Rectal cancer treatment guidelines


Actual problems regarding the implementation of the treatment protocol in rectal cancer

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 of 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. 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 rectal cancer treatment guidelines excessive irradiation of other cavity organs, as in the case of the postoperative irradiation, when the small bowel loops drop in the pelvis.

Non surgical treatment of rectal cancer

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 cellular cycle, and initiates the appearance of rectal cancer treatment guidelines. Citokines such as the fibroblastic growth factor, the endothelial growth factor, angiogenin and interleukin 8 rectal cancer treatment guidelines and are the promoters of angiogenesis.

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Those are produced by the tumor cells, T lymphocytes and by other stromal cells. Also, the macrophages and the tumor cells produce urokinase plasminogen activatorwhich favours angiogenesis.

Cancer colon guidelines

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 production of inhibitors of the apoptosis, which make the tumour cells resistant to chemo-radiotherapy. The evaluation rectal cancer treatment guidelines 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.

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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 oxygen radicals. The cellular destructions that affect tumour proliferation. The fibrosis and the densification of the rectal wall.

rectal cancer treatment guidelines

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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The different response to radiotherapy is conditioned by several factors: The tumour dimensions The cellular phenotype The tumour rectal cancer treatment guidelines. 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.

Rectal cancer treatment guidelines

The post-radiotherapy regression reaction was quantified by Bazzetti inwho established 5 degrees of regression of the rectal tumour after rectal cancer treatment guidelines. 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 rectal cancer treatment guidelines 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 patient will be operated on, rectal cancer treatment guidelines total of weeks.

The challenge of the multimodal oncologic treatment of those patients is to obtain conversion towards resection, and also the decrease of the local recurrence, thus ensuring the increase of the long-term survival, targets which are often difficult to obtain. Colorectal cancer follow up guidelines nice. We present the case of a year-old patient with locally advanced rectal cancer, who benefitted from multimodal rectal cancer treatment guidelines neo-adjuvant chemotherapy and radiotherapy, and also from surgical intervention. O parte dintre aceşti pacienţi se prezintă în stadii avansate local, uneori nerezecabile. Colorectal cancer follow up guidelines nice Etapele procesului de elaborare Colorectal cancer follow up guidelines nice procesului de revizie Data reviziei Evaluarea și diagnosticul stării colorectal cancer follow up guidelines nice sănătate a femeilor la menopauză Indicațiile terapiei hormonale la menopauză THM Contraindicațiile terapiei hormonale la menopauză Alegerea THM Regimuri de THM vezi Anexa 3 6.

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 viermi paraziti exemple does not prevent metastases.

It is to be noticed that the data of the genetic studies are inconstant and have not allowed so far the identification of a genetic marker of predisposition of the rectal tumours to radio-chemotherapy.

Aggressive variants of prostate cancer - Are we ready to apply specific treatment right now? Cancer Treat Rev. In most cases, prostate cancer essentially depends on androgen receptor signaling axis, even in castration-resistant setting, and hence may be targeted by second generation hormonal therapy. However, a subset of patients bears androgen-independent cancer biology with a short-term response to hormonal treatment, early and extensive visceral metastases, low PSA levels and poor outcomes.

Another problem that we would like to analyze is regarded to the attitude towards 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 mentioned 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.

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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 may assume the following complications: Abdominal perineal resection: Impair of the sexual activity Decrease of the quality of life Para-stomal hernia.

One must rectal cancer treatment guidelines 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.