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Surgical oncology M Asif Chaudry Digital Instant
Download
Author(s): M Asif Chaudry, Marc Christopher Winslet
ISBN(s): 9780199237098, 0199237093
Edition: Poc
File Details: PDF, 4.02 MB
Year: 2009
Language: english
OXFORD MEDICAL PUBLICATIONS
Surgical Oncology
Published and forthcoming Oxford Specialist Handbooks
General Oxford Specialist Oxford Specialist Handbooks in

Handbooks Paediatrics
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Ultrasound Techniques Old Age Psychiatry
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Cardiology Radiology
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Cardiac Catheterization and Musculoskeletal Imaging
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Echocardiography Oxford Specialist Handbooks in
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Heart Failure Cardiothoracic Surgery
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Pacemakers and ICDs Oral and Maxillofacial Surgery
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Oxford Specialist Handbooks in Operative Surgery, second edition
Critical Care Otolaryngology and Head and Neck
Advanced Respiratory Critical Care Surgery
Paediatric Surgery
Oxford Specialist Handbooks in Plastic and Reconstructive Surgery
End of Life Care Surgical Oncology
End of Life Care in Cardiology Urological Surgery
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End of Life Care in Nephrology
End of Life Care in Respiratory
Disease
End of Life in the Intensive Care Unit
Oxford Specialist Handbooks in
Neurology
Epilepsy
Parkinson’s Disease and Other
Movement Disorders
Stroke Medicine
Oxford Specialist
Handbooks in Surgery
Surgical
Oncology
Edited by
M. Asif Chaudry
Specialist Registrar in Surgery, London
& Surgical Research Fellow,
Division of Surgery & Interventional Science,
University College London,
London, UK
Marc C. Winslet
Professor of Surgery, Head of Department & Chairman of
Division of Surgery & Interventional Science,
University College London,
London, UK
1
1
Great Clarendon Street, Oxford OX2 6DP
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide in
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With offices in
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Oxford is a registered trade mark of Oxford University Press
in the UK and in certain other countries
Published in the United States
by Oxford University Press Inc., New York
© Oxford University Press, 2009
The moral rights of the author have been asserted
Database right Oxford University Press (maker)
First published 2009
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
without the prior permission in writing of Oxford University Press,
or as expressly permitted by law, or under terms agreed with the appropriate
reprographics rights organization. Enquiries concerning reproduction
outside the scope of the above should be sent to the Rights Department,
Oxford University Press, at the address above
You must not circulate this book in any other binding or cover
and you must impose this same condition on any acquirer
British Library Cataloguing in Publication Data
Data available
Library of Congress Cataloging-in-Publication Data
Chaudry, M. Asif.
Surgical oncology / M. Asif Chaudry, Marc Winslet.
p. ; cm. -- (Oxford specialist handbooks in surgery)
Includes index.
ISBN 978-0-19-923709-8 (alk. paper)
1. Cancer--Surgery--Handbooks, manuals, etc. I. Winslet, M. C. (Marc
C.) II. Title. III. Series: Oxford specialist handbooks in oncology.
[DNLM: 1. Neoplasms--surgery--Handbooks. QZ 39 C496s 2009]
RD651.C43 2009
616.99’4059--dc22
2009008905
Typeset by Cepha Imaging Private Ltd., Bangalore, India
Printed in China
on acid-free paper through
Asia Pacific Offset
ISBN 978–0–19–923709–8
10 9 8 7 6 5 4 3 2 1
Oxford University Press makes no representation, express or implied, that the drug dosages in
this book are correct. Readers must therefore always check the product information and clinical
procedures with the most up to date published product information and data sheets provided by
the manufacturers and the most recent codes of conduct and safety regulations. The authors and
publishers do not accept responsibility or legal liability for any errors in the text or for the misuse
or misapplication of material in this work.
Some of the medication discussed in this book may not be available through normal channels
and only available by special arrangements. Other examples used in research studies and recom-
mended in international guidelines are unlicensed or may be subject to being used outside of their
licensed dosage ranges within the UK. We suggest consulting the BNF and local prescribing guide-
lines/protocols before using unfamiliar medication.
v
Foreword
The editors and authors of this book are to be congratulated on the pro-
duction of an excellent manuscript which will be of immense value both
to specialist registrars in general surgery and to anyone who wants a con-
temporary reference text on their bookshelf.
Over the past decade especially, and in almost every sub-speciality of
surgical oncology, there have been major changes in routine management
as a result of improvement in technology and systemic therapies. Some of
these changes have been dramatic and have taken many of us by surprise.
The changes include staging techniques, neo– and adjuvant therapies and
especially new surgical tools which have had a profound effect on our sur-
gical practice. It is now more difficult then ever to keep abreast of changes
in near-parallel sub-specialities which previously was not difficult.
This book will help to overcome some of these difficulties and will be of
great value for life-long students of surgery. Throughout the book, the results
of major trials which have brought about these changes are discussed and
easy references provided. I have nothing but praise for this book which has
been written by highly motivated members of our profession. The quality
of the writing, its content, and presentation is exceptionally good and
one is left with a sense of admiration for the authors and the reassurance
that the future of surgery in this complex and challenging area is secure.
J Meirion Thomas MS FRCP FRCS

Professor of Surgical Oncology
Royal Marsden Hospital and Imperial College
This page intentionally left blank
vii
Preface
How should surgeons deal with cancer patients? The cornerstone of

effective treatment is a multidisciplinary collaboration between many
specialties in which surgeons are not only concerned about operative
accessibility and technique, but rather have a deep understanding of the
fundamental biology of the malignancy they are dealing with and appre-
ciate the reach of multi-modal treatment.
Higher surgical trainees regularly moving to the variety of general
surgical sub-specialties are required to rapidly assimilate updated clinical
algorithms based on evidence-based guidelines that go beyond the basic
level achieved at the MRCS. This is essential if we are to ensure that the
clinical trajectory of our cancer patients is optimal. Clinical guidelines
issued by national bodies usually run into hundreds of pages of dense
text, as do the many textbooks of surgical oncology that often provide
encyclopaedic reference material and conceptual information, but are
not targeted at immediate practice.
In writing this handbook, our aim has been to provide a summarized
yet reliable compendium of all of those books and resources online that
both our colleagues and ourselves have quickly peered into on so many
occasions: after reading a pathology report or CT scan in the outpatient’s
clinic; before presenting a case at a multidisciplinary team meeting at a
regional cancer centre; or perhaps, before asking our seniors or colleagues
for advice about surveillance for a complex case and before proceeding to
the operating theatre. It is also the book that many were in search of when
preparing for exams that contained the breadth of surgical oncology that
had to be studied from an array of sub-specialty sources. It is an essen-
tial practical handbook that draws together all the varied guidelines and
source materials that form the basis of this complex subject.
MAC
MCW
ix
Acknowledgements
We acknowledge all those who have helped in producing this book at

OUP namely Susan Crowhurst and Suzy Armitage.
We gratefully acknowledge that many figures in this book have been
reproduced from Operative Surgery, second edition, (2006) edited by
Greg R. McLatchie and David J. Leaper (Oxford: Oxford University Press).
We are deeply thankful to and acknowledge the assistance of Dr Dhiren
Shah, St Thomas’s Hospital, London, who provided the radiological images
used in this book.
We thank Christopher Liao for his invaluable input throughout.
We also thank Mr Don Menzies, ICENI Centre, Colchester, UK, for the
laparoscopic images used—and Tino Solomon, ICENI Centre, Colchester,
UK, for his assistance in the compilation of this book.
We gratefully acknowledge Mr Daren Francis, Chase Farm Hospital,
Enfield, for his suggestions in the anal and colorectal chapters.
xi
Contents
Symbols and abbreviations xiii

Contributors xxiii
Detailed contents xxv
1 Cancer radiology 1
2 Breast cancer 79
3 Thyroid and parathyroid tumours 175
4 Oesophageal cancer 221
5 Gastric cancer 281
6 Liver and biliary cancers 313
7 Cancers of the pancreas 359
8 Small bowel and rare GI cancers 415
9 Colorectal cancer 439
10 Anal cancer 525
11 Renal cancer 535
12 Bladder and upper urinary tract cancer 555
13 Prostate carcinoma 579
14 Testicular cancer 603
15 Soft tissue sarcoma 619
Index 659
Additional references including comprehensive trial references

can be found online at www.oup.com/uk/isbn/9780199237098
xiii
Abbreviations
18 18
FDG fluorodeoxyglucose
5-FU 5-fluorouracil
5-HT 5-hydroxytryptamine
5-HTP 5-hydroxytryptophan
4 male
5 female
d decreased
i increased
ii increased considerably
> more than
< less than
>> much more than
AAT alpha-1-antitrypsin
ABC–OAS adjuvant breast cancer–ovarian ablation or suppression
(trial)
AC adriamycin, cyclophosphamide
ACC adrenocortical carcinoma
ACS American Cancer Society
ACTH adrenocorticotrophic hormone
ADCC antibody-dependent cellular cytotoxicity
ADH anti-diuretic hormone
ADT androgen deprivation therapy
AFP alpha-1 foetoprotein
AGP alpha-1-glycoprotein
AI aromatase inhibitors
AIN anal intra-epithelial neoplasia
AIDS autoimmune deficiency syndrome
AJCC American Joint Committee on Cancer
ALA aminolaevulinic acid
AML acute myeloid leukaemia
ANC axillary nodal clearance
APC adenomatous polyposis coli
APR abdominoperineal resection
APTT activated partial thromboplastin time
APUD amine precursor uptake and decarboxylation
ASCO American Society of Clinical Oncology
ATAC anastrozole or tamoxifen alone or in combination (trial)
xiv ABBREVIATIONS
ATLAS adjuvant tamoxifen longer against shorter

ATTOM aTTom: adjuvant tamoxifen-to offer more?
AXR abdominal X-ray
B biopsy
BCC basal cell carcinoma
BCG bacillus Calmette–Guerin
BCS breast conserving surgery
BEP bleomycin-etoposide-cisplatin
BILCAP biliary tract cancer capecitabine RCT
BMI Body Mass Index
BRCA breast cancer gene
BRCA-1 breast cancer gene 1
BRCAPRO breast cancer pro statistical model and software
BV bevacizumab
bx biopsy
C cytology
CA 19-9: carbohydrate antigen 19-9
Ca cancer, carcinoma
CBD common bile duct
CC cranial-caudal
CCA cholangiocarcinoma
CDDP cisplatin
CEA carcinoembryonic antigen
CFTR cystic fibrosis transmembrane conductance regulator
CHOP cyclophosphamide, hydroxydaunorubicin, vincristine,
prednisolone
CHRPE congenital hypertrophic retinal pigmentation
CHT chemotherapy
CHT/RT chemoradiotherapy
CIS carcinoma in situ
CLOCC chemotherapy and local ablation vs. chemotherapy
CMF cyclophosphamide-methotrexate-5-fluorouracil
CNBCS Canadian National Breast Cancer Screening Study
CNS central nervous system
CORE continuing outcomes relevant to evista
CPA cyproterone acetate
CR complete response rate or complete remission
CRC colorectal cancer
CRP C reactive protein
CSF colony-stimulating factor
CT computed tomography
CTZ cyclophosphamide
ABBREVIATIONS xv
CVA cerebrovascular accident
CX cetuximab
CXR chest radiograph
DCBE double-contrast barium enema
DCC deleted in colorectal cancer
DCF docetaxel, cisplatin and 5-FU
DCIS ductal carcinoma in situ
DDFS distant disease-free survival
DEXA dual energy X-ray absorptiometry
DFS disease-free survival
DFSP dermatofibrosarcoma protuberans
DGE delayed gastric emptying
DHT dihydrotestosterone
DIEA deep inferior epigastric artery
DIEP deep inferior epigastric perforator
DJ duodeno-jejunal
DM diabetes mellitus
DRE digital rectal examination
DTC differentiated thyroid cancer
DVT deep vein thrombosis
DXT radiotherapy
EBCTG Early Breast Cancer Trialists’ Group
EBRT external beam radiotherapy
EBV Epstein–Barr virus
ECF epirubicin, cisplatin, fluorouracil
ECOG Eastern Cooperative Oncology Group
ECX epirubicin, cisplatin, capecitabine
EGFR epidermal growth factor receptor
EMR endoscopic mucosal resection
EOF epirubicin, oxaliplatin, 5-FU
EORTC European Organization for Research and Treatment
of Cancer
EOX epirubicin, oxaliplatin, capecitabine
ER oestrogen receptor
ERCP endoscopic retrograde cholangiopancreatography
ES endoscopic sonography
ESPAC European Study Group for Pancreatic Cancer
ET endotracheal
ETOH ethanol
EUA examination under anaesthetic
EUS endoscopic ultrasound
FA folinic acid
xvi ABBREVIATIONS
FAC fluorouracil, adriamycin, cyclophosphamide (cytoxan)

