eMedicine Specialties > Radiology > Gastrointestinal

Rectal Carcinoma: Follow-up

Author: Isaac Hassan, MB, ChB, FRCR, DMRD, Former Senior Consultant Radiologist, Department of Radiology, St Bernard's Hospital, Gibraltar
Contributor Information and Disclosures

Updated: Mar 2, 2009

Intervention

Metallic stents may be placed across obstructing carcinomas of the rectum as a temporary measure to reduce the need for emergency surgery. In patients who are unable to undergo surgery or who have unresectable tumors, stents are used as a palliative procedure. Stent placement is a relatively simple procedure that rapidly improves the general condition of patients with large bowel obstruction.

In some institutions, intra-arterial chemotherapy via the internal iliac arteries is performed in patients with unresectable tumors. Similarly, intra-arterial chemotherapy via the hepatic artery may be used in the management of liver metastases from colorectal cancer.

Guided liver-directed therapy, such as RF ablation and interstitial laser photocoagulation, causes preferential tumor necrosis. RF electrodes or laser fibers are inserted into the hepatic metastasis under CT or ultrasonographic control, followed by tumor ablation procedures. Promising results (eg, a 40% 5-year survival rate) have been achieved from RF thermal ablation in select patients with hepatic metastases from colorectal cancer.

Medicolegal Pitfalls

  • Failure to recognize the signs and symptoms of rectal cancer
  • Failure to appropriately screen patients at various levels of risk
  • Failure to detect a carcinoma or polyp (>10 mm) by double-contrast barium enema or sigmoidoscopy
  • Failure to stage the carcinoma correctly using CT or MRI
 


More on Rectal Carcinoma

Overview: Rectal Carcinoma
Imaging: Rectal Carcinoma
Follow-up: Rectal Carcinoma
Multimedia: Rectal Carcinoma
References
Further Reading
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References

  1. American Cancer Society. Colorectal cancer: facts and figure 2008-1010. American Cancer Society Statistics. Available at http://www.cancer.org/downloads/STT/F861708_finalforweb.pdf. Accessed March 2, 2009.

  2. Zinkin LD. A critical review of the classifications and staging of colorectal cancer. Dis Colon Rectum. Jan 1983;26(1):37-43. [Medline].

  3. Rouse HC, Godoy MC, Lee WK, Phang PT, Brown CJ, Brown JA. Imaging findings of unusual anorectal and perirectal pathology: a multi-modality approach. Clin Radiol. Dec 2008;63(12):1350-60. [Medline].

  4. Dighe S, Swift I, Brown G. CT staging of colon cancer. Clin Radiol. Dec 2008;63(12):1372-9. [Medline].

  5. Xie Y, Chao M, Lee P, Xing L. Feature-based rectal contour propagation from planning CT to cone beam CT. Med Phys. Oct 2008;35(10):4450-9. [Medline].

  6. Thoeni RF, Moss AA, Schnyder P, Margulis AR. Detection and staging of primary rectal and rectosigmoid cancer by computed tomography. Radiology. Oct 1981;141(1):135-8. [Medline].

  7. American Joint Committee on Cancer. AJCC Cancer Staging Manual. 5th ed. Philadelphia, Pa: Lippincott-Raven; 1997.

  8. Tessonnier L, Gonfrier S, Carrier P, Valerio L, Mouroux J, Benisvy D, et al. [Unexpected focal bowel 18-FDG uptake sites: should they be systematically investigated?]. Bull Cancer. Nov 2008;95(11):1083-7. [Medline].

  9. Agrawal A, Nair N, Agrawal R, Baghel NS. Unsuspected second malignancy detection by FDG PET scan. Clin Nucl Med. Dec 2008;33(12):868-9. [Medline].

  10. Capirci C, Rubello D, Chierichetti F. Long-term prognostic value of 18F-FDG PET in patients with locally advanced rectal cancer previously treated with neoadjuvant radiochemotherapy. AJR Am J Roentgenol. Aug 2006;187(2):W202-8.

