DOCSLIB.ORG

Management of Locally Advanced Rectal Adenocarcinoma Oncology Board Review Manual

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Management of Locally Advanced Rectal Adenocarcinoma Oncology Board Review Manual ONCOLOGY BOARD REVIEW MANUAL STATEMENT OF EDITORIAL PURPOSE Management of Locally The Hospital Physician Oncology Board Review Advanced Rectal Manual is a study guide for fellows and practicing physicians preparing for board examinations in oncology. Each manual reviews a topic essential Adenocarcinoma to the current practice of oncology. PUBLISHING STAFF Contributors: Nishi Kothari, MD PRESIDENT, GROUP PUBLISHER Assistant Member, Department of Gastrointestinal Bruce M. White Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL SENIOR EDITOR Khaldoun Almhanna, MD, MPH Robert Litchkofski Associate Member, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research EXECUTIVE VICE PRESIDENT Institute, Tampa, FL Barbara T. White EXECUTIVE DIRECTOR OF OPERATIONS Jean M. Gaul Table of Contents Introduction .............................1 Clinical Evaluation and Staging ..............2 Management .............................4 NOTE FROM THE PUBLISHER: This publication has been developed with­ Surveillance and Long-Term Effects ..........8 out involvement of or review by the Amer­ ican Board of Internal Medicine. Conclusion ..............................9 Board Review Questions ...................10 References .............................10 Hospital Physician Board Review Manual www.turner-white.com Management of Locally Advanced Rectal Adenocarcinoma ONCOLOGY BOARD REVIEW MANUAL Management of Locally Advanced Rectal Adenocarcinoma Nishi Kothari, MD, and Khaldoun Almhanna, MD, MPH INTRODUCTION ence to screening guidelines in persons of lower socioeco nomic status.5–8 Colorectal cancers are among the most common The majority of colorectal cancers occur sporad- cancers worldwide, and there is a high mortality ically and incidence increases with age, especially rate for advanced-stage disease. Approximately after the fourth decade of life. The incidence in 132,000 new cases of colorectal cancer will be the older population is decreasing while incidence diagnosed in the United States in 2015, and ap- rates in patients under 50 years of age have been proximately 40,000 of these cases will be primary increasing, but most new cases are still diagnosed rectal cancers.1 The incidence and mortality rates in older patients.9 Though relatively rare, hereditary have been steadily declining over the past two cancer syndromes dramatically increase the risk decades, largely through advances in screen- of colorectal cancers in affected individuals. The ing and improvements in treatment.2,3 However, most common inherited cause of colorectal cancer rectal cancer remains a significant cause of mor- is the autosomal dominant hereditary nonpolyposis bidity and mortality in the United States and colorectal cancer (HNPCC), or Lynch syndrome. worldwide. Less common inherited colorectal cancer syn- The worldwide incidence rates of colorectal can- dromes include familial adenomatous polyposis cers are variable, with the highest rates of disease and its variants (Gardner and Turcot syndromes) in North America, Europe, and Australia, and the and MUTYH-associated polyposis. A unique set lowest rates in Africa and parts of Asia.4 Within of screening guidelines for both colorectal and a population, risk factors for the development of noncolorectal cancers are warranted for patients disease include lower socioeconomic status. This identified with these syndromes.10–12 has been attributed to decreased physical activ- Inflammation has long been thought to play a ity, obesity, smoking, decreased dietary intake of role in colorectal carcinogenesis. Patients with fruits and vegetables, as well as decreased adher- chronic bowel inflammation from ulcerative colitis Copyright 2015, Turner White Communications, Inc., Strafford Avenue, Suite 220, Wayne, PA 19087-3391, www.turner-white.com. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, electronic, photocopying, recording, or otherwise, without the prior written permission of Turner White Communications. The preparation and distribution of this publication are supported by spon- sorship subject to written agreements that stipulate and ensure the editorial independence of Turner White Communications. Turner White Communications retains full control over the design and production of all published materials, including selection of topics and preparation of editorial content. The authors are solely responsible for substantive content. Statements expressed reflect the views of the authors and not necessarily the opinions or policies of Turner White Communications. Turner White Communications accepts no responsibility for statements made by authors and will not be liable for any errors of omission or inaccuracies. Information contained within this publication should not be used as a substitute for clinical judgment. www.turner-white.com Oncology Volume 11, Part 5 1 Management of Locally Advanced Rectal Adenocarcinoma and Crohn’s disease have a higher risk of cancer care physician after noting red blood in the toilet development, as do patients with a history of ra- and pain with defecation for the last 3 weeks. She diation. These patients should also be screened reports no abdominal or pelvic pain. Physical exam more frequently than the general population.13–15 is notable for no palpable inguinal lymph nodes Because they decrease inflammation, aspirin and and no external anal lesions or hemorrhoids. Rec- nonsteroidal anti-inflammatory drugs have long tal exam reveals a palpable mass at 9 o’clock and been evaluated as a protective factor against stool guaiac test is positive. Laboratory evaluation colorectal cancer development. A significant num- is notable for hemoglobin of 10 mg/dL and a mean ber of observational and randomized trials have corpuscular volume of 75 fL. Rigid sigmoidoscopy shown a reduction in both the incidence of colorec- reveals a nonobstructing ulcerated mass 4 cm tal adenomas and colorectal cancers.16–18 How- from the anal verge. Biopsy is performed and find- ever, because of their side effects these drugs are ings are consistent with grade II adenocarcinoma. not yet recommended for the general population, although they are suggested for select high-risk • How is rectal cancer defined? patients, such as those with Lynch syndrome.19 This review focuses on the diagnosis, manage- On average, the human rectum is 12 cm long. ment, and surveillance of locally advanced rectal The sigmoid colon becomes the rectum at the fu- cancer. Although often grouped with colon cancers, sion of the sigmoid colon tenia. The distal end of the rectal cancers differ from colon cancers in terms of rectum transitions to an ampulla with a circumfer- diagnosis and management. Though early-stage ence of 35 cm rather than the 15 cm of the rest of disease can be cured with local excision, most can- the rectum. The end of the rectum is considered to cers are more advanced at presentation in terms be the puborectalis ring or the dentate line, where of depth of tumor invasion and adherence to local the transitional mucosa of the anus begins.20 The pelvic structures. Because of surgical challenges majority of the rectum (10 cm) lies outside the peri- regarding tumor location, rectal cancers have his- toneum, demarcated by the peritoneal reflection. torically been at higher risk for local recurrence than The significant majority of rectal cancers are car- colon cancers. In addition, managing rectal tumors cinomas, which are primarily comprised of adeno- requires particular attention to quality of life issues, carcinomas. Though squamous cell carcinomas, such as anal sphincter preservation and the bowel adenosquamous carcinomas, and undifferentiated toxicity and sexual dysfunction that can arise from carcinomas have been described, they are rela- radiation. For the best outcome, these cancers re- tively unusual. Rarely, other tumors of the rectum, quire a multidisciplinary approach including chemo- including neuroendocrine tumors, hamartomas, therapy, radiation, and surgery. and lymphomas, have been described.21 After es- tablishing the histology of the tumor, the grade of CLINICAL EVALUATION AND STAGING differentiation is described. This is based on the degree of gland formation present, with well and CASE PATIENT moderately differentiated tumors exhibiting defined A 64-year-old woman without significant past glandular structures and poorly differentiated tu- medical or family history presents to her primary mors not exhibiting defined structures. The tumor 2 Hospital Physician Board Review Manual www.turner-white.com Management of Locally Advanced Rectal Adenocarcinoma grade has been evaluated and is generally found to evaluate for metastatic disease.25 In general, to have prognostic significance.22 positron