FACS Follow up after colorectal surgery
FAM 5-FU, doxorubicin, and mitomycin
FAP familial adenomatous polyposis
FBC full blood count
FDG fluorodeoxyglucose
FDR 1st degree relative
FDR fixed dose rate
FFP fresh frozen plasma
FHx family history
FISH fluorescent in situ hybridization
FL-HCC fibrolamellar hepatocellular carcinoma
FNA fine needle aspiration
FNAC fine needle aspiration cytology
FNH focal nodular hyperplasia
FNNAC fine needle non-aspiration cytology
FOB faecal occult bloods
FOLFIRI 5FU + leucovorin + irinotecan
FOLFOX 5-fluorouracil + leucovorin + oxaliplatin
FPC familial polyposis coli
FSH follicle stimulating hormone
FTC follicular thyroid cancer
FUDR floxuridine
G&S group and save
GA general anaesthetic
GAP gluteal artery perforator
GCT germ-cell tumour
GDA gastroduodenal artery
GFR glomerular filtration rate
GI gastrointestinal
GIA gastrointestinal anastomosis
GIST gastrointestinal stromal tumour
GIT gastrointestinal tract
GITSG Gastrointestinal Tumour Study Group
GM granulocyte/macrophage
GnRH gonadotrophin-releasing hormone
GORD gastro-oesophageal reflux disease
GRE gradient echo
GS Gardeners’ syndrome
GSA galactosyl-human serum albumin-diethylenetriamine-
pentaacetic acid
ABBREVIATIONS xvii
h hours
HAI hepatic artery infusion
HAL (hexi)-aminolaevulinic acid
HASTE Half fourier Acquisition Single shot Turbo
spin Echo
HBV hepatitis B virus
HCC hepatocellular carcinoma
HCG human chorionic gonadotropin
HD haemodialysis
HDU high dependency unit
HIAA 5-hydroxyindoleacetic acid
HIF hypoxia inducible factor
HIFU high intensity focused ultrasound
HIP health insurance plan
HIV human immunodeficiency virus
HNPCC hereditary non-polyposis colorectal cancer
HPF high power field
HPV human papillomavirus
HRPC hormone-refractory prostate cancer
HRT hormone replacement therapy
IBD inflammatory bowel disease
ICS intercostal space
IES Inter-Group Exemestane Study
IGCCCG International Germ Cell Cancer Collaborative
Group
IGCNU intratubular germ-cell neoplasia unclassified
IHC immunohistochemistry
IJV internal jugular vein
IM intramuscular
IMA inferior mesenteric artery
IMN internal mammary node
IMPACT immediate preoperative arimidex compared
to tamoxifen
IMRT intensity modulated radiotherapy
IMV inferior mesenteric vein
INR International Normalized Ratio
IPMN intraductal papillary mucinous neoplasm
IPSS International Prognostic Scoring System
ISUP International Society of Urological Pathology
ITA Italian Tamoxifen Anastrozole (study)
ITU intensive care unit
xviii ABBREVIATIONS
IV intravenous
IVAC ifosfamide, mesna, etoposide, and cytarabine
IVC inferior vena cava
IVU intravenous urography
c-KIT CD117
LA left atrial
LA local anaesthetic
LCIS lobular carcinoma in situ
LD latissimus dorsi
LDH lactate dehydrogenase
LFT liver function test
LH luteinizing hormone
LMS leimoyosarcoma
LN lymph node
LOH loss of heterozygosity
LHRH luteinizing hormone-releasing hormone
M metastases
MAGIC Medical Research Council Adjuvant Gastric Infusional
Chemotherapy
MALT mucosa-associated lymphoid tissue
MC&S microscopy, culture & sensitivity
MCN mucinous cystic neoplasm
MDCT multi-detector computed tomography
MDT multidisciplinary team
MEGX monoethylglycinexylidide
MEN multiple endocrine neoplasia
MFH malignant fibrous histiocytomas
MI myocardial infarction
MIBG meta-iodobenzylguanidine131I
MIBI methoxyisobutylisonitrile
min minutes
MLO medio-lateral-oblique
MMC mitomycin C
MMP matrix metalloproteinases
MMR mismatch repair
MMS Mohs micrographic surgery
MORE Multiple Outcomes for Raloxifene Evaluation
(trial)
MPNST malignant peripheral nerve sheath tumours
MRA magnetic resonance arteriography
MRCP magnetic resonance cholangiopancreatography
MRCS member of the Royal College of Surgeons
ABBREVIATIONS xix
MRI magnetic resonance imaging
MRS magnetic resonance spectroscopy
MRSA methicillin-resistant Staphylococcus aureus
MSI microsatellite instability
MTC medullary thyroid carcinoma
MTD malignant teratoma differentiated
MTI malignant teratoma intermediate
MTU malignant teratoma undifferentiated
MVAC methotrexate, vinblastine, adriamycin, and cisplatin
MVD microvessel density
MYH MUTYH: mutY Homolog (gene)
N nodes
NBM nil by mouth
NCCN National Comprehensive Cancer Network
Nd: YAG neodynium: yttrium-aluminium-garnet
NG nasogastric
NGT nasogastric tube
NHL non-Hodgkins lymphoma
NHSBSP National Health Service Breast Screening Programme
NICE National Institute for Health and Clinical Excellence
NO nitric oxide
NPI Nottingham Prognostic Index
NPV negative predictive value
NSGCT non-seminomatous germ cell tumour
OCP oral contraceptive pill
O-G oesophagogastric
OGD oesophagogastro-duodenoscopy
OS overall survival
PanIN pancreatic intra-epithelial neoplasia
PD pancreatico-duodenal
PDS polydioxanone
PDT photodynamic therapy
PE pulmonary embolus
PEB cisplatin, etoposide, and bleomycin
PEG percutaneous endoscopic gastrostomy
PEI percutaneous ethanol injection
PET positron emission tomography
PFS progression-free survival
PG prostaglandin
PgR progesterone receptor
PHex protein-bound hexose
xx ABBREVIATIONS
PICC peripherally inserted central catheters

PJ Peutz–Jeughers
po orally by mouth
PPPD pylorus preserving pancreatico-duodenectomy
PPV positive predictive value
PR progesterone receptor
PRLV percentage remnant liver volume
PSA prostate-specific antigen
PSC primary sclerosing cholangitis
PTC papillary thyroid cancer
PTEN phosphatase and tensin homolog
PTH parathyroid hormone
PUNLMP papillary urothelial neoplasms of low malignant
potential
PV per vaginum
PVE portal vein embolization
qds four times daily
QUART quadrantectomy + ANC + RT
RAS a signal transduction protein
RBA retinol-binding protein
RCC renal cell carcinoma
RCT randomized control trial
RF radiofrequency
RFA radiofrequency ablation
RH rhenium
ROLL radioisotope-guided occult lesion localization
RPLND retroperitoneal lymph node dissection
RR response rate
RT radiotherapy
RTOG Radiation Therapy Oncology Group
RT-PCR reverse transcriptase polymerase chain reaction
Rx treatment
s seconds
SBFT small bowel follow through
SCA senile cardiac amyloidosis
SC subcutaneous
SCC squamous cell carcinoma
SCLN supraclavicular lymph node
SCM sternocleidomastoid
SCPRT short course pre-operative radiotherapy
SCV subclavian vein
ABBREVIATIONS xxi
SDR 2nd degree relative
SERM selective oestrogen receptor blocker
SHARP Sorafenib HCC Assessment Randomized Protocol (trial)
SIEA superficial inferior epigastric artery
SLE systemic lupus erythomatosus
SLN sentinel lymph node
SLNB sentinel lymph node biopsy
SMA superior mesenteric artery
SMV superior mesenteric vein
SNB sentinel node biopsy
SOFEA Study of Faslodex, Exemestane, and Arimidex
SPECT single photon emission computerized tomography
SPIO supermagnetic iron oxide particles
SRS somatostatin receptor scintigraphy
SSFSE single shot fast spin echo
STIR short tau inversion recovery (MRI sequence)
STZ streptozotocin
SVC superior vena cava
T tumour
TAC taxotere, adriamycin, and cyclophosphamide
TAP thoracodorsal artery perforator
TB tuberculosis
TBG thyroxine-binding globulin
TBPA thyroxine-binding pre-albumin
TCC transitional cell carcinoma
tds three times daily
TE echo time
TEAM Tamoxifen Exemestane Adjuvant Multinational Trial
TEM transanal endoscopic microsurgery
TFT thyroid function test
Tg thyroglobulin
TIN testicular intra-epithelial neoplasia
TME total mesenteric excision
TNM tumour, nodes, metastases
TPA tissue polypeptide
TPN total parenteral nutrition
TRAM transverse rectus abdominis myocutaneous
TRH thyrotrophin-releasing hormone
TRUS trans-rectal ultrasound
TS thymidine synthase
xxii ABBREVIATIONS
TSE turbo spin echo

TSH thyroid stimulating hormone
TTP time to tumour progression
TUG transverse upper gracilis (flap)
TURBT treatment of non-invasive bladder cancer
TURP transurethral resection of the prostate
TVUS trans-vaginal ultrasound
U&E urea & electrolytes
UC ulcerative colitis
UICC International Union Against Cancer
UKCCCR UK Coordinating Committee on Cancer Research
ULN upper limit of normal range
US ultrasound
USPIO ultrasmall particle iron oxide
USS ultrasound scan
UW University of Wisconsin solution
VEGF vascular endothelial growth factor
VIP etopside-ifosfamide-cisplatin
VNPI Van Nuys Prognostic Index
WLE wide local excision
WHI Women’s Health Initiative
X Xeloda
YSR 5-year survival rate
ZEBRA Zoladex Early Breast Cancer Research Association
xxiii
Contributors
Irfan Ahmed Mark Emberton

Department of Interventional Institute of Urology,
Radiology, University College London
St Thomas’s Hospital, London and
Cancer Radiology Clinical Director,
Clinical Effectiveness Unit,
Manit Arya The Royal College of Surgeons
The Institute of Urology, of England
University College London Renal Cancer, Bladder Cancer,
Renal Cancer, Bladder Cancer, Prostate Cancer, Testicular Cancer
Prostate Cancer, Testicular Cancer Asma Fikree
Hennah Bashir Department of Gastroenterology
Chelsea & Westminster Hospital, Barnet & Chase Farm Hospital
London London
Palliative Care Topics Small Bowel Cancer
M. Asif Chaudry Said A. Mohamed

Division of Surgery & Interventional Epsom & St Helier University
Science, University College Hospital, Epsom
London Gastric Cancer
Editor and Author Borzoueh Mohammadi
Gemma Conn Department of HPB Surgery,
University Department of Surgery, Royal Free Hospital, London
Royal Free Hospital, London Pancreatic Cancer
Liver and Biliary Cancer Antony Pittathankal
Jason Constantinou Department of Surgery,
Department of Surgery, St Bartholomew’s Hospital, London
Whittington Hospital, London Breast Cancer
Anal Cancer Shahnawaz Rasheed
Harleen Kaur Deol St Mark’s Hospital & Academic
Department of Surgery, Institute, London
The Royal London Hospital, Colorectal Cancer
London
Thyroid Cancer
xxiv CONTRIBUTORS
James R. A. Skipworth Hashim Uddin Ahmed

Department of Upper The Institute of Urology,
Gastrointestinal Cancer, University College London
Division of Surgical & Interventional Renal Cancer, Bladder Cancer,
Sciences, Prostate Cancer, Testicular Cancer
University College London
Oesophageal Cancer Marc C. Winslet
Division of Surgery & Interventional
Simon G. T. Smith Science, University College
Department of Breast and London
Oncoplastic Surgery, Editor
Broomfield Hospital, Chelmsford
Thyroid Cancer, Breast Cancer
Ben Stubbs
Princess Alexandra Hospital,
Harlow
Soft Tissue Sarcoma
xxv
Detailed contents
1 Cancer radiology 1
1. Common imaging modalities 2
Plain film ‘X-rays’ and barium studies 2
Ultrasound 3
Computed tomography 4
Magnetic resonance imaging 5
Positron emission tomography (PET) – CT 6
Radionuclide imaging 8
2. Regional cancer imaging 10
Head and neck cancer 10
Thyroid cancer 14
Breast cancer 18
Oesophageal cancer 22
Gastric cancer 23
Primary tumours of liver and biliary tract 24
Cancers of the pancreas 30
Colon and rectal cancer 32
Carcinoma of the anal region 36
Renal cancer 38
Adrenal malignancy 40
Bladder cancer 44
Prostate cancer 46
Testicular cancer 48
Neuroendocrine tumours 50
Soft tissue sarcomas 54
Skin cancers 56
3. Cancer and interventional radiology 57
Fine needle aspiration cytology and percutaneous biopsy 57
Radiotherapy planning 58
Radionuclide therapy 59
xxvi DETAILED CONTENTS
Central venous access for chemotherapy 60

