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PubMed1984

[Screening for colo-rectal neoplasms by the study of fecal occult blood].

Occult blood testing has been proposed as a screening tool for colorectal cancer. At the present time guaiac testing is considered the most suitable for mass screening. The specificity of the test is affected by diet. For this reason it is necessary to adhere to a meat-free diet while the necessity of eliminating peroxidase containing foods as uncooked vegetables and fruit is controversial. The sensitivity of guaiac test is affected by the intermittence of colorectal cancer bleeding, by the quantity of ascorbic acid and fibers in the diet and by the development modality of the test. The experience of the authors is based on a screening protocol applied on some populations in the province of Florence (Italy). The protocol is based on guaiac test and an anamnestic selection of high-risk patients. 6029 patients have performed guaiac test. In 1159 patients, the results of occult blood testing and sigmoidoscopy have been compared. This analysis accounts for a predictive value of 50%, a specificity of 95.6%, and a sensitivity of 68% for carcinomas and 21.3% for adenomas. In conclusion, guaiac testing seems to warrant a good cost/benefit ratio but because its sensitivity is too low, it is necessary to include other selective tools (the anamnestic questionnaire) as well as an over-all major effort in the research of more sensitive ways of testing.

Colonic Neoplasms↗
PubMedDate not supplied

[The preoperative staging of rectal neoplasms: the clinical exam and diagnostic imaging].

The management of rectal cancer remains an important clinical problem. Although there was been great progress in surgical management, the survival of patients with locally advanced disease has not improved significantly during the past decades. Preoperative staging and evaluation of the risk of recurrence may help in the choice of operation. It is difficult for clinicians to quantify reliably with digital examination the degree of fixation of the tumor, and they usually cannot distinguish nodal metastases except in advanced cases. The more frequent overstaging of small tumors within one quadrant of the rectum is a major drawback of digital examination. Computed tomography and magnetic resonance seems to underestimate the extension of rectal tumors, but both can be helpful in selecting patients with advanced tumors for whom preoperative adjuvant treatment is being considered. Endoluminal ultrasound is superior in staging tumors confined to the rectal wall, but is not the ideal tool for staging: the results are examiner dependent, the field of vision in depth is limited, and stricturing tumors cannot be passed by the ultrasound transducer. Imaging diagnostic attendibility confirms the preeminent role of intraoperative exploration in the assessment of neoplastic diffusion in order to plan a correct surgical treatment.

Endosonography↗
PubMedDate not supplied

[Transrectal ultrasonography in the study of recurrences in patients surgically treated for rectal neoplasms].

The value of transrectal US is known in the preoperative staging of rectal cancer but remains debated in the follow-up of the patients submitted to anterior resection or local therapy. The authors report their experience with the postoperative follow-up of 80 patients submitted to 125 transrectal US exams to study method reliability. The results were 9 true positive, 2 false positive, 113 true negative and 1 false negative cases, with 90% sensitivity, 98.3% specificity and 97.6% accuracy rates. Positive predictive value was 81.8% and negative predictive values was 99.1%. Twelve patients were submitted also to MRI which correctly diagnosed one false negative result of transrectal US. Twenty-one patients were examined also with transrectal Doppler and color-Doppler US: in rectal cancer recurrences the peak velocity of hemorrhoid vascular flow was higher than in non-recurrent patients. On the basis of our results, transrectal US deserves to be included in the postoperative follow-up of the patients submitted to anterior resection or to local therapy for rectal cancer. Moreover, according to our preliminary findings, Doppler and color-Doppler US can improve transrectal US reliability in detecting local recurrences.

Female↗
PubMedDate not supplied

[Sensitivity and specificity of transrectal ultrasonography in the preoperative staging and postoperative follow-up in rectal neoplasms. Experience with 100 clinical cases].

UNLABELLED: Preoperative staging plays an important role in the surgical treatment of rectal cancer. The most sensitive imaging techniques currently available are CT, MRI and transanal ultrasound (TAUS). The aim of the study was to evaluate the sensitivity and specificity of TAUS in the preoperative staging and postoperative follow-up of rectal cancer. METHODS: From January 1992 to May 1999, TAUS was used to study 100 patients with rectal cancer. RESULTS: Patients were staged according to the Astler-Coller classification: 1) A: 8 patients; 2) B1: 16 patients; 3) B2: 22 patients; C1: 30 patients; C2: 24 patients. The sensitivity and specificity of TAUS in the preoperative staging of these tumors were 96% for the T parameter, and 100% for the N parameter. The N but not the T parameter results are in line with the values reported in the international literature. CONCLUSION: Transanal ultrasound, in our personal experience, has proved to be a very accurate imaging technique in the preoperative staging and postoperative follow-up of rectal cancer.

Endosonography↗
PubMedDate not supplied

[Rectal neoplasms : treatment and results (author's transl)].

Between 1963 and 1980, there were 151 resections by patients with rectal cancer. A good postoperative reanimation has decreased the mortality enormously. The corrected five years survival-rate comes to 58.5%. The corrected ten years survival-rate comes to 49.7%; 58.3% of the patients has been treated with sphincter-saving procedures. Though a bigger margin is desirable, a resection of three centimeters under the macroscopic most distal part of the tumor would be sufficient to remove eventual intramural spread. For a sufficient continence one needs : the internal and the external sphincter, the musculus levator ani, and the last centimeters of rectal mucosa at the same height of the anal canal till the linea pectinea. This is pursued with sphincter-saving operations. The younger the patient is the better the function. Psycho-social considerations play a prominent part in the treating of the patient and the evaluation of the results.

Adaptation, Psychological↗