emission tomography (PET) scans are not routinely indicated in the staging of rectal cancer.26 • What pretreatment staging evaluation is recom- Similarly, liver magnetic resonance imaging (MRI) mended? can be used if there are equivocal results on CT scan. Even though screening for colorectal cancer is Despite their use for distant disease, CT scans increasingly utilized, the majority of patients are still are not optimal for local evaluation of tumor depth, diagnosed after presenting due to symptoms. Care- nodal invasion, and circumferential resection mar- ful medical history should include information about gin (CRM). The CRM is an important prognostic constitutional symptoms like weight
Load more

Recommended publications
  • Serous Papillary Adenocarcinoma of Unknown Primary in a Recurrent Paravaginal Cyst
    Hindawi Case Reports in Obstetrics and Gynecology Volume 2019, Article ID 8125129, 4 pages https://doi.org/10.1155/2019/8125129 Case Report Serous Papillary Adenocarcinoma of Unknown Primary in a Recurrent Paravaginal Cyst Khilen Patel , Advaita Punjala-Patel, Angela Stephens, and John Lue Department of Obstetrics and Gynecology, Augusta University, Medical College of Georgia, 1120 15th St., Augusta, GA 30912, USA Correspondence should be addressed to Khilen Patel; [email protected] Received 14 February 2019; Revised 1 May 2019; Accepted 28 May 2019; Published 10 June 2019 Academic Editor: Giampiero Capobianco Copyright © 2019 Khilen Patel et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Cystic lesions located in the paravaginal region are rare. When present, paravaginal cysts are typically benign and are incidentally found on routine gynecological exams; however, rarely they can be malignant. Treatment options for paravaginal cancers are not well studied and early diagnosis may help improve prognosis in these patients. Our case describes a 55-year-old female with a recurrent paravaginal cyst that was remarkable for serous papillary adenocarcinoma despite biopsy and fuid cytology negative for malignancy. Tis case demonstrates that malignancy should be considered highly with a recurrent paravaginal cyst, especially when present over a short interval. 1. Introduction due to postmenopausal symptoms and denied any vaginal bleeding or vaginal discharge. On bimanual examination, the Large paravaginal cysts are rare and when present are most uterus and cervix were noted to be surgically absent; however, commonlybenign.Tesecystscanbeeithercongenitalor alargepelvicmasswaspalpated.Tismasswassmooth, acquired.
    [Show full text]
  • Board Review from ACP MEDICINE
    BOARD REVIEW FROM MEDSCAPE Case-Based InternalInternal Medicine Self-Assessment Questions CLINICAL ESSENTIALS CARDIOVASCULAR MEDICINE DERMATOLOGY ENDOCRINOLOGY GASTROENTEROLOGY HEMATOLOGY IMMUNOLOGY/ALLERGY INFECTIOUS DISEASE INTERDISCIPLINARY MEDICINE METABOLISM NEPHROLOGY NEUROLOGY ONCOLOGY PSYCHIATRY RESPIRATORY MEDICINE RHEUMATOLOGY www.acpmedicine.com BOARD REVIEW FROM MEDSCAPE Case-Based Internal Medicine Self-Assessment Questions Director of Publishing Cynthia M. Chevins Director, Electronic Publishing Liz Pope Managing Editor Erin Michael Kelly Development Editors Nancy Terry, John Heinegg Senior Copy Editor John J. Anello Copy Editor David Terry Art and Design Editor Elizabeth Klarfeld Electronic Composition Diane Joiner, Jennifer Smith Manufacturing Producer Derek Nash © 2005 WebMD Inc. All rights reserved. No part of this book may be reproduced in any form by any means, including photocopying, or translated, trans- mitted, framed, or stored in a retrieval system other than for personal use without the written permission of the publisher. Printed in the United States of America ISBN: 0-9748327-7-4 Published by WebMD Inc. Board Review from Medscape WebMD Professional Publishing 111 Eighth Avenue Suite 700, 7th Floor New York, NY 10011 1-800-545-0554 1-203-790-2087 1-203-790-2066 [email protected] The authors, editors, and publisher have conscientiously and carefully tried to ensure that recommended measures and drug dosages in these pages are accurate and conform to the standards that prevailed at the time of publication. The reader is advised, however, to check the product information sheet accompanying each drug to be familiar with any changes in the dosage schedule or in the contra- indications. This advice should be taken with particular seriousness if the agent to be administered is a new one or one that is infre- quently used.
