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Staging and Evaluation of Rectal Cancer and Pelvic Malignancy

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Pelvic Cancer Surgery

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Abstract

Imaging has become an integral part of staging for most cancers. Identifying prognostic risk factors for survival outcomes aids clinicians to offer the most suitable and appropriate treatments. Magnetic resonance imaging (MRI), computed tomography (CT) and endoanal ultrasound (EAUS) all play some role in the local and distant staging rectal cancer and pelvic malignancy. Such factors as tumor penetration, nodal disease, circumferential margin involvement, vascular invasion and tumor height as important determinants in the risk of disease recurrence. In the local staging of tumor spread, MRI is the most accurate imaging modality which can identify the important prognostic factors of circumferential resection margin involvement and mesorectal spread. CT remains the optimal modality in staging distant disease in the chest, abdomen and pelvis. However, as newer technology develops such as PET-CT, patients may be offered combinations of imaging techniques determined by their risk of disease recurrence.

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References

  1. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4.

    Article  PubMed  Google Scholar 

  2. Stamos MJ, Murrell Z. Management of early rectal T1 and T2 cancers. Clin Cancer Res. 2007;13(22 Pt 2):6885s–9.

    Article  CAS  PubMed  Google Scholar 

  3. Taylor FG, Quirke P, Heald RJ, Moran B, Blomqvist L, Swift I, et al. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg. 2011;253(4):711–9.

    Article  PubMed  Google Scholar 

  4. Blackstock W, Russo SM, Suh WW, Cosman BC, Herman J, Mohiuddin M, et al. ACR appropriateness criteria: local excision in early-stage rectal cancer. Curr Probl Cancer. 2010;34(3):193–200.

    Article  PubMed  Google Scholar 

  5. Bretagnol F, Merrie A, George B, Warren BF, Mortensen NJ. Local excision of rectal tumours by transanal endoscopic microsurgery. Br J Surg. 2007;94(5):627–33.

    Article  CAS  PubMed  Google Scholar 

  6. Brown G. Staging rectal cancer: endoscopic ultrasound and pelvic MRI. Cancer Imaging. 2008;8(Spec No A):S43–5.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Heald RJ. The ‘Holy Plane’ of rectal surgery. J R Soc Med. 1988;81(9):503–8.

    PubMed Central  CAS  PubMed  Google Scholar 

  8. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery – the clue to pelvic recurrence? Br J Surg. 1982;69(10):613–6.

    Article  CAS  PubMed  Google Scholar 

  9. Brown G, Kirkham A, Williams GT, Bourne M, Radcliffe AG, Sayman J, et al. High-resolution MRI of the anatomy important in total mesorectal excision of the rectum. AJR Am J Roentgenol. 2004;182(2):431–9.

    Article  PubMed  Google Scholar 

  10. Taylor FG, Swift RI, Blomqvist L, Brown G. A systematic approach to the interpretation of preoperative staging MRI for rectal cancer. AJR Am J Roentgenol. 2008;191(6):1827–35.

    Article  PubMed  Google Scholar 

  11. Jass JR, Love SB, Northover JM. A new prognostic classification of rectal cancer. Lancet. 1987;1(8545):1303–6.

    Article  CAS  PubMed  Google Scholar 

  12. Cawthorn SJ, Parums DV, Gibbs NM, A’Hern RP, Caffarey SM, Broughton CI, et al. Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer. Lancet. 1990;335(8697):1055–9.

    Article  CAS  PubMed  Google Scholar 

  13. Merkel S, Mansmann U, Siassi M, Papadopoulos T, Hohenberger W, Hermanek P. The prognostic inhomogeneity in pT3 rectal carcinomas. Int J Colorectal Dis. 2001;16(5):298–304.

    Article  CAS  PubMed  Google Scholar 

  14. Shihab OC, Taylor F, Salerno G, Heald RJ, Quirke P, Moran BJ, et al. MRI predictive factors for long-term outcomes of low rectal tumours. Ann Surg Oncol. 2011;18(12):3278–84.

