Limitations of Existing Systems of Staging for Rectal Cancer: The Forgotten Margin

Abstract

Good staging is central to the logical management of patients with rectal cancer since the choice of future treatment is frequently based upon the stage of the tumour. Before one can describe the limitations of existing staging systems, the best method must be considered. The ideal staging system would be clinicopathological, however, there are two disadvantages of such methods. Firstly, clinical impressions can be inaccurate with false-positive and negative diagnoses, e.g. radiological imaging of metastases, surgeon’s impression of adequacy of resection, and secondly, communication and cooperation must be high between the surgeon and his specialist pathologist, which may not always be the case. With improved imaging, more specialisation of both surgeons and pathologists, and the realisation of the importance of the close relationship between the pathologist and surgeon, it should be possible to move towards a clinicopathological system.