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Imaging in Colorectal Cancer

  • Rishi Sethi
  • Stephen H. Lee
Chapter

Abstract

Imaging plays a pivotal role in the preoperative staging of malignant colorectal cancer. Multidetector computed tomography (CT or MDCT) is the principal investigation in the staging of colon cancer while both CT and magnetic resonance imaging (MRI), for local staging, have roles in the staging of rectal cancer. The introduction of CT colonography (CTC), also known as virtual or CT colonoscopy, has increased the sensitivity of CT in detecting small tumors and polyps. This clearly has implications in the screening of both symptomatic and asymptomatic populations. Though MRI and CT scanning are the main tools for staging colorectal cancers, other imaging modalities may be occasionally used. Endoscopic ultrasound (EUS) can be used to locally stage rectal tumors in certain cases, and EUS+FNA (fine needle aspiration) may be employed to determine nodal involvement. Positron emission tomography combined with CT (PET-CT) does not have a routine use in the staging of colorectal cancer but may be used for problem solving and detecting recurrent disease. In staging liver metastases, both MRI scanning (using liver-specific contrast agents) and contrast-enhanced ultrasound have roles. Double-contrast barium enema (DCBE) is still in use but is being replaced by CTC due to its greater accuracy (see below). Single contrast enema studies may still play a role in large bowel obstruction but have been largely replaced by MDCT [1].

Keywords

Rectal Cancer Circumferential Resection Margin Optical Colonoscopy Large Bowel Obstruction Principal Investigation 
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.