    Article  PubMed  Google Scholar 

  15. Brown G. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology. 2007;243(1):132–9.

    Article  Google Scholar 

  16. Wolmark N, Fisher B, Wieand HS. The prognostic value of the modifications of the Dukes’ C class of colorectal cancer. An analysis of the NSABP clinical trials. Ann Surg. 1986;203(2):115–22.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Tang R, Wang JY, Chen JS, Chang-Chien CR, Tang S, Lin SE, et al. Survival impact of lymph node metastasis in TNM stage III carcinoma of the colon and rectum. J Am Coll Surg. 1995;180(6):705–12.

    CAS  PubMed  Google Scholar 

  18. Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet. 2009;373(9666):821–8.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Brown G, Richards CJ, Bourne MW, Newcombe RG, Radcliffe AG, Dallimore NS, et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology. 2003;227(2):371–7.

    Article  PubMed  Google Scholar 

  20. Dworak O. Morphology of lymph nodes in the resected rectum of patients with rectal carcinoma. Pathol Res Pract. 1991;187(8):1020–4.

    Article  CAS  PubMed  Google Scholar 

  21. Puli SR, Reddy JB, Bechtold ML, Choudhary A, Antillon MR, Brugge WR. Accuracy of endoscopic ultrasound to diagnose nodal invasion by rectal cancers: a meta-analysis and systematic review. Ann Surg Oncol. 2009;16(5):1255–65.

    Article  PubMed  Google Scholar 

  22. Shihab OC, Taylor F, Bees N, Blake H, Jeyadevan N, Bleehen R, et al. Relevance of magnetic resonance imaging-detected pelvic sidewall lymph node involvement in rectal cancer. Br J Surg. 2011;98(12):1798–804.

    Article  CAS  PubMed  Google Scholar 

  23. Takahashi T, Ueno M, Azekura K, Ohta H. Lateral node dissection and total mesorectal excision for rectal cancer. Dis Colon Rectum. 2000;43(10 Suppl):S59–68.

    Article  CAS  PubMed  Google Scholar 

  24. Ueno H, Yamauchi C, Hase K, Ichikura T, Mochizuki H. Clinicopathological study of intrapelvic cancer spread to the iliac area in lower rectal adenocarcinoma by serial sectioning. Br J Surg. 1999;86(12):1532–7.

    Article  CAS  PubMed  Google Scholar 

  25. Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S, et al. Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 2006;49(11):1663–72.

    Article  PubMed  Google Scholar 

  26. Nagawa H, Muto T, Sunouchi K, Higuchi Y, Tsurita G, Watanabe T, et al. Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum. 2001;44(9):1274–80.

    Article  CAS  PubMed  Google Scholar 

  27. Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet. 1994;344(8924):707–11.

    Article  CAS  PubMed  Google Scholar 

  28. Taylor FG, Quirke P, Heald RJ, Moran B, Blomqvist L, Swift I, et al. One millimetre is the safe cut-off for magnetic resonance imaging prediction of surgical margin status in rectal cancer. Br J Surg. 2011;98(6):872–9.

    Article  CAS  PubMed  Google Scholar 

  29. Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet. 1986;2(8514):996–9.

    Article  CAS  PubMed  Google Scholar 

  30. Hall NR, Finan PJ, Al-Jaberi T, Tsang CS, Brown SR, Dixon MF, et al. Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence? Dis Colon Rectum. 1998;41(8):979–83.

    Article  CAS  PubMed  Google Scholar 

  31. Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol. 2008;26(2):303–12.

    Article  PubMed  Google Scholar 

  32. Cecil TD, Sexton R, Moran BJ, Heald RJ. Total mesorectal excision results in low local recurrence rates in lymph node-positive rectal cancer. Dis Colon Rectum. 2004;47(7):1145–9; discussion 1149–50.

    Article  PubMed  Google Scholar 

  33. Shihab OC, Quirke P, Heald RJ, Moran BJ, Brown G. Magnetic resonance imaging-detected lymph nodes close to the mesorectal fascia are rarely a cause of margin involvement after total mesorectal excision. Br J Surg. 2010;97(9):1431–6.