    [Show full text]
  • Grading Evidence
    Grading Evidence Analysis of the colonoscopic findings in patients with rectal bleeding according to the pattern of their presenting symptoms Journal Diseases of the Colon & Rectum Publisher Springer New York ISSN 0012-3706 (Print) 1530-0358 (Online) Issue Volume 34, Number 5 / May, 1991 Abstract Patients presenting with rectal bleeding were prospectively categorized according to the pattern of their presentation into those with outlet bleeding (n=115), suspicious bleeding (n=59), hemorrhage (n=27), and occult bleeding (n=68). All patients underwent colonoscopy and this was complete in 94 percent. There were 34 patients with carcinoma and 69 with adenomas >1 cm diameter. The percentage of neoplasms proximal to the splenic flexure was 1 percent in outlet bleeding, 24 percent with suspicious bleeding, 75 percent with hemorrhage, and 73 percent with occult bleeding. Barium enema was available in 78 patients and was falsely positive for neoplasms in 21 percent and falsely negative in 45 percent. Colonoscopy is the investigation of choice in patients with suspicious, occult, or severe rectal bleeding. Bleeding of a typical outlet pattern may be investigated by flexible sigmoidoscopy. J Surg Res. 1993 Feb;54(2):136-9. Colonoscopy for intermittent rectal bleeding: impact on patient management. Graham DJ, Pritchard TJ, Bloom AD. Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106. Abstract Rectal bleeding is a frequent presenting symptom of a number of benign anorectal disorders. However, it may also be a warning sign of more significant gastrointestinal pathology. For this reason, full colonic evaluation has been recommended in patients with intermittent bright red rectal bleeding.
    [Show full text]
  • CASE FILES® Family Medicine
    SECOND EDITION CASE FILES® Family Medicine Eugene C. Toy, MD The John S. Dunn, Senior Academic Chair and Program Director The Methodist Hospital Obstetrics and Gynecology Residency Program Houston, Texas Vice Chair of Academic Affairs Department of Obstetrics and Gynecology The Methodist Hospital–Houston Associate Clinical Professor and Clerkship Director Department of Obstetrics and Gynecology University of Texas Medical School at Houston Houston, Texas Donald Briscoe, MD Director, Family Medicine Residency Program and Chair, Department of Family Medicine The Methodist Hospital—Houston Medical Director Houston Community Health Centers, Inc. Houston, Texas Bruce Britton, MD Clinical Associate Professor and Family Medicine Clerkship Director Department of Family and Community Medicine Eastern Virginia Medical School Portsmouth, Virginia Bal Reddy, MD Director of Predoctoral Education Assistant Professor Department of Family Medicine University of Texas Medical School at Houston Houston, Texas New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2010 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-0-07-160024-8 MHID: 0-07-160024-8 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-160023-1, MHID: 0-07-160023-X. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occur- rence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark.
    [Show full text]
  • Case 18-2004: a 61-Year-Old Man with Rectal Bleeding and a 2-Cm Mass in the Rectum
    The new england journal of medicine case records of the massachusetts general hospital Founded by Richard C. Cabot Nancy Lee Harris, m.d., Editor Jo-Anne O. Shepard, m.d., Associate Editor Stacey M. Ellender, Assistant Editor Sally H. Ebeling, Assistant Editor Christine C. Peters, Assistant Editor Case 18-2004: A 61-Year-Old Man with Rectal Bleeding and a 2-cm Mass in the Rectum Paul C. Shellito, M.D., Jeffrey W. Clark, M.D., Christopher G. Willett, M.D., and Aaron P. Caplan, M.D. presentation of case From the Department of Surgery (P.C.S.), A 61-year-old man was referred to this hospital for treatment of a low rectal adenocar- the Hematology–Oncology Unit, Depart- cinoma. He had been well until five months previously, when he occasionally began to ment of Medicine (J.W.C.), the Department of Radiation Oncology (C.G.W.), and the note blood in his stool. A stool guaiac test was positive. Three weeks before the patient’s Department of Pathology (A.P.C.), Massa- referral, a colonoscopy was performed at another hospital. A sessile polyp, 10 mm in chusetts General Hospital; and the De- diameter, was removed from the right side of the colon and was determined to be a tu- partments of Surgery (P.C.S.), Medicine (J.W.C.), Radiation Oncology (C.G.W.), bular adenoma; a sessile polyp, 4 mm in diameter, was found 80 cm into the left side of and Pathology (A.P.C.), Harvard Medical the colon; it was excised and found to be associated with a hyperplastic polyp containing School.
