colorectal cancer staging. how is rectal cancer staged? dr. anton titov, md: preoperative staging of rectal cancer tumors is important. because correct colorectal cancer staging allows the surgeon to select the right patient for the right type of surgery. colorectal cancer staging is also important for selection of radiotherapy and chemotherapy combination. how do you stage patients with rectal cancer before you take them to the operating room? dr. torbjorn holm, md (rectal cancer surgeon, professor, karolinska institute, stockholm): we have to think about the history. because there were times maybe 10 or 15 years ago when there was no colorectal cancer preoperative staging. the surgeon just had palpated the tumor. surgeon may be took a rectal cancer biopsy and then brought rectal cancer patient for surgery directly. surgeons had no idea of how colorectal tumor is growing outside the bowel. then people started to do ultrasound for colorectal cancer staging. ultrasound is good for the superficial colorectal cancer tumors, but it's very difficult to detect by ultrasound if cancer is more extensive. ultrasound does not detect if rectal cancer is going outside the bowel wall into the mesorectum and maybe even into other body organs. i think we were the first in the world at the karolinska institute with professor lennart blomquist to actually start doing mri for rectal cancer staging before surgery. first we did mri to stage locally recurrent rectal cancer to plan the surgery. then we started doing mri to stage all colorectal cancer patients before surgical operation. i remember still the first lecture we had at the first rectal cancer surgical treatment course with professor heald. we showed him mri of the rectal cancer patient he was going to operate on. he was completely enthusiastic about use of mri for colorectal cancer preoperative staging. he had never seen anything like that. since then mri use for preoperative colorectal cancer staging has spread around the world. so today the golden standard for preoperative staging of rectal cancer is an mri. no patient with rectal cancer should have an operation unless they have had an mri. because mri allows good local staging of rectal cancer. mri is the road map for the surgeon how to do the rectal cancer operation. dr. torbjorn holm, md (rectal cancer surgeon, professor, karolinska institute, stockholm): surgeon can see on the mri if colorectal cancer tumor is more extensive than initially thought. surgeon can see if there are lymph nodes that colorectal cancer affects. mri is very crucial for preoperative staging of colorectal cancer patients. but also of course you need to have a good ct scan of the chest and the abdomen to see if there are any metastasis from colorectal cancer. so a combination of mri and ct scan is the diagnostic staging method of choice for rectal cancer staging before surgery.
dr. anton titov, md: so the primary method of assessing rectal cancer tumor is mri. dr. holm: yes.
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