Skip to main content
SpringerLink
Log in

Role of Imaging in Colorectal Cancers

  • Chapter
  • First Online:
Colon Polyps and Colorectal Cancer

  • 1257 Accesses

Abstract

Being the most common gastrointestinal cancer and the second most common cause of cancer deaths, colorectal cancer is a major health problem. Risk factors for colorectal cancer are variable and include dietary, hereditary, and environmental factors.

In recent years, the mortality rate has significantly decreased and 5-year survival has improved due to successful screening and early detection techniques as well as optimization of surgical techniques, new neoadjuvant therapies, and developments in diagnostic imaging modalities. Radiological imaging plays an important role in the screening, primary diagnosis, staging, management, evaluation of treatment response and follow-up of colorectal cancer.

Therapeutic options of colon cancer differ significantly from the rectal cancer. The treatment strategies differ depending on the staging of the disease and also for local/primary tumor management and management of distant metastatic disease. Therefore, imaging algorithms and preferred imaging modalities also differ substantially for colon and rectal cancers.

Significant advances have been made in imaging technologies over the last decades. Several imaging modalities are used, and each modality has its inherent advantages and limitations. Improvements in imaging technology will further play an important role in reducing the incidence and mortality of colorectal cancer as well as optimizing the patient management.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. van de Velde CJ, Boelens PG, Borras JM, Coebergh JW, Cervantes A, Blomqvist L, et al. EURECCA colorectal: multidisciplinary management: European consensus conference colon and rectum. Eur J Cancer. 2014;50:1.e1–34.

    Article  Google Scholar 

  2. Expert Panel on Gastrointestinal Imaging, Fowler KJ, Kaur H, Brooks D, Cash BD, Feig BD, Gage KL, et al. ACR appropriateness criteria. Pretreatment staging of colorectal cancer. J Am Coll Radiol. 2017;14(5S):234–44.

    Google Scholar 

  3. Lin JS, Piper MA, Perdue LA, Rutter C, Webber EM, O’Connor E, et al. Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force. J Am Med Assoc. 2016;315:2576–94.

    Article  CAS  Google Scholar 

  4. Tamandl D, Mang T, Ba-Ssalamah A. Imaging of colorectal cancer – the clue to individualized treatment. Innov Surg Sci. 2018;3(1):3–15.

    Google Scholar 

  5. Kekelidze M, D’Errico L, Pansini M, Tyndall A, Hohmann J. Colorectal cancer: current imaging methods and future perspectives for the diagnosis, staging and therapeutic response evaluation. World J Gastroenterol. 2013;19(46):8502–14.

    Article  Google Scholar 

  6. Badea RI, Caraiani CN, Florian DI. Imaging of colonic and rectal cancer. Rijeka, Croatia: IntechOpen; 2016. https://doi.org/10.5772/62307.

    Book  Google Scholar 

  7. Brenner H, Bouvier AM, Foschi R, Hackl M, Larsen IK, Lemmens V, et al. Progress in colorectal cancer survival in Europe from the late 1980s to the early 21st century: the EUROCARE study. Int J Cancer. 2012;131:1649–58.

    Article  CAS  Google Scholar 

  8. Martens MH, Maas M, Heijnen LA, Lambregts DM, Leijtens JW, Stassen LP, et al. Long-term outcome of an organ preservation program after neoadjuvant treatment for rectal cancer. J Natl Cancer Inst. 2016;108:djw171.

    Article  Google Scholar 

  9. Niekel MC, Bipat S, Stoker J. Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. Radiology. 2010;257:674–84.

    Article  Google Scholar 

  10. McKeown E, Nelson DW, Johnson EK, et al. Current approaches and challenges for monitoring treatment response in colon and rectal cancer. J Cancer. 2014;5:31–43.

    Article  CAS  Google Scholar 

  11. Glimelius B, Tiret E, Cervantes A, Arnold D, Group EGW. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi81–8.

    Article  Google Scholar 

  12. Samee A, Selvasekar CR. Current trends in staging rectal cancer. World J Gastroenterol. 2011;17:828–34.

    Article  Google Scholar 

  13. Tamas K, Walenkamp AM, de Vries EG, et al. Rectal and colon cancer: not just a different anatomic site. Cancer Treat Rev. 2015;41(8):671–9.