Vascular embolotherapy 62
Tumour ablation 64
Percutaneous drainage procedures 66
Pain control 70
Feeding techniques 72
Oesophageal stenting 74
Tracheobronchial stenting 76
Malignant central venous obstruction 77
Breast intervention 78
2 Breast cancer 79
Breast cancer epidemiology, aetiology, and risk factors 80
Familial breast cancer and genetics 84
Pathology and biology of invasive breast cancer 86
Breast screening 90
Evaluation of breast cancer 92
Investigations: cytology and histology 96
Investigations: imaging 100
Staging of breast cancer 104
Prognostic factors 108
Management of early breast cancer 110
Surgical anatomy: breast and axilla 114
Surgical anatomy: breast reconstruction 118
Breast conserving surgery 120
Mastectomy 126
Reconstruction in breast conserving surgery 132
Post-mastectomy reconstruction 136
Systemic endocrine treatment 144
Chemotherapy and other systemic therapy 146
Adjuvant radiotherapy 148
Post-treatment follow-up and surveillance 150
Management of advanced breast cancer 152
Non-invasive cancer: DCIS and LCIS 154
Breast cancer: special conditions 156
Other breast cancers and pathology 162
Management of breast cancer risk 164
DETAILED CONTENTS xxvii
Breast cancer: key trials and evidence base 168
Organization of breast cancer care and
medicolegal aspects 172
3 Thyroid and parathyroid tumours 175

Thyroid cancer 176
Neck lumps: differential and clinical evaluation 178
Thyroid status 180
Solitary/dominant nodule 181
Differentiated thyroid cancer 182
Medullary thyroid carcinoma and multiple endocrine
neoplasia (MEN) 186
Anaplastic carcinoma 188
Rare thyroid tumours: lymphomas, SCC, and secondaries 190
Indications for thyroid lobectomy and total thyroidectomy 192
Pre-operative assessment: thyroidectomy 196
Surgical anatomy of thyroids and parathyroids 198
Operative technique: FNA thyroid lump 202
Operative technique: total thyroidectomy 204
Post-thryoidectomy: emergencies and complications 208
Adjuvant treatment: radioiodine therapy and radiotherapy 210
Surveillance and management of recurrence 212
Parathyroid cancer: clinical evaluation and staging 214
Management of deranged serum calcium 216
Operative technique: parathyroidectomy/exploration 218
Adjuvant therapy and recurrence 220
4 Oesophageal cancer 221

Epidemiology, presentation, and clinical evaluation 222
Barrett’s oesophagus 224
Adenocarcinoma 226
Squamous cell carcinoma 228
Staging classification 230
Staging and pre-operative preparation 232
Management algorithms 234
Neo-adjuvant therapy 236
Primary chemoradiotherapy 238
xxviii DETAILED CONTENTS
Operative considerations 240

Surgical anatomy of the oesophagus 244
Operative technique: left thoracolaparotomy and subtotal
oesophagectomy 246
Operative technique: Ivor–Lewis oesophagectomy 250
Operative technique: transhiatal
oesophagectomy 252
Operative technique: further techniques 256
Laparoscopic oesophagectomy 257
Operative technique: anastomosis 258
Replacement conduits: stomach 262
Replacement conduits: colon 264
Replacement conduits: jejunum 266
Post-operative care and complications 268
Adjuvant therapy 270
Follow-up and surveillance protocols 272
Chemotherapy for metastatic disease 274
Palliative therapy 276
Oesophageal cancer and the future 280
5 Gastric cancer 281

Epidemiology 282
Pathology 284
Clinical presentation 286
Clinical evaluation and staging 288
Neoadjuvant treatment 292
Surgical anatomy of the stomach 294
Surgical management 296
Operative techniques: total gastrectomy with
Roux-en-Y reconstruction 300
Operative technique: subtotal gastrectomy 302
Complications of gastric surgery 304
Adjuvant chemoradiotherapy 308
Chemotherapy for advanced or
metastatic disease 309
Palliation 310
Surveillance 311
DETAILED CONTENTS xxix
6 Liver and biliary cancers 313
Clinical presentation and evaluation 314
Primary liver cancers 316
Staging 318
Management: hepatic resection 322
Management: liver transplantation 324
Local ablative treatment 326
Embolic therapies 328
Liver metastases 330
Surgical anatomy 334
Operative techniques: liver resection 338
Operative techniques: right hepatic lobectomy/left
hepatic lobectomy 338
Operative techniques: laparoscopic liver resection 339
Operative techniques: donor liver retrieval 339
Operative techniques: orthotopic liver transplant 340
Operative technique: piggy back liver transplant 341
Post-operative hepatic ITU care 342
Bile duct tumours/cholangiocarcinoma 344
ERCP 346
Extrahepatic biliary tumours staging 347
Treatment 348
Operative technique: hilar carcinoma 350
Operative technique: hepaticojejunostomy 351
Operative technique: palliative bypass 351
Carcinoma of the gallbladder 352
Staging of gallbladder tumours 354
Surgery for gallbladder tumours 356
Adjuvant and palliative treatment for gallbladder tumours 357
Operative technique: open cholecystectomy 358
7 Cancers of the pancreas 359

Epidemiology, aetiology, and pathology 360
Non-invasive pancreatic tumours 362
Adenocarcinoma of the pancreas 366
Investigation 368
xxx DETAILED CONTENTS
Management 372
Controversial issues in management 376
Resectability criteria 380
Pre-operative assessment 381
Staging and prognosis 382
Surgical anatomy of the pancreas 384
Surgical management of pancreatic
adenocarcinoma 386
Operative technique: pylorus preserving
pancreatico-duodenectomy (PPPD) 390
Operative technique: distal pancreatectomy 392
Operative technique: total pancreatectomy 394
Neoadjuvant therapy 400
Management of locally advanced (unresectable)
disease 402
Management of metastatic disease 404
Pancreatic endocrine tumours (PET) 408
Insulinomas 412
Gastrinomas 414
8 Small bowel and rare GI cancers 415

Epidemiology and presentation 416
Clinical evaluation 417
Adenocarcinoma 418
Staging of small bowel malignancy 420
Carcinoid tumours and syndrome 422
Carcinoid: presentation 424
Carcinoid: investigation 425
Carcinoid: treatment 426
Lymphoma: epidemiology and classification 430
Lymphoma: clinical evaluation 432
Small bowel sarcoma 434
Predisposing conditions 436
9 Colorectal cancer 439

Epidemiology and aetiology 440
DETAILED CONTENTS xxxi
Colorectal adenocarcinoma biology 442
Inheritance and CRC 444
Familial adenomatous polyposis 446
Other rare polyposis syndromes 447
Inflammation and CRC 448
Squamous cell colorectal carcinoma 449
Screening for cancer and premalignant polyps 450
Colorectal cancer screening recommendations 452
Diagnosis 456
Pre-operative assessment and preparation 458
Staging and prognosis 460
Neoadjuvant therapy: rectal cancer 466
Management of colonic cancer basic resection
algorithm (Fig. 9.2) 468
Surgical anatomy of the colon and rectum 470
Operative technique: right hemicolectomy 474
Operative technique: left hemicolectomy 478
Operative technique: total mesorectal excision (TME)
anterior resection 480
Operative technique: Hartmann’s procedure 484
Operative technique: abdomino-perineal excision 486
Other operative techniques:
laparoscopic resection 490
Laparoscopic right hemicolectomy 492
Laparoscopic left hemicolectomy 494
Laparoscopic total mesorectal excision (TME):
anterior resection 496
Local excision for rectal cancer 500
Post-operative care and complications 502
Metastatic colorectal disease 506
Chemotherapy and targeted therapy for advanced
metastatic disease 510
Interventional palliative therapies 514
Follow-up and surveillance 518
Colorectal cancer and the future 520
xxxii DETAILED CONTENTS
10 Anal cancer 525

Epidemiology and presentation 526
Squamous cell anal cancer 528
Treatment 530
11 Renal cancer 535

Haematuria protocols 536
Renal cell carcinoma 537
Investigation of renal cell carcinoma 538
Localized renal cell carcinoma: staging 540
Localized renal cell carcinoma: management 542
Operative technique: radical nephrectomy 544
Operative technique: laparoscopic nephrectomy 546
Operative technique: nephron sparing partial nephrectomy 548
Surveillance 552
Advanced renal cell carcinoma 554
12 Bladder and upper urinary tract cancer 555

Bladder tumours 556
Investigation and staging 558
Stage and grade of bladder tumours 560
Upper urinary tract tumours 562
Treatment of non-invasive bladder cancer (TURBT) 563
Surveillance of non-invasive bladder tumours 564
Operative technique: transurethral resection of bladder
tumour (TURBT) 565
Treatment of invasive bladder cancer 566
Surveillance protocol 567
Treatment of upper urinary tract tumours 568
Operative technique: radical cystectomy 570
Operative technique: ileal conduit formation 572
Operative technique: orthotopic bladder substitution 576
Nephro-uretectomy 577
13 Prostate carcinoma 579

Transrectal ultrasound and biopsy 582
DETAILED CONTENTS xxxiii
Gleason grading and staging 584
Management 1 586
Management 2 588
Operative technique: radical prostatectomy 590
Hormonal therapy strategies 594
Testosterone-lowering therapy (castration) 596
Side effects of hormonal approaches (Table 13.3) 598
Follow-up after treatment with curative intent 599
Management of PSA relapse after radical prostatectomy 600
Management of PSA relapse after radiation therapy 601
Chemotherapy 602
14 Testicular cancer 603

Testicular cancer histology 605
Staging 606
Prognostic groups 608
Treatment: seminomas 610
Treatment non-seminomatous germ cell tumours 611
Treatment of metastatic germ cell tumours 612
Operative technique: radical orchidectomy 613
Operative technique: retroperitoneal lymph node
dissection 614
15 Soft tissue sarcoma 619

Introduction 620
Biopsy in sarcoma surgery 621
Staging 622
Principles of sarcoma surgery 624
Gastrointestinal stromal tumours (GIST) 626
Other intra-abdominal sarcomas 629
Desmoid tumours 630
Retroperitoneal sarcoma 632
Angiosarcomas 634
Dermatofibrosarcoma protuberans 638
Fibrosarcoma 640
Kaposi’s sarcoma 642
xxxiv DETAILED CONTENTS
Leiomyosarcomas 644
Liposarcomas 646
Malignant peripheral nerve sheath tumours 648
Malignant fibrous histiocytomas/ myxofibrosarcomas 650
Rhabdomyosarcoma 652
Synovial sarcomas 656
Extremity sarcoma 658
Index 659
Chapter 1 1
Cancer radiology
1. Common imaging modalities 2

Plain film ‘X-rays’ and barium studies 2
Ultrasound 3
Computed tomography 4
Magnetic resonance imaging 5
Positron emission tomography (PET) – CT 6
Radionuclide imaging 8
2. Regional cancer imaging 10
Head and neck cancer 10
Thyroid cancer 14
Breast cancer 18
Oesophageal cancer 22
Gastric cancer 23
Primary tumours of liver and biliary tract 24
Cancers of the pancreas 30
Colon and rectal cancer 32
Carcinoma of the anal region 36
Renal cancer 38
Adrenal malignancy 40
Bladder cancer 44
Prostate cancer 46
Testicular cancer 48
Neuroendocrine tumours 50
Soft tissue sarcomas 54
Skin cancers 56
3. Cancer and interventional radiology 57
Fine needle aspiration cytology and percutaneous biopsy 57
Radiotherapy planning 58
Radionuclide therapy 59
Central venous access for chemotherapy 60
Vascular embolotherapy 62
Tumour ablation 64
Percutaneous drainage procedures 66
Pain control 70
Feeding techniques 72
Oesophageal stenting 74
Tracheobronchial stenting 76
Malignant central venous obstruction 77
Breast intervention 78
2 CHAPTER 1 Cancer radiology
1. Common imaging modalities

Imaging techniques for diagnosis, staging, surveillance, and treatment of
cancer are rapidly improving. Advances in technology and development
of novel techniques have meant that ‘best practice’ is constantly evolving.
Radiologists are at the forefront of deciding which test is appropriate.
Plain film ‘X-rays’ and barium studies