    Article  CAS  PubMed  Google Scholar 

  34. Talbot IC, Ritchie S, Leighton MH, Hughes AO, Bussey HJ, Morson BC. The clinical significance of invasion of veins by rectal cancer. Br J Surg. 1980;67(6):439–42.

    Article  CAS  PubMed  Google Scholar 

  35. Smith NJ, Barbachano Y, Norman AR, Swift RI, Abulafi AM, Brown G. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg. 2008;95(2):229–36.

    Article  CAS  PubMed  Google Scholar 

  36. Rullier A, Gourgou-Bourgade S, Jarlier M, Bibeau F, Chassagne-Clement C, Hennequin C, et al. Predictive factors of positive circumferential resection margin after radiochemotherapy for rectal cancer: the French randomised trial ACCORD12/0405 PRODIGE 2. Eur J Cancer. 2013;49(1):82–9.

    Article  PubMed  Google Scholar 

  37. Smith NJ, Shihab O, Arnaout A, Swift RI, Brown G. MRI for detection of extramural vascular invasion in rectal cancer. AJR Am J Roentgenol. 2008;191(5):1517–22.

    Article  PubMed  Google Scholar 

  38. MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ. 2006;333(7572):779.

    Article  PubMed Central  Google Scholar 

  39. Marr R, Birbeck K, Garvican J, Macklin CP, Tiffin NJ, Parsons WJ, et al. The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg. 2005;242(1):74–82.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365(9472):1718–26.

    Article  PubMed  Google Scholar 

  41. Nagtegaal ID, van de Velde CJ, Marijnen CA, van Krieken JH, Quirke P. Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol. 2005;23(36):9257–64.

    Article  PubMed  Google Scholar 

  42. Shihab OC, Heald RJ, Rullier E, Brown G, Holm T, Quirke P, et al. Defining the surgical planes on MRI improves surgery for cancer of the low rectum. Lancet Oncol. 2009;10(12):1207–11.

    Article  PubMed  Google Scholar 

  43. Shihab OC, How P, West N, George C, Patel U, Quirke P, et al. Can a novel MRI staging system for low rectal cancer aid surgical planning? Dis Colon Rectum. 2011;54(10):1260–4.

    Article  PubMed  Google Scholar 

  44. Cohade C, Osman M, Leal J, Wahl RL. Direct comparison of (18)F-FDG PET and PET/CT in patients with colorectal carcinoma. J Nucl Med. 2003;44(11):1797–803.

    PubMed  Google Scholar 

  45. Brush J, Boyd K, Chappell F, Crawford F, Dozier M, Fenwick E, et al. The value of FDG positron emission tomography/computerised tomography (PET/CT) in pre-operative staging of colorectal cancer: a systematic review and economic evaluation. Health Technol Assess. 2011;15(35):1–192, iii–iv.

    Article  CAS  PubMed  Google Scholar 

  46. Hunter CJ, Garant A, Vuong T, Artho G, Lisbona R, Tekkis P, et al. Adverse features on rectal MRI identify a high-risk group that may benefit from more intensive preoperative staging and treatment. Ann Surg Oncol. 2012;19(4):1199–205.

    Article  PubMed  Google Scholar 

  47. Avallone A, Aloj L, Caraco C, Delrio P, Pecori B, Tatangelo F, et al. Early FDG PET response assessment of preoperative radiochemotherapy in locally advanced rectal cancer: correlation with long-term outcome. Eur J Nucl Med Mol Imaging. 2012;39(12):1848–57.

    Article  CAS  PubMed  Google Scholar 

  48. Murcia Durendez MJ, Frutos Esteban L, Lujan J, Frutos MD, Valero G, Navarro Fernandez JL, et al. The value of (18)F-FDG PET/CT for assessing the response to neoadjuvant therapy in locally advanced rectal cancer. Eur J Nucl Med Mol Imaging. 2013;40(1):91–7.

