
Contents
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Oesophageal cancer: epidemiology and clinical features Oesophageal cancer: epidemiology and clinical features
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Epidemiology Epidemiology
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Aetiology and pathology Aetiology and pathology
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Clinical features Clinical features
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Further reading Further reading
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Oesophageal cancer: screening, diagnosis, and staging Oesophageal cancer: screening, diagnosis, and staging
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Screening and surveillance Screening and surveillance
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Diagnosis Diagnosis
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Barium swallow Barium swallow
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Endoscopy and endoscopic ultrasound Endoscopy and endoscopic ultrasound
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Computer tomography and magnetic resonance imaging Computer tomography and magnetic resonance imaging
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Positron emission tomography Positron emission tomography
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Laparoscopy Laparoscopy
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Bronchoscopy Bronchoscopy
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Staging Staging
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T: tumour T: tumour
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N: nodal N: nodal
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M: metastasis M: metastasis
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Tumours of lower thoracic oesophagus Tumours of lower thoracic oesophagus
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Tumours of upper thoracic oesophagus Tumours of upper thoracic oesophagus
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Tumours of mid-thoracic oesophagus Tumours of mid-thoracic oesophagus
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Stage grouping Stage grouping
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Siewert classification Siewert classification
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References References
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Oesophageal cancer: treatment of localized disease Oesophageal cancer: treatment of localized disease
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Principles of management Principles of management
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Surgery Surgery
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Radiotherapy Radiotherapy
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Definitive chemoradiotherapy Definitive chemoradiotherapy
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Preoperative chemotherapy Preoperative chemotherapy
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Preoperative chemoradiotherapy Preoperative chemoradiotherapy
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Further reading Further reading
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Oesophageal cancer: treatment of advanced disease, symptom control, and palliation Oesophageal cancer: treatment of advanced disease, symptom control, and palliation
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Principles of management Principles of management
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Localized treatments for dysphagia Localized treatments for dysphagia
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Dilatation Dilatation
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Stenting/intubation Stenting/intubation
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Injection/thermal ablation Injection/thermal ablation
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Radiotherapy Radiotherapy
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Chemotherapy Chemotherapy
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General palliation General palliation
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References References
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Gastric cancer: introduction and clinical features Gastric cancer: introduction and clinical features
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Epidemiology Epidemiology
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Pathology Pathology
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Aetiology Aetiology
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Clinical features Clinical features
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Further reading Further reading
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Internet resource Internet resource
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Gastric cancer: screening, diagnosis, staging and prognosis Gastric cancer: screening, diagnosis, staging and prognosis
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Screening Screening
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Diagnosis and staging Diagnosis and staging
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Endoscopy Endoscopy
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Barium studies Barium studies
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Computed tomography and magnetic resonance imaging Computed tomography and magnetic resonance imaging
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Endoscopic ultrasound Endoscopic ultrasound
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Positron emission tomography Positron emission tomography
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Laparoscopy and peritoneal cytology Laparoscopy and peritoneal cytology
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Staging systems Staging systems
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T: primary tumour T: primary tumour
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N regional lymph nodes N regional lymph nodes
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M: distant metastasis M: distant metastasis
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Stage grouping Stage grouping
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Prognosis Prognosis
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Further reading Further reading
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Internet resource Internet resource
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Gastric cancer: treatment of localized disease Gastric cancer: treatment of localized disease
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Principles of treatment Principles of treatment
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Early gastric cancer (EGC) Early gastric cancer (EGC)
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Surgery Surgery
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Chemotherapy Chemotherapy
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Adjuvant chemoradiotherapy Adjuvant chemoradiotherapy
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Targeted therapies Targeted therapies
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Further reading Further reading
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Internet resource Internet resource
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Gastric cancer: treatment of advanced disease, symptom control, and palliative care Gastric cancer: treatment of advanced disease, symptom control, and palliative care
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Principles of management Principles of management
