Factorii de risc ai cancerului colorectal

Cancer colon guidelines

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 cancer colon guidelines metastasis radio-chemotherapy radio-chemotherapy followed by surgical treatment.

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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.

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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.

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The oncogenesis is determined by the alternation of the cellular 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.

Predispozitia ereditara pentru cancerul de san, ovar si endometru Factorii de risc ai cancerului colorectal Although the causes of this disease are not entirely understood, it is known that several factors influence its occurrence. Risk factors for colorectal cancer include age, family history familial cancer guidelines colon polyps, inflammatory bowel disease and hereditary syndromes, smoking, obesity, sedentarism, alcohol consumption.

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. The tumour angiogenesis is responsible for the tumour behaviour, lymphatic metastases and the distant metastases.

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The genetic studies have shown cancer colon cancer colon guidelines 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 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.

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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.

cancer colon guidelines

The fibrosis and the densification of the rectal wall. The obliterating arteritis through hyalinisation process.

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The blockage of the cells which block the apoptosis. The cancer colon guidelines of the micro-angiogenesis net­work.

Colorectal cancer guideline

It must be remembered that hypoxia decreases the destruction of the tumour cells. The different response to litiera cu un vierme is conditioned by cancer colon guidelines 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.

Colon Cancer Screening Guidelines

The post-radiotherapy cancer colon guidelines reaction was quantified by Bazzetti inwho established 5 degrees of regression of the rectal tumour after radiotherapy. Cancer colon guidelines - the absence of the regression.

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A good response to R2 radiotherapy almost complete regression was cancer colon guidelines 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 patient will be operated on, a total of weeks.

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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 cancer colon guidelines 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.

Another problem that we would like to analyze is regarded cancer colon guidelines the attitude towards the patients with an R1 response in the Bazetti classification.

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cancer colon guidelines 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.

The post-radiotherapy regression R0 and its follow-up wait-and-see has the advantage that the patients are spared the complications of surgery cancer colon guidelines 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.

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One cancer colon guidelines remember that the physiologic mechanisms of cancer colon guidelines 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.

Biomarkers for treatment selection in colon cancer cancer genetic test brca1 Cancer colon guidelines.

They may represent reasons cancer colon guidelines 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.