14. TNM Classification Tis T 1 T 2 T 3 T 4 Extension to an adjacent organ Mucosa Muscularis mucosae Submucosa Muscularis propria Subserosa Serosa T X Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ: intraepithelial or invasion of lamina propria T1 Tumor invades submucosa T2 Tumor invades muscularis propria T3 Tumor invades through the muscularis propria into pericolorectal tissues T4a Tumor penetrates to the surface of the visceral peritoneum T4b Tumor directly invades or is adherent to other organs or structures
18. Stage and Prognosis Stage 5-year Survival (%) 0,1 Tis,T1;No;Mo > 90 I T2;No;Mo 80-85 II T3-4;No;Mo 70-75 III T2;N1-3;Mo 70-75 III T3;N1-3;Mo 50-65 III T4;N1-2;Mo 25-45 IV M1 <3
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20. Colonoscopy or barium enema Figure: C arcinoma of the rectum. Double-contrast barium enema shows a long segment of concentric luminal narrowing (arrows) along the rectum with minimal irregularity of the mucosal surface. To evaluate remainder of large bowel to rule out synchronous tumor or presence of polyp syndrome.
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23. Figure: Mucinous adenocarcinoma of the rectum. CT scan shows a large heterogeneous mass (M) with areas of cystic components. Note marked luminal narrowing of the rectum (arrow) . Figure: Rectal cancer with uterine invasion. CT scan shows a large heterogeneous rectal mass (M) with compression and direct invasion into the posterior wall of the uterus (U).
51. Stage Rectal cancer ~5-year LF/OS III (T4/ Locally unresectable) If obstructed, diverting colostomy or stent placed definitive treatment. 5-FU/RT resection if possible. Consider IORT for microscopic disease (after 50 Gy EBRT, give IORT 12.5–15 Gy) or brachytherapy for macroscopic disease adjuvant 5-FU-based therapy* IV Individualized options, including combination 5-FU-based chemo alone, or chemo ± resection ± RT Recurrent Individualized options. If no prior RT, then chemoRT surgery ± IORT or brachytherapy. If prior RT, then chemo surgery ± IORT or brachytherapy as appropriate.
There are interesting things to be found when researching information on the internet to include in a presentation. The Colossal Colon is a replica of the human colon that is four feet wide. It was modeled from colonoscopy footage. It has traveled across the U.S. to inform the public about colon health. People can crawl through the colon or view through windows on the outside. It shows healthy colon tissue as well as diseased tissue including polyps and colon cancer. This picture was taken at a mall near the Creighton University Medical Center. It’s a fun way to spread information about colon health.