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Endoscopic treatment Endoscopic treatment
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Surgery Surgery
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Radiotherapy Radiotherapy
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Chemotherapy and targeted therapies Chemotherapy and targeted therapies
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Best supportive care Best supportive care
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Further reading Further reading
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Internet resources Internet resources
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Hepatocellular cancer: introduction Hepatocellular cancer: introduction
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Epidemiology Epidemiology
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Aetiology Aetiology
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Hepatitis B virus infection Hepatitis B virus infection
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Hepatitis C virus infection Hepatitis C virus infection
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Alcohol Alcohol
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Non- alcoholic fatty liver disease Non- alcoholic fatty liver disease
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Aflatoxin Aflatoxin
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Metabolic disease Metabolic disease
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Adenoma, contraceptive, androgenes Adenoma, contraceptive, androgenes
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Screening Screening
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Patients who should be screened for HCC Patients who should be screened for HCC
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Hepatitis B carriers Hepatitis B carriers
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Non-hepatitis B cirrhosis Non-hepatitis B cirrhosis
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Patients who may benefit from screening Patients who may benefit from screening
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Surveillance interval Surveillance interval
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Pathology Pathology
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Further reading Further reading
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Hepatocellular cancer: clinical features and staging Hepatocellular cancer: clinical features and staging
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Clinical features Clinical features
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Diagnosis Diagnosis
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Staging systems Staging systems
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Prognosis Prognosis
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Further reading Further reading
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Hepatocellular cancer: management Hepatocellular cancer: management
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Principles of management Principles of management
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Surgical resection Surgical resection
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Non- cirrhotic liver Non- cirrhotic liver
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Cirrhotic liver Cirrhotic liver
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Risk of recurrence Risk of recurrence
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Liver Transplantation Liver Transplantation
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Loco regional therapy as a bridge to transplantation for HCC Loco regional therapy as a bridge to transplantation for HCC
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Priority listing for transplantation for HCC Priority listing for transplantation for HCC
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Live donor liver transplant for HCC Live donor liver transplant for HCC
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Post-transplant management Post-transplant management
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Percutaneous ablation Percutaneous ablation
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Further reading Further reading
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Biliary tract tumours: introduction Biliary tract tumours: introduction
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Epidemiology Epidemiology
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Aetiology Aetiology
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Primary sclerosing cholangitis (PSC) Primary sclerosing cholangitis (PSC)
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Parasitic biliary infections (liver flukes) Parasitic biliary infections (liver flukes)
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Hepatolithiasis (recurrent pyogenic cholangiohepatitis or Oriental cholangiohepatitis) Hepatolithiasis (recurrent pyogenic cholangiohepatitis or Oriental cholangiohepatitis)
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Congenital cystic dilation of the bile ducts Congenital cystic dilation of the bile ducts
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Chronic exposure to DNA-damaging chemical agents Chronic exposure to DNA-damaging chemical agents
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Pathology Pathology
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Further reading Further reading
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Biliary tract tumours: clinical features, staging, and prognosis Biliary tract tumours: clinical features, staging, and prognosis
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Clinical features Clinical features
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Diagnosis and staging Diagnosis and staging
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Serum tumour markers Serum tumour markers
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Imaging Imaging
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Ultrasonography Ultrasonography
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Computed tomography Computed tomography
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Magnetic resonance imaging Magnetic resonance imaging
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Endoscopic retrograde cholangiography (ERC) and percutaneous transhepatic cholangiography (PTC) Endoscopic retrograde cholangiography (ERC) and percutaneous transhepatic cholangiography (PTC)
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Positron emission tomography (PET) Positron emission tomography (PET)
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Cytology and biopsy Cytology and biopsy
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Endoscopic ultrasound with fine needle aspiration Endoscopic ultrasound with fine needle aspiration
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Laparoscopy ± laparoscopic ultrasound Laparoscopy ± laparoscopic ultrasound
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Emerging technologies Emerging technologies
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Staging Staging
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Bismuth and Corlette classification (Fig. ) Bismuth and Corlette classification (Fig. )
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American Joint Committee on Cancer staging system American Joint Committee on Cancer staging system
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Prognosis Prognosis
