0:01

For the next case, I'm showing you one more colon cancer.

0:04

In this case, we, it is in the sigmoid colon,

0:07

so I'll show it to you with a primary three D view.

0:10

First. Oftentimes a colon cancer, uh,

0:13

an obstructing mass won't show up too well on a three D fly

0:16

through because basically the lumin is so narrowed

0:19

that you're not seeing much on the endoluminal view.

0:22

But whenever there's an area of endoluminal narrowing,

0:25

you wanna look back at your two D views

0:27

to really appreciate the portion

0:28

of the colon that you're not seeing.

0:30

The part that's outside of the, the narrowed lumen.

0:33

And here you can see there's soft tissue annular, um,

0:35

thickening of the sigmoid colon.

0:40

And in this particular case,

0:41

you can see there's a lot more fullness here than just in

0:44

the wall of the colon itself.

0:47

Just upstream from that, uh, annular constricting mass,

0:51

you can see that there's another polyp right here.

0:54

And on the three D view, you can see it's, um,

0:56

measuring more than a centimeter in size.

0:58

And this is the, uh, other side of the, um, of the lumen,

1:02

the side that the endoscope may not have gotten

1:05

through to seeing.

1:07

Looking at the primary mass itself, it's um, not something

1:11

that we're traditionally trained to do,

1:13

but you can t stage a cancer by looking at

1:17

how deep does the, um, the mass invade through the wall

1:21

and beyond the wall of the colon.

1:23

In this particular case, you can see that

1:25

on the sagittal planes, uh, much

1:28

of the mass looks like it extends beyond the outer contour

1:31

of the colonic wall, which would make it at least AAT three,

1:36

uh, if it's extending into the adjacent fat.

1:39

In this case, there's,

1:40

there's tumor extension into the presacral space here.

1:43

There's probably adjacent lymph nodes here, uh,

1:46

in the presacral space.

1:48

So this would be, uh, adjacent lymphadenopathy in

1:50

an invasive colon cancer.

1:53

Um, that's at least T three with, uh, positive nodes.

1:58

Uh, in addition to that, I will show you the utility

2:03

of looking at extra colonic findings here.

2:05

So we've got advanced stage colon cancer.

2:08

We've got a polyp just upstream from the colon cancer,

2:14

so the rest of the colon is clear,

2:16

but if you look at the liver in this case,

2:20

there's a little bit of heterogeneity here.

2:22

It may be difficult to appreciate on, uh,

2:25

thin size two D images,

2:26

but again, I'm gonna try to show you the utility of, um,

2:30

reading thicker cuts

2:32

or just generating thicker cuts on packs for, uh, evaluation

2:37

of extra colon findings.

2:39

So when you go to thicker cuts in your narrower your window,

2:42

you can see that there's too much

2:44

heterogeneity in the liver.

2:46

This would be enough automatically to, uh,

2:48

send somebody onto MRI

2:51

or even just CT, just to judge, um,

2:54

whether there are areas of abnormal enhancement

2:57

and somebody with suspected

2:59

Colon cancer metastases to the liver.

3:01

But this, this ends up being, um,

3:04

liver metastasis throughout the liver

3:06

and somebody with an invasive colon cancer.

3:09

So M one disease,

3:11

and again, showing you the difference between,

3:13

uh, thicker cuts.

3:14

See what happens when we're looking back at the cuts again,

3:19

you can see how much noisier it is to read the, uh,

3:22

the liver on these coronal images.