Skip to main content

Colon Cancer: Preoperative Evaluation and Staging

  • Chapter
  • First Online:
The ASCRS Textbook of Colon and Rectal Surgery

Abstract

The preoperative assessment of patients with colorectal cancer (CRC) often requires a multidisciplinary approach, involving a complete endoscopic evaluation as well as both clinical and radiographic staging. In addition to providing a concrete diagnosis, histologic review by the pathologist imparts valuable information about tumor grade and other important prognostic features, which will be discussed in greater detail in this chapter. A thorough history and physical examination rounds out the initial evaluation and provides the surgeon with vital information that may influence operative planning.

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

Access this chapter

Institutional subscriptions

References

  1. Cunningham D, Atkin W, Lenz HJ, Lynch HT, Minsky B, Nordlinger B, et al. Colorectal cancer. Lancet. 2010;375:1030–47.

    PubMed  Google Scholar 

  2. Haggar FA, Boushey RP. Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg. 2009;22:191–7.

    PubMed  Google Scholar 

  3. Cappell MS. Pathophysiology, clinical presentation, and management of colon cancer. Gastroenterol Clin North Am. 2008;37:1–24. v.

    PubMed  Google Scholar 

  4. Chang GJ, Kaiser AM, Mills S, Rafferty JF, Buie WD. Practice parameters for the management of colon cancer. Dis Colon Rectum. 2012;55:831–43.

    PubMed  Google Scholar 

  5. Aarons CB, Mahmoud NN. Current surgical considerations for colorectal cancer. Chin Clin Oncol. 2013;2:14.

    PubMed  Google Scholar 

  6. Engstrom PF, Arnoletti JP, Benson 3rd AB, Chen YJ, Choti MA, Cooper HS, et al. NCCN Clinical Practice Guidelines in Oncology: colon cancer. J Natl Compr Canc Netw. 2009;7:778–831.

    PubMed  Google Scholar 

  7. Engstrom PF, Arnoletti JP, Benson 3rd AB, Chen YJ, Choti MA, Cooper HS, et al. NCCN Clinical Practice Guidelines in Oncology: rectal cancer. J Natl Compr Canc Netw. 2009;7:838–81.

    PubMed  Google Scholar 

  8. Govindarajan R, Shah RV, Erkman LG, Hutchins LF. Racial differences in the outcome of patients with colorectal carcinoma. Cancer. 2003;97:493–8.

    PubMed  Google Scholar 

  9. Tammana VS, Laiyemo AO. Colorectal cancer disparities: issues, controversies and solutions. World J Gastroenterol. 2014;20:869–76.

    PubMed  Google Scholar 

  10. Winawer SJ, Stewart ET, Zauber AG, Bond JH, Ansel H, Waye JD, et al. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med. 2000;342:1766–72.

    CAS  PubMed  Google Scholar 

  11. Lynch ML, Brand MI. Preoperative evaluation and oncologic principles of colon cancer surgery. Clin Colon Rectal Surg. 2005;18:163–73.

    PubMed  Google Scholar 

  12. Moiel D, Thompson J. Early detection of colon cancer-the kaiser permanente northwest 30-year history: how do we measure success? Is it the test, the number of tests, the stage, or the percentage of screen-detected patients? Perm J. 2011;15:30–8.

    PubMed  Google Scholar 

  13. Joseph DA, King JB, Miller JW, Richardson LC. Prevalence of colorectal cancer screening among adults—Behavioral Risk Factor Surveillance System, United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61(Suppl):51–6.

    Google Scholar 

  14. Fleshman JW, Wolff BG. The ASCRS textbook of colon and rectal surgery. New York: Springer; 2007.

    Google Scholar 

  15. Majumdar SR, Fletcher RH, Evans AT. How does colorectal cancer present? Symptoms, duration, and clues to location. Am J Gastroenterol. 1999;94:3039–45.

    CAS  PubMed  Google Scholar 

  16. Amri R, Bordeianou LG, Sylla P, Berger DL. Impact of screening colonoscopy on outcomes in colon cancer surgery. JAMA Surg. 2013;148:747–54.

    PubMed  Google Scholar 

  17. Mulder SA, Kranse R, Damhuis RA, de Wilt JH, Ouwendijk RJ, Kuipers EJ, et al. Prevalence and prognosis of synchronous colorectal cancer: a Dutch population-based study. Cancer Epidemiol. 2011;35:442–7.

    PubMed  Google Scholar 

  18. Luigiano C, Ferrara F, Morace C, Mangiavillano B, Fabbri C, Cennamo V, et al. Endoscopic tattooing of gastrointestinal and pancreatic lesions. Adv Ther. 2012;29:864–73.

    PubMed  Google Scholar 

  19. Dawson K, Wiebusch A, Thirlby RC. Preoperative tattooing and improved lymph node retrieval rates from colectomy specimens in patients with colorectal cancers. Arch Surg. 2010;145:826–30.