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Survival data according to therapy (Malhi and Gores 2006) Survival data according to therapy (Malhi and Gores 2006)
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Surgery and 5-year survival Surgery and 5-year survival
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Liver transplantation Liver transplantation
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Palliative therapy and median survival Palliative therapy and median survival
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Further reading Further reading
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Biliary tract tumours: management Biliary tract tumours: management
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Principles of management (see Fig. ) Principles of management (see Fig. )
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Role of surgery and resectability Role of surgery and resectability
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Adjuvant treatment Adjuvant treatment
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Liver transplantation Liver transplantation
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Management of unresectable tumours Management of unresectable tumours
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Treatment of biliary obstruction Treatment of biliary obstruction
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Photodynamic therapy (PDT) Photodynamic therapy (PDT)
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Palliative radiotherapy Palliative radiotherapy
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Systemic chemotherapy and new targeted agents Systemic chemotherapy and new targeted agents
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Further reading Further reading
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Pancreatic cancer: introduction Pancreatic cancer: introduction
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Epidemiology Epidemiology
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Aetiology Aetiology
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Hereditary pancreatitis Hereditary pancreatitis
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Cancer family syndromes Cancer family syndromes
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Secondary screening Secondary screening
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Pathology Pathology
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The TNM classification for pancreatic cancer (Sobin and Wittekind 2002): The TNM classification for pancreatic cancer (Sobin and Wittekind 2002):
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T: primary tumour T: primary tumour
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N: regional lymph nodes N: regional lymph nodes
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M: distant metastasis M: distant metastasis
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Clinical features Clinical features
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Symptoms Symptoms
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Signs Signs
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Further reading Further reading
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Internet resources Internet resources
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Pancreatic cancer: diagnosis, staging, and prognosis Pancreatic cancer: diagnosis, staging, and prognosis
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Diagnosis Diagnosis
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Blood tests Blood tests
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Tumour markers Tumour markers
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Non-invasive diagnostic imaging Non-invasive diagnostic imaging
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Transabdominal ultrasound (TAUS) Transabdominal ultrasound (TAUS)
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Contrast-enhanced computed tomography (CE-CT) Contrast-enhanced computed tomography (CE-CT)
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Magnetic resonance imaging Magnetic resonance imaging
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Magnetic resonance cholangio-pancreatography Magnetic resonance cholangio-pancreatography
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Positron emission tomography and PET-CT Positron emission tomography and PET-CT
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Invasive diagnostic imaging Invasive diagnostic imaging
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Endoluminal ultrasonography (EUS) Endoluminal ultrasonography (EUS)
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Endoscopic retrograde cholangiopancreatography Endoscopic retrograde cholangiopancreatography
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Percutaneous transhepatic cholangiography (PTHC) Percutaneous transhepatic cholangiography (PTHC)
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Percutaneous fine needle aspiration biopsy Percutaneous fine needle aspiration biopsy
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Staging Staging
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Diagnostic imaging Diagnostic imaging
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Laparoscopy and laparoscopic staging Laparoscopy and laparoscopic staging
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Peritoneal cytology Peritoneal cytology
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Stage grouping for pancreatic cancer—UICC (Sobin and Wittekind 2002) Stage grouping for pancreatic cancer—UICC (Sobin and Wittekind 2002)
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Stage grouping Stage grouping
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Prognosis Prognosis
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Tumour- related factors Tumour- related factors
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Patient- related factors Patient- related factors
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Treatment- related factors Treatment- related factors
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Further reading Further reading
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Pancreatic cancer: treatment of resectable cancer Pancreatic cancer: treatment of resectable cancer
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Definition of resectability Definition of resectability
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Principles of management Principles of management
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Preoperative biliary drainage Preoperative biliary drainage
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Surgical management Surgical management
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Tumours of the head of pancreas Tumours of the head of pancreas
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Tumours of the body and tail of pancreas Tumours of the body and tail of pancreas
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Morbidity and mortality Morbidity and mortality
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Management of complications Management of complications
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Intra-abdominal abscess Intra-abdominal abscess
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Haemorrhage Haemorrhage
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Fistula after pancreatoduodenectomy Fistula after pancreatoduodenectomy
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Delayed gastric emptying Delayed gastric emptying
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Role of octreotide Role of octreotide
