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What is the diagnostic accuracy of laparoscopic staging following a CT scan for assessing whether pancreatic and periampullary cancer is resectable?

Pancreas is an organ situated in the abdomen close to the junction of the stomach and small bowel. It secretes digestive juices which are necessary for the digestion of all food materials. The digestive juices secreted in the pancreas drain into the upper part of the small bowel via the pancreatic duct. The bile duct is a tube which drains bile from the liver and gallbladder. The pancreatic and bile ducts share a common path just before they drain into the small bowel. This area is called the periampullary region. Surgical removal is the only potentially curative treatment for cancers arising from the pancreatic and periampullary regions. A considerable proportion of patients undergo unnecessary major open abdominal exploratory operation (laparotomy) because their CT scan has underestimated the spread of cancer. If the cancer is spread within the abdomen during the major open operation, patients are referred for alternate treatments such as chemotherapy which do not cure the cancer but may improve survival. Thus the major open abdominal operation can be avoided if the spread of cancer within the abdomen is known prior to the major operation. This is called 'staging' the cancer. Usually the minimum test used for staging is the CT scan. However, CT scan can understage the cancer, i.e. it can underestimate the spread of cancer. Laparoscopy, a procedure whereby a small telescope is inserted inside the abdomen through a small (keyhole) surgical incision can detect spread not identified on CT scanning. Different studies report different accuracy of laparoscopy in assessing whether the cancer can be removed. In this study, we have identified all such studies and using the appropriate mathematical methods, we have identified the average diagnostic accuracy of laparoscopy for staging pancreatic and periampullary cancers considered to be removable after a CT scan.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

What happens during a PET scan?

Positron emission tomography (PET) is an examination that creates several cross-sectional images of the body or of a particular part of the body. The special thing about PET: It shows how active the metabolism in certain tissues is.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 16, 2013

Understanding tests used to detect bone problems

Just like other tissues and organs in our body, bones can be affected by medical conditions too. These include things like fractures, signs of wear and tear, inflammations and cancer. Injuries and fractures are common in younger people. As we grow older, diseases like osteoporosis and osteoarthritis are more likely to develop. Various tests and examinations can be used to find out what is causing problems like pain or difficulties moving.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 7, 2013

PET‐CT scanning to assess the spread of non‐small cell lung cancer within the chest

In the absence of distant metastasis, treatment options for non‐small cell lung cancer depend on how much the disease has spread to the different lymph nodes within the chest, that is, the stage of the disease. If the cancer has not spread beyond the nearest (N1) lymph nodes, surgery is often the treatment of choice. Other treatment options for these patients include treatment with either radiotherapy, chemotherapy, or both. Planning the optimal treatment is therefore critically dependent on accurate staging of the disease. PET‐CT scanning is a non‐invasive method of establishing the spread of NSCLC within the chest and elsewhere in the body, which is increasingly available and used by lung cancer multi‐disciplinary teams. Although the non‐invasive nature of PET‐CT constitutes one of the major advantages of the test, PET‐CT may be suboptimal in detecting malignancy in normal‐sized lymph nodes and in ruling out malignancy in patients with coexisting inflammatory or infectious diseases. We examined the accuracy of PET‐CT scanning in establishing the spread of cancer in patients with suspected or confirmed NSCLC that is potentially suitable for surgical treatment with curative intent.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Ankle fractures: Overview

If you are unlucky, twisting your ankle very badly can break your upper ankle too. This is a more serious injury that may affect one or several bones. Is surgery always needed? And what kinds of rehabilitation can best improve recovery?

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 23, 2014

Breast cancer: Overview

Being diagnosed with breast cancer often makes people feel very frightened and anxious. It is helpful to know that if you get breast cancer for the first time and it has not spread far, there’s a good chance that treatment will lead to a full recovery nowadays. Also, there are many options for support in daily life, for the return to work or for coping with the emotional and psychological aspects of the disease.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 6, 2013

Bowel cancer: Does positron emission tomography improve treatment for recurrent bowel tumors?

If there is good reason to believe that someone has recurrent bowel cancer, positron emission tomography (PET) or a combination of PET and computed tomography (PET/CT) can be used to detect new tumor growth better than conventional methods. But it remains unclear whether it improves treatment and noticeably benefits those affected.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 8, 2013

Alzheimer's disease: Overview

Alzheimer's disease is the most common cause of dementia. People who have dementia become forgetful and find it increasingly difficult to express themselves in words. Some, mainly older, people have a combined form of Alzheimer’s and vascular dementia. Vascular dementia is caused by blood flow problems in the brain.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 18, 2013

External radiotherapy

Radiotherapy, also called radiation therapy, aims to destroy cancer tissue by exposing it to high-energy rays. In external radiotherapy because the radiation is beamed from a source outside of the body through the skin into the body and right through to the tumor tissue.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 7, 2012

Low back pain: Overview

Most people will end up experiencing low back pain at some point in their lives. It usually starts without warning and then goes away again after a few days or weeks. It is only rarely caused by a serious health problem. Exercise can be effective at preventing low back pain.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 1, 2012

Bowel cancer: Overview

People sometimes think that bowel cancer typically affects only men, but that is not true. Men are more likely to develop bowel cancer, and may get it at an earlier age, but women are also affected by the disease. Our information covers bowel cancer risks and causes, as well as screening and living with the disease.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 3, 2014

Bisphosphonate therapy for children and adolescents with secondary osteoporosis.

‐ may not lead to any difference in bone mineral density (bone thickness and strength).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Cardiopulmonary Syndromes (PDQ®): Patient Version

Expert-reviewed information summary about common conditions that produce chest symptoms. The cardiopulmonary syndromes addressed in this summary are cancer-related dyspnea, malignant pleural effusion, pericardial effusion, and superior vena cava syndrome.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: February 13, 2015

Unusual Cancers of Childhood Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of unusual cancers of childhood such as cancers of the head and neck, chest, abdomen, reproductive system, skin, and others.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 10, 2015

Small Cell Lung Cancer Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of small cell lung cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 12, 2015

Gastrointestinal Stromal Tumors Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of Gastrointestinal Stromal Tumors.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 2, 2015

Osteosarcoma and Malignant Fibrous Histiocytoma of Bone Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of osteosarcoma/malignant fibrous histiocytoma of bone.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 22, 2015

Malignant Mesothelioma Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of malignant mesothelioma

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 2, 2015

Langerhans Cell Histiocytosis Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of childhood Langerhans Cell Histiocytosis.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: March 5, 2015

Gallbladder Cancer Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of gallbladder cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 23, 2014

Systematic Reviews in PubMed

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