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Intestinal Adenocarcinoma (view source)

Revision as of 18:07, 10 August 2010

153 bytes added ,  18:07, 10 August 2010
→‎Treatment
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==Treatment==
 
==Treatment==
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===Surgery===
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Surgical excision is advised as primary treatment for intestinal [[Adenocarcinoma|adenocarcinoma]]. Extraserosal invasion or adhesions may cause difficulties and care must be taken to ensure there is no iatrogenic damage to the biliary and pancreatic ducts for duodenal lesions. In the small intestine, wide local resection (4-8cm margins) can usually be achieved via enterectomy and anastomosis. Stapling and suturing by hand have been shown to be equally efficient for this procedure. If appropriate, regional lymph nodes should also be removed. Large margins may be more difficult to achieve for colorectal lesions due to access issues. Perioperative complications include peritonitis and sepsis.
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===Adjuvant Chemotherapy===
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Surgical resection and anastomosis is the treatment of choice for both small and large intestinal adenocarcinoma. For small intestinal lesions, a margin of 4-8cm  is resected, and anastomosis may be achieved by suturing or stapling with no difference in outcome. Extraserosal invasion or adhesions may cause difficulties during resection and, for duodenal lesions, care must be taken to ensure there is no iatrogenic damage to the biliary or pancreatic ducts. Regional lymph nodes should be removed if there is evidence of metastasis. For colorectal adenocarcinomas, large margins may be more difficult to achieve for colorectal lesions due to restricted access. Transcolonic debulking is a palliative alternative for obstructive large intestinal lesions. For all types of surgery, postoperative complications include peritonitis and sepsis.
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Doxirubicin has been shown to significantly improve survival times for cats with colonic [[Adenocarcinoma|adenocarcinoma]] with median durations of 56 and 280 days for those not receving and those receiving chemotherapy respectively. No other evidence exists to confirm the benefits of adjuvant chemotherapy in dogs or cats. Piroxicam, a non-steroidal anti-inflammatory drug may have beneficial effects for rectal lesions.
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===Radiotherapy===
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Adjunctive chemotherapy in the form of doxirubicin has been shown to significantly improve survival times for cats with colonic adenocarcinoma, with median survival times improved from 56 to 280 days when doxorubicin treatment was used. No other evidence exists to confirm the benefits of adjuvant chemotherapy in dogs or cats. Piroxicam, a non-steroidal anti-inflammatory drug may have palliative effects for large intestinal and rectal lesions.
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Rarely reported due to concerns of intolerance of surrounding tissues leading to for example perforations and adhesions. In addition it cannot be relied upon that the same target will be irradiated each day due to intestinal mobility. There has been a report of single high-dose irradiation being used for anorectal [[Adenocarcinoma|adenocarcinomas]] which had been surgically exposed and no long-term side effects were observed.
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The use of radiotherapy in intestinal adenocarcinoma has not been subject to detailed investigations due to the relative intolerance of the surrounding tissues to radiation. As well as potential to cause intestinal perforations or adhesions, intestinal motility means that there is no certainty the same target will be irradiated each day. In a report of single high-dose irradiation used against a surgically-exposed anorectal tumour, no long-term side effects were observed.
    
==Prognosis==
 
==Prognosis==
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