• In 1895 William Conrad Rontgen produced and detected
electromagnetic radiation known today as X-rays.
• Since then X-ray use has developed as a useful diagnostic tool in the
detection of cancer.
• Oral and IV contrast agents may be used in conjunction with plain film
radiography to detect specific pathologies.
• X-rays are used therapeutically in radiotherapy.
Common indications for plain film and barium examinations in cancer
diagnosis include:
• CXR – initial imaging for lung Ca or metastases.
• Barium enema for colorectal Ca.
• Barium swallow/meal/follow-through for upper GI malignancies.
Oral contrast media
Barium sulphate
Different preparations are used for different parts of the GI tract – e.g.
E-Z HD® 250% 100mL for barium swallow. Advantages over water soluble
contrast include cost and better coating, allowing better demonstration of
mucosal pattern. The main risk is high morbidity associated with barium in
the peritoneal cavity. CT and US must be done prior to barium studies if
they are needed due to artefacts or difficulty in interpretation subsequent
to barium ingestion.
Water soluble contrast media
E.g. Gastromiro®, Gastrografin®. Used in cases of meconium ileus, suspected
perforation, and as oral contrast for CT examinations. The main risks are
allergic reactions, ileus, hypovolaemia, and pulmonary oedema if aspirated
(the latter two are unlikely if low osmolar contrast media is used).
Contraindications
• All barium studies are contraindicated in suspected perforation, where
water-soluble contrast, e.g. Gastrografin®, may be used instead.
• Barium follow-through and meal is contraindicated in cases of complete
large bowel obstruction.
• Barium enema is also contraindicated in cases of toxic megacolon,
pseudomembranous colitis and recent rectal biopsy (via rigid
endoscope within the previous 5 days or flexible endoscope within the
previous 24 h).
• Gastrografin® may be used with care to diagnose SBO; as it is
hyperosmolar it may increase intraluminal pressure. Paradoxically it
may therefore have a therapeutic effect.
ULTRASOUND 3
Ultrasound
• Utilizes cyclic high frequency sound waves to produce images of the
body. Most diagnostic procedures use frequencies between 2 and
20MHz.
• Internal organs, muscle, tendons, etc., are seen in real-time image.
Doppler mode enables patterns of blood flow to be examined.
• Contrast agents are available, e.g. microbubbles. The most important
application of this in US imaging is in the detection and differentiation
of focal liver lesions.
• US in diagnostic imaging for cancer can be performed via a
transcutaneous, transabdominal, transvaginal, transrectal endoscopic,
and intraoperative approach.
• Endosocopic US utilizes a small US probe at the tip of an endoscope.
It is useful in the staging of cancers of the oesophagus, stomach,
pancreas, and rectum. It aids visualization of radial penetration of the
tumour, as well as circumferential extent in viscous organs.
• Intraoperative US is used occasionally as an adjunctive tool to more
conventional imaging for staging tumours and guiding segmental
resection. It is of particular benefit in cases of non-palpable breast
tumour surgery, as well as for hepatic tumours.
• The use of US as an imaging medium is limited because of the means by
which US penetrates tissue. US does not readily cross tissue–bone and
tissue–gas boundaries. Structures lying deep to gas-containing and bony
structures are not visible. Hence, the use in imaging of lung and brain
is limited (except in neonates with open fontanelles). The inspection of
the bowel transabdominally is restricted for the same reason.
• It is highly useful in assessing tubular structures, such as the biliary
ducts that may contain a small focal lesion that may be missed between
sequential slices on CT. As a dynamic imaging modality it is highly
useful to guide biopsies of relatively superficially lying lesions. Cystic
structures are well visualized and can be aspirated, e.g. thyroid and
breast cysts.
• Heat generated by US can be used therapeutically – high intensity
focused US (HIFU) treatment is available for the treatment of early
prostate cancer or as ‘salvage treatment’ if recurrence following other
treatments (approved by NICE, March 2005). There may be a larger
role for HIFU in the future for other tumours – clinical trials are
ongoing.
Computed tomography
• First introduced in the 1970s at Northwick Park Hospital, London.
• Tomographic images are produced from a large 2-D series of X-ray
images taken around a single axis of rotation.
• Data produced is digitally reconstructed to demonstrate various organs
based on differential radio-opacity.
• Most centres now use multi-detector CT (MDCT) scanners – longer
scanning range and shorter scanning times due to multiple rows of
detectors.
• Slice thicknesses of less than 1mm can be obtained using MDCT.
• Images from MDCT can be reconstructed in any plane without
significant loss of image quality.
• Computed tomography is essential for the localization and staging of
various malignancies. Its use as the gold standard for staging has been
challenged by MRI and PET-CT for regional cancers such as the rectum.
• CT is also important in radiotherapy planning in the case of most
tumours and for radiofrequency (RF) ablation (see ‘Radiofrequency
ablation’, p. 74).
IV water soluble contrast media
• First report of use in 1923 by Osborne et al. to opacify urinary tract.
• Newer non-ionic low osmolar contrast agents have fewer toxic effects.
• Risks include contrast extravasation leading to pain, skin erythema,
and sloughing, contrast-induced nephropathy (incidence of 5%),
cardiovascular and neurotoxicity with intracardiac and intracerebral
arteriography, respectively, haematological changes (e.g. haemolysis,
thrombus formation, etc.), thyrotoxicosis, and idiosyncratic reactions
(ranging from mild to severe and even death).
• Use of N-acetylcysteine to prevent contrast-induced nephropathy is
not agreed upon.
• Similarly, steroid prophylaxis for patients considered at risk of adverse
reactions remains controversial. Lasser et al. recommend two oral
doses of 32mg methylprednisolone, 12 and 2 h before high osmolar
contrast media injection. They believe this may also prevent adverse
reactions where newer non-ionic low osmolar contrast agents are used.
Contraindications to CT scanning
• Pregnancy (relative contraindication).
• Allergies to iodine or contrast agents.
• Diabetic patients cannot take metformin for 48 h following IV contrast
injections.
• Extremely overweight patients might have difficulties accessing the
scanner.
Further reading
Lasser EC, Lang J, Sovak M, Kolb W, Lyon S, Hamlin AE. Steroids: theoretical and experimental basis
for utilization in prevention of contrast media reactions. Radiology 1977; 125(1):1–9.
Osborne ED, Sutherland CG, Scholl AJ, Jr., Rowntree LG. Landmark article Feb 10, 1923:
Roentgenography of urinary tract during excretion of sodium iodid. By Earl D. Osborne, Charles G.
Sutherland, Albert J. Scholl, Jr. and Leonard G. Rowntree. JAMA 1983; 250(20):2848–53.
MAGNETIC RESONANCE IMAGING 5
Magnetic resonance imaging

• Does not use ionizing radiation to obtain images.
• A magnetic field is employed to align the magnetization of hydrogen
atoms in the body. Radio waves then alter the alignment of this
magnetization causing the hydrogen atoms to produce a rotating
magnetic field detectable by the scanner, from which an image can
reconstructed.
• The spatial resolution of the image is not as good as CT, but there is
superior contrast resolution and no radiation dose to patient.
• MRI use is central in the localization and staging of various malignancies.
• Gadolinium containing contrast agents often used to look for
enhancement but risk of nephrogenic systemic fibrosis in chronic
severe renal insufficiency (glomerular filtration rate <30 mL/min/1.73 m2),
or acute renal insufficiency of any severity caused by hepato-renal
syndrome or in the perioperative liver transplantation period.
Magnetic resonance spectroscopy
• Magnetic resonance spectroscopy (MRS) is an application of MRI.
• MRS provides chemical information about tissue metabolites.
• Detects the resonance spectra of chemical compounds other than
hydrogen, e.g. carbon 13, fluorine 19, etc.
• Primary clinical use is for brain cancer, but also has a role as an adjunct
to conventional imaging in prostate, colon, breast, cervix, oesophageal,
and pancreatic cancer.
Absolute contraindications to MRI
• Electronically, magnetically, and mechanically activated implants, such as:
• cardiac pacemakers;
• defibrillators;
• ferromagnetic or electronically-operated stapedial implants.
• CNS aneurysm clips.
• Ocular foreign body, e.g. metal shavings.
Relative contraindications
• Other pacemakers, e.g. carotid sinus.
• Insulin pumps and nerve stimulators.
• Lead wires or similar wires.
• Non-ferromagnetic stapedial implants.
• Cochlear implants.
• Claustrophobia.
• Pregnancy (although there is no evidence that MRI is harmful to the
foetus during any trimester).
• Prosthetic heart valves (if dehiscence is suspected).
Positron emission tomography

(PET) – CT
• PET-CT is a technique by which a 3-D image map of functional
processes within the body is produced through the use of a positron
emitting radioisotope introduced into the body on a metabolically
active molecule. Images from a simultaneously taken CT scan (or MRI
scan) are then reconstructed to provide metabolic and anatomical
information.
• In current oncology imaging practice PET-CT is performed using the
radioactive tracer isotope 18fluoro deoxyglucose (18FDG) to localize
cancer cells that have a higher rate of glucose metabolism and,
therefore, concentrate the molecule within them (Fig. 1.1).
• FDG is not a tumour specific agent.
• Occasionally, PET-CT can detect functional abnormalities in structures
that look normal on conventional CT and MR.
• PET-CT is now considered a key investigation in the management of
several malignancies, particularly in primary tumour staging, assessment
of treatment response, and as a prognostic indicator for detecting
disease recurrence.
• Tumour specific radiotracers detected by PET-CT scanners are in
development, e.g. radiotracers linked to oestrogen receptor/HER-2 in
breast cancer.
Common pitfalls
False positives
Skin contamination (tracer or urine), normal uptake in skeletal muscle,
brown fat and urinary tract, respiratory motion, inflammatory conditions
(e.g. sarcoid, tuberculosis, abscesses, fungal infections), certain physiolog-
ical states (e.g. lactating breast, thymus, growth plates in children, etc.),
trauma, and recent surgery.
False negatives
Small lesions size (less than 1cm), type of neoplasm (see ‘Regional cancer
imaging’, p. 14), tumour grade, and lesion location, e.g. adjacent to urinary
tract or bladder, respiratory motion, etc.
POSITRON EMISSION TOMOGRAPHY (PET) – CT 7
Fig. 1.1 PET-CT demonstrating increased 18FDG uptake in the distal oesophagus,
where there is increased mucosal thickening secondary to oesophageal malignancy.
Radionuclide imaging
• Provides physiological or metabolic images by using tracer studies
employing various radiopharmaceuticals, which are administered to
patients.
• The radiation emitted is detected with a gamma camera and an image
is formed.
Radionuclides in common use for cancer imaging and their
clinical application
• 131
Iodine and 123Iodine: thyroid malignancy.
• 67
Ga – gallium citrate: lymphoma, used with variable success in a
variety of other tumours, e.g. hepatoma, bronchial carcinoma, multiple
myeloma, and sarcoma.
• 99m
Tc -sulphur colloid: liver/spleen imaging.
• 201Thallous chloride: brain neoplasia and lung tumours. It may also be
used to detect lymphomas, and thyroid and breast cancers.

