Clinical staging of rectal cancer Journal Article
| Authors: | Barabouti, D. G.; Wong, W. D. |
| Article Title: | Clinical staging of rectal cancer |
| Abstract: | Initial accurate clinical staging of patients with rectal cancer is necessary in order to select optimal treatment and determine prognosis. Decision-making for the best possible treatment is predicated on achieving the highest rate of cure while maintaining acceptable quality of life and avoiding unnecessary morbidity. Surgical options and indications for combined modality therapy will differ significantly, however, depending on tumor stage. Staging is based on depth of invasion of the rectal wall by tumor (T-stage) and presence of lymph node involvement (N-stage). Digital rectal examination (DRE), computed tomography (CT), magnetic resonance imaging (MRI), and endorectal ultrasound (ERUS) have all been used in local staging of rectal cancer. In the hands of an experienced clinician, the currently available technology can satisfactorily determine T-stage; however, prediction of N-stage is less reliable. This review discusses and compares the indications for, and advantages and limitations of, the various diagnostic modalities used in clinical staging of rectal cancer, with emphasis on ERUS and MRI. These two modalities have shown a similar accuracy in overall tumor staging. MRI seems to be more accurate in assessment of T3 and T4 lesions, whereas ERUS may be more accurate in assessment of T1 and T2 lesions. ERUS is faster, portable, more accessible and less expensive. MRI provides a multiplanar and larger field of view, capable of encompassing the entire mesorectal fascia and assessing the possibility of obtaining a tumor-free circumferential resection margin. Both modalities show moderate accuracy in predicting nodal disease. © 2005 Elsevier Inc. All rights reserved. |
| Keywords: | review; multimodality cancer therapy; cancer staging; nuclear magnetic resonance imaging; lymph node metastasis; cancer diagnosis; diagnostic accuracy; quality of life; computer assisted tomography; morbidity; ultrasound; cancer invasion; disease severity; intermethod comparison; rectum carcinoma; decision making; cost; rectal cancer; digital rectal examination; rectum; fascia; endorectal ultrasound; mesorectal fascia |
| Journal Title: | Seminars in Colon and Rectal Surgery |
| Volume: | 16 |
| Issue: | 3 |
| ISSN: | 1043-1489 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2005-09-01 |
| Start Page: | 104 |
| End Page: | 116 |
| Language: | English |
| DOI: | 10.1053/j.scrs.2005.09.002 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 1" - "Export Date: 24 October 2012" - "CODEN: SCRSF" - "Source: Scopus" |
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