Slovenská chirurgia 4/2019
A surgeon perspective of magnetic resonance imaging in rectal cancer
Around eight thousand colorectal carcinoma patients are newly diagnosed in the Czech Republic per year, almost two thousand of them with rectal cancer. Its incidence is increasing steadily, while mortality has a decreasing tendency due to effective treatment that has improved over the last few decades. It‘s expected to cause about 3400 deaths per year. Rectal cancer may cause one or more of these symptoms - rectal bleeding with bright red blood or blood in the stool,tenesms, a change in bowel habits, such as diarrhea, constipation, that lasts for more than a few days or local inflammation in the breakdown process of the rectal tumor itself. The diagnostic of rectal cancer is based primarily on targeted examination or tests that can be used to screen for colorectal cancer.The main examination is colonoscopy and also rectoscopy with sampling or removing any suspicious-looking areas with histological verification. The detection of the synchronous colon carcinoma may appear of approximately 5%.For a further surgical strategy, it is very important to accurately determine the distance of the lower end of the tumor and to determine staging of the disease. Computed tomography of the chest, abdomen and pelvis will help us find possible distant organ metastasis. Local range of the rectal tumor and involvement of regional lymph nodes (N) can be detected by transrectal ultrasonography (TRUS) and mainly by magnetic resonance imaging (MRI) of rectum and pelvis. MRI has an important, almost irreplaceable role in the primary staging of rectal tumors. It has also leading role in decision-making which patients will benefit from pre-operative neoadjuvant chemotherapy and radiotherapy, as well as in type of surgery resection. The combinations of different treatment modalities like surgery, chemotherapy, biological therapy, and radiotherapy play an important role in treatment, more or less as a combination of them individualized for the patient. Intense cooperation between all disciplines is estimated for the best treatment outcomes. However, oncosurgery with total mesorectal excision plays an indispensable role in the treatment of rectal cancer.
Keywords: rectal cancer, magnetic resonance imaging, oncosurgery