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Role of neo-adjuvant and adjuvant treatment Role of neo-adjuvant and adjuvant treatment
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Neoadjuvant therapy Neoadjuvant therapy
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Adjuvant therapy Adjuvant therapy
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Adjuvant chemotherapy Adjuvant chemotherapy
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Adjuvant chemoradiotherapy Adjuvant chemoradiotherapy
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Chemoradiotherapy and follow-on chemotherapy Chemoradiotherapy and follow-on chemotherapy
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Meta-analysis Meta-analysis
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Further reading Further reading
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Pancreatic cancer: treatment of unresectable and metastatic cancer Pancreatic cancer: treatment of unresectable and metastatic cancer
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Unresectable cancer Unresectable cancer
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Principles of management Principles of management
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Pain relief Pain relief
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Jaundice and duodenal obstruction Jaundice and duodenal obstruction
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Weight loss Weight loss
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Systemic chemotherapy Systemic chemotherapy
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Role of chemoradiotherapy Role of chemoradiotherapy
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Metastatic disease Metastatic disease
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Principles of management Principles of management
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Treatment options Treatment options
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Systemic chemotherapy Systemic chemotherapy
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Novel approaches Novel approaches
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Further reading Further reading
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Internet resources Internet resources
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Uncommon pancreatic tumours Uncommon pancreatic tumours
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Carcinoid tumours Carcinoid tumours
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Epidemiology Epidemiology
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Clinical presentation and diagnosis/staging Clinical presentation and diagnosis/staging
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Histology Histology
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Treatment Treatment
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Surgical Surgical
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Non-surgical Non-surgical
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Pancreatic endocrine tumours Pancreatic endocrine tumours
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Epidemiology Epidemiology
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Aetiology Aetiology
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Clinical presentation and diagnosis/staging Clinical presentation and diagnosis/staging
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Treatment Treatment
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Surgical Surgical
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Non-surgical Non-surgical
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Uncommon histologies Uncommon histologies
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Cystic tumours Cystic tumours
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Diagnosis Diagnosis
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Management Management
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Pancreatic lymphoma Pancreatic lymphoma
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Metastases to the pancreas Metastases to the pancreas
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Further reading Further reading
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Internet resources Internet resources
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Tumours of small intestine Tumours of small intestine
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Epidemiology Epidemiology
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Pathology Pathology
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Aetiology Aetiology
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Clinical features Clinical features
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Diagnosis Diagnosis
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Staging Staging
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Principles of treatment Principles of treatment
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Surgery Surgery
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Systemic therapy Systemic therapy
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Small bowel adenocarcinoma Small bowel adenocarcinoma
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Carcinoid tumours Carcinoid tumours
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Small bowel lymphoma Small bowel lymphoma
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Sarcoma Sarcoma
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Prognosis Prognosis
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Further reading Further reading
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Colorectal cancer: introduction Colorectal cancer: introduction
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Epidemiology Epidemiology
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Geographical variation Geographical variation
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UK and Europe UK and Europe
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Age and incidence Age and incidence
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Sex distribution Sex distribution
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Aetiology Aetiology
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Colorectal polyps Colorectal polyps
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Dietary risk factors Dietary risk factors
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Fat and red meat Fat and red meat
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Dietary fibre intake Dietary fibre intake
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Other dietary factors Other dietary factors
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Obesity and lifestyle Obesity and lifestyle
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Familial risk factors Familial risk factors
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Undefined familial colorectal cancer Undefined familial colorectal cancer
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Hereditary colorectal cancer syndromes (HCS) Hereditary colorectal cancer syndromes (HCS)
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Inflammatory bowel disease Inflammatory bowel disease
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Risk factors for CRC in IBD patients Risk factors for CRC in IBD patients
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Further reading Further reading
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Colorectal cancer: genetics, screening, and prevention Colorectal cancer: genetics, screening, and prevention