  11. Meta J, Seltzer M, Schiepers C. Impact of (18)f-fdg pet on managing patients with colorectal cancer: the referring physician''s perspective. J Nucl Med. Apr 2001;42(4):586-90. [Medline].

  12. Beets-Tan RG, Beets GL. Rectal cancer: review with emphasis on MR imaging. Radiology. Aug 2004;232(2):335-46.

  13. Brady AP, Stevenson GW, Stevenson I. Colorectal cancer overlooked at barium enema examination and colonoscopy: a continuing perceptual problem. Radiology. Aug 1994;192(2):373-8. [Medline].

  14. Dachman AH, Kuniyoshi JK, Boyle CM. CT colonography with three-dimensional problem solving for detection of colonic polyps. AJR Am J Roentgenol. Oct 1998;171(4):989-95. [Medline].

  15. Day JJ, Freeman AH, Coni NK, Dixon AK. Barium enema or computed tomography for the frail elderly patient?. Clin Radiol. Jul 1993;48(1):48-51. [Medline].

  16. Glick S. Double-contrast barium enema for colorectal cancer screening: a review of the issues and a comparison with other screening alternatives. AJR Am J Roentgenol. Jun 2000;174(6):1529-37. [Medline].

  17. Greenlee RT, Murray T, Bolden S. Cancer statistics, 2000. CA Cancer J Clin. Jan-Feb 2000;50(1):7-33. [Medline].

  18. Kim NK, Kim MJ, Yun SH, et al. Comparative study of transrectal ultrasonography, pelvic computerized tomography, and magnetic resonance imaging in preoperative staging of rectal cancer. Dis Colon Rectum. Jun 1999;42(6):770-5. [Medline].

  19. Krestin GP, Steinbrich W, Friedmann G. Recurrent rectal cancer: diagnosis with MR imaging versus CT. Radiology. Aug 1988;168(2):307-11. [Medline].

  20. Levine MS, Rubesin SE, Laufer I. Diagnosis of colorectal neoplasms at double-contrast barium enema examination. Radiology. Jul 2000;216(1):11-8. [Medline].

  21. Livraghi T, Goldberg SN, Monti F. Saline-enhanced radio-frequency tissue ablation in the treatment of liver metastases. Radiology. Jan 1997;202(1):205-10. [Medline].

  22. Rifkin MD, Marks GJ. Transrectal US as an adjunct in the diagnosis of rectal and extrarectal tumors. Radiology. Nov 1985;157(2):499-502. [Medline].

  23. Schaffzin DM, Wong WD. Endorectal ultrasound in the preoperative evaluation of rectal cancer. Clin Colorectal Cancer. Jul 2004;4(2):124-32.

  24. Shank B, Dershaw DD, Caravelli J, et al. A prospective study of the accuracy of preoperative computed tomographic staging of patients with biopsy-proven rectal carcinoma. Dis Colon Rectum. Apr 1990;33(4):285-90. [Medline].

  25. Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology. Feb 1997;112(2):594-642. [Medline].

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Keywords

rectal carcinoma, adenocarcinoma of the rectum, carcinoma of the rectum, colorectal cancer, colon cancer

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Contributor Information and Disclosures

Author

Isaac Hassan, MB, ChB, FRCR, DMRD, Former Senior Consultant Radiologist, Department of Radiology, St Bernard's Hospital, Gibraltar
Isaac Hassan, MB, ChB, FRCR, DMRD is a member of the following medical societies: American Roentgen Ray Society and Royal College of Radiologists
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Udo P Schmiedl, MD, PhD, Clinical Professor, Department of Radiology, University of Washington; Consulting Staff, Swedish Medical Center, University of Washington Medical Center, Seattle Radiologists
Udo P Schmiedl, MD, PhD is a member of the following medical societies: American College of Radiology and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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