Magnification Endoscopy

Magnifying endoscopes use various lenses to enlarge an already high-resolution video image. By using special dials on the endoscope handle, the endoscopist can zoom in on an image, magnifying it 1.5-105 times the original size (46). This feature has been used with chromoendoscopy (see Section 4.2.) to characterize Barrett's epithelium (47,48), small bowel atrophy in patients with suspected malabsorption (49), colonic polyps, and aberrant crypt foci (50,51). Chromoendoscopy is the term...

Barium Enema

A barium enema is contraindicated in those patients with suspected colonic perforation. If an enema must be performed in a patient with suspected colonic perforation, an ionic water-soluble contrast agent should be used. Perforation of the colon or rectum is a rare but serious complication of barium enema, occurring in less than 1 in 10,000 examinations (4). The rectum is the most common site of perforation. Rectal perforations are usually owing to insertion of the enema tip or use of a...

Islet Cell Neoplasms Neuroendocrine Tumors

Neuroendocrine Gastric Tumor

Contrast-enhanced MRI MRCP appears to be sensitive for detection of pancreatic islet cell tumors, although studies are often limited by small patient populations and different proportions of the various subtypes of tumors. Islet cell tumors are well demonstrated on multiple imaging sequences on MRI MRCP (29,30). Compared with CT, MRI demonstrates better soft tissue contrast and increased sensitivity for intravenous contrast enhancement that potentially makes smaller tumors more apparent. The...

Squamous Cell Carcinoma

Patients with esophageal cancer usually develop symptoms only after the tumor has invaded adjacent mediastinal structures (31). As a result, most patients have advanced disease at the time of diagnosis, with 5-yr survival rates of less than 10 (32). Occasionally, however, early esophageal cancers can be detected by serendipity or by screening of asymptomatic patients in high-risk groups. Early esophageal cancers may be manifested on double-contrast barium studies by small polypoid lesions,...

Lung Cancer

Lung cancer is the most common neoplasm in the Western world. Management depends on histological type and stage of the disease at diagnosis. Although the tumor is usually diagnosed by bronchoscopy, staging is dependent on various imaging procedures. The prognosis for non-small cell lung cancer (NSCLC) correlates closely with the presence of mediastinal adenopathy. Mediastinal lymph node involvement is reported in 28-38 of patients at the time of diagnosis. Patients with large subcarinal nodes...

Benign Tumors

Benign tumors of the esophagus constitute only about 20 of all esophageal neoplasms (1). Often they are small, asymptomatic lesions that are detected fortuitously on barium studies or endoscopy. However, some patients may exhibit dysphagia, bleeding, or other symptoms. Depending on the site of origin in the esophageal wall, benign tumors may be classified as mucosal or submucosal. These lesions have typical radiographic features that are discussed separately in the following sections. Squamous...

Info

Data from SEER database 1992-2002 (www.seer.cancer.gov). aPer 100,000. Data from SEER database 1992-2002 (www.seer.cancer.gov). aPer 100,000. Cancer-Related Indications for Endoscopic Procedures EGD Dysphagia, Barrett's, anemia, f u gastric ulcer, familial polyposis, abnormal X-ray Colonoscopy Heme+, CRC screen surveillance, ulcerative colitis screening, polyp on flex sig, family history, hematochezia, f u polyp abnormal X-ray ERCP Jaundice, biliary obstruction, stricture, pancreatic duct...

Small Bowel And Colonic Lymphomas

About 10 of all GI tract lymphomas arise in the small intestine. The incidence of small bowel lymphoma peaks in the seventh decade of life and there is slight male predominance. Most tumors arise in the distal small bowel, most likely because there is more lymphoid tissue in these areas, especially in the terminal ileum. Patients often present with abdominal pain, weight loss, anorexia, and less commonly, GI bleeding or iron deficiency anemia (50). Small bowel lymphomas can be divided into the...

Systemic Chemotherapy

In order to understand the current literature in the neoadju-vant and adjuvant settings, a review of chemotherapy agents in the metastatic disease will be discussed. As with many cancers, gastric cancer was thought to be relatively insensitive to chemotherapy. Most agents used in gastric cancer did not induce a complete response, responses in general were poor, and time to progression was short. Table 1 shows a list of singleagent drugs with activity in gastric cancer. The standard first-line...