    PubMed  Google Scholar 

  20. Bartels SA, van der Zaag ES, Dekker E, Buskens CJ, Bemelman WA. The effect of colonoscopic tattooing on lymph node retrieval and sentinel lymph node mapping. Gastrointest Endosc. 2012;76:793–800.

    PubMed  Google Scholar 

  21. Compton CC, Fielding LP, Burgart LJ, Conley B, Cooper HS, Hamilton SR, et al. Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med. 2000;124:979–94.

    CAS  PubMed  Google Scholar 

  22. Au FC, Stein BS, Gennaro AR, Tyson RR. Tissue CEA in colorectal carcinoma. Dis Colon Rectum. 1984;27:16–8.

    CAS  PubMed  Google Scholar 

  23. Fletcher RH. Carcinoembryonic antigen. Ann Intern Med. 1986;104:66–73.

    CAS  PubMed  Google Scholar 

  24. McCall JL, Black RB, Rich CA, Harvey JR, Baker RA, Watts JM, et al. The value of serum carcinoembryonic antigen in predicting recurrent disease following curative resection of colorectal cancer. Dis Colon Rectum. 1994;37:875–81.

    CAS  PubMed  Google Scholar 

  25. Wiratkapun S, Kraemer M, Seow-Choen F, Ho YH, Eu KW. High preoperative serum carcinoembryonic antigen predicts metastatic recurrence in potentially curative colonic cancer: results of a five-year study. Dis Colon Rectum. 2001;44:231–5.

    CAS  PubMed  Google Scholar 

  26. Huh JW, Oh BR, Kim HR, Kim YJ. Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer. J Surg Oncol. 2010;101:396–400.

    PubMed  Google Scholar 

  27. Kirat HT, Ozturk E, Lavery IC, Kiran RP. The predictive value of preoperative carcinoembryonic antigen level in the prognosis of colon cancer. Am J Surg. 2012;204:447–52.

    CAS  PubMed  Google Scholar 

  28. Locker GY, Hamilton S, Harris J, Jessup JM, Kemeny N, Macdonald JS, et al. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol. 2006;24:5313–27.

    CAS  PubMed  Google Scholar 

  29. Park IJ, Choi GS, Lim KH, Kang BM, Jun SH. Serum carcinoembryonic antigen monitoring after curative resection for colorectal cancer: clinical significance of the preoperative level. Ann Surg Oncol. 2009;16:3087–93.

    PubMed  Google Scholar 

  30. Mauchley DC, Lynge DC, Langdale LA, Stelzner MG, Mock CN, Billingsley KG. Clinical utility and cost-effectiveness of routine preoperative computed tomography scanning in patients with colon cancer. Am J Surg. 2005;189:512–7. discussion 517.

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  32. Sahani DV, Bajwa MA, Andrabi Y, Bajpai S, Cusack JC. Current status of imaging and emerging techniques to evaluate liver metastases from colorectal carcinoma. Ann Surg. 2014;259:861–72.

    PubMed  Google Scholar 

  33. Furukawa H, Ikuma H, Seki A, Yokoe K, Yuen S, Aramaki T, et al. Positron emission tomography scanning is not superior to whole body multidetector helical computed tomography in the preoperative staging of colorectal cancer. Gut. 2006;55:1007–11.

    CAS  PubMed  Google Scholar 

  34. Pelosi E, Deandreis D. The role of 18F-fluoro-deoxy-glucose positron emission tomography (FDG-PET) in the management of patients with colorectal cancer. Eur J Surg Oncol. 2007;33:1–6.

    CAS  PubMed  Google Scholar 

  35. Whiteford MH, Whiteford HM, Yee LF, Ogunbiyi OA, Dehdashti F, Siegel BA, et al. Usefulness of FDG-PET scan in the assessment of suspected metastatic or recurrent adenocarcinoma of the colon and rectum. Dis Colon Rectum. 2000;43:759–67. discussion 767–70.

    CAS  PubMed  Google Scholar 

  36. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti AIII. AJCC cancer staging manual. New York: Springer; 2010.

    Google Scholar 

  37. Flamen P, Hoekstra OS, Homans F, Van Cutsem E, Maes A, Stroobants S, et al. Unexplained rising carcinoembryonic antigen (CEA) in the postoperative surveillance of colorectal cancer: the utility of positron emission tomography (PET). Eur J Cancer. 2001;37:862–9.

    CAS  PubMed  Google Scholar 

  38. Ruers TJ, Wiering B, van der Sijp JR, Roumen RM, de Jong KP, Comans EF, et al. Improved selection of patients for hepatic surgery of colorectal liver metastases with (18)F-FDG PET: a randomized study. J Nucl Med. 2009;50:1036–41.

    PubMed  Google Scholar 

  39. Parsons DP. Preoperative evaluation and risk management. Clin Colon Rectal Surg. 2009;22:5–13.

    PubMed  Google Scholar 

  40. Menke H, Klein A, John KD, Junginger T. Predictive value of ASA classification for the assessment of the perioperative risk. Int Surg. 1993;78:266–70.

    CAS  PubMed  Google Scholar 

  41. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:e278–333.

    PubMed  Google Scholar 

  42. Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144:581–95.

