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Philipps-Universität Marburg
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Abstract
Rectal cancer is one of the most common form of cancer in the industrialized countries and is associated with a high lethality. In the last decades a change has taken place in treatment options. Developments in surgery such as Healds introduction of TME as well as preoperative radiochemotherapy have led to a notable decrease of high local recurrence rate which is a major problem in rectal cancer. A preoperative radiochemotherapy is indicated when a T-stage ≥ 3 or a lymph node involvement becomes apparent. Thus a correct definition of tumor stage by means of endosonography or complementary MRI is essential to provide adequate treatment modalities and to diminish the risk of overtreatment. This retrospective study aims to evaluate the significance of endosonography and MRI in general practice with focus on effectiveness and efficiency. Therefore all patients with rectal cancer diagnosed in between the years 2005 and 2007 and internally performed local staging were included in this study. From a total of 127 patients endosonography failed in nearly every third case due to stenotic tumor growth. The availability of an experienced examiner posed another problem. Both led to delay in diagnosis and treatment. The use of MRI was necessary in every second case and failed in three cases. Correlation with histopathological findings was restricted to dominating tumor stages T2 and T3, whose differentiation is essential for adequate treatment modalities. Both MRI and endosonography were equal in detecting wall penetrating T3 lesions, but MRI was better in distinguishing between a T2- and a T3 lesion. Correct classification of nodal stage was a general problem and still poses a challenge for all participating disciplines. In general practice the use of MRI seems to be not only desirable but necessary and is characterized by high practicability and a low failure rate. Not the exact definition of tumor stage but the reliable prediction of wall penetrating T3 or T4 lesions makes it a valuable and essential tool for local staging of rectal cancer. With regard to the predominance of T3 lesions and the intention to optimize process flows MRI might be used prior to endosonography and could serve as a filter for those tumor stages which are likely to succeed in endosonography. A classification in “not wall penetrating” (T1-T2) and “wall penetrating” (T3-T4) would be sufficient according to the treatment options. In consequence nodal staging would only be required in case of a “not wall penetrating” lesion. In the future the use of USPIO contrast agent might improve the prediction of nodal stage. The CRM still plays a marginal role in general practice but could gain importance as it announces a more specific selection of patients who benefit from preoperative radiochemotherapy.
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Dates
Created: 2011Issued: 2011-06-28Updated: 2011-08-08
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
COLORECTAL NEOPLASMSCancer Staging
DFG-subjects
NMR-TomographieEndosonographieTransrektale EndosonographieGastroenterologische EndosonographieStagingMastdarmkrebs
DDC-Numbers
610
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Hesse, Julia Mahnaz: Lokales Staging beim Rektumkarzinom. : Philipps-Universität Marburg 2011-06-28. DOI: https://doi.org/10.17192/z2011.0424.
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This item has been published with the following license: In Copyright