I get this question a good deal. I think it’s probably somewhat confusing as to what we do and we offer a lot of procedures and products. Basically we are a two surgeon medical group offering services in Veins, Acupuncture, Plastic Surgery, and General Surgery. That can be quite a lot. But even with that said, it’s somewhat confusing as to what each of these items involves. So I thought I’d make a list which doesn’t include everything, but covers most of what we do:
These are just educational notes on stage 4 colon cancer – no personalized medical advice is given here. In my Modesto surgical experience, I have had the privilege of participating in the care of several patients with stage 4 colon cancer. Some of these surgical patients have also become my acupuncture patients.
Colon Cancer Stages with TNM designation
Stage IV Colon Cancer
Cancer spread from the colon to other organs and tissues, ie. liver, lungs, peritoneum (in the abdomen surrounding), or ovaries.
Considered the most advanced cancer stage
Stage IV A: spread to one organ not near the colon, such as the liver, lung, ovary, or to a distant lymph node.
Stage IV B: spread to more than one organ not near the colon or into the lining of the abdominal wall (peritoneum)
Any T, Any N, M1a: The cancer may or may not have grown through the wall of the colon or rectum, and it may or may not have spread to nearby lymph nodes. It has spread to 1 distant organ (such as the liver or lung) or set of lymph nodes (M1a).
Any T, Any N, M1b: The cancer may or may not have grown through the wall of the colon or rectum, and it may or may not have spread to nearby lymph nodes. It has spread to more than 1 distant organ (such as the liver or lung) or set of lymph nodes, or it has spread to distant parts of the peritoneum (the lining of the abdominal cavity) (M1b).
T categories of colorectal cancer describe the extent of spread through the layers that form the wall of the colon and rectum.
N categories indicate whether or not the cancer has spread to nearby lymph nodes
M0: No distant spread is seen.
M1a: The cancer has spread to 1 distant organ or set of distant lymph nodes.
M1b: The cancer has spread to more than 1 distant organ or set of distant lymph nodes, or it has spread to distant parts of the peritoneum (the lining of the abdominal cavity).
Reviewing my Personal Experience with Stage IV colon cancer
I’ve operated on several patients with Stave IV colon cancer
I’ve also done wedge resections on the liver for areas of cancer spread (metastases)
In some patients I’ve made diverting colostomies.
Some patients I’ve had receive chemotherapy before surgery to shrink down the size of the tumor load. The is called Neoadjuvant therapy.
Most of the patients after surgery with Stage 4 colon cancer have received chemo therapy after surgery – and the chemotherapy is decided up and performed by the oncologist.
Some get radiation afterwards to relieve symptoms
There are clinical trials
Re-operations are done for recurrences.
Web sources of info regarding the stages of Colon Cancer
1 hour Lecture by Grace Nadolny, MD on 4/20/13 in Modesto, CA, CME provided by Sutter Gould Medical Foundation as part of it’s Subspecialty Lecture Series. 4 hours total of CME was provided. Part of the 4 hours of CME included discussion about back pain and ovarian cancer.
Why this is interesting to me
I have learned some of this before in my NeuroScience years at Brown University. It was good to review.
I have an acupuncture practice which has a good number of patients with depression.
Learning points (not all points were made in the lecture, but they were learning points for me):
Evidence Based medicine supported treatment of depression
includes the use of methylphenidate, exercise, and sertraline
NE and DA reuptake inhibitor. (Norepinephrine adn Dopamine)
Used for ADHD, Narcolepsy, and Depression
Also known as Zoloft, Lustral
SSRI – selective serotonin reuptake inhibitor
Population affected: 20%
Depression is a state of chronic stress
Anatomically there is decreased amount of gray matter in the brain. Decreased size of Cortex and Hippocampus has been found.
The hippocampus is involved in several functions of the body including:
Consolidation of New Memories
Current concepts of depression
glutamatergic theory of depression: exposition to stressful stimuli increases hippocampal glutamatergic neurotransmission and triggers excitotoxic changes.
Another theory: depression is closly correlated with neuronal atrophy due to a decrease in BDNF (Brain Derived Neurotrophic Factor)
Monoamine hypothesis is considered old school: deficiency in monoaminergic neurotransmission. Monoamines being Catecholamines (NE, DA) and Indolamines (5-HT).
Results of Star*D Trials
Sequenced Treatment Alternatives to Relieve Depression
Officed based – what is done after a patient fails first line treatment for depression?
Level 1 through Level 3 choices in medication to switch to.
After the lecture: What about Acupuncture for Depression?
I asked Dr. Nadolny about what she thought of acupuncture for depression. And she seemed very excited. She said that she didn’t know that acupuncture was readily available in Modesto, CA. I do hope to recommend some of my patients to Dr. Grace Nadolny in the future and other psychiatrists too, because I feel that at times combination treatment with acupuncture and excellent psychiatric care would be of greatest benefit.
Disclaimer: I am not an expert on the topic of Depression. These are notes from a lecture that I took and feel free to use this as a springboard for your own studies.