44391 - PROFESSOR PANKAJ G. JANI. M.MED., FRCS. DEPT. OF...

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PROFESSOR PANKAJ G. JANI. M.MED., FRCS. DEPT. OF SURGERY, UNIVERSITY OF NAIROBI. KENYATTA NATIONAL HOSPITAL CHAIR. EXAMINATIONS AND CREDENTIALS COMMITTEE COSECSA INT. ONCOLOGY CONF. NAIROBI, OCTOBER 2011
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THEME Translating recent advances into local practice/clinical care
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RECTAL CANCER Progress in MULTIMODAL THERAPY of Rectal Cancer is one of the BEST examples of success of Clinical Research in the last 2 decades.
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RECTAL CARCINOMA – RECENT ADVANCES -- OVERALL 1.SPHINCTER SAVING PROCEDURES – UP FROM 15% TO 50% -- NO COLOSTOMY (IMPROVED QOL) 2. OVERALL FIVE YR SURVIVAL – UP FROM 30% TO 60% 3. DEPTH OF INVASION – DECREASED BY 40%-60% WITH ADJUVANT Rx 4. LYMPH NODE STATUS AND REC. FREE SURVIVAL - SAME
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RECENT ADVANCES 1. MOLECULAR BIOLOGY 2. SURGERY 3. IMAGING – MRI, CT AND PET 4. CHEMO/RADIOTHERAPY
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MOLECULAR BIOLOGY DNA CHIP TECH. – DNA SEQUENCE CHECKED -- APC GENE – FAP -- MISMATCH REPAIR GENES – HNPCC SUCH PTS.(5%) PUT ON A SURVEILLANCE PROG. --PROPHYLACTIC SURGERY
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MOLECULAR BIOLOGY DNA SEQUENCE OF MICROSATELLITE INSTABILITY -- GOOD RESPONSE WITH 5 FU CHEMO. P21 MARKER POSITIVE – RADIOSENSITIVE
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MOLECULAR BIOLOGY P53 PROTEIN MUTANT EXPRESSED -- RADIORESISTANT KRAS, DCC, AND P53 -- IF +ve – POOR PROGNOSIS MICROSATELLITE INSTABILITY OR LOW Cox2 EXPRESSION & P21 MARKER – IF +ve – GOOD PROGNOSIS
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SURGICAL CHALLANGES I - STAGING II- USE OF CH/RT III - SURGICAL TECHNIQUE
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- STAGING DECIDES –TRANS ANAL LOCAL EXCISION APR . NEOADJUVANT CH/RT
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44391 - PROFESSOR PANKAJ G. JANI. M.MED., FRCS. DEPT. OF...

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