• 99m
Technetium: bone scans, diagnosis of breast cancer.
• 99m
Tc-MIBI: parathyroid adenomas and carcinoma.
• 111
In-pentetreotide: somatostatin receptor positive tumours.
• 123
I-MIBG: neuroblastoma, phaeochromocytoma, carcinoid tumours,
medullary thyroid carcinoma, other neuroendocrine tumours.
2. Regional cancer imaging

Head and neck cancer
Paranasal sinus neoplasms
• Least common of all head and neck malignancies.
• Usually advanced at presentation (60% at stage T3 or T4) and poor
prognosis.
• Imaging required for identification of the neoplasm, staging, determining
suitability for surgery, planning radiotherapy treatment, and as baseline
for assessment of recurrence.
Imaging
Plain radiography:
• Used as a screening tool.
• Will identify ~80% of cases of bone destruction.
CT
• CT and MRI can both be used to identify and stage paranasal sinus
neoplasms.
• 2–3mm axial sections if using spiral technique following IV contrast
thought skull base and primary tumour. (MDCT slice thickness will
depend on scanner capability). 5mm axial sections through whole neck
for lymph node assessment and coronal reformats for pre-surgical
planning.
• CT is better at identifying bony erosion than MRI.
• Aggressive bony destruction is observed in SCC, lymphoma, and
metastases.
• Bone remodelling in inverted papillomas, olfactory neuroblastomas,
most sarcomas, haemangiopericytomas, minor salivary gland tumours.
• Sclerotic bony changes not usually seen with tumours.
• CT accurately assesses nodal disease.
• CT is not accurate in identifying tumour margins, differentiating tumour
from secretions and detecting early intracranial extension.
MRI
• MRI provides multiplanar imaging and superior soft tissue contrast
allowing for better differentiation of tumour from surrounding tissue
and fluid.
• Recommended sequences: coronal 3mm STIR, T1W, T1W +
Gadolinium Fat Sat, axial 5mm T1W + Gad Fat Sat, T1W and 3mm axial
T2W Fat Sat., sagittal 3mm T1W + Gad Fat Sat
• Patients with intracranial and perineural extension can be more
accurately identified by MRI as they are excluded from surgery.
• Use of IV supermagnetic iron oxide particles (SPIOs) as MR
lymphangiographic agents may increase specificity in nodal disease
(metastatic nodes do not show signal drop on T2* sequences).
• Overall, MRI is considered more accurate in staging sinonasal tumours
(MRI 94% accurate or 98% accurate if post-contrast images as opposed
to CT accuracy of 78–85%).
Exploring the Variety of Random
Documents with Different Content
"They had heard of Moses and seventy Elders of Israel, and of Jesus
appointing other Seventies, but had never heard of Twelve Apostles
and of Seventies being called in this Church before. It was a strange
saying, "The Lord has made you president of the Seventies," as though
it had already taken place, and it caused these brethren to marvel.
"The Prophet did not say that any others would be called to be the
bearers of this message abroad, but the inference might be clearly
drawn, that this was his meaning, from the language he used at the
time.
"Agreeable to his request to Elder Brigham Young, the branches were

all notified, and a meeting of the brethren in General Conference was
held in Kirtland, in the new school house, under the printing office, on
the following Saturday, February 14th, when the Twelve were
appointed and ordained, and the Conference adjourned for two weeks.
"Pursuant to this adjournment, the Conference convened on Saturday,

the 28th of that month, when the first quorum of Seventies were
appointed and ordained, under the hands of the Prophet, his
Counselors, and others.
"Adjourned meetings were held from time to time, and the second
quorum of Seventies were appointed and ordained."
8. The First Report of the Seventy: The first report that the Seventies
made of their labors seems to have given very great satisfaction to the
Prophet. Under date of December 28, 1835, (less than a year after their
organization) the Prophet says:
"This day the Council of the Seventy met to render an account of their
travels and ministry, since they were ordained to that Apostleship. The
meeting was interesting, indeed, and my heart was made glad while
listening to the relation of those that had been laboring in the vineyard
of the Lord, with such marvelous success. And I pray God to bless
them with an increase of faith and power, and keep them all, with the
endurance of faith in the name of Jesus Christ to the end." (History of
the Church, Vol. II, p. 346.)
9. The Anointing of the Seventy: The Seventies were privileged to receive
their washings and anointings in the Kirtland Temple preparatory to its
public dedication. The Presidency of the Seventy received their anointing
and blessing under the hands of the Twelve Apostles on the 22nd of
January, 1836; and had sealed "upon their heads power and authority to
anoint their brethren"—the members of their quorums. (History of the
Church, Vol. II, p. 383.) Under date of the 30th of January, 1836, members
of the quorums were anointed and blessed, of which circumstance the
Prophet says:
"In the evening, went to the upper room of the Lord's house, and set
the different quorums in order. Instructed the presidents of the Seventy
concerning the order of their anointing, and requested them to proceed
and anoint the Seventy." (History of the Church, Vol. II, p. 388.)
10. The Seventy Sustained as Apostles: During the dedicatory services in

the Kirtland Temple, March 27, 1836, when the various officers of the
Church were sustained, the Seventies were sustained as "Apostles and
special witnesses to the nations to assist the Twelve," etc. I quote the
passage in full.
"I then called upon the quorums and congregation of Saints to

acknowledge the Twelve Apostles, who were present, as Prophets,
Seers, Revelators, and special witnesses to all the nations of the earth,
holding the keys of the kingdom, to unlock it, or cause it to be done,
among them, and uphold them by their prayers, which they assented to
by rising. I next called upon the quorums and congregation of Saints to
acknowledge the presidents of Seventies who act as their
representatives, as Apostles and special witnesses to the nations, to
assist the Twelve in opening the gospel kingdom among all people, and
to uphold them by their prayers, which they did by rising." (History of
the Church, Vol. II, p. 417-18.)
11. The First Council of Seventy Lead Kirtland Camp to Missouri:

Perhaps the greatest work achieved by the First Council of the Seventies in
their organized capacity, was the organization of the Kirtland Camp, and
leading it from Kirtland, Ohio, to Adam-ondi-Ahman, Missouri, a distance
of 860 miles. The camp numbered 105 families, 529 souls in all. They left
the vicinity of Kirtland on the 6th day of July, 1838, and arriving at Adam-
ondi-Ahman on the 4th of October, of the same year. A full history of the
organization of this camp and its journey is to be found in the History of the
Church, Vol. III, p.. 87 to 148.
12. Increase of Quorums at Nauvoo: At the October Conference, 1844,

the number of the Seventy was greatly increased. On the third day of the
conference, "Elder George A. Smith moved that all in the Elders' quorum
under the age of thirty-five should be ordained into the Seventies', if they
are in good standing, and worthy, and will accept it. The motion was
seconded and carried unanimously." Enough members were added to make
in all eleven quorums, and forty more were ordained to be part of the
twelfth quorum. (See minutes of Conference, "Times and Seasons," Vol. V,
p. 695-696.) By the first of January, 1845, the number of quorums had
increased to fourteen, and a Seventies' library was started, which caused the
editor of the "Times and Seasons" to exclaim:
"Ten years ago but one Seventy, and now fourteen [quorums of]
Seventies, and the foundation for the best library in the world. It looks
like old times when they had 'Kirjath Sapher,' the City of Books."
(Times and Seasons, Vol. V, p. 762-3.)
Meantime the Seventies had built a large brick hall in Nauvoo, known as
the "Seventies' Hall," and on the 26th of December, 1844, this building was
dedicated with imposing ceremonies extending through an entire week.
Most of the members of the Council of the Apostles participated in the
dedicatory services. It may be of interest for the Seventies to know that the
heroic hymn, "The Seer, the Seer, Joseph the Seer," by the late President
John Taylor, was written for these services though dedicated by the author
to President Brigham Young. (Times and Seasons, Vol. V, p. 767.) The
arrangement was made for two quorums to be in attendance at the
dedication each day with their wives and children and a number of invited
guests. By this time there were fifteen quorums in existence. By the 19th of
January, 1846, the number of quorums had increased to thirty. (Times and
Seasons, Vol. VI, p. 1096.) Whether or not any more quorums than these
were organized in Nauvoo we do not know.
13. Status of the Quorums Since Nauvoo Times: For some time after the
settlement of the Church in Utah some confusion existed in relation to the
quorums of Seventy, and the members of the respective quorums were so
badly scattered that they convened in what were known as "mass quorums,"
consisting of all the Seventies living in a stake or ward, without regard to
the particular quorum to which they belonged. In the year 1883, however, a
movement was set on foot to put the quorums in order, and the Presidency
of the Church issued the following instructions on the subject of
THE ORGANIZATION OF THE SEVENTY.
SALT LAKE CITY, U. T., April 13, 1883.
In the organization of these quorums in October, 1844, there were ten

quorums, each provided with seven presidents, which presidents
constituted the First Quorum of Seventies, and of which the First
Seven Presidents of the Seventies were members, and over which they
presided. But as the Seventies have greatly increased, these regulations
will not apply to the present circumstances; and furthermore, the First
Quorum, according to the present organization, has not acted in a
quorum capacity, but it would seem there are duties devolving upon its
members, as a quorum, that may require their official action.
The First Quorum of Seventies may be composed of the First Seven

Presidents of the Seventies, and the senior president of the first sixty-
four quorums. These may form the Seventy referred to in the Book of
Doctrine and Covenants, and may act in an official capacity as the
First Quorum of Seventies.
The senior presidents of the other quorums, over and above the sixty-
four, may meet with the First Quorum in their assemblies in any other
than an official capacity; but in case of the absence of any of the
members of the First Quorum, they can act, in the place of such
members with the First Quorum during such absence, in any cases of
importance that may arise.
The headquarters of the different quorums, and the records thereof,
may be distributed throughout the various Wards and Stakes, under the
direction of the First Seven Presidents, as the number of the Priesthood
residing in such localities may seem to justify and any vacancies that
exist, either in the presidency or membership of the different quorums
may be filled by the ordination of persons residing in the locality in
which the respective quorums are organized.
Any of the members or presidents of other quorums who are in good

standing may have the privilege of joining the quorum located in the
district in which they reside; but in such cases they should first obtain
a certificate as to their standing in the quorum from which they desire
to withdraw; to obtain which it would only be necessary to procure a
certificate of their good standing from the Bishop of the Ward to which
they belong, provided their names are found upon the record of their
quorum as in good standing.
The presidents of the quorums residing in the district where their

respective quorums are organized shall have a general supervision of
all the Seventies residing in their district.
In all cases where members of quorums are called in question, a

majority of their respective quorums will have jurisdiction in all cases
involving their standing in the quorum, but in case there is not a
majority residing in the district where the quorum is organized, or in
the case of scattered members, the members present should investigate
the matter and report their findings to the First Seven Presidents. Any
complaints regarding the presidents of quorums should be made to the
First Seven Presidents of the Seventies, who may suspend such
presidents, if their conduct seem to justify it, pending the action of the
First Quorum. Any presidents or members from whom fellowship has
been withdrawn by the quorums, should be reported to the High
Council having jurisdiction.
The Seventies, when abroad, if anything should occur requiring their

supervision, in the absence of other authorities, may act upon the case
of any delinquent belonging to the Seventies, and should report their
decisions to the First Seven Presidents of the Seventies.
Your Brethren in the gospel,
JOHN TAYLOR,
GEORGE Q. CANNON,
JOSEPH F. SMITH,
First Presidency of the Church of Jesus Christ of Latter-day Saints.
A revelation given through President John Taylor, at Salt Lake City, Utah
Territory, on Saturday, April 14th, 1883, in answer to the question: "Show
unto us thy will, O Lord, concerning the organization of the Seventies."
What ye have written is my will, and is acceptable unto me: and

furthermore,
Thus saith the Lord unto the First Presidency, unto the Twelve, unto
the Seventies and unto all my holy Priesthood, let not your hearts be
troubled, neither be ye concerned about the management and
organization of my Church and Priesthood and the accomplishment of
my work. Fear me and observe my laws and I will reveal unto you,
from time to time, through the channels that I have appointed,
everything that shall be necessary for the future development and
perfection of my Church, for the adjustment and rolling forth of my
kingdom, and for the building up and the establishment of my Zion.
For ye are my Priesthood and I am your God. Even so. Amen.
Under the instructions given in the foregoing communication and

revelation, the First Council of the Seventy have proceeded with the work
of increasing the quorums and managing their affairs. The quorums now
number 151, giving to the foreign ministry of the Church a body of men
numbering about ten thousand.
Footnotes
1. Hackett edition, in four volumes, now and always quoted.
2. I take occasion here to remark that by making reference to works such as

Edersheim's Life of Jesus, Bible Dictionaries Ecclesiastical Histories, etc., it
must not be understood that in making such references I approve the works,
or even accept the correctness of the passages indicated. Such references
are made that the student may consult the literature on a given point. He
must make his own deductions as to the correctness of the statements and
arguments of such authors. As for instance, in this very passage cited from
Edersheim's really great work, I think him, in the main, wrong in his
treatment of this subject of the Seventy, but our Seventies should know
what so high an authority, as Edersheim is generally accepted to be, has said
upon the subject.
3. It will be observed from this statement that the "Cephas," or "Peter"

whom Paul "withstood to his face" at Antioch, was not the chief Apostle
Peter, but another "Cephas" or "Peter," one of the Seventy. I fear, however,
that the testimony in Galatians ii, as to its being Peter, the chief Apostle,
with whom Paul had his unfortunate controversy, is too strong to be
overturned by this inference in Eusebius.
LESSON II.
THE ORGANIZATION AND DUTIES OF
THE SEVENTY.
ANALYSIS. REFERENCES.
I. The Priesthood. Note 1; Alma xiii; Doc, &

1. Definition, and the Cov. 84; Sec. 107;
Grouping of Powers and Compendium[1] pp. 64-73.
Officers. History of the Church Vol.
II, Chap. 33; Vol. IV,
Chap. 11; Outlines Eccl.
History, Part IV, Sec. v.
The Gospel[2] pp. 210-216.
II. The Church: Defined. Note 2. I Corinthians xii.

1. The Depository of Articles of Faith,
Revealed Truth. (Talmadge) Lecture XI.
2. Of Divine Authority-- Compendium pp. 157-
Her Commission. 158. Book of Mormon,
Mosiah 5:7-12. Doc. &
Cov. Sec. 76; 50-70. The
Gospel pp. 216-227.
III. The Mission of the Note 3; Eph. iv:4-17. The

Church. Gospel pp. 216-227.
1. Proclamation of the History of the Church Vol.
Truth. II. pp. 47. 476-480.
2. Perfecting the Lives of
Those Who Receive Her
Truth.
IV. The Foreign Note 4, 5, 6. Doc. & Cov.

Ministry. Sec. 107; also Sec. 124;
1. The Twelve Apostles. 138-140. History of the
2. The Seventy. Church, Vol. III,[3] Chap.
3. Special Duties of the xxvi. Luke x; Outlines
Seventy. Eccl. History[4] Sec. v, p.
336-7, p. 360; also pp.
343-6. Also note 7.
SPECIAL TEXT: "Wherefore now, let every man learn his duty, and to act in
the office in which he is appointed, in all diligence." Doc. and Cov., Sec.
107.
NOTES.
1. Priesthood. Priesthood is authority which God gives to man, by which
man is made an agent of God, authorized to speak, act, and administer in
the divine name, and have his words and administrations of binding effect
as if done by the Lord himself; provided, of course, said administrations are
in accordance with the divine directions or instructions, within the limits of
the authority confirmed upon the agent, performed in righteousness and
relate to the matters for which the divine authority was given to man.
Necessarily this delegated authority is one in kind;[5] it is simply authority

given of God to man by which man is authorized to act in God's stead in
relation to certain things; but its powers are grouped in various ways for the
purpose of facilitating the administration of its government. First, its
powers are grouped with reference to temporal and spiritual affairs; the
division of the Priesthood which has charge more especially of spiritual
affairs is called the Melchisedek Priesthood; that which has charge more
especially of temporal affairs, the Aaronic Priesthood. The officers of the
Melchisedek Priesthood are, Apostles, Prophets, Patriarchs, High Priests,
Seventies, Elders; of the Aaronic Priesthood: Bishops (who are High
Priests, ordained to be Bishops and constitute the Presidency of the Aaronic
Priesthood), Priests, Teachers, Deacons.
While this division of the Priesthood, or this grouping of its officers with
reference to spiritual and temporal labors, assigns one to spiritual and the
other to temporal concerns, it must not be thought that there is anything
rigid in said division of labor; that the Aaronic Priesthood is excluded from
participation in spiritual labors; or that the Melchisedek Priesthood is
excluded from dealing with temporal affairs. The line of demarkation,[6] as a
matter of fact, is crossed by each division; some of the duties of the Aaronic
Priesthood are spiritual, and some of the duties of the Melchisedek,
temporal. This division then rests upon the fact that the duties assigned the
Aaronic priesthood are chiefly temporal, and the duties of the Melchisedek
chiefly spiritual.
Another division of the Priesthood may be said to exist within the

Melchisedek Priesthood, which is also a division with reference to its
labors, viz., the foreign ministry and the home ministry, of which more is to
be said later.
2. The Church. The Church may be said to arise from the Priesthood.
Comprehensively defined it may be said to be an organization of people—
including all officers and members—who believe in and endeavor to
incorporate in their lives God's Truth; who have obeyed the ordinances or
sacraments appointed of God for salvation and admission into his Church;
whose officers are of divine appointment and commission, (that is,
possessed of divine authority, the Priesthood) guided by an ever present
inspiration from God, and walking within reach of an ever present and
continuous source of immediate revelation.
The Church is the depository of God's revealed truth. Man may be able by
searching to find out many truths. What he has learned by study, by
investigation, aided by the inspiration of the Lord—for "there is a spirit in
man, and the inspiration of the Almighty giveth them understanding"—
amounts to very much; but there are some things which even by searching
man may not learn. "Canst thou by searching find out God? Canst thou find
out the Almighty unto perfection?"[7] The inference in the scripture is, and
the fact is, that the answer must be, no. God can not be perfectly known,
only as he reveals himself to man; man can know his relationship to God
only as God is pleased to reveal it; man can only know the terms and means
of his salvation as the Lord reveals it; and these revelations, when he has
one in the earth, God gives to his Church; these truths which man by
searching, by his own wisdom, may not find out in their perfection—God
deposits with his Church—hence the Church is the depository of God's
revealed truth—she receives and is the custodian of the Gospel.
And not only is the Church the depository of revealed truth; but she is also
the depository of the divine authority; she, in organized capacity, holds as
content the Holy Priesthood; and she has commission and agency to
dispense the truth and administer through her instrumentalities all the
ordinances of the gospel.
3. The Mission of the Church: The Church of Jesus Christ of Latter-day

Saints was brought into existence for the accomplishment of two great
things: first, the proclamation of the truth concerning man's salvation to all
the world: and second, the perfecting of those who accept that truth. The
Church is organized with reference to the accomplishment of these two
purposes, and has, for the accomplishment of those purposes, a foreign
ministry and a home ministry. In defining the duties of a Seventy it is with
the foreign ministry that we have to deal.
4. The Foreign Ministry. The business of the foreign ministry is to make

proclamation of the gospel in all the world, and gather, as soon as wisdom
dictates, those who accept it into the organized stakes of Zion. This foreign
ministry, strictly speaking, is composed of the Twelve Apostles and the
quorums of the Seventy.
5. The Twelve: "The twelve traveling counselors are called to be the

Twelve Apostles, or special witnesses of the name of Christ in all the world;
thus differing from other officers in the Church in the duties of their calling.
* * * * The Twelve are a traveling presiding High Council, to officiate in
the name of the Lord, under the direction of the Presidency of the Church,
agreeable to the institution of heaven; to build up the Church, and regulate
all the affairs of the same in all nations; first unto the Gentiles, and secondly
unto the Jews. * * * * The Twelve being sent out, holding the keys to open
the door by the proclamation of the gospel of Jesus Christ—and first unto
the Gentiles and then unto the Jews." (Doc & Cov., Sec. cvii.) This is the
special calling of the Twelve Apostles, and the calling of the Seventy is like
unto it.
6. The Seventy: "The Seventy are also called to preach the gospel, and to
be especial witnesses unto the Gentiles and in all the world. Thus differing
from other officers in the Church in the duties of their calling. * * * * The
Seventy are to act in the name of the Lord, under the direction of the
Twelve or the traveling High Council, in building up the Church and
regulating all the affairs of the same in all nations—first unto the Gentiles
and then to the Jews. * * * * It is the duty of the traveling High Council to
call upon the Seventy, when they need assistance, to fill the several calls for
preaching and administering the gospel, instead of any others. * * * * And
these Seventy (the reference is to the whole body of that Priesthood) are to
be traveling ministers unto the Gentiles first, and also unto the Jews. * * * *
Whereas other officers of the Church, who belong not unto the Twelve,
neither to the Seventy, are not under the responsibility to travel among all
nations, but are to travel as their circumstances shall allow, notwithstanding
they may hold as high and responsible offices in the Church." (Doc. & Cov.,
Sec. cvii.)
When the Church was set in order at Nauvoo, in 1841, by direction of a

revelation (Doc. & Cov.; Sec. cxxiv.) after naming the First Seven
Presidents, who were to preside over the quorums of Seventies, the Lord
said: "Which quorum is instituted for traveling Elders to bear record of my
name in all the world, whenever the traveling High Council, my Apostles,
shall send them to prepare a way before my face. The difference between
this quorum and the quorum of Elders is, that one is to travel continually,
and the other is to preside over the churches from time to time: the one has
the responsibility of presiding from time to time, and the other has no
responsibility of presiding, saith the Lord your God."
In these passages the special calling and duties of the Seventies are so
clearly set forth that neither comment nor amplification is necessary, since
these foregoing quotations are the word of the Lord, and evidence the fact
that the Twelve, with the Seventy, constitute the foreign ministry of the
Church. They are special witnesses of God and Christ to the truth of the
gospel, and that is their special and peculiar calling in the Church. Not that
the whole responsibility of preaching the gospel rests upon the Twelve and
the Seventy alone. That responsibility rests upon the whole body of the
Church. These quorums, the Twelve and Seventy, are merely the
instrumentality through which the Church discharges its obligations to the
people of the world in making known to them the truth.
7. President Joseph F. Smith on the Calling of the Seventy: We have also

in the Church today, I am informed, 146 quorums of Seventy [the number in
1904]. These constitute a body of Elders of somewhere in the neighborhood
of 10,000 men, whose special duty it is to respond to the call of the Apostles
to preach the gospel, without purse or scrip, to all the nations of the earth.
They are minute men. It is expected that they will be ready, whenever they
are called, to go out in the world, or to go out to the various organizations of
the Church to fulfill missions and to perform such duties as shall be
required of them, in order that the work of the Lord and the work of the
ministry may be upheld and sustained and carried on in the Church and
throughout the world. These councils or quorums of Seventy are not always
full, a full council being 70 Elders. But there are approximately 10,000
Elders who now hold that position in the Church. They are called to an
apostolic calling. They are required to be special witnesses of the Lord
Jesus Christ. It is expected of this body of men that they will have burning
in their souls the testimony of Jesus Christ, which is the spirit of prophecy;
that they will be full of light and of the knowledge of the truth; that they
will be enthusiastic in their calling, and in the cause of Zion, and that they
will be ready at any moment, when required, to go out into the world, or
anywhere throughout the Church and bear testimony of the truth, preach the
gospel of Jesus Christ, and set examples before the world of purity, love,
honesty, uprightness and integrity to the truth. (The General Conference
Reports, October 6th, 1904, p. 3.)
Footnotes
1. Richards and Little's, of "The Seventy's Indispensible Library," always
meant.
2. Third edition always quoted.
3. "After all that has been said, the greatest and most important duty is to
preach the Gospel."—Joseph Smith.
5. "There are two Priesthoods spoken of in the Scriptures, viz., the

Melchisedek and the Aaronic or Levitical. Although there are two
Priesthoods, yet the Melchisedec Priesthood comprehends the Aaronic or
Levitical Priesthood, and is the grand head, and holds the highest authority
which pertains to the Priesthood, and the keys of the Kingdom of God in all
ages of the world to the latest posterity on the earth, and is the channel
through which all knowledge, doctrine, the plan of salvation, and every
important matter is revealed from heaven." (History of the Church, Vol. IV,
pp. 207, et. seq.)
"Therefore, in viewing the Church as a whole, we may strictly denominate

it one Priesthood." (History of the Church, Vol. II, p. 478.)
6. The distinction in the terms "temporal" and "spiritual" are used in

connection with this subject that man may understand; that is, God adapts
himself to man's terms, but with God there is no such distinction as
temporal and spiritual, but all things are spiritual. (See Doc. & Cov., Sec.
29:31-35.)
7. Job xi: 7.
LESSON III.
THE ORGANIZATION AND DUTIES OF
THE SEVENTY. (Continued.)
I. Of Other Than the Note 1. Doc. & Cov. Sec.

Special Labors of the 107; 8-10, 34. Note 2.
Seventy.
II. Quorum Note 3. Doc. & Cov. Sec.

Organization. 107; 93-98; Note 4, 5.
1. Presidents.
2. Members.
3. Effectiveness of the
Quorum Organization.
III. The First Quorum of Note 4. Doc. & Cov. Sec.

the Seventy. 107; 25, 33[1] Art. of Faith.
1. Jurisdiction--Local, (Talmadge) p. 214.
General. Outlines Eccl. Hist. Sec. v,
2. Limitation in the p. 344.
Choice of Presidents.
3. Distinction and
Authority of the First
Quorum. Summary.
IV. The Seventy to be an Note 6. Doc. & Cov. Sec.

