Selective use of [18]F-fluorodeoxyglucose-positron emission tomography and computed tomography in the management of metastatic disease from colorectal cancer. Results from a regional centre

Computed tomography [CT] scans are routinely used for primary staging and disease surveillance in patients with colorectal cancer. However, these scans have limited sensitivity in some organs and can only detect lesions with morphological changes, whereas [18]F-fluorodeoxyglucose-positron emission tomography [[18]F-FDG-PET] scans are able to detect areas of metabolic change before morphological changes appear. The aim of this study was to evaluate the impact of 18F-FDG-PET/CT scans over conventional imaging during preoperative work-ups or follow-ups in a selected group of patients. This retrospective cohort study, which took place between July 2009 and May 2011, assessed 1,043 patient records from the South East Scotland Cancer Network colorectal cancer database. A total of 102 patients who underwent [18]F-FDG-PET/CT scans in addition to conventional imaging were included in the study. These patients had potentially resectable metastases, equivocal findings on CT scans and elevated carcinoembryonic antigen levels with negative conventional imaging. Of the 102 patients included in the study, 22 underwent a preoperative [18]F-FDG-PET/CT scan and 80 underwent a follow-up [18]F-FDG-PET/CT scan. In the preoperative scan group, the [18]F-FDG-PET/CT scan had a major impact on 16 patients [72.75%] and no impact on six patients [27.25%]. In the follow-up scan group, the [18]F-FDG-PET/CT scan had a major impact on 51 [63.75%], a minor impact on four [5%], no impact on 22 [27.5%] and a negative impact on three [3.75%] patients. The results of this study demonstrated that [18]F-FDGPET/CT scans have a considerable effect on disease management when undertaken among indicated colorectal cancer patients

Support expectations of cancer patients

Patients' satisfaction is a paramount in the delivery of health care provisions, particularly in patients with poor prognosis. Effective communication with such patients helps in achieving a better satisfaction score. A survey was conducted on upper gastrointestinal cancer patients to assess their perceived satisfaction regarding the healthcare received. A frank but supportive communication helps in meeting the expectations of these patients in their cancer journey

Chronic umbilical discharge. An unusual presentation of endometriosis

Umbilical endometriosis is an important differential diagnosis of any umbilical lesion. A 35-yearold type 2 diabetic woman presented with intermittent umbilical discharge which failed to respond to various antibiotics. An ultrasound scan and MRI scan failed to show any obvious abnormality. The umbilicus was excised and histology confirmed endometriosis. Surgical excision provides a definitive diagnosis and curative treatment for isolated endometriosis

Managing gastric linitis plastica: keep the scalpel sheathed

Gastric linitis plastic is a diffuse type of cancer which is characterised by a thickening and rigidity of the stomach wall. It is notorious for its failure to cause early symptoms, and patients with symptoms generally have a more advanced form of the disease. We report our 18-month-long experience of managing gastric linitis plastica at Barnsley District General Hospital, UK. In our series of 8 patients, only one patient was offered surgery; the rest were offered palliative or supportive treatment. The findings in our series were consistent with the available evidence that curative treatment is not an option for the majority of cases with linitis plastica