    PubMed  Google Scholar 

  43. Taylor A, DeBoard Z, Gauvin JM. Prevention of postoperative pulmonary complications. Surg Clin North Am. 2015;95(2):237–54.

    Google Scholar 

  44. Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124:144–54.

    PubMed  Google Scholar 

  45. Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart AK. Revised TN categorization for colon cancer based on national survival outcomes data. J Clin Oncol. 2010;28:264–71.

    PubMed  Google Scholar 

  46. Compton CC. Colorectal carcinoma: diagnostic, prognostic, and molecular features. Mod Pathol. 2003;16:376–88.

    PubMed  Google Scholar 

  47. Fleming M, Ravula S, Tatishchev SF, Wang HL. Colorectal carcinoma: pathologic aspects. J Gastrointest Oncol. 2012;3:153–73.

    PubMed  Google Scholar 

  48. Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst. 2007;99:433–41.

    PubMed  Google Scholar 

  49. Ueno H, Hashiguchi Y, Shimazaki H, Shinto E, Kajiwara Y, Nakanishi K, et al. Peritumoral deposits as an adverse prognostic indicator of colorectal cancer. Am J Surg. 2014;207:70–7.

    PubMed  Google Scholar 

  50. Read TE, Fleshman JW, Caushaj PF. Sentinel lymph node mapping for adenocarcinoma of the colon does not improve staging accuracy. Dis Colon Rectum. 2005;48:80–5.

    PubMed  Google Scholar 

  51. Broderick-Villa G, Ko A, O’Connell TX, Guenther JM, Danial T, DiFronzo LA. Does tumor burden limit the accuracy of lymphatic mapping and sentinel lymph node biopsy in colorectal cancer? Cancer J. 2002;8:445–50.

    PubMed  Google Scholar 

  52. Joosten JJ, Strobbe LJ, Wauters CA, Pruszczynski M, Wobbes T, Ruers TJ. Intraoperative lymphatic mapping and the sentinel node concept in colorectal carcinoma. Br J Surg. 1999;86:482–6.

    CAS  PubMed  Google Scholar 

  53. Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;93:583–96.

    CAS  PubMed  Google Scholar 

  54. Aarons CB, Shanmugan S, Bleier JI. Management of malignant colon polyps: current status and controversies. World J Gastroenterol. 2014;20:16178–83.

    PubMed  Google Scholar 

  55. Bujanda L. Malignant colorectal polyps. World J Gastroenterol. 2010;16:3103–11.

    PubMed  Google Scholar 

  56. Hassan C, Zullo A, Risio M, Rossini FP, Morini S. Histologic risk factors and clinical outcome in colorectal malignant polyp: a pooled-data analysis. Dis Colon Rectum. 2005;48:1588–96.

    PubMed  Google Scholar 

  57. Tominaga K, Nakanishi Y, Nimura S, Yoshimura K, Sakai Y, Shimoda T. Predictive histopathologic factors for lymph node metastasis in patients with nonpedunculated submucosal invasive colorectal carcinoma. Dis Colon Rectum. 2005;48:92–100.

    PubMed  Google Scholar 

  58. Coppede F, Lopomo A, Spisni R, Migliore L. Genetic and epigenetic biomarkers for diagnosis, prognosis and treatment of colorectal cancer. World J Gastroenterol. 2014;20:943–56.

    PubMed  Google Scholar 

  59. Gausachs M, Mur P, Corral J, Pineda M, Gonzalez S, Benito L, et al. MLH1 promoter hypermethylation in the analytical algorithm of Lynch syndrome: a cost-effectiveness study. Eur J Hum Genet. 2012;20:762–8.

    CAS  PubMed  Google Scholar 

  60. Kurzawski G, Suchy J, Debniak T, Kladny J, Lubinski J. Importance of microsatellite instability (MSI) in colorectal cancer: MSI as a diagnostic tool. Ann Oncol. 2004;15 Suppl 4:iv283–4.

    PubMed  Google Scholar 

  61. Benatti P, Gafa R, Barana D, Marino M, Scarselli A, Pedroni M, et al. Microsatellite instability and colorectal cancer prognosis. Clin Cancer Res. 2005;11:8332–40.

    CAS  PubMed  Google Scholar 

  62. Ribic CM, Sargent DJ, Moore MJ, Thibodeau SN, French AJ, Goldberg RM, et al. Tumor microsatellite-instability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer. N Engl J Med. 2003;349:247–57.

    CAS  PubMed  Google Scholar 

  63. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Najjia N. Mahmoud M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 ASCRS (American Society of Colon and Rectal Surgeons)

About this chapter

Cite this chapter

Aarons, C.B., Mahmoud, N.N. (2016). Colon Cancer: Preoperative Evaluation and Staging. In: Steele, S.R., Hull, T.L., Read, T.E., Saclarides, T.J., Senagore, A.J., Whitlow, C.B. (eds) The ASCRS Textbook of Colon and Rectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-25970-3_25

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-25970-3_25

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-25968-0

  • Online ISBN: 978-3-319-25970-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics