Advances In Colorectal Neoplasia: An Issue Of Surgical Clinics

Issue Editor(s)

• James D. Luketich, MD
• W. Scott Melvin, MD

Table of Contents

1. Molecular Genetics of Colorectal Neoplasia
2. Preoperative Evaluation And Preparation Of The Patient With Colorectal Neoplasia
3. Surgical Treatment of Early Colorectal Cancers
4. The Role of Minimally Invasive Surgery In Colorectal Carcinoma
5. Preoperative Radiation and Chemotherapy for Colorectal Cancers
6. Postoperative Management of Colorectal Cancer Patients
7. The Role of Intraoperative Radiation Therapy in Rectal Cancer
8. Surgical Treatment of Advanced Colorectal Cancer

Molecular Genetics of Colorectal Neoplasia

Colorectal neoplasia is a complex disease with a multifactorial etiology. The development of colorectal cancer is a multistep process that involves the accumulation of genetic alterations in key genes. These alterations can be inherited or acquired, and they can lead to the activation of oncogenes or the inactivation of tumor suppressor genes.

The most common genetic alterations in colorectal neoplasia are mutations in the APC gene. The APC gene encodes a protein that plays a role in the Wnt signaling pathway. Mutations in the APC gene can lead to the activation of the Wnt signaling pathway, which can promote cell proliferation and tumorigenesis.

Advances in Colorectal Neoplasia, An Issue of Surgical Clinics (The Clinics: Surgery Book 97)

by Richard D. Urman

5 out of 5

Language	:	English
File size	:	31241 KB
Text-to-Speech	:	Enabled
Screen Reader	:	Supported
Enhanced typesetting	:	Enabled
Print length	:	462 pages

FREE

Other common genetic alterations in colorectal neoplasia include mutations in the KRAS, BRAF, and PIK3CA genes. These genes encode proteins that play a role in the MAPK and PI3K signaling pathways, respectively. Mutations in these genes can lead to the activation of these signaling pathways, which can also promote cell proliferation and tumorigenesis.

The molecular genetics of colorectal neoplasia is a complex and rapidly evolving field. As our understanding of the genetic basis of colorectal cancer improves, we will be better able to develop new strategies for the prevention, diagnosis, and treatment of this disease.

Preoperative Evaluation And Preparation Of The Patient With Colorectal Neoplasia

The preoperative evaluation and preparation of the patient with colorectal neoplasia is essential for optimizing surgical outcomes. The evaluation should include a thorough history and physical examination, as well as a variety of imaging studies. The preparation should include bowel preparation, antibiotic prophylaxis, and optimization of medical comorbidities.

The history and physical examination should focus on identifying any signs or symptoms of colorectal cancer, such as bleeding, pain, or changes in bowel habits. The physical examination should also include a digital rectal examination to assess the rectum for any abnormalities.

Imaging studies are essential for evaluating the extent of colorectal neoplasia. The most commonly used imaging studies are colonoscopy and computerized tomography (CT) colonography. Colonoscopy allows for direct visualization of the colon and rectum, and it can be used to biopsy any suspicious lesions. CT colonography is a non-invasive imaging study that can be used to detect colorectal neoplasia, but it is not as sensitive as colonoscopy.

Bowel preparation is essential for optimizing surgical outcomes. The goal of bowel preparation is to clean out the colon and rectum so that the surgeon can have a clear view of the surgical field. There are a variety of different bowel preparation regimens available, and the best regimen for a particular patient will depend on their individual needs.

Antibiotic prophylaxis is also essential for optimizing surgical outcomes. The goal of antibiotic prophylaxis is to prevent surgical site infections. The most commonly used antibiotic prophylaxis regimens for colorectal surgery are cephalosporins and fluoroquinolones.

Optimization of medical comorbidities is also important for optimizing surgical outcomes. Patients with uncontrolled medical comorbidities, such as diabetes or heart disease, are at increased risk for postoperative complications. It is important to optimize these comorbidities before surgery to reduce the risk of complications.

Surgical Treatment of Early Colorectal Cancers

The surgical treatment of early colorectal cancers is typically curative. The goal of surgery is to remove the cancer and any surrounding lymph nodes that may be involved with the cancer. The type of surgery that is performed will depend on the location and size of the cancer.

For early colorectal cancers that are located in the colon, the most common surgical procedure is a colectomy. A colectomy is a surgical procedure to remove part or all of the colon. The type of colectomy that is performed will depend on the location and size of the cancer.

For early colorectal cancers that are located in the rectum, the most common surgical procedure is a low anterior resection. A low anterior resection is a surgical procedure to remove the rectum and the surrounding lymph nodes. The type of low anterior resection that is performed will depend on the location and size of the cancer.

After surgery, patients with early colorectal cancer will typically need to undergo a course of chemotherapy and/or radiation therapy. The goal of adjuvant therapy is to reduce the risk of the cancer recurring.

The Role of Minimally Invasive Surgery In Colorectal Carcinoma

Minimally invasive surgery (MIS) is a surgical technique that uses small incisions and specialized instruments to perform surgical procedures. MIS has been shown to have a number of advantages over traditional open surgery, including reduced pain, scarring, and recovery time.

MIS is increasingly being used for the treatment of colorectal carcinoma. MIS can be used to perform a variety of surgical procedures, including colectomy, low anterior resection, and rectal resection. MIS has been shown to be as effective as open surgery for the treatment of colorectal carcinoma, and it is associated with a number of benefits, including reduced pain, scarring, and recovery time.

However, MIS is not appropriate for all patients with colorectal carcinoma. Patients with large or complex tumors, or who have had previous abdominal surgery, may not be candidates for MIS. It is important to discuss the risks and benefits of MIS with your surgeon before making a decision about your treatment.

Preoperative Radiation and Chemotherapy for Colorectal Cancers

Preoperative radiation and chemotherapy (

Advances in Colorectal Neoplasia, An Issue of Surgical Clinics (The Clinics: Surgery Book 97)

by Richard D. Urman

5 out of 5

Language	:	English
File size	:	31241 KB
Text-to-Speech	:	Enabled
Screen Reader	:	Supported
Enhanced typesetting	:	Enabled
Print length	:	462 pages

FREE