Educated, Trained 88; 77, 8, 117, 118. Ibid.
Ministry. Sec. 130; 18-21. Sec. 131;
1. Need of Knowing the 6. Brigham Young on
Truth in Order to Teach It. Education, Contributor
2. Admonition of the Lord Vol. X, pp. 281-283;
to the Elders. Mormon Point of View in
Education, Improvement
Era Vol. II, pp. 119 et seq.
Doc. & Cov. Sec. 84; 85
Note 7.
SPECIAL TEXT: Let it become a special conviction with all, that to become
a Seventy means mental activity, intellectual development, and finally
spiritual power.
"All are to preach the gospel by the power and influence of the Holy Ghost;
and no man can preach the gospel without the Holy Ghost."—JOSEPH
SMITH.
NOTES.
1. Of Labors Other than Special that Seventies May Perform: While

preaching the gospel unto all nations is the special business of the Twelve
and Seventy, it must not be thought that that is the only function which the
Seventy may discharge. As on occasion the High Priests and Elders and
members of the lesser Priesthood can be used to assist in the work of the
foreign ministry (Doc. & Cov., Sec. 84:106-111), so also, when at home,
and not engaged in the special work of their calling, the Seventy may be
employed in the home ministry, and assist the standing ministry in the
wards and stakes of Zion in perfecting the Saints and edifying the body of
Christ until they shall all come unto a unity of the faith and the knowledge
of the Son of God, "unto the measure of the stature of the fulness of Christ."
Paul, in his most excellent description of the Church organization, likens it
unto the body of a man. Accepting his illustration it may be said that the
foreign ministry may be regarded as the right arm of the Church, and the
home ministry as the left arm. Now, because one is the right arm and one
the left, shall either refuse to assist the other at need? Or shall this
organization (the Church), which is said to be the "body of Christ," be as
effectual in the performance of its functions as the natural body of man is,
and in every case of need have the right hand come to the assistance of the
left, and vise versa? Right reason will approve an affirmative answer.
2. Power of the Melchisedek Priesthood: The Melchisedek Priesthood

holds the right of Presidency, and has power and authority over all the
offices in the Church in all ages of the world, to administer in spiritual
things. The Presidency of the High Priesthood, after the order of
Melchisedek, have a right to officiate in all the offices in the Church. High
Priests after the order of the Melchisedek Priesthood, have a right to
officiate in their own standing, under the direction of the Presidency, in
administering spiritual things; and also in the office of an Elder, Priest, (of
the Levitical order), Teacher, Deacon, and member. (Doc. & Cov. Sec.
106:8-10.)
While the statements here made about the higher officers of the Church
administering in the lower offices—a High Priest officiating in the office of
Elder, Priest, Teacher or Deacon—are limited to High Priests, yet the
principle holds good as to Seventies also. Besides note the statement, "The
Melchisedek Priesthood holds the right of presidency and has power and
authority over all the offices in the Church, in all ages of the world, to
administer in spiritual things;" and as the Seventy holds this Melchisedek
Priesthood, he may, under the direction of the presidency (See Ibid verse
10), administer in any of the offices of the Church; also this has always
been the practice of the Church; and the practice of the Church, generally
speaking, is the best interpretation of the scripture.
3. Organization of the Seventy. The quorums of Seventy are organized

with special reference to their calling as the foreign ministry of the Church.
It will be observed that their organization is different from that of every
other quorum in the Church, for whereas in all other quorums of the higher
Priesthood the presidency consists of one president and two counselors, in
the quorum of the Seventy there are seven presidents of equal power and
authority. That is to say, there is not one president and six counselors, but
each of the seven is a president and in power and authority is equal with his
fellow-presidents; but for the sake of order the right of presidency is
recognized as being vested in the senior president by ordination. "And it is
according to the vision, showing the order of the Seventy, that they should
have seven presidents to preside over them, chosen out of the number of the
Seventy. And the seventh president (counting from the one last ordained) of
these presidents is to preside over the six." In the absence of the senior
president the next senior in ordination becomes the acting president. By this
simple arrangement all confusion as to the right of presiding is obviated, for
no sooner does the council of a quorum or any part thereof convene, than
each president knows at once upon whom the responsibility of presiding
rests, let them meet where they may.
By virtue of having seven presidents a quorum of Seventy is not easily

disorganized, and this doubtless was one of the objects in view in this
arrangement. One, two, three, or even six of the presidents could be sent
abroad upon missions (although that is not likely to be the case at any one
time) and yet the quorum would have a president left, who, with the
quorum, would be competent to transact whatever of business might be
necessary for that quorum.
Other duties and advantages growing out of this organization are apparent
on a little reflection. Suppose, for instance, that a quorum of Seventy should
be sent out bodily to preach the gospel, as the quorum of the Twelve at
times have been. You would then have an organization which could be
broken up into seven groups of ten men each, with a president for each
group. These groups could be broken up into five pairs, and the Elders
travel two and two, as the law of the gospel requires. It can be readily seen
that such a quorum could be a flying column, capable of being broken up,
first into groups and sent into different districts; and the groups again
broken up into pairs and spread out over a wide area of country. The pairs
could be called together in groups of ten for conference, for adjustment and
rearrangement of traveling companions, and the groups occasionally
brought together in quorum conference, report, or transact whatever
business might be necessary, and again be scattered into fields of labor. In
all of which there appears the very finest adaptation of means to an end; and
also there appears more than mere human wisdom displayed in this
organization of the quorums of the foreign ministry.
4. Of the First Quorum of the Seventy: In the revelation before quoted it
is said: "And it is according to the vision, showing the order of the Seventy,
that they should have seven presidents to preside over them, chosen out of
the number of the seventy. * * * And these seven presidents are to choose
other Seventy besides the first Seventy, to whom they belong, and are to
preside over them; and also other Seventy, until seven times seventy, if the
labor in the vineyard of necessity requires it."
It must not be understood that this passage limits the number of quorums to
seven times seventy, for the Prophet, at the time the quorums were being
organized, stated that "If the first Seventy are all employed and there is a
call for more laborers, it will be the duty of the seven presidents of the first
Seventy to call and ordain other Seventy, and send them forth to labor in the
vineyard, until if needs be, they set apart seven times seventy, and even
until there are 144,000 thus set apart for the ministry." (See Church History,
Vol. II: 221 and Notes.)
It will be observed in the quotation from the Doctrine & Covenants above
that provision is made that the presidents of Seventy are to be "chosen out
of the number of the Seventy." It is because of this special provision that
when inadvertently High Priests have been selected for presidents of
Seventy they have taken their place again in the quorum of High Priests and
others from among the Seventy, as provided by the law of God, chosen to
fill their place. It will also be observed that the council of the First Seventy,
in addition to presiding over their own quorum (the first), have a general
presidency over all the quorums of the Church. It is this first quorum,
members and presidents together, which constitutes what, by way of
explanation, we may call the quorum of Seventy, the quorum of which it is
said that they are equal in authority to the quorum of the twelve special
witnesses, or Apostles.
5. Summary. It may be said by way of recapitulation that the Seventy hold

the Melchisedek Priesthood; that with the Twelve, under whose directions
they labor, they constitute the foreign ministry of the Church: that their
special calling is to travel and preach the gospel in all nations, first to the
Gentiles and then to the Jews; that they can, on occasion be employed in the
work of the ministry at home, because their Priesthood authorizes them to
do good and bring to pass righteousness wherever they may be, and when
acting in order and under the direction of the Twelve Apostles they may do
whatever is necessary to be done in order to accomplish the purposes of
God, whose ministers they are; but their organization has particular
reference to their special work of preaching the Gospel in all the world.
6. An Intelligent and Informed Ministry Contemplated in the Church:

After this brief review of the organization and duties of the Seventies, it
must be clearly manifest that it is the imperative duty of those holding this
office in the Priesthood to make careful and thorough preparation to
discharge the responsibilities of their high calling as the ambassadors of the
Lord Jesus. Being special witnesses of the name of Christ in all the world,
preachers (i. e., teachers) of the gospel, and authorized under the direction
of the Twelve Apostles to act in the name of the Lord in "building up the
Church and regulating all the affairs of the same in all nations" (Doc. &
Cov. Sec. cvii), it behooves them to become witnesses who understand the
truth of which they testify, skilled workman, ambassadors of whom the
Master need not be ashamed. It is evident that the Lord never designed that
his ministry should be an ignorant ministry; for to the early Elders of his
Church, in this last dispensation, when instructing a number of them to
prepare for labor in the vineyard, he said:
"And I give unto you a commandment that you shall teach one another
the doctrine of the kingdom; teach ye diligently and my grace shall
attend you, that you may be instructed more perfectly in theory, in
principle, in doctrine, in the law of the gospel, in all things that pertain
unto the kingdom of God, that are expedient for you to understand. Of
things both in heaven and in the earth, and under the earth; things
which have been, things which are, things which must shortly come to
pass; things which are at home, things which are abroad; the wars and
the perplexities of the nations, and the judgments which are on the
land, and a knowledge also of countries and of kingdoms. That ye may
be prepared in all things when I shall send you again to magnify the
calling whereunto I have called you, and the mission with which I have
commissioned you. * * * Therefore, verily, I say unto you, my friends,
call your solemn assembly, as I have commanded you; and as all have
not faith, seek, ye diligently and teach one another words of wisdom;
yea, seek ye out of the best books words of wisdom; seek learning
even by study, and also by faith." (Doc. & Cov. Sec. 88:77, 78, 80 and
117, 118.)
The instructions then given to the Elders of the Church are still applicable
to men engaged in the same ministry, and charged with like responsibility.
Elsewhere I have said, on the foregoing passage from the Doctrine and
Covenants:
"I think I may safely challenge any one to point out a broader field of
knowledge than is here indicated. It includes all spiritual truth, all
scientific truth, all secular knowledge—knowledge of the past, of the
present, of the future; of the heavens, and of the earth. A knowledge of
all countries, their geography, languages, history, customs, laws and
governments—everything in fact that pertains to them. There is
nothing in the heights above or the depths below that is not included in
this field of knowledge into which the commandment of God directs
his servants to enter. I may claim for it that it includes the whole realm
of man's intellectual activities. And the doctrine that whatever
principles of intelligence man attains unto in this life will rise with him
in the morning of the resurrection—this doctrine that nothing acquired
in respect of knowledge is ever lost, must forever form the most
powerful incentive to intellectual effort that possibly can be conjured
up by the wit of man. So that, referring to the acquirement of
knowledge, and intellectual development, Mormonism at once both
indicates the broadest field and furnishes the grandest incentive to
intellectual effort." ("The Mormon Point of View in Education,"
Improvement Era, Vol. II, p. 119.)
Commenting once upon the above passages from the Doctrine and
Covenants, the writer remarked:
"I trust no one will receive the impression that I leave out of
consideration, or have not attached proper importance to the part
which the Spirit of God takes in these things (the preaching of the
gospel). I think there is no one with whom I am acquainted that
believes more fervently than I do that in order to succeed in preaching
the gospel one must do so by the gift and by the power of the Holy
Ghost. I know that the Lord has given instruction to the Elders of the
Church that separates their methods of work, as wide as day is
separated from the night, from those methods of preaching adopted by
the world—I know that he has said: "Think not what ye shall say, but
in the very hour that it is needed it shall be given to you that which you
shall say." But while I remember that, I remember also the admonition
which he has given to the Elders in the self same passage, to the effect
that they should "treasure up continually the words of life," a part of
the instruction that I have sometimes thought is too much neglected. I
believe we shall best succeed if, when treasuring up the words of life,
we do it systematically; that instead of being like an unwise builder
who throws into one promiscuous heap lime, sand, bricks and frames,
together with a hundred and one other materials that enter into the
construction of his building, that each be placed by itself, carefully
stored away where the workmen can readily find it and bring each part
to the building as the builder has need. So, I say, systematize your
efforts in reading, in thought, in speech, and after you have done all
that, I believe that you will have all the more claim upon the Spirit and
blessing of God. After you have made the attempt to carry out the
instructions which our Father in heaven has given in respect of storing
your minds with the words of life, you can then go to him saying:
"Father, I have done all I can with the powers thou hast placed at my
command, now help me by thy grace; and bless all that I have done,
and the honor and praise and the glory shall be thine." Under these
circumstances, if your efforts be accompanied by secret prayer before
God, who hears in secret and rewards openly, he will bless your
ministry beyond all your expectation." ("Preparation for the Ministry,"
a discourse delivered in Salt Lake Tabernacle, Oct. 28, 1894.)
Footnotes
1. Compare verse 33 with verse 32: also verses 25 and 26, with verses 23
and 24, Doc. & Cov., Sec. 107.
PART II.
A Study of the Hebrew Scriptures.—-The
Old Testament.
LESSON I.
THE ANTIQUITY, CLASSIFICATION
AND CHARACTER OF THE OLD
TESTAMENT.
I. Definitions of the The Seventies Bible

Term "Bible." Dictionary word, "Bible;"
[1]
also other Bible Helps;
"Smith's Dictionary of the
Bible;"[2] "Cyclopaedia
Biblical Literature,"
(Kitto); "The Gospel,"
(Roberts), Chap. vi[3].
II. Antiquity of the Old Notes 1 and 2. Josephus'

Testament Writings. Antiquities of the Jews.
Book XX, Chap. x.
Josephus' Preface to
Antiquities of the Jews;
"Commentary Critical and
Explanatory;"[4] The
Gospel, (Roberts), Chap.
vi and vii, Book of
Mormon, I Nephi, chap.
v:10-13; Y. M. M. I. A.
Manual, 1903-4, on the
Book of Mormon, Part. I.
Chap. I, II. Pearl of Great
Price, Chap. 1; History of
the Church Vol. I, p. 98.
III. Classification of the Josephus vs Apion, Bk. I.

