Surgical decision making for large bowel cancer metastatic to the liver

Article Abstract:

Recurrence of cancer of the large intestine often involves the spread of the cancer to other areas of the body. In a small but significant number of such cases, the spread of cancer is limited to the liver. Surgery can be an effective treatment for selected patients with cancer involving the liver. Improvements in surgical techniques and diagnostic imaging have greatly improved results from liver surgery. Studies examining the criteria for selecting patients appropriate for such surgery have indicated that the best candidates are those in whom the cancer has not spread to the lymph nodes of the liver or to other areas of the body and in whom the cancerous areas in the liver involve three or fewer locations. In theory, surgery cannot remove all the cancerous cells. Weiss and colleagues have proposed a new hypothesis on how cancer spreads that may lead to improved surgical treatments for cancer. Their theory is that many tumor cells from intestinal cancer are released into the portal vein, which passes through the liver. Most of these cells are destroyed, but if the number of cells is very large, some may deposit in the liver and grow. This would then produce a supply of cancer cells in the liver that could spread to the lungs and other areas of the body. The surgical implications of this theory are that initial treatment of colon cancer should include removal of tissues from the blood vessels that drain the primary tumor as well as from the lymph nodes draining it to eliminate the spread of the cancer. Liver surgical techniques have been facilitated by the segmental approach to the liver, in which the liver is segmented into nine anatomical areas. Diagnostic imaging has also led to improvements in liver surgery results. The use of these techniques can be helpful in determining the number and locations of liver tumors and in determining if cancer has spread to other sites in the body. Imaging can be used to evaluate tumor masses in relationship to liver structures and veins. Imaging is less useful in detecting cancerous spread to liver lymph nodes. In the future, a test that could detect microscopic areas of cancer would be of great value. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Colorectal cancer, Surgery, Liver, Cancer, Cancer treatment, Cancer metastasis, Liver cancer, editorial

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Acute cervical spine trauma: correlation of MR imaging findings with degree of neurologic deficit

Article Abstract:

Magnetic resonance (MR) imaging has become a useful tool for the noninvasive evaluation of spinal cord injuries. It can produce detailed images of soft tissues, intervertebral disks, and the spinal cord itself. MR can clearly detect lesions (changes in tissues) that other imaging techniques such as computed tomography (CT) only suggest. Little research has examined the findings of MR imaging of spinal cord injuries and their relation with clinical findings. Consequently, the MR findings of 78 patients with spinal cord injuries were assessed and compared with the patients' clinical conditions and CT findings. The goals of the study were to see if MR information could determine the severity of the injury, what types of injuries were most severe clinically, and to compare the relative uses of MR and CT. MR imaging demonstrated 14 main characteristics of spinal cord injury. The three features that were considered to be indicative of severity of injury were spinal cord swelling, cord edema, and intramedullary hemorrhage. The extent of edema and swelling imaged by MR correlated well with the clinical severity of injury. Hemorrhage was seen in only the most severe cases and was an indicator of a poor prognosis. All patients with clinical spinal cord abnormalities had positive results on MR images; conversely, all patients with normal clinical spinal cord findings had no abnormalities on MR imaging. Although MR was much more useful in detecting soft tissue injuries, CT was more reliable in detecting fractures. The results of MR and CT showed that no correlation existed between severity of injury and the degree of bone and/or soft-tissue injury. Compression of the spinal cord, which is associated with decreased nerve function, could be observed with MR imaging. These results demonstrate the usefulness of MR imaging in evaluating spinal cord injuries. It is particularly useful in detecting soft-tissue injuries that are indicative of the severity of spinal cord damage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Magnetic resonance imaging, Spinal cord, Spinal cord injuries, Spinal cord compression

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