Wednesday, July 5, 2017

rectal cancer tnm staging system









peritoneal cancer spread and peritoneal metastases. dr. anton titov, md: hello! we are with dr paul sugarbaker - a renowned cancer surgeon from the united states, washington, dc. dr. sugarbaker is a medical director at the center for gastrointestinal malignancies at the medstar washington medical center. dr sugarbaker received his md from cornell university medical college. he did post-graduate training in surgery at peter bent brigham hospital (now brigham and women's hospital) in boston. dr. sugarbaker also did cancer immunology fellowship at harvard university. dr sugarbaker pioneered a surgical procedure for cancer treatment that combines chemotherapy and surgery for metastatic disease in the peritoneum. now this procedure is called the sugarbaker procedure. dr. sugarbaker is an author of more than 800 scientific articles on cancer treatment and more than 10 textbooks on surgery and oncology. dr sugarbaker, it's very good to have you here! thank you very much for coming! - pleasure to be here! dr. anton titov, md: let's start with a general question of how gastrointestinal cancer spreads alongside a peritoneum? maybe you could give example of gastrointestinal cancers that can spread into the peritoneal cavity. how the cancer cells get entry to the peritoneal cavity? where do cancer cells go in the peritoneal space? what is the overall cancer treatment strategy when that happens? dr. paul sugarbaker, md (renowned gastrointestinal cancer surgeon, usa): maybe we could even be a little bit more general. we can ask the question how does a malignancy within the abdominal cavity disseminate? well, cancer can go to the lymph nodes. and the surgeon can remove these lymph nodes if they are involved with cancer. [gastrointestinal cancer or ovarian cancer] cancer can go through the bloodstream to the liver and give rise to liver metastases. an alternative pathway for [bowel caner, rectal cancer, gastric cancer] dissemination is through the bowel wall. like the wall of the colon or through the wall of the stomach. then those cancer seedlings just spread in a random manner in and around the peritoneal space. so it's usually full thickness invasion of the bowel wall by gastrointestinal cancer.


there are gynecologic malignancies such as ovarian cancer. in ovarian cancer the dissemination into the peritoneal space happens very early in the natural history of ovarian cancer. and of course the ovary has very thin capsule, or the ovarian cancer comes from the fallopian tubes. dr. paul sugarbaker, md (renowned gastrointestinal cancer surgeon, usa): ovarian cancer goes in retrograde manner out into the peritoneal space. so it's generally a gastrointestinal or ovarian cancer somewhere else that then finds access to the peritoneal cavity. dr. anton titov, md: therefore cancers like colorectal cancer, colon cancer and rectal cancer, and more rare malignancy, such as peritoneal mesothelioma or appendix cancer can gain entry to the peritoneum and spread in the peritoneal cavity? dr. paul sugarbaker, md (renowned gastrointestinal cancer surgeon, usa): correct. what we would like for our cancer treatments to be maximally effective is for the peritoneal dissemination, peritoneal metastases, to be the only site for metastatic disease. if you have a lymph node metastases and liver metastases and peritoneal metastases, the likelihood that some surgical strategy will be helpful in cancer treatment is very small. dr. paul sugarbaker, md (renowned gastrointestinal cancer surgeon, usa): for example, appendiceal cancer (appendix cancer) almost never metastasizes to the liver. only a few percent of appendix cancer metastasize to the liver. appendix cancer very rarely metastasizes to the lymph nodes. but early in the natural history of appendix cancer the appendix bursts and these mucinous cancer cells go all over the place. so our best results and where this all started was with appendiceal cancer malignancy.










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