Clinical Presentation

Small tumors that present owing to symptoms of hormone excess might be diagnosed at an early and potentially surgically Insulinoma Insulinoma syndrome Gastrinoma Zollinger-Ellison syndrome Glucagonoma Glucagonoma syndrome VIPoma Verner-Morrison, pancreatic cholera Headaches, visual disturbances, irrational behavior, confusion, drowsiness Abdominal pain, peptic ulcer disease, diarrhea, reflux esophagitis Necrolytic migratory erythema, diabetes, weight loss Secretory diarrhea > 1 L d,...

References

Tumors of the esophagus and stomach. In Ming SC, ed. Atlas of Tumor Pathology, Fascicle 7. Washington, DC Armed Forces Institute of Pathology 1973 16-23. 2. Sandvik AK, Aase S, Kveberg KH, Dalen A, Folvik M, Naess O. Papillomatosis of the esophagus. J Clin Gastroenterol 1996 22 35-37. 3. Montesi A, Pesaresi A, Graziani L, Salmistraro D, Dini L, Beazi I. Small benign tumors of the esophagus radiological diagnosis with double-contrast examination. Gastrointest Radiol 1983 8 207-212. 4....

B

Bladder Cancer Radiographically

Liver metastases confirmed by positron emission tomography imaging. (A) Axial computed tomography (CT) image through dome of liver shows a 9-mm low attenuation lesion in the lateral segment of the left lobe. A smaller, 7-mm nodule was seen in the liver tip. (B) Positron emission tomography image demonstrates uptake of 5-fluorodeoxyglucose in the lesion in the lateral segment of the liver lobe (arrow) and at the liver tip, corresponding to the tiny lesions detected at CT, findings...

Celiac Plexus Neurolysis

Pancreas Tumor Algorithm

The majority of pancreatic cancer patients have pain (68,69), therefore pain control and quality of life are of paramount importance in this unfortunate group of patients with limited life expectancy. Opioid administration is frequently necessary, however side effects such as constipation, nausea, vomiting, and drowsiness may limit dosing and effect. CPN, where the celiac plexus is ablated with a neurolytic agent, has additionally been offered to pancreatic cancer patients for pain control....

Other Colonic Tumors

LIPOMAS AND OTHER BENIGN LESIONS Colonic lipomas are encapsulated masses of mature fat cells, predominately arising in the submucosa. Most lipomas (70 ) are found in the cecum and ascending colon. Multiple lipomas are found in 25 of patients (53). Radiographically, these tumors appear as smooth-surfaced pedunculated, semi-pedunculated, or sessile masses that change size and shape with compression and varying degrees of colonic distension (54,55) (Fig. 22). These tumors are not infrequently...

Plastic Stents

Bioabsorbable Pancreatic Stent

In 1980, Soehendra and Reynders-Frederix described for the first time the endoscopic insertion of a 7-French (F) biliary stent to restore biliary flow in a distal CBD tumor (19). For many years plastic stents had been the only available devices and today they still represent a valid therapeutic option (Fig. 1A). The most common configuration is a straight or curved stent with side flaps at each end to minimize the risk of proximal or distal migration, which may still occur up to 9 of patients...

Gastritis

Probably no term in gastroenterology is so widely misused as gastritis. As an endoscopic finding it may be used to indicate redness of the mucosa, or whiteness, mucosal lesions, erosions or red dots, and the state of the stomach when yellow fluid is present. In this chapter, gastritis refers to the histological state, Multifocal atrophic gastritis Atrophic gastritis of body and environmental or genetic factors Autoimmune inflammation of antrum with intestinal metaplasia Chronic active Normal...

Photodynamic Therapy

Explai Pdt Tretment For Face

PDT Indications and Contraindications PDT is a nonthermal ablative technique resulting in local necrosis of malignant esophageal tissue. PDT is indicated for the palliative management of malignant esophageal strictures and ablation of Barrett's esophagus with high-grade dysplasia in non-surgical candidates. In this chapter, the focus is solely on palliation of malignant dysphagia. When considering PDT for palliation, most esophageal cancer patients have either failed, refused, or are...