    Article  CAS  Google Scholar 

  14. Qaseem A, Denberg TD, Hopkins RH, et al. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156:378–86.

    Article  Google Scholar 

  15. Carroll MR, Seaman HE, Halloran SP. Tests and investigations for colorectal cancer screening. Clin Biochem. 2014;47(10–11):921–39.

    Article  CAS  Google Scholar 

  16. Meyerhardt JA, Mangu PB, Flynn PJ, et al. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol. 2013;31:4465–70.

    Article  Google Scholar 

  17. Levine MS, Yee J. History, evolution, and current status of radiologic imaging tests for colorectal cancer screening. Radiology. 2014;273(2):S160–80.

    Article  Google Scholar 

  18. Regula J, Rupinski M, Kraszewska E, et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med. 2006;355(18):1863–72.

    Article  CAS  Google Scholar 

  19. Neri E, Halligan S, Hellstrom M, Lefere P, Mang T, Regge D, et al. The second ESGAR consensus statement on CT colonography. Eur Radiol. 2013;23:720–9.

    Article  Google Scholar 

  20. Atkin W, Dadswell E, Wooldrage K, Kralj-Hans I, von Wagner C, Edwards R, et al. Computed tomographic colonography versus colonoscopy for investigation of patients with symptoms suggestive of colorectal cancer (SIGGAR): a multicentre randomised trial. Lancet. 2013;381:1194–202.

    Article  Google Scholar 

  21. Pooler BD, Baumel MJ, Cash BD, Moawad FJ, Riddle MS, Patrick AM, et al. Screening CT colonography: multicenter survey of patient experience, preference, and potential impact on adherence. AJR Am J Roentgenol. 2012;198:1361–6.

    Article  Google Scholar 

  22. Taylor SA, Laghi A, Lefere P, Halligan S, Stoker J. European Society of Gastrointestinal and Abdominal Radiology (ESGAR): consensus statement on CT colonography. Eur Radiol. 2007;17:575–9.

    Article  Google Scholar 

  23. Kinner S, Kuehle CA, Langhorst J, et al. MR colonography vs. optical colonoscopy: comparison of patients’ acceptance in a screening population. Eur Radiol. 2007;17(9):2286–93.

    Article  Google Scholar 

  24. van der Paardt MP, Stoker J. Magnetic resonance colonography for screening and diagnosis of colorectal cancer. Magn Reson Imaging Clin N Am. 2014;22:67–83.

    Article  Google Scholar 

  25. Ridereau-Zins C. Imaging in colonic cancer. Diagn Interv Imaging. 2014;95(5):475–83.

    Article  CAS  Google Scholar 

  26. Kijima S, Sasaki T, Nagata K, et al. Preoperative evaluation of colorectal cancer using CT colonography, MRI, and PET/CT. World J Gastroenterol. 2014;20(45):16964–75.

    Article  Google Scholar 

  27. Dighe S, Purkayastha S, Swift I, et al. Diagnostic precision of CT in local staging of colon cancers: a metaanalysis. Clin Radiol. 2010;65:708–19.

    Article  CAS  Google Scholar 

  28. Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging. Radiol Clin N Am. 2007;45:85–118.

    Article  Google Scholar 

  29. 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;15:1–192, iii–iv.

    Article  CAS  Google Scholar 

  30. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The eighth edition AJCC Cancer Staging Manual: continuing to build a bridge from a population based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67:93–9.

    Article  Google Scholar 

  31. Tudyka V, Blomqvist L, Beets-Tan RG, et al. EURECCA consensus conference highlights about colon & rectal cancer multidisciplinary management: the radiology experts review. Eur J Surg Oncol. 2014;40(4):469–75.

    Article  CAS  Google Scholar 

  32. Wiggans MG, Shahtahmassebi G, Aroori S, et al. Assessment of the value of MRI scan in addition to CT in the pre-operative staging of colorectal liver metastases. J Gastrointest Cancer. 2014;45:146–53.

    Article  CAS  Google Scholar 

  33. Schmoll HJ, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K, et al. ESMO consensus guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol. 2012;23:2479–516.

