Rectal Cancer: Preoperative Staging Using Endorectal Ultrasonography (Methodology)

  • Ho-Kyung Chun
  • Yong Beom Cho
  • Yong Jin Lee
Part of the Methods of Cancer Diagnosis, Therapy, and Prognosis book series (HAYAT, volume 4)

The prognosis of patients with rectal cancer is closely related to accurately assessing the extent of tumor within or beyond the rectal wall, and to the presence or absence of lymph node involvement. The risk of postoperative tumor recurrence is 5% for T1, 10% for T2, and 25% for T3. In case of lymph node involvement, the risk of tumor recurrence increases to 33% for T2 tumor and 66% for T3 tumor. The purpose of preoperative staging of rectal cancer is to predict as accurately as possible the two most important factors for determining the prognosis and risk of recurrence: rectal wall infiltration and regional lymph node metastasis. Accurate preoperative staging of rectal cancer facilitates optimal management, and it helps to determine the need for preoperative neoadjuvant therapy. Those patients whose tumors are confined within the mucosa/submucosa (T1) can be offered local excision as a good alternative to a radical operation. For more advanced rectal lesions, neoadjuvant chemoradiation succeeds in increasing the number of sphincter-preserving operations and improves the local tumor control and survival of these patients.


Rectal Cancer Rectal Wall Muscularis Propria Preoperative Staging Endorectal Ultrasonography 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Akasu, T., Kondo, H., Moriya, Y., Sugihara, K., Gotoda, T., Fujita, S., Muto, T., and Kakizoe, T. 2000. Endorectal ultrasonography and treatment of early stage rectal cancer.World J. Surg. 24: 1061–1068.PubMedCrossRefGoogle Scholar
  2. Bali, C., Nousias, V., Fatouros, M., Stefanou, D., and Kappas, A. M. 2004. Assessment of local stage in rectal cancer using endorectal ultrasonography (EUS).Tech. Coloproctol. 8: S170–S173.PubMedCrossRefGoogle Scholar
  3. Beynon, J. 1989. An evaluation of the role of rectal endosonography in rectal cancer.Ann. R. Coll. Surg. Engl. 71: 131–139.PubMedGoogle Scholar
  4. Beynon, J., Mortensen, N. J., Foy, D. M., Channer, J. L., Virjee, J., and Goddard, P. 1986. Preoperative assessment of local invasion in rectal cancer: digital examination, endoluminal sonography or computed tomography?Br. J. Surg. 73: 1015–1017.PubMedCrossRefGoogle Scholar
  5. Bianchi, P. P., Ceriani, C., Rottoli, M., Torzilli, G., Pompili, G., Malesci, A., Ferraroni, M., and Montorsi, M. 2005. Endoscopic ultrasonography and magnetic resonance in preoperative staging of rectal cancer: comparison with histologic findings.J. Gastrointest. Surg. 9: 1222–1227.PubMedCrossRefGoogle Scholar
  6. Fuchsjäger, M. H., Maier, A. G., Schima, W., Zebedin, E., Herbst, F., Mittlbück, M., Wrba, F., and Lechner, G. L. 2003. Comparison of tran-srectal sonography and double-contrast MR imaging when staging rectal cancer. Am. J. Roentgenol. 181: 421–427.Google Scholar
  7. Garcia-Aguilar, J., Pollack, J., Lee, S. H., Hernandez De Anda, E., Mellgren, A., Wong, W. D., Finne, C. O., Rothenberger, D. A., and Madoff, R. D. 2002. Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors.Dis. Colon Rectum 45: 10–15.PubMedCrossRefGoogle Scholar
  8. Giovannini, M., Bories, E., Pesenti, C., Moutardier, V., Lelong, B., and Delpero, J. R. 2006. Three-dimensional endorectal ultrasound using a new freehand software program: results in 35 patients with rectal cancer.Endoscopy 38: 339–343.PubMedCrossRefGoogle Scholar
  9. Glaser, F., Schlag, P., and Herfarth, C. 1990. Endorectal ultrasonography for the assessment of invasion of rectal tumours and lymph node involvement.Br. J. Surg. 77: 883–887.PubMedCrossRefGoogle Scholar