Old Testament Books. (See note 1). The Gospel,
1. The Law; (Roberts), Chap. vi; Dr.
2. The Prophets; Smith's Old Testament
3. The Writings or History, Appendix 1, pp.
Hagiographa; 651-3. The Seventy's
4. The Apocrypha. Bible Dictionary, Art.
Bible, subdivision
"Structure of the Bible;"
Ibid. Art. Apocrypha.
Oxford and other Bible
Helps.
SPECIAL TEXT: "Search the Scriptures; for in them ye think ye have

eternal life: and they are they which testify of me."—JESUS.
NOTES.
1. Antiquity of the Hebrew Sacred Books: Josephus in his first book

against Apion ascribes the most ancient books of the Hebrew race—the
Pentateuch, the five books—to Moses, and in contrasting the Hebrew
literature with that of the Greeks, he says:
"We, therefore, (who are Jews) must yield to the Grecian writers as to
language and eloquence of composition; but then we shall give them
no such preference as to the verity of ancient history, and least of all as
to that part which concerns the affairs of our several countries. As to
the care of writing down the records from the earliest antiquity among
the Egyptians and Babylonians; that the priests were intrusted
therewith, and employed a philosophical concern about it; that they
were the Chaldean priests that did so among the Babylonians, and that
the Phoenicians, who were mingled among the Greeks, did especially
make use of their letters both for the common affairs of life and for the
delivering down the history of common transactions, I think I may
omit any proof, because all men allow it so to be. But now as to our
forefathers, that they took no less care about writing such records, (for
I will not say they took greater care than the others I spoke of,) and
that they committed that matter to their high priests and to their
prophets, and that these records have been written all along down to
our own times with the utmost accuracy. * * * * * For our forefathers
did not only appoint the best of these priests, and those that attended
upon the divine worship, for that design from the beginning, but made
provision that the stock of the priests should continue unmixed and
pure; for he who is partaker of the Priesthood must propagate of a wife
of the same nation, without having regard to money, or any other
dignities: but he is to make a scrutiny, and take his wife's genealogy
from the ancient tables, and procure many witnesses to it. And this is
our practice not only in Judea, but wheresoever any body of men of
our nation do live; and even there an exact catalogue of our priests'
marriages is kept; I mean at Egypt and at Babylon, or in any other
place of the rest of the habitable earth, whithersoever our priests are
scattered; for they send to Jerusalem the ancient names of their parents
in writing, as well as those of their remoter ancestors, and signify who
are the witnesses also. * * * But what is the strongest argument of our
exact management in this matter is what I am now going to say. That
we have the names of our high priests from father to son set down in
our records, for the interval of two thousand years; and if any of these
have been transgressors of these rules, they are prohibited to present
themselves at the altar, or to be partakers of any other of our
purifications; and this is justly, or rather necessarily done, because
every one is not permitted of his own accord to be a writer, nor is there
any disagreement in what is written; they being only prophets that
have written the original and earliest accounts of things, as they
learned them of God himself by inspiration; and others have written
what hath happened in their own time, and that in a very distinct
manner also: For we have not an innumerable multitude of books
among us, disagreeing from and contradicting one another, (as the
Greeks have,) but only twenty-two books, which contain the records of
all the past times, which are justly believed to be divine. And of them,
five belong to Moses, which contain his laws and the traditions of the
origin of mankind till his death. This interval of time was little short of
three thousand years; but as to the time from the death of Moses till the
reign of Artaxerxes, king of Persia, who reigned after Xerxes; the
prophets, who were after Moses, wrote down what was done in their
times in thirteen books. The remaining four books contain hymns to
God, and precepts for the conduct of human life. It is true, our history
hath been written since Artaxerxes very particularly, but hath not been
esteemed of the like authority with the former by our forefathers,
because there hath not been an exact succession of prophets since that
time; and how firmly we have given credit to these books of our own
nation, is evident by what we do; for during so many ages as have
already passed, no one hath been so bold as either to add anything to
them, to take anything from them, or to make any change in them; but
it is become natural to all Jews, immediately and from their very birth,
to esteem these books to contain divine doctrines, and to persist in
them, and, if occasion be, willingly to die for them. For it is no new
thing for our captives, many of them in number, and frequently in
time, to be seen to endure racks and deaths of all kinds upon the
theatres, that they may not be obliged to say one word against our laws
and the records that contain them." (Antiquity of the Jews, Flavius
Josephus Against Apion, Book 1, pp. 582-583.)
2. The Effect of Recent Discoveries in Chaldea and Egypt on the

Authorship of the Five Books in the Bible Ascribed to Moses:
"The Assyrian inscriptions which have been recently recovered and

given to the English-speaking peoples by Layard, George Smith,
Sayce, and others, show that in the ancient religions of Chaldea and
Babylonia there was elaborated a narrative of the creation which, in its
most important features, must have been the source of that in our own
sacred books. It has now become perfectly clear that from the same
sources which inspired the accounts of the creation of the universe
among the Chaldee-Babylonian, the Assyrian, the Phoenician, and
other ancient civilizations came the ideas which hold so prominent a
place in the sacred books of the Hebrews. * * * * From this idea of
creation was evolved in time a somewhat nobler view. Ancient
thinkers, and especially, as is now found, in Egypt, suggested that the
main agency in creation was not the hands and fingers of the Creator,
but his voice. Hence was mingled with the earlier, cruder belief
regarding the origin of the earth and heavenly bodies by the Almighty
the more impressive idea that "he spake and they were made"—that
they were brought into existence by his word." (A History of the
Warfare of Science with Theology in Christendom, Vol. 1, pp. 2-3).
Referring again to the work of the noted Archaeologists mentioned above,

with others, Mr. White goes on to say that they "have deciphered a
multitude of ancient texts, especially the inscriptions found in the great
library of Assurbanipal at Nineveh, and have discovered therein an account
of the origin of the world identical in its most important features with the
later accounts in our own book of Genesis. These men have had the courage
to point out these facts and to connect them with the truth that these
Chaldean and Babylonian myths, legends, and theories were far earlier than
those of the Hebrews, which so strikingly resemble them, and which we
have in our sacred books; and they have also shown us how natural it was
that the Jewish accounts of the creation should have been obtained at that
remote period when the earliest Hebrews were among the Chaldeans, and
how the great Hebrew poetic accounts of creation were drawn either from
the sacred traditions of these earlier peoples or from antecedent sources
common to various ancient nations." (A History of the Warfare of Science
with Theology in Christendom, Vol. 1, p. 20.)
There can be no doubt but what the accounts of creation found in these
Assyrian and Egyptian sources are earlier than those written by Moses, or
that they are similar in import, but because of these facts is it necessary to
discredit either the Mosaic authorship of the five books of the Bible
accredited to that Prophet, or doubt the inspiration of these accounts? And
yet this has been the result of these discoveries on many minds. The truth is,
that the outlined facts of the creation have been known by our race from
earliest times, from the days of Adam in fact. They were matters of
common knowledge among the antediluvian patriarchs, and through the
family of Noah were preserved for the families and races of men
subsequent to the flood; and variously distorted these creation facts were
preserved by all people. But all this did not prevent the Lord from revealing
the creation history to Moses, nor does it require us to doubt the inspiration
which rested upon him and that enabled him to weave into splendid
coherent form the fragmentary truths held among the ancient Egyptians and
Assyrian peoples. That there were pre-Mosaic documents containing
accounts of creation and the history of God's hand-dealings with ancient
peoples, we have abundant proof of in the Book of Abraham, which so
strangely came into the possession of the Prophet Joseph Smith (See
Church History, Vol. II, pp. 235-6, 348-350). Also that the Lord revealed the
creation facts, and also the early history of our race to Moses, is confirmed
by revelation to the Prophet of the nineteenth century, Joseph Smith (See
Pearl of Great Price, Book of Moses, pp. 1-48, also History of the Church,
Vol. I, 98 et seq.)
The student will find a well written article by Professor A. H. Sayce, in

"The Bible Treasury," pp. 37-42, that bears upon this subject. The matter is
also discussed at some length in Young Men's Manual for 1903-4 (No. 7).,
chap. I.
Furthermore, it should be noted that the writers of the New Testament bear
emphatic testimony to the authenticity and divine authority of the Old
Testament, since these writers so frequently quoted it as a work of divine
authority. "Indeed," says an accepted authority in this class of literature,
"the references are so numerous, and the testimonies so distinctly borne to
the existence of the Mosaic books throughout the whole history of the
Jewish nation, and the unity of character, design and style pervading these
books is so clearly perceptible, notwithstanding the rationalistic assertions
of their forming a series of separate and unconnected fragments, that it may
with all safety be said, there is immensely stronger and more varied
evidence in proof of their being the authorship of Moses than of any of the
Greek or Roman classics being the productions of the authors whose names
they bear." (Commentary on the Old and New Testaments, Jamieson-
Fausset-Brown, preface.)
3. Hagiographa: Hagiographa—the Greek name of the last of the three

Jewish divisions of the Old Testament. They are variously reckoned, but
usually comprise the Psalms, Proverbs, Job, Canticles, Ruth, Lamentations,
Ecclesiastes, Esther, Daniel, Ezra, Nehemiah, and Chronicles. (The Century
Dictionary and Cyclopaedia, Vol. IX.)
4. The Subdivisions of the Old Testament—Its Dignity and Authority:

The student will observe that the classification of the books in the several
authorities cited, all vary somewhat in the grouping and subdivisions of
them; but I believe it will be found that the grouping in the analysis of the
Seventies' Bible Dictionary will be found most complete and satisfactory.
One thing should be borne in mind with reference to this whole volume of
ancient Hebrew scripture, and that is, whatever the sub-division may be,
history, legislation, poetry, prophecy, biography, or proverbs, it is written
under the inspiration of God. That does not mean that human elements are
not to be found in it, but rather that a divine spirit is present in the midst of
those human elements giving forth light and truth and wisdom such as is to
be found in no merely human production. There is a divine spirit always
present in these scripture narratives, prophecies and poetry that make the
whole to contain a revelation of God, and an account of his methods of
doing things among men, all of which gives to those writings an authority
that does not pertain to the ordinary writings of men.
Footnotes
1. It will be understood that by "Seventies' Bible," is meant throughout the

Bible selected for the "Seventies' Indispensible Library," "The Teacher's
Bible," Cambridge edition.
2. Hackett edition always quoted.
4. This work will always be so quoted, it is a recent work produced in

collaboration by Robert Jamieson, D. D., St. Paul's, Glasgow, Scotland; A.
R. Fausset, D.D., St. Cuthberts, York, England; and David Brown, D.D.,
Professor of Theology, Aberdeen, Scotland. It is one of the best works of its
kind, and represents the latest orthodox interpretations of the Scriptures,
and while the Elders which make up our ministry may not accept the

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Symbols and abbreviations xiii

Additional references including comprehensive trial references

ATLAS adjuvant tamoxifen longer against shorter

FAC ﬂuorouracil, adriamycin, cyclophosphamide (cytoxan)

PICC peripherally inserted central catheters

TSE turbo spin echo

Irfan Ahmed Mark Emberton

M. Asif Chaudry Said A. Mohamed

James R. A. Skipworth Hashim Uddin Ahmed

Central venous access for chemotherapy 60

3 Thyroid and parathyroid tumours 175

4 Oesophageal cancer 221

Operative considerations 240

5 Gastric cancer 281

7 Cancers of the pancreas 359

8 Small bowel and rare GI cancers 415

9 Colorectal cancer 439

10 Anal cancer 525

11 Renal cancer 535

12 Bladder and upper urinary tract cancer 555

13 Prostate carcinoma 579

14 Testicular cancer 603

15 Soft tissue sarcoma 619

1. Common imaging modalities 2

1. Common imaging modalities

Plain ﬁlm ‘X-rays’ and barium studies

Magnetic resonance imaging

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2. Regional cancer imaging

"Agreeable to his request to Elder Brigham Young, the branches were

"Pursuant to this adjournment, the Conference convened on Saturday,

10. The Seventy Sustained as Apostles: During the dedicatory services in

"I then called upon the quorums and congregation of Saints to

11. The First Council of Seventy Lead Kirtland Camp to Missouri:

12. Increase of Quorums at Nauvoo: At the October Conference, 1844,

THE ORGANIZATION OF THE SEVENTY.

SALT LAKE CITY, U. T., April 13, 1883.

In the organization of these quorums in October, 1844, there were ten

The First Quorum of Seventies may be composed of the First Seven

Any of the members or presidents of other quorums who are in good

The presidents of the quorums residing in the district where their

In all cases where members of quorums are called in question, a

The Seventies, when abroad, if anything should occur requiring their

What ye have written is my will, and is acceptable unto me: and