TorontoGiFellow

In rectal LST (>20 mm insize) with at least a 10 mm nodular component, the overall risk of SMI malignancy is 12%.  Patients with LST (Mixed or NG) (IIa + Is or Is) with nodule atleast 10 mm in size should be conisdered for upfront ESD than EMR 33% of cancers resected by ESD can be potentially curative (the others harboring high-risk histological features, or >1000 micron invasion) Number of ESD needed for 1 curative cancer resection = 12

  Source: https://www.youtube.com/watch?v=6c4qiecpYPg

  CEA Levels:   CEA >192 is 60% sensitive and 90% specific for mucinous cysts (ipmn/mcn) This was based on a study of 70 lesions in 2004 and has stuck till date   CEA < 5 has excellent negative predictive value for mucinous cysts   CEA > 5, therefore can still be a mucinous neoplasm and needs to be taken in context. Other markers such as Ca 72-4, CA 19-9, CA 15-3, CA 125 have lower accuracy than CEA   Amylase levels: ·        Amylase < 250 IU/L is highly unlikely to be connected to PD (eg  SCA) ·        MCN usually have very low / low amylase (one study suggested it has similar amylase to ipmn)   Glucose: ·        Glucose is very low in mucinous tumors & pseudocysts (those with communication to PD)– usually less than 2.8 mmol/l     Glucose < 2.8 mmol/l has Sens/Spec of 90/90 ( more accurate)  compared to CEA >192 (sens/spec 60/90) for identification of mucinous cysts

 MCN - (Mother cyst) >95% in pre-menopausal women Mostly in body and tail of pancreas Thick-walled cyst, lined by Ovarian type stroma. Cyst contains mucinous / hemorrhagic material. Does not communicate with PD (unlike IPMN) 10-20% have in-dwelling cancer One review found - no dysplasia in cysts <3 cm in size LN mets is rare. Distal pancreatectomy usually suffices.  Doesnt result in metachronous lesions. Surveillance isnt really necessary SCA - (Grandmother cyst) 75% of SCAs seen in post-menopausal women Can be anywhere in pancreas Honeycombing, with tiny cysts containing clear fluid distributed around central scarring. Central scarring may bear calcification in 30% cases Microcystic SCAs can undergo degeneration and become macrocystic variants zero risk of malignancy, but they can continue to grow and cause obstructive symptoms SPN - (daughter lesion) - Solid Pseudopapillary Neoplasm 90% of lesion occur in young women, in teens / twenties Anywhere  in pancreas Solid / Solid-cys

Source: DDW 2023

 

  Indication for TIPS 1) Pre-emptive Rx for variceal bleeding 2) Treatment of transfusion dependent PHG despite endotherapy / betablockers 3) Ascites requiring >3 LVP a year

  NZGG Family History categories 12   Category 1  - individuals with a slight increase in risk of colorectal cancer (CRC) ·          One first -degree relative diagnosed at age 55 years or over Category 2  - individuals with a moderate increase in risk of CRC Who have one of more of the following: ·          One first-degree relative diagnosed at age 54 years or under ·          OR ·          Two first-degree relatives on the same side of the family diagnosed at any age Category 3  - individuals with a potentially high risk of CRC Who have one or more of the following: ·          FAP, Lynch, other cancer syndrome ·          Three relatives with cancer: One first-degree relative plus two or more first- or second-degree relatives all on the same side of the family with a diagnosis of CRC at any age ·          Two first-degree relatives, or one first-degree relative plus one or more second degree relatives, all on the same side of the family with a diagnosis of