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Genetics Genetics
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Genomic instability Genomic instability
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Genomic instability in CRC Genomic instability in CRC
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CIN microsatellite stable (MSS) CRC CIN microsatellite stable (MSS) CRC
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CIN and adenoma–carcinoma sequence CIN and adenoma–carcinoma sequence
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Adenomatous polyposis coli (APC) (5q21) Adenomatous polyposis coli (APC) (5q21)
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k-ras (12p12) k-ras (12p12)
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DCC, SMAD2, and SMAD4 (18q21) DCC, SMAD2, and SMAD4 (18q21)
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p53 (17p13) p53 (17p13)
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Microsatellite instability Microsatellite instability
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Molecular staging and ‘genetic signatures’ Molecular staging and ‘genetic signatures’
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Screening Screening
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UK CRC screening initiative UK CRC screening initiative
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Screening protocols Screening protocols
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Digital rectal examination Digital rectal examination
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Faecal occult blood test (FOBT) Faecal occult blood test (FOBT)
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Sigmoidoscopy Sigmoidoscopy
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Colonoscopy Colonoscopy
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Double- contrast barium enema Double- contrast barium enema
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Faecal immunochemical test (FIT) Faecal immunochemical test (FIT)
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Other modern technologies Other modern technologies
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Screening in high-risk individuals Screening in high-risk individuals
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Prevention Prevention
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Further reading Further reading
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Colorectal cancer: clinical features, diagnosis, and staging Colorectal cancer: clinical features, diagnosis, and staging
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Clinical features Clinical features
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Rectal bleeding Rectal bleeding
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Change in bowel habit Change in bowel habit
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Abdominal pain Abdominal pain
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Other symptoms Other symptoms
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Emergency presentation Emergency presentation
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Features of hereditary colorectal syndrome-associated CRC Features of hereditary colorectal syndrome-associated CRC
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Features of CRC in inflammatory bowel disease Features of CRC in inflammatory bowel disease
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Diagnosis Diagnosis
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History and physical examination History and physical examination
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Endoscopy Endoscopy
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Flexible sigmoidoscopy (FS) Flexible sigmoidoscopy (FS)
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Colonoscopy Colonoscopy
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Barium enema Barium enema
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CT colonography CT colonography
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Endoscopic-guided biopsy Endoscopic-guided biopsy
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Staging Staging
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Laboratory tests Laboratory tests
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Local staging of rectal tumours Local staging of rectal tumours
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MRI scanning MRI scanning
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Rectal endosonography (RE) Rectal endosonography (RE)
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Exclusion of metastatic disease Exclusion of metastatic disease
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Staging protocols (Table ) Staging protocols (Table )
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Further reading Further reading
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Colorectal cancer: treatment of localized disease Colorectal cancer: treatment of localized disease
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Preparation for surgery Preparation for surgery
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Technique Technique
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Colon cancer Colon cancer
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Elective procedures: Elective procedures:
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Right hemicolectomy Right hemicolectomy
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Left hemicolectomy Left hemicolectomy
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Rectal cancer Rectal cancer
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Sphincter preservation and surgical approaches Sphincter preservation and surgical approaches
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Development of total mesorectal excision (TME) Development of total mesorectal excision (TME)
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Temporary stomas Temporary stomas
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Role of radiotherapy Role of radiotherapy
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Quality of life Quality of life
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Surgery for early stage disease Surgery for early stage disease
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Anastomotic technique Anastomotic technique
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Laparoscopic surgery Laparoscopic surgery
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Emergency procedures Emergency procedures
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Surgical Surgical
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Obstruction Obstruction
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Perforation Perforation
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Stenting Stenting
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Postoperative care Postoperative care
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Colorectal cancer: adjuvant treatment Colorectal cancer: adjuvant treatment
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Chemotherapy in colorectal cancer Chemotherapy in colorectal cancer
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Why 5-FU? Why 5-FU?
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Recent developments Recent developments
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Toxicity Toxicity
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Patient selection Patient selection
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Can current treatments be improved? Can current treatments be improved?