Gastric Lymphomas

Rugal Surface Stomach

The stomach is the most common site for GI lymphoma to occur, accounting for 75 of all GI lymphomas and 10 of lymphomas overall (10). Only 3 of gastric cancers are lymphomas. The clinical features of a patient with gastric lymphoma vary but include epigastric pain, dyspepsia, anorexia, weight loss, nausea, emesis, and early satiety. Physical exam is usual normal, but a palpable abdominal mass or peripheral lymphadenopathy may be present. Most gastric lymphomas are extranodal marginal zone...

Investigational Methods In Development

Laser-scanning confocal microscopy LCM is a novel optical method that may be able to provide a microscopic image of mucosal surfaces. A special LCM instrument and a probe-type endomicroscope that can be passed through the working channel of an endoscope have been developed for LCM. They scan the mucosa using an argon laser beam with a wavelength of 488 nm and analyze the reflected light. An objective lens with a magnification of x40 is mounted on the LCM instrument. Two studies have shown that...

Fecal Occult Blood Tests 321 Guaiac Based Stool Tests

Elektolit Batrai

The American College of Physicians has published comprehensive guidelines for fecal occult blood testing FOBT and interpretation with review of the data 7,8 . FOBT has been estimated to detect around 90 of cancers with repeated testing over several years 9 . However, a one-time FOBT three samples has an estimated sensitivity for advanced neo-plasia of only 23.9 10 . FOBT is most commonly performed using a guaiac-based test for peroxidase activity. Therefore, it is important that patients avoid...

Serous Cystadenomas

Cystadenomas

Serous cystadenomas previously known as glycogen-rich cystadenomas are benign, solitary, cystic tumors that arise from centro-acinar cells Fig. 1 . Although the majority of serous cystadenomas are microcystic, there are two other variants based on growth pattern macrocystic and solid. Micro-cystic serous cystadenomas are made up of multiple small thin-walled cysts with a honeycomb-like appearance on cross-section. Microcystic serous cystadenomas may grow to a large diameter over the long-term...

Adenocarcinoma

Ncer Rectal

Although the incidence of gastric carcinoma has declined during the past 50 yr, it continues to be a deadly disease, with overall 5-yr survival rates of less than 20 54 . There also has been a gradual shift in the distribution of gastric cancer from the antrum proximally to the fundus and cardia 55 . As a result, 30-40 of all gastric cancers are located in the fundus or cardiac region 55 . The gastric cardia and fundus therefore should be carefully evaluated in all patients with suspected...

Eus In The Followup Of Anal Cancer

The treatment strategy of anal cancer was changed in the early to mid-1980s when several authors reported excellent T Primary anal cancer Description Fig. 8. A Endoscopic appearance of anal cancer, biopsies confirm squamous cell carcinoma. B,C Rectal endoscopic ultrasound confirms that this is T2N1 stage, with involvement of the internal anal sphinter U , and disruption of the external anal sphinter anteriorly and a single round, hypoechoic, malignant-appearing perirectal lymph node anal cancer...

Morphology

Transverse Colon Radiograph

The most common form of adenocarcinoma is the annular or semiannular lesion, accounting for about one-half of colon carcinomas 25 . Annular cancers are the end-stage of polypoid lesions that have spread circumferentially around the lumen of the bowel. This morphological type is usually found in the transverse, descending, and sigmoid colon. The annular narrowing is often asymmetric, thicker at the site of the original polypoid tumor 27 . The mucosal surface is nodular or ulcerated Fig. 7 . The...

Diagnostic Methods

Mucinous Cystadenoma Cytology

CT is an excellent test for cystic lesions of the pancreas because of its widespread availability and ability to detect cysts 22 Fig. 3 . MRI is used increasingly because of the lack of radiation exposure and the ability to image the pancreatic duct with MR cholangiopancreatography 23 . Transabdominal ultrasonography may aid in differentiating between solid and cystic lesions, but complete evaluation of the pancreas is often difficult owing to overlying bowel gas. Although seen in less than 20...

Metastases Involving Colon

Tumors can secondarily involve the colon in a variety of ways direct invasion by contiguous tumor either primary or recurrence , spread via a mesentery, intraperitoneal metastases, or hematogenous metastasis 59 . A wide variety of organs about the colon as it courses through the peritoneal space and retroperitoneum. Carcinomas of the gallbladder invade the superior border of the hepatic flexure. Carcinomas of the left kidney or recurrences of left kidney cancer invade the medial border of the...