    [Show full text]
  • Colorectal Cancer Screening Facts
    How Screening Saves Lives Screening Tests for Colorectal Cancer Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the Below is a list of several tests that are available to screen for colon or rectum. Screening tests can find colorectal cancer. Some are used alone, while others are used in combination with each other. Talk with your doctor about polyps, so they can be removed before they which screening test is best for you. turn into cancer. Screening tests can also find colorectal cancer early, when treatment Fecal Occult Blood Test (FOBT, Hemoccult, works best. Stool Guaiac) This test checks for occult (hidden) blood in the stool. You receive a test kit from your doctor. You may be asked to follow When Should I Begin Screening? a special diet before and during the test. At home, you place a Colorectal Cancer Screening Facts small amount of your stool from three bowel movements in a You should begin screening for colorectal cancer when you row on test cards. You return the cards to your doctor's office turn 50, then continue at regular intervals. However, you may or lab, where the stool samples are checked for hidden blood. need to be tested earlier or more often than other people if: ! You or a close relative have had colorectal polyps or Flexible Sigmoidoscopy colorectal cancer, or This test allows the doctor to examine the lining of your ! You have inflammatory bowel disease. rectum and lower part of your colon using a thin, flexible, lighted tube called a sigmoidoscope. The tube is inserted into What is Colorectal Talk with your doctor about when you should begin screening your rectum and lower part of the colon.
    [Show full text]
  • Mario's ITE Database V2010.007 Document Copy for the Sole
    Mario’s ITE database V2010.007 Document copy for the sole personal use of Dr. Mario Alberto Jimenez Mario’s Family Medicine In-Training Examination (ITE) Database One of the most important objectives in creating this database is to help the physician in organizing and associating topics to increase memorization efficiency and retention. Another important objective is to allow the physician to focus on any particular organ systems or clinical category he/she might be interested by using simple search queries. For instance, in order to search for the organ system category of Cardiovascular, you only need to press Shift+Ctrl+F, type the letters “Car” after a “+” sign in the search box, i.e. type: “+Car” (do not include “ ), and click the search button, or to search for the clinical category of Care of Children, you only need to type: “+Cca” in the search box and click the search button. The ITE database was exported to adobe acrobat format to ease portability, readability and searchability. Other search examples include: questions that more than 50% of residents missed, type “>L”. This database is based on memorization techniques described here: http://www.web-us.com/memory/improving_memory.htm, but if you have difficulty memorizing all that is written here, remember the warning from one of the smartest and most creative minds of our times, Albert Einstein: "the spirit of learning and creative thought are lost in strict rote learning." Organ Systems: Respiratory=Res; Cardiovascular=Car; Musculoskeletal=Mus; Gastrointestinal=Gas; Special Sensory=Sen; Endocrine=End; Integumentary=Int; Neurologic=Neu; Psychogenic=Psy; Reproductive: Female=Ref; Reproductive: Male=Rem; Nephrologic=Nep; Hematologic/Immune=Hem; Nonspecific=Non; Population-based Care=Pbc (Recommendations); Patient-based Systems=Pbs; Clinical Category: Adult Medicine=Adm; Care of the Surgical Patient=Csp; Maternity Care=Mac; Community Medicine=Com; Care of Children and Adolescents=Cca; Mental Health=Mhe; Care of the Elderly=Cel; Care of the Female Patient=Cfp; Emergent & Urgent Care=Euc.