    Article  CAS  Google Scholar 

  34. Tirumani S, Kim KW, Nishino M, Howard SA, Krajewski KM, Jagannathan JP. Update on the role of imaging in management of metastatic colorectal cancer. Radiographics. 2014;34:1908–28.

    Article  Google Scholar 

  35. Kim DJ, Kim JH, Ryu YH, Jeon TJ, Yu JS, Chung JJ. Nodal staging of rectal cancer: high-resolution pelvic MRI versus (1)(8)F-FDGPET/CT. J Comput Assist Tomogr. 2011;35:531–4.

    Article  Google Scholar 

  36. Kaur H, Choi H, You YN, et al. MR imaging for preoperative evaluation of primary rectal cancer: practical considerations. Radiographics. 2012;32:389–409.

    Article  Google Scholar 

  37. Beets-Tan RGH, Lambregts DMJ, Maas M, Bipat S, Barbaro B, Curvo-Semedo L, et al. Magnetic resonance imaging for clinical management of rectal cancer: updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol. 2017;28:1465. https://doi.org/10.1007/s00330-017-5026-2.

    Article  Google Scholar 

  38. Mainenti PP, Mancini M, Mainolfi C, et al. Detection of colo-rectal liver metastases: prospective comparison of contrast enhanced US, multidetector CT, PET/CT, and 1.5 Tesla MR with extracellular and reticulo-endothelial cell specific contrast agents. Abdom Imaging. 2010;35:511–21.

    Article  Google Scholar 

  39. Lowenthal D, Zeile M, Lim WY, et al. Detection and characterisation of focal liver lesions in colorectal carcinoma patients: comparison of diffusion-weighted and Gd-EOB-DTPA enhanced MR imaging. Eur Radiol. 2011;21:832–40.

    Article  CAS  Google Scholar 

  40. Yu MH, Lee JM, Hur BY, et al. Gadoxetic acid-enhanced MRI and diffusion-weighted imaging for the detection of colorectal liver metastases after neoadjuvant chemotherapy. Eur Radiol. 2015;25:2428–36.

    Article  Google Scholar 

  41. Duman M, Tas S, Mecit EA, et al. Preoperative local staging of colorectal cancer patients with MDCT. Hepato-Gastroenterology. 2012;59:1108–12.

    Google Scholar 

  42. McQueen AS, Scott J. CT staging of colorectal cancer: what do you find in the chest? Clin Radiol. 2012;67:352–8.

    Article  CAS  Google Scholar 

  43. McKeown E, Nelson DW, Johnson EK, Maykel JA, Stojadinovic A, Nissan A. Current approaches and challenges for monitoring treatment response in colon and rectal cancer. J Cancer. 2014;5:31–43.

    Article  CAS  Google Scholar 

  44. Walker A, Zwintscher NP, Johnson EK, Maykel JA, Stojadinovic A, Nissan A. Future directions for monitoring treatment response in colorectal cancer. J Cancer. 2014;5:44–57.

    Article  Google Scholar 

  45. Park IJ, Yu CS. Current issues in locally advanced colorectal cancer treated by preoperative chemoradiotherapy. World J Gastroenterol. 2014;20:2023–9.

    Article  Google Scholar 

  46. van der Paardt MP, Zagers MB, Beets-Tan RG, Stoker J, Bipat S. Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic MR imaging: a systematic review and meta-analysis. Radiology. 2013;269:101–12.

    Article  Google Scholar 

  47. Iyer R, Silverman PM, DuBrow RA, Charnsangavej C. Imaging in the diagnosis, staging, and follow-up of colorectal cancer. Am J Roentgenol. 2002;179:3–13.

    Article  Google Scholar 

  48. Van Cutsem E, Henk MW, Verheul HVM, Flamen P, Rougier P, Beets-Tan R, Glynne-Jones R, Seufferlein T. Imaging in colorectal cancer: progress and challenges for the clinicians. Cancers. 2016;8:81. https://doi.org/10.3390/cancers8090081.

    Article  CAS  Google Scholar 

  49. Raman PS, Chen Y, Fishman E. Evolution of imaging in rectal cancer: multimodality imaging with MDCT, MRI, and PET. J Gastrointest Oncol. 2015;6(2):172–84.

