| Welcome |
|
Thank you for your interest in our practice. We can offer you the most technologically advanced endoscopic procedures in the Inland Northwest. Our focus is on endoscopic oncology and invasive mediastinal staging of lung cancer with endoscopic ultrasound. We also perform routine endoscopies and colon cancer screening.
We work closely with your primary care or specialty care provider. Once our diagnostic or therapeutic procedures have been completed we will communicate with the referring physician who will resume your overall care.
Colon Cancer Screening
We proudly support Newstalk 590's efforts to promote colon cancer screening. Listen to our own radio ad here.
Most insurance carriers pay for screening colonoscopies. You do not even need a referral. Call as directly (509-455-3453) or send us an email (klaus.gottlieb@providence.org) and we will schedule you at a location of your choice for a test which very well may save your life.
To learn more about colonoscopy and colon cancer screening follow this link to a patient information site sponsored by the American Society for Gastrointestinal Endoscopy.
| EUS case of the week |
|
The Prostate
The zonal anotomy of the prostate according to John E. McNeal (1981) |
A different rendering of the McNeal prostate zones |
A normal appearing prostate imaged with the radial echoendoscope at 7.5 MHz |
The Prostate:
Gastroenterologists or Colorectal Surgeons performing endorectal or transrectal ultrasound need to have a degree of familiarity with the zonal anatomy of the prostate and the likely appearance of prostate cancers on rectal ultrasound even if they cannot be expected to be experts in TRUP (trans-rectal ultrasound of the prostate).
McNeal’s zonal model of the prostate is widely accepted:
The peripheral zone : forms the postero-inferior aspect of the gland and represents 70% of the prostatic volume. It is the zone where the majority (60-70%) of prostate cancers are found
The central zone : represents 25% of the prostate volume and contains the ejaculatory ducts. Inflammatory processes (eg prostatitis) are usually found here.
The transitional zone : represents 5% of the total prostatic volume. Benign prostatic hypertrophy occurs in this location in two lateral lobes together with periurethral glands. Approximately 25% of prostatic adenocarcinomas also occur in the transitional zone
The Anterior Zone : Predominantly Fibromuscular With No Glandular Structures.
Most cancers of the prostate are either isoechoic or hypoechoic to the surrounding parenchyma in the outer portion of the gland. Those which are more hypoechoic or more easily visualized tend to have a higher Gleason grade (Halpern, Ethan J., Dennis L. Cochlin, and Barry B. Goldberg. Imaging of the Prostate. London: Martin Dunitz, 2002.)
Prostate cancer is frequently invisible on gray-scale ultrasound and this is the rationale for sextant biopsies when prostate cancer is suspected for other reasons. However, in this author's opinion, the non-urologist doing transrectal ultrasound should be concerned when a hypoechoic are in the peripheral zone is seen and refer the patient appropriately.
See More»
|
