Stage 1: T1N0 or T2N0
Stage 2: T3N0 or T4N0
Stage 3: Any T, N1 or 2
Stage 4: Any T, Any N, M1
T1: invades into submucosa
T2: invades into muscularis propria
T3: invades through muscularis propria into subserosa or non-peritonealized pericolonic tissue
T4: invades through serosa into adjacent organs
N0: 0 LN mets (min 12 LN sampled)
N1: 1-3 LN
N2: >=4 LN
Showing posts with label Colon Ca. Show all posts
Showing posts with label Colon Ca. Show all posts
Wednesday, November 18, 2009
Tuesday, November 17, 2009
Diagnostic Criteria for Lynch Syndrome
Amsterdam Criteria (3-2-1):
Amsterdam criteria was developed for research and therefore very specific criteria.
- 3 relatives with colon ca
- 2 generations
- 1 family member <50 yo
Modified Amsterdam and Bethesda criteria were subsequently developed to be further encompassing.
Modified Amsterdam Criteria:
- same as Amsterdam criteria but cancers can also include: colon, small bowel, ureter, renal pelvis and endometrial ca.
Bethesda Criteria:
- Amsterdam criteria or
- 2 cases of HNPCC cancers in 1 pt, including synch or metach CRC
- Colon CA and 1st deg relative with CA/adenoma (CA <45, adenoma <40)
- Colon or endometrial CA <45
- R sided colon CA with histo undiff, solid, cribiform, signet-cell <45
- Adenoma <40
Amsterdam criteria was developed for research and therefore very specific criteria.
- 3 relatives with colon ca
- 2 generations
- 1 family member <50 yo
Modified Amsterdam and Bethesda criteria were subsequently developed to be further encompassing.
Modified Amsterdam Criteria:
- same as Amsterdam criteria but cancers can also include: colon, small bowel, ureter, renal pelvis and endometrial ca.
Bethesda Criteria:
- Amsterdam criteria or
- 2 cases of HNPCC cancers in 1 pt, including synch or metach CRC
- Colon CA and 1st deg relative with CA/adenoma (CA <45, adenoma <40)
- Colon or endometrial CA <45
- R sided colon CA with histo undiff, solid, cribiform, signet-cell <45
- Adenoma <40
Risk of Cancer in IBD
Risk increases significatntly 8 years after pancolitis:
Therefore, recommendation is to begin colonscopic screening 8 years after the onset of pancolitis.
- In patients with left-sided colitis only, screening can begin 12-15 years after the onset of disease.
Therefore, recommendation is to begin colonscopic screening 8 years after the onset of pancolitis.
- In patients with left-sided colitis only, screening can begin 12-15 years after the onset of disease.
Haggitt Levels - Colonic Polyps
Describe invasion of invasive carcinoma in pedunculated colonic polyps. The Kudo classification is used to describe invasion in sessile polyps.
Level 0 - CIS (carcinoma confined to mucosal layer)
Invasion through Lamina propria:
Level 1 - invasion into submucosa limited to head of polyp
Level 2 - invasion into submucosa extending to neck of polyp
Level 3 - invasion into submucosa extending to stalk of polyp
Level 4 - invasion beyond the stalk but above the muscularis propria
Indications for Surgical Management of Polyps after Polypectomy:
- Positive margins
- Piecemeal resection
- Lymphovascular invasion
- Poorly differentiated
- Haggit level 4
- Unable to resect endoscopically
Level 0 - CIS (carcinoma confined to mucosal layer)
Invasion through Lamina propria:
Level 1 - invasion into submucosa limited to head of polyp
Level 2 - invasion into submucosa extending to neck of polyp
Level 3 - invasion into submucosa extending to stalk of polyp
Level 4 - invasion beyond the stalk but above the muscularis propria
Indications for Surgical Management of Polyps after Polypectomy:
- Positive margins
- Piecemeal resection
- Lymphovascular invasion
- Poorly differentiated
- Haggit level 4
- Unable to resect endoscopically
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