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Imaging and management of rectal cancer

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 665–676 (2007)Cite this article

A Corrigendum to this article was published on 01 February 2008

Abstract

Local staging and management of rectal cancer has evolved during the past decade. Imaging modalities used for staging rectal cancer include CT, endoscopic ultrasound, pelvic phased-array coil MRI, endorectal MRI, and PET. Each modality has its strengths and limitations. Evidence supports the use of both endoscopic ultrasound and CT in staging rectal cancer. MRI is the only reliable tool for determining the status of the circumferential resection margin, which is important for the assessment of the risk of local recurrence.

Key Points

  • Endoscopic ultrasound (EUS) is the best method of local T staging of rectal cancer

  • The use of EUS for staging rectal cancer seems to improve disease-free survival because EUS facilitates the appropriate selection of patients for neoadjuvant therapy; the use of EUS has also increased the number of sphincter-preserving surgeries performed in patients with rectal cancer

  • CT plus EUS is the most cost-effective strategy for staging rectal cancer

  • Rectal cancer staging with EUS or MRI is not accurate after patients have received neoadjuvant therapy

  • The clinical outcomes of local recurrence, overall recurrence, and survival are better after radical resection versus transanal excision in patients with stage T1 rectal cancer

  • MRI is the most useful staging tool for determining the status of the circumferential resection margin, which is important in the assessment of the risk of local recurrence

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Figure 1: Endoscopic ultrasound images of rectal tumors.
Figure 2: T2-weighted endorectal MRI of rectal tumors.

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Acknowledgements

I would like to thank Jane Schoening for her help in preparing this manuscript. I would also like to thank Dr Kumar Sandrasegaran for providing the MRI images.

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  1. Division of Gastroenterology and Hepatology, Indiana University Medical Center, 550 N University Boulevarde, UH 4100, Indianapolis, IN 46202, USA juleblan@iupui.edu

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  1. JK LeBlanc is Director of the Endoscopic Ultrasound Program and an Assistant Professor of Medicine in the Division of Gastroenterology and Hepatology at the Indiana University Medical Center, Indianapolis, IN, USA.,

    Julia K LeBlanc

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LeBlanc, J. Imaging and management of rectal cancer. Nat Rev Gastroenterol Hepatol 4, 665–676 (2007). https://doi.org/10.1038/ncpgasthep0977

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