References

  1. 1.
    Jacob SE, Lee SH, Hill J. The demise of the instant/unprepared contrast enema in large bowel obstruction. Colorectal Dis. 2008;10:729–31.PubMedCrossRefGoogle Scholar
  2. 2.
    Johnson CD, Chen MH, Toledano AY, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med. 2008;359:1207–17.PubMedCrossRefGoogle Scholar
  3. 3.
    Barnes E. SIGGAR trial results a win-win for virtual colonoscopy. http://www.auntminnie.com/index.aspx?sec=sup&sub=vco&pag=dis&ItemID=92515 [Accessed 04.01.2011].
  4. 4.
    Pickhardt PJ. Incidence of colonic perforation at CT colonography: review of existing data and implications for screening of asymptomatic adults. Radiology. 2006;239:313–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Beraland L. Incidental extracolonic findings on CT colonography: the impending deluge and its implications. J Am Coll Radiol. 2009;6:14–20.CrossRefGoogle Scholar
  6. 6.
    Dighe S, Swift I, Brown G. CT staging of colon cancer. Clin Radiol. 2008;63:1372–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Klessen C, Rogalla P, Taupitz M. Local staging of rectal cancer: the current role of MRI. Eur Radiol. 2007;17:379–89.PubMedCrossRefGoogle Scholar
  8. 8.
    Gray PR, Morton MD, Seymour PM. Foxtrot: fluoropyrimidine, oxaliplatin & targeted receptor pre-operativetherapy for colon cancer. A randomised trial assessing whether preoperative chemotherapy and/or an anti-EGFR monoclonal antibody improve outcome in high-risk operable colon cancer, http://Pfsearch.Ukcrn.Org.Uk/Studydetail.Aspx?Topicid¼&Studyid¼3771 [accessed 15.04.2008].PubMedCrossRefGoogle Scholar
  9. 9.
    Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med. 1997;336:980–7.CrossRefGoogle Scholar
  10. 10.
    Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–46.PubMedCrossRefGoogle Scholar
  11. 11.
    Glynne-Jones R, Harrison M. Locally advanced rectal cancer: what is the evidence for induction chemoradiation? Oncologist. 2007;12:1309–18.PubMedCrossRefGoogle Scholar
  12. 12.
    Jones J, Bahr R. Neoadjuvant chemoradiation treatment impairs accuracy of MRI staging in rectal cancer. Gut. 2006;55:1214–5.CrossRefGoogle Scholar
  13. 13.
    Kim DJ, Kim JH, Lim JS, et al. Restaging of rectal cancer with MRI imaging after concurrent chemotherapy and radiation therapy. Radiographics. 2010;30:699–716.CrossRefGoogle Scholar
  14. 14.
    Kuo LJ, Chem MC, Tsou MH, et al. Interpretation of magnetic resonance imaging for locally advanced rectal carcinoma after preoperative chemoradiation therapy. Dis Colon Rectum. 2005;48:23–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Dresen RC, Beets GL, Rutten HJ, et al. Locally advanced rectal cancer: MR imaging for restaging after neoadjuvant radiation therapy with concomitant chemotherapy Part 1. Are we able to predict tumour confined to the rectal wall. Radiology. 2009;252:71–80.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    Kong G, Jackson C, Koh DM, et al. The use of 18F-FDG PET/CT in colorectal liver metastases—comparison with CT and liver MRI. Eur J Nucl Med Mol Imaging. 2008;35:1323–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Wiering B, Krabbe PF, Jager GJ, Oyen WJ, Ruers TJ. The impact of fluor-18-deoxyglucose-positron emission tomography in the management of colorectal liver metastases. Cancer. 2005;104:2658–70.PubMedCrossRefGoogle Scholar
  19. 19.
    FDG-PET/CT plays a definite role in detecting colorectal cancer recurrences. www.sciencedaily.com/releases/2010/05/100505091625. May 2010.
  20. 20.
    EFSUMB study group. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) – update 2008. www.efsumb.org/mediafiles01/ceus-guidelines2008.pdf.
  21. 21.
    Renehan AG, Egger M, Saunders MP, O’Dwyer ST. Impact on survival of intensive follow up after curative resection for colorectal cancer: systemic review and meta-analysis of randomised trials. BMJ. 2002;324:813.PubMedCrossRefGoogle Scholar
  22. 22.
    Morris EJ, Forman D, Thomas JD, et al. Surgical management and outcomes of colorectal cancer liver metastases. Br J Surg. 2010;97:1110–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Laubert T, et al. Intensified surveillance after surgery for colorectal cancer significantly improves survival. Eur J Med Res. 2010;15:25–30.PubMedCrossRefGoogle Scholar
  24. 24.
    Scheer A, Auer RAC. Surveillance after curative resection of colorectal cancer. Clin Colon Rectal Surg. 2009;22:242–50.PubMedCrossRefGoogle Scholar
  25. 25.
    Cairns SR, Scholefield JH, Steele RJ, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut. 2010;59:666–89.PubMedCrossRefGoogle Scholar
  26. 26.
    Figueredo A, Zuraw L, Wong RK, et al. Follow up of patients with curatively resected colorectal cancer: a practice guideline. BMC Cancer. 2003;3:26.PubMedCrossRefGoogle Scholar
  27. 27.
    Tjandra JJ, Chan MK. Follow up after curative resection of colorectal cancer: a meta-analysis. Dis Colon Rectum. 2007;50:1783–99.PubMedCrossRefGoogle Scholar
  28. 28.
    Jeffery M, Hickey BE, Hider PN. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev. 2007;Issue 1. Art. No: CD002200. doi: 10.1002/14651858.CD002200.pub2.Google Scholar
  29. 29.
    Macafee DA, Whynes DK, Scholefield JH. Risk stratified intensive follow up for treated colorectal cancer – realistic and cost saving. Colorectal Dis. 2008;10:222–30.PubMedCrossRefGoogle Scholar
  30. 30.
    Alvarez JA, Baldonedo RF, Bear IG, et al. Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg. 2005;190:376–82.PubMedCrossRefGoogle Scholar
  31. 31.
    Anderson JH, Hole D. Elective surgery versus emergency surgery for patients with colorectal cancer. Br J Surg. 1992;7:706–9.CrossRefGoogle Scholar
  32. 32.
    Tekkis P, Poloniecki J, Thompson M, Stamatakis J. ACPGBI Colorectal Cancer Study 2002: part A: unadjusted outcomes. London: Association of Coloproctology of Great Britain and Ireland; 2002.Google Scholar
  33. 33.
    Hill J. CREST The role of endoluminal stenting in the acute management of obstructing ­colorectal cancer. CREST PROTOCOL. www.crest.bham.ac.uk/investigations/CReST_Protocol_v2.1_16072009.pdf [Accessed 04.01.2011].

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  1. 1.Department of RadiologyManchester Royal InfirmaryManchesterUK

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