodes post radiotherapy have opted for clinical follow-up, denying the surgical treatment.
Five patients were operated on: Four patients with remaining lesions batch II. One patient with lymph nodes at the level of the mesorectum, but without a remaining lesion at the level of the rectal wall batch I. The pathology exam: In the patient with increased lymph node noticed on MRI rectal cancer lung metastasis treatment, a cancerous lesion was confirmed at the level of the lymph node.
In the 4 patients with a remaining lesion an induration of the wall or different degrees of stenosisno tumour cells were identified.