Arulampalam, Thanjakumar HA; (2003) The role of positron emission tomography in the management of colorectal cancer. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Colorectal cancer (CRC) is the second commonest cancer in the Western World. Successful treatment relies on accurate detection and staging of primary disease as well as the early identification of the presence and extent of recurrence. Morphological imaging techniques, particularly computed tomography, although established and widely available to carry out these tasks, have weaknesses. Positron emission tomography (PET) is a functional imaging technique that is able to detect cancer foci based on the uptake of positron labelled tracer in malignant tissue. PET can be considered both an alternative and complimentary' method of imaging in CRC, which at present is not widely available or established in the UK. The aims of this thesis were; firstly, to study the role of fluorodeoxyglucose (FDG) PET in the diagnosis and staging of both primary and recurrent/metastatic CRC. Secondly, having assessed the benefits and weaknesses of FDG-PET in these applications, to study a novel tracer, fluorothymidine (FLT). Current modalities appear better suited than FDG-PET for diagnosing symptomatic primary CRC. There is evidence of increased accuracy for FDG-PET in staging primary' disease, but the data is equivocal and larger studies are needed. However, FDG-PET imaging for suspected recurrent/metastatic disease is more accurate than conventional techniques and this leads to alteration in patient management. Experience with FLT-PET in CRC was established and tracer dynamics characterised. FLT shows promise, but the nature of the clinical benefits are not clear in this pilot study. The evidence suggests that PET has the potential to become routinely incorporated into patient management algorithms for recurrent/metastatic disease. Technological advances coupled with novel tracer research will facilitate this, making PET a formidable imaging tool for the oncologist, both medical and surgical.

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