    Article  CAS  PubMed  Google Scholar 

  49. Calvo FA, Domper M, Matute R, Martinez-Lazaro R, Arranz JA, Desco M, et al. 18F-FDG positron emission tomography staging and restaging in rectal cancer treated with preoperative chemoradiation. Int J Radiat Oncol Biol Phys. 2004;58(2):528–35.

    Article  PubMed  Google Scholar 

  50. Kalff V, Duong C, Drummond EG, Matthews JP, Hicks RJ. Findings on 18F-FDG PET scans after neoadjuvant chemoradiation provides prognostic stratification in patients with locally advanced rectal carcinoma subsequently treated by radical surgery. J Nucl Med. 2006;47(1):14–22.

    PubMed  Google Scholar 

  51. Martoni AA, Di Fabio F, Pinto C, Castellucci P, Pini S, Ceccarelli C, et al. Prospective study on the FDG-PET/CT predictive and prognostic values in patients treated with neoadjuvant chemoradiation therapy and radical surgery for locally advanced rectal cancer. Ann Oncol. 2011;22(3):650–6.

    Article  CAS  PubMed  Google Scholar 

  52. Ruby JA, Leibold T, Akhurst TJ, Shia J, Saltz LB, Mazumdar M, et al. FDG-PET assessment of rectal cancer response to neoadjuvant chemoradiotherapy is not associated with long-term prognosis: a prospective evaluation. Dis Colon Rectum. 2012;55(4):378–86.

    Article  PubMed  Google Scholar 

  53. Valls C, Andia E, Sanchez A, Guma A, Figueras J, Torras J, et al. Hepatic metastases from colorectal cancer: preoperative detection and assessment of resectability with helical CT. Radiology. 2001;218(1):55–60.

    Article  CAS  PubMed  Google Scholar 

  54. Nino-Murcia M, Olcott EW, Jeffrey Jr RB, Lamm RL, Beaulieu CF, Jain KA. Focal liver lesions: pattern-based classification scheme for enhancement at arterial phase CT. Radiology. 2000;215(3):746–51.

    Article  CAS  PubMed  Google Scholar 

  55. Mitry E, Guiu B, Cosconea S, Jooste V, Faivre J, Bouvier AM. Epidemiology, management and prognosis of colorectal cancer with lung metastases: a 30-year population-based study. Gut. 2010;59(10):1383–8.

    Article  PubMed  Google Scholar 

  56. Grossmann I, Avenarius JK, Mastboom WJ, Klaase JM. Preoperative staging with chest CT in patients with colorectal carcinoma: not as a routine procedure. Ann Surg Oncol. 2010;17(8):2045–50.

    Article  PubMed Central  PubMed  Google Scholar 

  57. Davis SD. CT evaluation for pulmonary metastases in patients with extrathoracic malignancy. Radiology. 1991;180(1):1–12.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Radiology, Royal Mardsen Hospital, Sutton, Surrey, UK

    Manish Chand MBBS, BSc, MRCS & Gina Brown MBBS, MD, FRCR

  2. Department of Radiology, The Royal Mardsen Hospital NHS Foundation Trust, Sutton, Surrey, UK

    Anita Wale BM, BS

Authors
  1. Manish Chand MBBS, BSc, MRCS
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  2. Anita Wale BM, BS
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  3. Gina Brown MBBS, MD, FRCR
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Correspondence to Manish Chand MBBS, BSc, MRCS .

Editor information

Editors and Affiliations

  1. Urology, University Hospital of North Norway, Tromsø, Norway

    Hitendra R.H. Patel

  2. University College London Hospital, London, United Kingdom

    Tim Mould

  3. Laparoscopic and Robotic Surgery, University of Rochester Medical Center, Rochester, New York, USA

    Jean V. Joseph

  4. Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA

    Conor P. Delaney

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Chand, M., Wale, A., Brown, G. (2015). Staging and Evaluation of Rectal Cancer and Pelvic Malignancy. In: Patel, H., Mould, T., Joseph, J., Delaney, C. (eds) Pelvic Cancer Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-4258-4_45

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  • DOI: https://doi.org/10.1007/978-1-4471-4258-4_45

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