Study on Colonoscopic Findinds in Positive Faecal Occult Blood Testing

INTRODUCTION: Colorectal cancer is the third most common cancer in the world and a leading cause of cancer death in the Western world. There is an increase in incidence of colorectal carcinoma in India due to, economic shift from low income to middle income economy and increase in ageing population, life style and dietary factors. AIMS OF STUDY: 1. To study colonoscopic findings in positive faecal occult blood test patients. 2. To study other screening modalities in colorectal carcinoma. MATERIALS AND METHODS: Patients admitted in various surgical units in thanjavur medical college hospital between January 2013 to July 2014 constitute the materials of this study. The exclusion criteria includes patients with complaints of bleeding PR, altered bowel habits, tenesmus, mucus discharge from PR, spurious diarrhea, mass desending PR ,FOBT within last one year, sigmoidoscopy within last 3 to 5 years, colonoscopy within last 10 years. The inclusion criteria includes patients with age of 50 and above, patients willing for further followup (invasive procedures like colonoscopy & UGI scopy). A total of 200 patients were studied, patients with positive faecal occult blood test are included in this study, those who are negative for FOBT were adviced for follow up, one year later for another FOBT test. RESULT: Only 52 patients were positive for FOBT out of 200 patients. In FOBT positive patients 12 patients are not willing for colonoscopy, 40 patients went through colonoscopy. Of them, 6 had haemorrhoids, 1 had a polyp and a carcinoma each and one other patient had diverticulum rest of patients have normal colonoscopy. CONCLUSION: 1. Faecal occult blood test screening offers no benefit without appropriate follow up diagnostic tests and treatment. 2. It is simple, safe and cost effective but is limited by lack of acceptability, compliance and adherence as well as poor sensitivity and specificity. 3. In considering all the advantages and drawbacks of FOBT in colorectal cancer screening, we can conclude that this examination is certainly better than no testing at all

New Techniques in Gastrointestinal Endoscopy

As result of progress, endoscopy has became more complex, using more sophisticated devices and has claimed a special form. In this moment, the gastroenterologist performing endoscopy has to be an expert in macroscopic view of the lesions in the gut, with good skills for using standard endoscopes, with good experience in ultrasound (for performing endoscopic ultrasound), with pathology experience for confocal examination. It is compulsory to get experience and to have patience and attention for the follow-up of thousands of images transmitted during capsule endoscopy or to have knowledge in physics necessary for autofluorescence imaging endoscopy. Therefore, the idea of an endoscopist has changed. Examinations mentioned need a special formation, a superior level of instruction, accessible to those who have already gained enough experience in basic diagnostic endoscopy. This is the reason for what these new issues of endoscopy are presented in this book of New techniques in Gastrointestinal Endoscopy

Colorectal Cancer

Colorectal cancer is one of the commonest cancers affecting individuals across the world. An improvement in survival has been attributed to multidisciplinary management, better diagnostics, improved surgical options for the primary and metastatic disease and advances in adjuvant therapy. In this book, international experts share their experience and knowledge on these different aspects in the management of colorectal cancer. An in depth analysis of screening for colorectal cancer, detailed evaluation of diagnostic modalities in staging colorectal cancer, recent advances in adjuvant therapy and principles and trends in the surgical management of colorectal cancer is provided. This will certainly prove to be an interesting and informative read for any clinician involved in the management of patients with colorectal cancer

Study of peritoneal elastic lamina invasion and extramural venous invasion in stage 2 colorectal carcinoma

AIM AND OBJECTIVES: The present study is aimed at evaluating the peritoneal elastic lamina invasion and extramural venous invasion using elastic stain in colorectal cancers and to identify its significance in staging. METHODS: In this study paraffin blocks from 50 colonic carcinoma specimens were stained with H and E stain and Elastic stain. These includes 44 T3 cases and 6 T4 cases. Identification and intactness of elastic lamina was studied in all the cases and recorded. RESULTS: Out of 50 cases studied, 30 cases were identified to have elastic lamina with elastic stain. Among the cases which were staged as T3, 3 cases were found to have peritoneal invasion. Peritoneal invasion was confirmed in all the T4 cases. Venous invasion was found in 3 cases in addition to the 4 cases identified by H and E stain. CONCLUSION: To conclude, elastic stain can be used regularly as surrogate marker to assess peritoneal invasion and lymphovascular invasion for proper staging and better treatment

Transanal endoscopic microsurgery in rectal cancer

In rectal cancer total mesorectal excision (TME) is the gold standard. However, driven by the aim to avoid major morbidity and stoma formation, local excision (LE), preferrably with transanal endoscopic microsurgery (TEM), is considered a curative alternative in selected rectal cancer patients. In this thesis the role of TEM in T1 rectal cancer is studied. It was shown that compared to TME, TEM achieves comparable survival rates, however local recurrence rates are as high as 24%, despite a microscopic negative excision margin of at least 2 mm. These recurrences can be managed with radical salvage surgery, but survival in this subgroup of patients is limited, mainly due to distant metastases. Analysis on histopathological evaluation in those recurrent tumors could identify larger tumors at risk for a local recurrence. Accepted high-risk criteria could not be confirmed in our study. Another item in TEM is anorectal functioning postoperative. It was shown that TEM has no detrimental effect on anorectal functioning, as measured with validated questionnaires, and compared to TME leads to less defaction disorders. In the future, special focus of interest should be on identifying rectal cancer in presumed adenomas and on rectal sparing surgery for rectal cancer patients following neoadjuvant chemoradiotherapy.UBL - phd migration 201

Phenotype and Biology of Early Colorectal Cancers

Background The increased detection of pT1 colorectal cancers (CRC) in the National Health Service Bowel Cancer Screening Programme (NHSBCSP) raises new concerns for clinicians. The aim of this study is to investigate the phenotypic features and biology of screened and symptomatic pT1 CRC and to assess current and new high risk features associated with lymph node metastasis (LNM). The second aim of this study is to investigate the inter-observer variation of reporting screened pT1 CRC between pathologists. Methods Symptomatic and screened pT1 CRC were identified from two databases (Northern and Yorkshire Cancer Registry and Information Services [NYCRIS] and NHSBCSP database). Phenotypic features of the pT1 CRC were evaluated and compared from both cohorts. The second part of the study investigated the inter-observer variability in the qualitative and quantitative assessments of screened pT1 CRC. Participating pathologists were asked to perform quantitative and qualitative assessments on 41 screened pT1 CRC. The level of agreement was determined using Fleiss Kappa statistics and intraclass correlation coefficient testing. Results Symptomatic CRC with LNM had a significantly wider area of invasion (p=0.001), a greater area of submucosal invasion (p < 0.001) and a higher proportion of tumour stroma (p = 0.005) compared to CRC without LNM. Symptomatic pT1 CRC were also significantly bigger in size than screened pT1 CRC. The inter-observer variation study showed that quantitative factors had better levels of agreements than qualitative factors. Conclusion This study has shown that screened pT1 CRC are quantitatively smaller to their symptomatic counterparts suggesting that the NHS BCSP detects earlier pT1 CRC. This study also showed that novel quantitative factors such as width of invasion, area of submucosal of invasion and PoTS could be used as valid parameters in determining the rate of LNM. Finally, this study highlights the need for better guidelines/definitions in the evaluation of screened pT1 CRC