Clinical Implications of Large Bowel Carcinoma

  • Paris A. Kosmidis
  • Christos A. PissiotisEmail author


Colorectal cancer is the third most common cancer in the world. In the USA, 150,000 new cases are diagnosed annually, whereas in Europe the respective incidence is 400,000. The ratio of colonic to rectal cancer is 2:1. With the incidence of rectal cancer rising. Colorectal cancer is more common in males than females. Colonoscopy with biopsy is the most often used method for diagnosis. Cross-sectional imaging follows colonoscopy for staging purposes in an effort to detect metastatic disease. CT and MRI are not recommended for detection of the colonic primary lesion, however, as always used for identification of extracolonic pelvic disease and/or metastatic lesions through the body. However, PET-CT scan is extremely useful for whole-body imaging especially in restaging where lung or liver metastasectomy is the preferred mode of treatment. Specifically for rectal cancer, staging is of major importance for treatment planning. Endorectal ultrasound (ERUS) and MRI visualize the extent of the tumor as well as the circumferential resection margin which is significant for total mesorectal excision. The ideal surveillance strategy for colorectal cancer has not been defined. NCCN guidelines recommend CT scans of upper and lower abdomen as well as chest every year for 5 years. Colonoscopy is recommended 1 year following surgery and then at 3 years and then every 5 years.


Colorectal cancer Staging Surveillance PET-CT scan Endorectal ultrasound 


  1. 1.
    Smith A, Young GP, Cole SR et al (2006) Comparison of a brush-sampling fecal immunochemical test for hemoglobin with a geniac-based fecal occult blood test in detection of colorectal neoplasia. Cancer 107:2152–2159CrossRefGoogle Scholar
  2. 2.
    Ninawer SJ, Stewart ET, Zamber AG et al (2000) A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med 342:1766–1772CrossRefGoogle Scholar
  3. 3.
    McHigh M, Osei-Anto A, Klabunde CN et al (2011) Adoption of CT colonography by US hospitals. J Am Coll Radiol 8:169–174CrossRefGoogle Scholar
  4. 4.
    National Comprehensive Cancer Network (NCCN) (2012) NCCN clinical practice guidelines in oncology. Colon cancer, Version 3, 2012. Accessed Apr 23Google Scholar
  5. 5.
    Khalil HI, Patterson SA, Panicek DM (2005) Hepatic lesions deemed too small to characterize at CT: prevalence and importance in women with breast cancer. Radiology 235:872–878CrossRefGoogle Scholar
  6. 6.
    Phang PT, Gollup MJ, Loh BD et al (2012) Accuracy of endorectal ultrasound for measurement of the closest predicted radial mesorectal margins for rectal cancer. Dis Colon Rectum 55:59–64CrossRefGoogle Scholar
  7. 7.
    Lahaye MJ, Engelen SM, Nelemans PJ et al (2005) Imaging for predicting the risk factors—the circumferential resection margin and nodal disease—of—local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR 26:259–268CrossRefGoogle Scholar
  8. 8.
    Maretto I, Pomerri F, Pucciarelli S et al (2007) The potential of restaging in the prediction of pathologic response after preoperative chemoradiotherapy for rectal cancer. Ann Surg Oncol 14:455–461CrossRefGoogle Scholar
  9. 9.
    Suppiah A, Maslekar S, Alabi A et al (2008) Transanal endoscopic microsurgery in early rectal cancer time for a trial? Color Dis 10:314–327CrossRefGoogle Scholar
  10. 10.
    Mehta VK, Cho C, Ford JM et al (2003) Phase II trial of preoperative 3D conformal radiotherapy, protracted venous infusion 5-fluorouracil and weekly CPT-11 followed by surgery for ultrasound-staged T3 rectal cancer. Int J Radiat Oncol Biol Phys 55:132–137CrossRefGoogle Scholar
  11. 11.
    Yeo SG, Kim DY, Park JW et al (2012) Tumor volume reduction rate after preoperative chemoradiotherapy as a prognostic factor in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 82:e193–e199CrossRefGoogle Scholar
  12. 12.
    Barbaro B, Fiorucci C, Tebala C et al (2009) Locally advanced rectal cancer: MR imaging in prediction of response after preoperative chemotherapy and radiation therapy. Radiology 250:730–739CrossRefGoogle Scholar
  13. 13.
    Floriani I, Torri V, Rulli E et al (2010) Performance of imaging modalities in diagnosis of liver metastases from colorectal cancer: a systematic review and metaanalysis. J Magn Reson Imaging 31:19–31CrossRefGoogle Scholar
  14. 14.
    Kuehl H, Antoch G, Stergar H et al (2008) Comparison of FDG-PET, PET-CT and MRI for follow-up of colorectal liver metastases treated with radiofrequency ablation: initial results. Eur J Radiol 67:362–371CrossRefGoogle Scholar
  15. 15.
    Park IJ, Kim HC, CS Y et al (2006) Efficacy of PET/CY in the accurate evaluation of primary colorectal carcinoma. Eur J Surg Oncol 32:941–947CrossRefGoogle Scholar
  16. 16.
    Lin M, Wong K, Ng WL et al (2011) Positron emission tomography and colorectal cancer. Crit Rev Oncol Hematol 77:30–47CrossRefGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Medical Oncologist, Head, Medical Oncology DepartmentHygeia HospitalAthensGreece
  2. 2.Department of SurgeryHygeia HospitalAthensGreece

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