    [Show full text]
  • Avoiding and Identifying Errors in Health Technology Assessment Models
    HealthConclusion Technology Assessment 2010; Vol. 14: No.251 Health Technology Assessment 2010; Vol. 14: No. 25 ChapterAbstract 6 ReferencesStrategies for avoiding errors ListOverview of abbreviations MutualAppendix understanding 1 ExecutiveModelAvoiding complexity summary and identifying errors in health technology assessment models HousekeepingBackground GuidelinesAppendixAim and objectives 2 SkillsMethodsSearch and training strategies ExplanatoryResults analysis concerning methods for preventing errors PlacingAppendixRecommendations the 3findings of the interviews in the context of the literature on avoiding errors ResearchCharts recommendations Avoiding and identifying errors in Chapter 7 ChapterHealthStrategies Technology 1 for identifying Assessment errors reports published to date health technology assessment models: OverviewIntroduction CheckHealthBackground face Technology validity with Assessment experts programme qualitative study and methodological DoAim the and results objectives appear reasonable? Testing model behaviour review ChapterIs the model 2 able to reproduce its inputs? CanMethods the model replicate other data not used in its construction? J Chilcott, P Tappenden, A Rawdin, CompareMethods answersoverview with the answers generated by alternative models PeerIn-depth review interviews of models with HTA modellers M Johnson, E Kaltenthaler, S Paisley, DoubleLiterature checking review of search input valuesmethods Double-programmingValidity checking D Papaioannou and A Shippam ExplanatoryThe organisation analysis of
    [Show full text]
  • Centre for Reviews and Dissemination Diagnostic Accuracy and Cost
    Centre for Reviews and Dissemination Diagnostic Accuracy and Cost-Effectiveness of Faecal Occult Blood Tests Diagnostic Accuracy and Cost-Effectiveness of Faecal Occult Blood Tests Used in Screening for Colorectal Cancer: A Systematic Review 36 Promoting the use of research based knowledge REPORT 36 CRD DIAGNOSTIC ACCURACY AND COST-EFFECTIVENESS OF FAECAL OCCULT BLOOD TESTS (FOBT) USED IN SCREENING FOR COLORECTAL CANCER: A SYSTEMATIC REVIEW Karla Soares-Weiser1 Jane Burch 1 Steven Duffy1 James St John2 Stephen Smith Marie Westwood1 Jos Kleijnen1 1 Centre for Reviews and Dissemination, University of York, York 2 The Cancer Council Victoria, Melbourne, Australia 3 University Hospitals of Coventry & Warwickshire, Coventry February 2007 © 2007 Centre for Reviews and Dissemination, University of York ISBN 978-1-900640-44-2 This report can be ordered from: Publications Office, Centre for Reviews and Dissemination, University of York, York YO10 5DD. Telephone 01904 321458; Facsimile: 01904 321035: email: [email protected] Price £12.50 The Centre for Reviews and Dissemination is funded by the NHS Executive and the Health Departments of Wales and Northern Ireland. The views expressed in this publication are those of the authors and not necessarily those of the NHS Executive or the Health Departments of Wales or Northern Ireland. Printed by York Publishing Services Ltd. ii CENTRE FOR REVIEWS AND DISSEMINATION The Centre for Reviews and Dissemination (CRD) is a facility commissioned by the NHS Research and Development Division. Its aim is to identify and review the results of good quality health research and to disseminate actively the findings to key decision makers in the NHS and to consumers of health care services.
    [Show full text]
  • The Hemo-Quik
    University of Tennessee, Knoxville TRACE: Tennessee Research and Creative Exchange Supervised Undergraduate Student Research Chancellor’s Honors Program Projects and Creative Work 5-2014 The Hemo-Quik Michelle Morin University of Tennessee - Knoxville, [email protected] Follow this and additional works at: https://trace.tennessee.edu/utk_chanhonoproj Part of the Biomedical Devices and Instrumentation Commons, and the Systems and Integrative Engineering Commons Recommended Citation Morin, Michelle, "The Hemo-Quik" (2014). Chancellor’s Honors Program Projects. https://trace.tennessee.edu/utk_chanhonoproj/1783 This Dissertation/Thesis is brought to you for free and open access by the Supervised Undergraduate Student Research and Creative Work at TRACE: Tennessee Research and Creative Exchange. It has been accepted for inclusion in Chancellor’s Honors Program Projects by an authorized administrator of TRACE: Tennessee Research and Creative Exchange. For more information, please contact [email protected]. The Hemo-Quik - Designed for Project Stakeholder - Dr. Matthew Mihelic, M.D. Associate Professor – Department of Family Medicine University of Tennessee Graduate School of Medicine April 24, 2014 Presented by Stool Solutions Design Team Michelle Morin (443) 968-1458 // [email protected] Bill McClintic (423) 845-0198 // [email protected] Patrick Jones (865) 202-9803 // [email protected] Derek Shambo (865) 771-0347 // [email protected] Table of Contents Executive Summary……………………………………………….…………………………….1 Background…………………………………………………………….………………………1-3 Problem Definition…………………………………………………….………………...........3-4 Conceptual Development…………………………………………………………………….4-9 Product Description…………………………………………………...……….…………….9-16 Design Evaluation……………………………………………………………………....…..16-19 Recommendations and Future Work……………………………………………..………19-20 Appendix: Sensitivity Testing Results……………………………………….……………21-23 References………………………………………………………………………………………24 Executive Summary This report serves to introduce the Hemo-Quik, a streamlined device for quick, easy, and reliable fecal occult blood detection.