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Increasing tolerability Increasing tolerability
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Increasing effectiveness Increasing effectiveness
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Better targeting Better targeting
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Rectal cancer Rectal cancer
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Radiotherapy Radiotherapy
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Indications Indications
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Reducing local recurrence in resectable disease Reducing local recurrence in resectable disease
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The development of the 25Gy in 5 fractions preoperative schedule The development of the 25Gy in 5 fractions preoperative schedule
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Conventionally fractionated radiation schedules Conventionally fractionated radiation schedules
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Postoperative approaches Postoperative approaches
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Preoperative versus postoperative radiation in resectable disease Preoperative versus postoperative radiation in resectable disease
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Radiotherapy for locally advanced rectal cancer Radiotherapy for locally advanced rectal cancer
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Improving sphincter preservation Improving sphincter preservation
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Summary Summary
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Further reading Further reading
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Colorectal cancer: treatment of advanced colorectal cancer Colorectal cancer: treatment of advanced colorectal cancer
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Introduction Introduction
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Chemotherapy Chemotherapy
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Fluoropyrimidines Fluoropyrimidines
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Irinotecan and oxaliplatin Irinotecan and oxaliplatin
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Newer agents Newer agents
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Role of surgery Role of surgery
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Resection of liver metastasis Resection of liver metastasis
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Special situations Special situations
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Who to treat and when to start? Who to treat and when to start?
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Do we need to use combination treatment first-line? Do we need to use combination treatment first-line?
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Intermittent or continuous chemotherapy? Intermittent or continuous chemotherapy?
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Second- line treatment and beyond? Second- line treatment and beyond?
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Is there a role for chemotherapy with operable metastases? Is there a role for chemotherapy with operable metastases?
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Conclusion Conclusion
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Further reading Further reading
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Internet resource Internet resource
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Colorectal cancer: prognosis, follow-up, and management of recurrence Colorectal cancer: prognosis, follow-up, and management of recurrence
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Prognosis Prognosis
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Key prognostic factors Key prognostic factors
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Other prognostic factors Other prognostic factors
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Tumour grading Tumour grading
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Tumour border and ‘budding’ Tumour border and ‘budding’
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Perineural invasion Perineural invasion
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Nodal micrometastasis Nodal micrometastasis
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Tumour immunity Tumour immunity
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Microsatellite instability Microsatellite instability
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Loss of heterozygosity (18q deletions and TP53) Loss of heterozygosity (18q deletions and TP53)
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Protein marker profiling (EGFR, VEGF, and ki-RAS) Protein marker profiling (EGFR, VEGF, and ki-RAS)
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Follow-up Follow-up
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Clinic reviews Clinic reviews
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Carcinoembryonic antigen Carcinoembryonic antigen
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Liver imaging Liver imaging
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Colonoscopy Colonoscopy
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Recurrence and management Recurrence and management
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Further reading Further reading
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Anal cancer: introduction Anal cancer: introduction
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Epidemiology Epidemiology
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Aetiology Aetiology
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Human papilloma virus Human papilloma virus
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Immunosuppression Immunosuppression
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Smoking Smoking
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Anatomy of anal canal Anatomy of anal canal
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Pathology Pathology
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Clinical features Clinical features
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Anal cancer: management Anal cancer: management
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Diagnosis and staging Diagnosis and staging
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Principles of management Principles of management
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Surgery Surgery
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Radiotherapy Radiotherapy
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Combined modality treatment Combined modality treatment
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Radiotherapy versus chemotherapy Radiotherapy versus chemotherapy
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Which chemotherapy? Which chemotherapy?
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Treatment of elderly and HIV positive patients Treatment of elderly and HIV positive patients
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Role of post-operative CRT Role of post-operative CRT
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Toxicity Toxicity
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Management of metastatic and recurrent disease Management of metastatic and recurrent disease
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Prognosis Prognosis
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Follow-up Follow-up
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Cite
Extract
Oesophageal cancer: epidemiology and clinical features
Epidemiology
Oesophageal cancer is a common cancer in the UK with an annual incidence of 16.5 for men and 8.5 for women per 100,000 and >7000 new cases per year (ONS 2004). The incidence has risen steadily over the last 20 years mainly due to an increase in adenocarcinomas, whereas SCCs have decreased slightly. Despite advances in the treatment OS rates remain poor at <15% (ONS 2004).
Worldwide it is the eighth commonest cancer and has the fifth highest mortality rate (Parkin et al. 2005). There is a large geographical variation in the incidence and histological types, being less common in the Western world although rates of adenocarcinoma are increasing exponentially. The incidence in countries such as China and in the Eastern Mediterranean is extremely high, consisting mainly of SCC. There is a male to female ratio of 2.5:1 although the incidence of cervical oesophageal cancer is higher in women. Incidence increases with age for both sexes.
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