  10. Gualdi, G. F., Casciani, E., Guadalaxara, A., d'Orta, C., Polettini, E., and Pappalardo, G. 2000. Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histologic findings.Dis. Colon Rectum 43: 338–345.PubMedCrossRefGoogle Scholar
  11. Hawes, R. H. 1993. New staging techniques. Endoscopic ultrasound.Cancer 71: 4207–4213.PubMedCrossRefGoogle Scholar
  12. Herzog, U., Von Flue, M., Tondelli, P., and Schuppisser, J. P. 1993. How accurate is endorec-tal ultrasound in the preoperative staging of rectal cancer?Dis. Colon Rectum 36: 127–134.PubMedCrossRefGoogle Scholar
  13. Hildebrandt, U., Feifel, G., Schwarz, H. P., and Scherr, O. 1986. Endorectal ultrasound: instrumentation and clinical aspects.Int. J. Colorectal Dis. 1: 203–207.PubMedCrossRefGoogle Scholar
  14. Hildebrandt, U., Klein, T., Feifel, G., Schwarz, H. P., Koch, B., Schmitt, R. M. 1990. Endosonography of pararectal lymph nodes. In vitro and in vivo evaluation.Dis. Colon Rectum 33: 863–868.PubMedCrossRefGoogle Scholar
  15. Holdsworth, P. J., Johnston, D., Chalmers, A. G., Chennells, P., Dixon, M. F., Finan, P. J., Primrose, J. N., and Quirke, P. 1988. Endoluminal ultrasound and computed tomography in the staging of rectal cancer.Br. J. Surg. 75: 1019–1022.PubMedCrossRefGoogle Scholar
  16. Hunerbein, M., and Schlag, P. M. 1997. Three-dimensional endosonography for staging of rectal cancer.Ann. Surg. 225: 432–438.PubMedCrossRefGoogle Scholar
  17. Katsura, Y., Yamada, K., Ishizawa, T., Yoshinaka, H., and Shimazu, H. 1992. Endorectal ultrasonog-raphy for the assessment of wall invasion and lymph node metastasis in rectal cancer.Dis. Colon Rectum 35: 362–368.PubMedCrossRefGoogle Scholar
  18. Kim, H. J., and Wong, W. D. 2000. Role of endorec-tal ultrasound in the conservative management of rectal cancers.Semin. Surg. Oncol. 19: 358–366.PubMedCrossRefGoogle Scholar
  19. Kim, J. C., Yu, C. S., Jung, H. Y., Kim, H. C., Kim, S. Y., Park, S. K., Kang, G. H., and Lee, M. G. 2001. Source of errors in the evaluation of early rectal cancer by endoluminal ultrasonography.Dis. Colon Rectum 44: 1302–1309.PubMedCrossRefGoogle Scholar
  20. Kim, J. C., Cho, Y. K., Kim, S. Y., Park, S. K., and Lee, M. G. 2002. Comparative study of three-dimensional and conventional endorectal ultra-sonography used in rectal cancer staging.Surg. Endosc. 16: 1280–1285.PubMedCrossRefGoogle Scholar
  21. Kim, J. C., Kim, H. C., Yu, C. S., Han, K. R., Kim, J. R., Lee, K. H., Jang, S. J., Lee, S. S., and Ha, H. K. 2006. Efficacy of 3-dimensional endorectal ultrasonography compared with conventional ultra-sonography and computed tomography in preopera-tive rectal cancer staging.Am. J. Surg. 192: 89–97.PubMedCrossRefGoogle Scholar
  22. Kim, N. K., Kim, M. J., Yun, S. H., Sohn, S. K., and Min, J. S. 1999. Comparative study of tran-srectal ultrasonography, pelvic computerized tomography, and magnetic resonance imaging in preoperative staging of rectal cancer.Dis. Colon Rectum 42: 770–775.PubMedCrossRefGoogle Scholar
  23. Kim, J. H., Beets, G. L., Kim, M. J., Kessels, A. G., and Beets-Tan, R. G. 2004a. High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size?Eur. J. Radiol. 52: 78–83.CrossRefGoogle Scholar
  24. Kim, S., Lim, H. K., Lee, S. J., Choi, D., Lee, W. J., Kim, S. H., Kim, M. J., and Lim, J. H. 2004b. Depiction and local staging of rectal tumors: comparison of transrectal US before and after water instillation.Radiology 231: 117–122.CrossRefGoogle Scholar
  25. Kumar, A., and Scholefield, J. H. 2000. Endosono-graphy of the anal canal and rectum.World J. Surg. 24: 208–215.PubMedCrossRefGoogle Scholar
  26. Kwok, H., Bissett, I. P., and Hill, G. L. 2000. Preoperative staging of rectal cancer.Int. J. Colorectal Dis. 15: 9–20.PubMedCrossRefGoogle Scholar
  27. Mackay, S. G., Pager, C. K., Joseph, D., Stewart, P. J., and Solomon, M. J. 2003. Assessment of the accuracy of transrectal ultrasonography in anorectal neoplasia.Br. J. Surg. 90: 346–350.PubMedCrossRefGoogle Scholar