    Google Scholar 

  50. Martínez-Ares D, Martín-Granizo Barrenechea I, Souto-Ruzo J, et al. The value of abdominal ultrasound in the diagnosis of colon cancer. Rev Esp Enferm Dig. 2005;97:877–86.

    Article  Google Scholar 

  51. Kim MJ. Transrectal ultrasonography of anorectal diseases: advantages and disadvantages. Ultrasonography. 2015;34:19–31.

    Article  CAS  Google Scholar 

  52. Samdani T, Garcia-Aguilar J. Imaging in rectal cancer: magnetic resonance imaging versus endorectal ultrasonography. Surg Oncol Clin N Am. 2014;23:59–77.

    Article  Google Scholar 

  53. Fernandez-Esparrach G, Ayuso-Colella JR, Sendino O, et al. EUS and magnetic resonance imaging in the staging of rectal cancer: a prospective and comparative study. Gastrointest Endosc. 2011;74:347–54.

    Article  Google Scholar 

  54. Leufkens AM, van den Bosch MA, van Leeuwen MS, Siersema PD. Diagnostic accuracy of computed tomography for colon cancer staging: a systematic review. Scand J Gastroenterol. 2011;46:887–94.

    Article  Google Scholar 

  55. Smith NJ, Bees N, Barbachano Y, Norman AR, Swift RI, Brown G. Preoperative computed tomography staging of nonmetastatic colon cancer predicts outcome: implications for clinical trials. Br J Cancer. 2007;96:1030–6.

    Article  CAS  Google Scholar 

  56. Spada C, Stoker J, Alarcon O, Barbaro F, Bellini D, Bretthauer M, et al. Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) guideline. Eur Radiol. 2015;25:331–45.

    Article  Google Scholar 

  57. Moawad FJ, Maydonovitch CL, Cullen PA, Barlow DS, Jenson DW, Cash BD. CT colonography may improve colorectal cancer screening compliance. AJR Am J Roentgenol. 2010;195:1118–23.

    Article  Google Scholar 

  58. American College of Radiology. ACR practice guideline for the performance of computed tomography (CT) colonography in adults, vol. 36. Reston VA: ACR Practice Guideline: American College of Radiology; 2009. p. 1–10.

    Google Scholar 

  59. Kim DH, Pickhardt PJ, Hanson ME, Hinshaw JL. CT colonography: performance and program outcome measures in an older screening population. Radiology. 2010;254:493–500.

    Article  Google Scholar 

  60. Johnson CD, Chen MH, Toledano AY, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med. 2008;359(12):1207–17.

    Article  CAS  Google Scholar 

  61. Pickhardt PJ, Hassan C, Halligan S, Marmo R. Colorectal cancer: CT colonography and colonoscopy for detection – systematic review and meta-analysis. Radiology. 2011;259:393–405.

    Article  Google Scholar 

  62. de Haan MC, van Gelder RE, Graser A, Bipat S, Stoker J. Diagnostic value of CT-colonography as compared to colonoscopy in an asymptomatic screening population: a metaanalysis. Eur Radiol. 2011;21:1747–63.

    Article  Google Scholar 

  63. Van der Paardt MP, Zijta FM, Stoker J. MRI of the colon. Imaging Med. 2010;2(2):195–209.

    Article  Google Scholar 

  64. Al-Sukhni E, Milot L, Fruitman M, et al. Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2012;19:2212–23.

    Article  Google Scholar 

  65. Taylor FG, Quirke P, Heald RJ, Moran BJ, Blomqvist L, Swift IR, et al. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study. J Clin Oncol. 2014;32:34–43.

    Article  Google Scholar 

  66. Karatag O, Karatag GY, Ozkurt H, et al. The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results. Diagn Interv Radiol. 2012;18:20–6.

    Google Scholar 

  67. Perez RO, Pereira DD, Proscurshim I, et al. Lymph node size in rectal cancer following neoadjuvant chemoradiation—can we rely on radiologic nodal staging after chemoradiation? Dis Colon Rectum. 2009;52:1278–84.