    [Show full text]
  • Three in 10 Diabetic Patients May Have Liver Fibrosis Many Drugs in The
    VOL. 12 NO. 3 MARCH 2018 ® Many drugs in the INSIDE IBD AND INTESTINAL pipeline for IBD DISORDERS High BMI linked to problems in IBD treatment Obesity related to EWS N increased rate of BY DOUG BRUNK sentation by highlighting ICAL hospitalization. • 23 ED Frontline Medical News anti-integrin therapies M for inflammatory bowel LIVER DISEASE LAS VEGAS – A wide disease (IBD) treatment. Obesity affects the RONTLINE /F variety of drugs are in These leukocyte membrane ability to diagnose the pipeline for both ul- glycoproteins target beta1 RUNK B cerative colitis (UC) and and beta7 subunits. They liver fibrosis OUG As BMI increases, so does D Crohn’s disease patients interact with endothelial li- Dr. Kenneth Cusi said, “Patients with diabetes [type 2] face the who are failing currently gands VCAM-1, fibronectin, discordance between greatest risk of fatty liver and of fibrosis.” available therapies. and MadCAM-1, and medi- imaging techniques. • 32 “The challenge for all ate leukocyte adhesion and GI ONCOLOGY of us is to integrate the trafficking. Approved an- Circulating tumor cell Three in 10 diabetic right drugs for the right ti-integrin therapies to date patients,” William J. Sand- include natalizumab and assay for CRC born, MD, AGAF, said at vedolizumab, while inves- High sensitivity and patients may have the annual congress of the tigational therapies include specificity reported. • 38 Crohn’s & Colitis Founda- etrolizumab, PF-00547659, tion, a partnership of the abrilumab, and AJM 300. AGA GUIDELINE liver fibrosis Crohn’s & Colitis Foun- In a phase 2 study of Use goal-directed dation and the American etrolizumab as induction fluid therapy, early BY DOUG BRUNK to treat it,” he said at the Gastroenterological Asso- therapy for moderate to se- refeeding in acute Frontline Medical News World Congress on Insulin ciation.
    [Show full text]
  • Volume - X Issue - Lx Nov / Dec 2013
    VOLUME - X ISSUE - LX NOV / DEC 2013 In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon 1 Editorial and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis. Disease The main forms of IBD are Crohn's disease and ulcerative colitis (UC). Inflammatory bowel 2 Diagnosis diseases are considered autoimmune diseases, in which the body's own immune system attacks elements of the digestive system. 9 Interpretation Accounting for far fewer cases are other forms of IBD, which are not always classified as typical IBD: Collagenous colitis, Lymphocytic colitis, Ischaemic colitis, Diversion colitis, Behçet's disease, 10 Bouquet Indeterminate colitis. Trouble The main difference between Crohn's disease and UC is the location and nature of the 11 inflammatory changes. Crohn's can affect any part of the gastrointestinal tract, from mouth to anus Shooting (skip lesions), although a majority of the cases start in the terminal ileum. Ulcerative colitis, in contrast, is restricted to the colon and the rectum. Microscopically, ulcerative colitis is restricted to 12 Tulip News the mucosa (epithelial lining of the gut), while Crohn's disease affects the whole bowel wall ("transmural lesions"). Finally, Crohn's disease and ulcerative colitis present with extra-intestinal manifestations (such as liver problems, arthritis, skin manifestations and eye problems) in different proportions. Rarely, a definitive diagnosis neither of Crohn's disease nor of ulcerative colitis can be made because of idiosyncrasies in the presentation. In this case, a diagnosis of indeterminate colitis may be made. Although a recognised definition, not all centres refer to this.
    [Show full text]