  28. Maldjian, C., Smith, R., Kilger, A., Schnall, M., Ginsberg, G., and Kochman, M. 2000. Endorectal surface coil MR imaging as a staging technique for rectal carcinoma: a comparison study to rectal endosonography.Abdom. Imag. 25: 75–80.CrossRefGoogle Scholar
  29. Marusch, F., Koch, A., Schmidt, U., Zippel, R., Kuhn, R., Wolff, S., Pross, M., Wierth, A., Gastinger, I., and Lippert, H. 2002. Routine use of transrectal ultrasound in rectal carcinoma: results of a prospective multicenter study.Endoscopy 34: 385–390.PubMedCrossRefGoogle Scholar
  30. Massari, M., De Simone, M., Cioffi, U., Rosso, L., Chiarelli, M., and Gabrielli, F. 1998. Value and limits of endorectal ultrasonography for preoperative staging of rectal carcinoma.Surg. Laparosc. Endosc. 8: 438–444.PubMedCrossRefGoogle Scholar
  31. Mathur, P., Smith, J. J., Ramsey, C., Owen, M., Thorpe, A., Karim, S., Burke, C., Ramesh, S., and Dawson, P. M. 2003. Comparison of CT and MRI in the pre-operative staging of rectal adenocarcinoma and prediction of circumferential resection margin involvement by MRI.Colorectal Dis. 5: 396–401.PubMedCrossRefGoogle Scholar
  32. Orrom, W. J., Wong, W. D., Rothenberger, D. A., Jensen, L. L., and Goldberg, S. M. 1990. Endorectal ultrasound in the preoperative staging of rectal tumors. A learning experience.Dis. Colon Rectum 33: 654–659.PubMedCrossRefGoogle Scholar
  33. Osti, M. F., Padovan, F. S., Pirolli, C., Sbarbati, S., Tombolini, V., Meli, C., and Enrici, R. M. 1997. Comparison between transrectal ultrasonogra-phy and computed tomography with rectal inflation of gas in preoperative staging of lower rectal cancer.Eur. Radiol. 7: 26–30.PubMedCrossRefGoogle Scholar
  34. Rifkin, M. D., Ehrlich, S. M., and Marks, G. 1989. Staging of rectal carcinoma: prospective comparison of endorectal US and CT.Radiology 170: 319–322.PubMedGoogle Scholar
  35. Sailer, M., Leppert, R., Kraemer, M., Fuchs, K. H., and Thiede, A. 1997. The value of endorectal ultrasound in the assessment of adenomas, T1- and T2-carcinomas.Int. J. Colorectal Dis. 12: 214–219.PubMedCrossRefGoogle Scholar
  36. Saitoh, N., Okui, K., Sarashina, H., Suzuki, M., Arai, T., and Nunomura, M. 1986. Evaluation of echographic diagnosis of rectal cancer using intrarectal ultrasonic examination.Dis. Colon Rectum 29: 234–242.PubMedCrossRefGoogle Scholar
  37. Spinelli, P., Schiavo, M., Meroni, E., Di Felice, G., Andreola, S., Gallino, G., Belli, F., and Leo, E. 1999. Results of EUS in detecting perirectal lymph node metastases of rectal cancer: the pathologist makes the difference.Gastrointest. Endosc. 49: 754–758.PubMedCrossRefGoogle Scholar
  38. Starck, M., Bohe, M., Fork, F. T., Lindstrom, C., and Sjoberg, S. 1995. Endoluminal ultrasound and low-field magnetic resonance imaging are superior to clinical examination in the preoperative staging of rectal cancer.Eur. J. Surg. 161: 841–845.PubMedGoogle Scholar
  39. Thaler, W., Watzka, S., Martin, F., La Guardia, G., Psenner, K., Bonatti, G., Fichtel, G., Egarter-Vigl, E., and Marzoli, G. P. 1994. Preoperative staging of rectal cancer by endo-luminal ultrasound vs. magnetic resonance imaging. Preliminary results of a prospective, comparative study.Dis. Colon Rectum 37: 1189–1193.PubMedCrossRefGoogle Scholar
  40. Waizer, A., Zitron, S., Ben-Baruch, D., Baniel, J., Wolloch, Y., and Dintsman, M. 1989. Comparative study for preoperative staging of rectal cancer.Dis. Colon Rectum 32: 53–56.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2009

Authors and Affiliations

  • Ho-Kyung Chun
    • 1
  • Yong Beom Cho
    • 1
  • Yong Jin Lee
    • 2
  1. 1.Department of Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineGangnam-guKorea
  2. 2.Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineGangnam-guKorea

Personalised recommendations