Dharamshila Narayana Superspeciality Hospital

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Diagnosis and Staging Work Up

Gastro-intestinal cancers are a heterogeneous group of neoplasms that differ in their biologic and physical behaviours depending on the organ of origin, location within the organ, and degree of differentiation. As a result, evaluation of these tumors is complex, requiring integration of information from a patient′s clinical history, physical examination, laboratory data, and imaging. With advances in anatomic and functional imaging techniques, we now have tools to assess and evaluate patients with different gastrointestinal tumour and treat them as per their needs. It is difficult for a single imaging modality to provide all the necessary information for a given GI tumor. However, well-chosen combinations of available imaging modalities based on the indications, strength, and limitations of the modalities will provide optimal evaluation of patients with these malignancies.

Diagnostic and stagingwork up for COLO-RECTAL CANCER

Diagnostic work up and staging

  • CBC, Biochemistry
  • Chest X-ray
  • CT scan Abdomen & Pelvis
  • Colonoscopy and biopsy,CEA
  • Significant family history Familial Adenomatous Polyposis (FAP)
  • Hereditary Non Polyposis Colon Cancer(HNPCC)
  • For obstructive lesions-post operative colonoscopy advised/EUS to assess sphincter involvement

Modified Dukes′ Staging for Colorectal Cancer (AstlerColler)

  • A: Tumor involves only the submucosa
  • B1: Tumor infiltrates muscularispropria& lymph nodes negative
  • B2: Tumor infiltrates full thickness of colonic wall & lymph nodes negative
  • C1: Tumor infiltrates uptomuscularispropria& lymph nodes positive
  • C2: Tumor infiltrates full thickness of colon & lymph nodes positive
  • D: Distant metastasis

Model histopathology report for Colo-Rectal Cancers

  • Tumor size and type
  • Tumor grade
  • Depth of invasion
  • Cut margins including the circumferential cut margin
  • No. of positive / total no. of lymph nodes dissected
  • Any e/o perforation

Optional details

  • Lymphovascular emboli
  • Perineural spread
  • Serosal deposit > 3 mm in size

Diagnostic and staging work up for Stomach Cancer

  • CBC, Biochemistry.
  • Upper GI endoscopy & biopsy
  • CT scan Abdomen & Pelvis
  • Laparoscopic assessment where indicated[11]

Model Histopathology Report

  • Tumor size
  • Tumour type
  • Tumor location
  • Tumor grade
  • Depth of infiltration
  • Cut margins including circumferential cut margins
  • Lymph nodes positive / total no. of lymph nodes dissected
  • Levels of lymph nodes

Optional details

  • Perineural invasion
  • Lymphovascular embolization

Diagnostic and stagingwork up for PERIAMPULLARY & PANCREATIC CANCER

  • CBC and Biochemistry
  • CT scan abdomen
  • Endoscopy & biopsy for periampullary tumors
  • Endoscopic ultrasound for accurate staging
  • ERCP & stenting is used judiciously for cholangitis / severe pruritis etc.

Diagnostic and stagingwork up GALL BLADDER CANCER

  • CBC, Biochemistry
  • Chest X Ray
  • CT scan abdomen
  • MRI & MRCP if jaundiced

Model Histopathology Report (Histology review essential for cases presenting after a cholecystectomy outside)

  • Tumor size
  • Depth of infiltration
  • Tumor grade
  • Cut margins (liver cut margin & cystic duct cut margin)
  • Positive lymph nodes / total no. of lymph nodes cleared

Optional details

  • Perineural spread
  • Lymphovascular emboli

Post Your Query

Call 186-0208-0208
Mon–Sat 9:00 AM to 6:00 PM IST
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