Current trends in staging rectal cancer

Abstract

Management of rectal cancer has evolved over the years. In this condition preoperative investigations assist in deciding the optimal treatment. The relation of the tumor edge to the circumferential margin (CRM) is an important factor in deciding the need for neoadjuvant treatment and determines the prognosis. Those with threatened or involved margins are offered long course chemoradiation to enable R₀ surgical resection. Endoanal ultrasound (EUS) is useful for tumor (T) staging; hence EUS is a useful imaging modality for early rectal cancer. Magnetic resonance imaging (MRI) is useful for assessing the mesorectum and the mesorectal fascia which has useful prognostic significance and for early identification of local recurrence. Computerized tomography (CT) of the chest, abdomen and pelvis is used to rule out distant metastasis. Identification of the malignant nodes using EUS, CT and MRI is based on the size, morphology and internal characteristics but has drawbacks. Most of the common imaging techniques are suboptimal for imaging following chemoradiation as they struggle to differentiate fibrotic changes and tumor. In this situation, EUS and MRI may provide complementary information to decide further treatment. Functional imaging using positron emission tomography (PET) is useful, particularly PET/CT fusion scans to identify areas of the functionally hot spots. In the current state, imaging has enabled the multidisciplinary team of surgeons, oncologists, radiologists and pathologists to decide on the patient centered management of rectal cancer. In future, functional imaging may play an active role in identifying patients with lymph node metastasis and those with residual and recurrent disease following neoadjuvant chemoradiotherapy.

Lokale Diagnostik beim Rektumkarzinom

“…Die EUS und MRT sind die diagnostischen Verfahren der Wahl im präthe-rapeutischen lokalen Staging des Rektumkarzinoms. Samee et al [14] Im Jahr 2010 stieg dieser Anteil auf 9,9% an.…”

“…Die EUS und MRT sind die diagnostischen Verfahren der Wahl im präthe-rapeutischen lokalen Staging des Rektumkarzinoms. Samee et al [14] sehen in der EUS und der MRT die Untersuchungsverfahren der Wahl für das lokale T-Staging des Rektumkarzinoms, wobei für fortgeschrittene Tumoren eher die MRT, für frühe Karzinome eher die EUS geeignet sind. Dabei bietet die MRT den Vorteil, prätherapeutisch mit hoher Genauigkeit den Abstand des Tumors zum CRM beurteilen zu können.…”

Staging of rectal carcinoma: MDCT, MRI or EUS. Single center experience

“…The surgeon aims to achieve a microscopic tumor free (R0) resection. However, even if it is achieved, local recurrence may still happen (2).…”

“…Accurate pre-operative staging of rectal carcinoma is paramount in tailoring the optimal surgical treatment and is the best predictor for recurrence (2). Local staging incorporates the assessment of tumor involvement of the rectal wall and adjacent structures, presence or absence of adjacent lymphadenopathy.…”

“…Around 30-40% of colorectal cancer is defined to arise from the rectum which is defined as the distal margin of tumor within 15 cm of the anal verge (2).…”