    Article  Google Scholar 

  68. Rafaelsen SR, Vagn-Hansen C, Sorensen T, Ploen J, Jakobsen A. Transrectal ultrasound and magnetic resonance imaging measurement of extramural tumor spread in rectal cancer. World J Gastroenterol. 2012;18:5021–6.

    Article  Google Scholar 

  69. Chand M, Evans J, Swift RI, Tekkis PP, West NP, Stamp G, et al. The prognostic significance of postchemoradiotherapy high-resolution MRI and histopathology detected extramural venous invasion in rectal cancer. Ann Surg. 2015;261:473–9.

    Article  Google Scholar 

  70. Barbaro B, Fiorucci C, Tebala C, et al. Locally advanced rectal cancer: MR imaging in prediction of response after preoperative chemotherapy and radiation therapy. Radiology. 2009;250:730–9.

    Article  Google Scholar 

  71. Patel UB, Taylor F, Blomqvist L, et al. Magnetic resonance imaging detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol. 2011;29:3753–60.

    Article  Google Scholar 

  72. Dighe S, Swift I, Magill L, et al. Accuracy of radiological staging in identifying high-risk colon cancer patients suitable for neoadjuvant chemotherapy: a multicentre experience. Colorectal Dis. 2012;14:438–44.

    Article  CAS  Google Scholar 

  73. Curvo-Semedo L, Lambregts DMJ, Maas M, Beets GL, Caseiro-Alves F, Beets-Tan RGH. Diffusion-weighted MRI in rectal cancer: apparent diffusion coefficient as a potential noninvasive marker of tumor aggressiveness. J Magn Reson Imaging. 2012;35:1365–71.

    Article  Google Scholar 

  74. Lambregts D, Vandecaveye V, Barbaro B, Bakers FCH, Lambrecht M, Maas M. Diffusion-weighted MRI for selection of complete responders after chemoradiation for locally advanced rectal cancer: a multicenter study. Ann Surg Oncol. 2011;18:2224–31.

    Article  Google Scholar 

  75. Neri E, Bali MA, Ba-Ssalamah A, Boraschi P, Brancatelli G, Alves FC, et al. ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents. Eur Radiol. 2016;26:921–31.

    Article  CAS  Google Scholar 

  76. Herbertson R, Scarsbrook AF, Lee ST, Tebbutt N, Scott AM. Established, emerging and future roles of PET/CT in the management of colorectal cancer. Clin Radiol. 2009;64:225–37.

    Article  CAS  Google Scholar 

  77. Grassetto G, Capirci C, Marzola MC, et al. Colorectal cancer: prognostic role of 18F-FDG-PET/CT. Abdom Imaging. 2012;37:575–9.

    Article  Google Scholar 

  78. Briggs RH, Chowdhury FU, Lodge JP, Scarsbrook AF. Clinical impact of FDG PET-CT in patients with potentially operable metastatic colorectal cancer. Clin Radiol. 2011;66:1167–74.

    Article  CAS  Google Scholar 

  79. Lee SJ, Kim JG, Lee SW, et al. Clinical implications of initial FDG-PET/CT in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy. Cancer Chemother Pharmacol. 2013;71:1201–7.

    Article  CAS  Google Scholar 

  80. Sun W, Xu J, Hu W, et al. The role of sequential 18(F)-FDG PET/CT in predicting tumour response after preoperative chemoradiation for rectal cancer. Color Dis. 2013;15:e231–8.

    Article  CAS  Google Scholar 

  81. Figueiras RG, Goh V, Padhani AR, Naveira AB, Caamano A, Martin CV, et al. AJR. 2010;195:54–66.

    Article  Google Scholar 

  82. Baessler B, Maintz D, Persigehl T. Imaging procedures for colorectal cancer. Visc Med. 2016;32:166–71.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiology Department, Tepecik Training and Research Hospital, Health Sciences University, Izmir, Turkey

    Dilek Oncel

Authors
  1. Dilek Oncel
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Surgery, Izmir Tepecik Training and Research Hospital, Konak, Izmir, Turkey

    Omer Engin

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Oncel, D. (2021). Role of Imaging in Colorectal Cancers. In: Engin, O. (eds) Colon Polyps and Colorectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-57273-0_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-57273-0_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-57272-3

  • Online ISBN: 978-3-030-57273-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation