Hospital Stories and Others: General Surgery Conference wk 1

Mucins are a family of large, heavily glycosylated proteins. Although some mucins are membrane-bound due to the presence of a hydrophobic membrane-spanning domain that favors retention in the plasma membrane, the concentration here is on those mucins that are secreted on mucosal surfaces and saliva.

The dense "sugar coating" of mucins gives them considerable water-holding capacity and also makes them resistant to proteolysis, which may be important in maintaining mucosal barriers.

Increased mucin production occurs in Adenocarcinoma, a type of lung cancer, and in lung diseases such as asthma, bronchitis, COPD or cystic fibrosis.

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TNM Staging

In the TNM system, TNM stands for Tumor, Nodes, and Metastases. Each of these is categorized separately and classified with a number to give the total stage. Thus a T1N1M0 cancer means the patient has a T1 tumor, N1 lymph node involvement, and no distant metastases. Of course the definitions of T, N and M are specific to each cancer, but it is possible to give a general idea of what they mean.

T: Tumor

T Classifies the extent of the primary tumor, and is normally given as T0 through T4. T0 represents a tumor that has not even started to invade the local tissues. This is called "In Situ". T4 on the other hand represents a large primary tumor that has probably invaded other organs by direct extension, and which is usually inoperable.

N: Lymph Nodes

N classifies the amount of regional lymph node involvement. It is important to understand that only the lymph nodes draining the area of the primary tumor are considered in this classification. Involvement of distant lymph nodes is considered to be metastatic disease. The definition of just which lymph nodes are regional depends on the type of cancer. N0 means no lymph node involvement while N4 means extensive involvement. In general more extensive involvement means some combination of more nodes involved, greater enlargement of the involved nodes, and more distant (But still regional) node involvement.

M: Metastasis

M is either M0 if there are no metastases or M1 if there are metastases.

As with the other system, the exact definitions for T and N are different for each different kind of cancer.

As you can see, the TNM system is more precise than the I through IV system and certainly has a lot more categories. The two systems are actually related. The I through IV groupings are actually defined using the TNM system. For example, stage II non-small cell lung cancer means a T1 or T2 primary tumor with N1 lymph node involvement, and no metastases (M0).

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Virtual colonoscopy (VC) is a Medical imaging procedure which uses x-rays and computers to produce two- and three-dimensional images of the colon (large intestine) from the lowest part, the rectum, all the way to the lower end of the small intestine and display them on a screen. The procedure is used to diagnose colon and bowel disease, including polyps, diverticulosis and cancer. VC can be performed with computed tomography (CT), sometimes called a CAT scan, or with magnetic resonance imaging (MRI).

Advantages

VC is more comfortable than conventional colonoscopy for some people because it does not use a colonoscope. As a result, no sedation is needed, and the patient can return to his/her usual activities or go home after the procedure without the aid of another person. VC provides clearer, more detailed images than a conventional x-ray using a barium enema, sometimes called a lower gastrointestinal (GI) series. It also takes less time than either a conventional colonoscopy or a lower GI series.

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Disadvantages

The radiologist cannot take tissue samples (biopsy) or remove polyps during VC, so a conventional colonoscopy must be performed if abnormalities are found. Also, VC does not show as much detail as a conventional colonoscopy, so polyps smaller than 2 millimeters in diameter may not show up on the images. Furthermore Virtual Colonoscopy performed with CT exposes the patient to ionizing radiation, however some research has demonstrated that ultra-low dose VC can be just as effective in demonstrating colon and bowel disease due to the great difference in x-ray absorption between air and the tissue comprising the inner wall of the colon.

virtual colonoscopy or barium enema, if abnormalities are found then colonoscopy has to be performed again.

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Stool guaiac test

The stool guiac test is a test that detects the presence of hidden (occult) blood in the stool (bowel movement). The stool guaiac is the most common form of fecal occult blood test (FOBT) in use today

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