6. Good prognostic
factors
Old age
Gender(F>M)
Asymptomatic pts
Polypoidal lesions
Non circumferential
lesions
Diploid
Poor prognostic factors
Obstruction
Perforation
Ulcerative lesion
Adjacent structures
involvement
Positive margins
LVSI
Signet cell carcinoma
High CEA
Tethered and fixed cancer
7. Tis T1 T2 T3 T4
Extension to an adjacent organ
Mucosa
Muscularis mucosae
Submucosa
Muscularis propria
Subserosa
Serosa
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ: intraepithelial or invasion of lamina propria
T1 Tumor invades submucosa
T2 Tumor invades muscularis propria
T3 Tumor invades through the muscularis propria into pericolorectal tissues
T4a Tumor penetrates to the surface of the visceral peritoneum
T4b Tumor directly invades or is adherent to other organs or structures
9. Stage 5-year Survival (%)
0,1 Tis,T1;No;Mo > 90
I T2;No;Mo 80-85
II T3-4;No;Mo 70-75
III T2;N1-3;Mo 70-75
III T3;N1-3;Mo 50-65
III T4;N1-2;Mo 25-45
IV M1 <3
11. 80-95% accurate in tumor staging
70-75% accurate in mesorectal lymph node
staging
Use is limited to lesion < 14 cm from anus, not
applicable for upper rectum, for stenosing
tumor
Very useful in determining extension of
disease into anal canal (clinical important for
planning sphincter preserving surgery)
Figure. Endorectal ultrasound
of a T3 tumor of the rectum,
extension through the
muscularis propria, and into
perirectal fat.
12. Part of routine workup.
Useful in identifying enlarged pelvic and extra-pelvic lymph-
nodes and visceral metastasis.
Limited utility in:
1. small primary cancer.
2. T – Stage assessment.
3. Peri-rectal lymph nodes assessment.
Sensitivity 50-80%
Specificity 30-80%
13. Shows promise as the most sensitive study for
the detection of metastatic disease in the
liver and elsewhere.
Sensitivity of 97% and specificity of 76% in
evaluating for recurrent colorectal cancer.
14. MRI may be Superior For:
1. Large field of view.
2. Better for proximal & stenotic lesions.
3. Less operator and technique dependent.
4. Size & morphologic characterization of peri-rectal nodes.
EUS may be Superior for:
1. More specific for muscularis propria invasion (T1 versusT2).
2. Significantly higher sensitivity forT3 disease.
High Resolution MRI & EUS Complementary Information.
Bipat et al.Radiology. 2004;232(3):773.
17. High LR following APR and AR: 20-50% (35%).
Sphincter preservation.
To live with a stoma.
Infections and sexual dysfunction.
The perfect scenario.
26. 1. T3 –T4 Lesions:The only definitive indication.
2. cT3N0: Should be treated (understaging).
3. Depth of Extramural Invasion:
T3 lesions (>5 mm) ++ LNs involvement Higher
Cancer Specific Survival (54%Versus 85%).
Selection of high riskT3 for treatment.
Approved outside US.
4. T1 – 2 lesions with Positive Nodes.
5. Low situated lesions.
6. Invasion of mesorectal fascia.
Br J Cancer 2000; 82:1131.
34. Rectal cancer should be treated by MDT.
Surgery is still the mainstay of treatment.
Neoadjuvant CRT is more appealing than
postoperative schedule regarding outcome and
toxicity profile for patients with stage II & III rectal
cancer.
Fluoroupyremidine therapy is still the backbone of
any regimen and can be substituted by the oral form.
Long course radiation therapy is still preferred by
majority of treating groups.
pCR is associated with significant improvement in
outcome.
Still more research is awaited.