RESUMO
Starting from a typical case, we try to highlight the main critical elements, both in the diagnostic algorithm and in the therapeutic one. We hereby present a 54-year old patient, known with hepatic steatosis and renal microlithiasis, which undergoes an ultrasonography in ambulatory, on the background of unsystematised abdominal discomfort; the ultrasound reveals the presence of a tumoral mass in the right iliac fossa.
Assuntos
Adenocarcinoma Mucinoso/cirurgia , Apendicectomia/métodos , Neoplasias do Apêndice/cirurgia , Apêndice/cirurgia , Doenças do Ceco/cirurgia , Mucocele/cirurgia , Dor Abdominal/etiologia , Adenocarcinoma Mucinoso/diagnóstico por imagem , Adenocarcinoma Mucinoso/patologia , Algoritmos , Neoplasias do Apêndice/complicações , Neoplasias do Apêndice/diagnóstico por imagem , Apêndice/diagnóstico por imagem , Apêndice/patologia , Doenças do Ceco/diagnóstico por imagem , Doenças do Ceco/patologia , Fígado Gorduroso/complicações , Humanos , Cálculos Renais/complicações , Laparoscopia , Pessoa de Meia-Idade , Mucocele/diagnóstico por imagem , Mucocele/patologia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
This clinical trial studies local invasions from primary colonic and rectal cancers (urinary bladder, abdominal wall, small bowls, uterus, vagina, stomach, bile tract, spleen, duodenum, pancreas, ureters, kidneys), with or without undiscovered metastasis. Primary locally aggressive colonic and rectal cancers include tumors that are staged T4N1-2Mx on diagnosis, and are often associated with a lower prognosis than earlier cancers. Diagnosis is based on thorough clinical evaluation, imagistic support: abdominal XR with contrast (barium enema), colonoscopy, abdominal and pelvic ultrasound exam, endoscopic endolumenal ultrasound exam, abdominal and pelvic CT/IRM with contrast (administrated both orally and intravenously), PET Scan, and intra-operatory confirmation. The primary symptom was pain. Locally aggressive colonic and rectal cancers, primary or secondary, can extend to any visceral or parietal structure. The ability to perform a total resection is based upon anatomical localization and on the fixation of other organs to the lesion. Identifying the anatomical extension provides a better appreciation of the purpose of the tumoral resection. Radical nuanced surgery is the base of treatment of the locally aggressive colon-rectal cancer. The studies have shown that in certain localizations of the colon-rectal cancer, the locally aggressive forms can be better controlled by using multimodal therapy, including radiotherapy, either external or guided intraoperatory radiotherapy and chemotherapy with much better results.