Preoperative Staging
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Preoperative Staging
Colorectal Cancer: Preoperative Evaluation and Staging- Key Concepts
- Diagnosis of Colorectal Cancer
- Screening and Diagnostic Modalities
- Fecal Sampling
- Flexible Sigmoidoscopy
- Computed Tomography (CT) Colonography
- Colonoscopy
- Delineating Colon Versus Rectum
- Staging and Workup of Colon and Rectal Cancer
- Preoperative Evaluation
- Prognostic Factors Associated with Overall and Disease-Free Survival
- Pathologic Features: Pre-Resection
- Lymphovascular Invasion (LVI)
- Perineural Invasion (PNI)
- Tumor Budding
- Mismatch Repair (MMR) Deficient or Microsatellite Instability-High (MSI) Status
- Tumor Grade
- Histologic Type
- Pathologic Factors: Post-Resection
- Extranodal Tumor Deposits
- Clinical or Imaging-Based Factors
- Conclusion
- References
Malignancy- A 60-year-old man presents for his postoperative visit 1 month after colon resection for stage II adenocarcinoma. Preoperative colonoscopy was otherwise unremarkable. When should surveillance colonoscopy be performed?
- A 68-year-old man is diagnosed with a 2.5-cm adenocarcinoma of the ascending colon on colonoscopy. His carcinoembryonic antigen level is 1.5. What is the next step in management?
- A 57-year-old man is taken to the operating room for resection of a distal transverse colon cancer. On exploration, you note direct extension of the mass to the posterior gastric body. What is the next step in management?
- A 64-year-old woman underwent laparoscopic sigmoid colectomy for adenocarcinoma. Staging workup was negative for distant metastases. Preoperative carcinoembryonic antigen level was 4.1 ng/mL (4.1 μg/L). Proximal, distal, and radial margins were negative. Which of the following findings on final pathology confers the poorest prognosis?
- A 56-year-old man presents to the office with biopsy-proven midrectal adenocarcinoma on colonoscopy. Rigid sigmoidoscopy in the office shows a 5-cm circumferential mass 8 cm from the anal verge. Staging evaluation with computed tomography of the chest, abdomen, and pelvis and magnetic resonance imaging of the pelvis preoperatively demonstrates a T3N1M0 cancer. What is the next step in management for this patient?
- A 54-year-old man presents to your office 1 year after undergoing sigmoid resection for T3N0 colon cancer. In addition to carcinoembryonic antigen, what surveillance approach do you recommend?
Malignancy- A 70-year-old woman with a medical history of hypertension and hypothyroidism reports rectal bleeding, maroon blood mixed in with her stool, and weight loss to her primary care physician. She is referred to undergo diagnostic colonoscopy. She is found to have a hepatic flexure mass with biopsies taken and tattoo placed distally, with pathology returning as moderately differentiated adenocarcinoma, mismatch repair (MMR) protein expression intact. Laboratory testing includes a complete blood count, basic chemistry, and carcinoembyronic antigen (CEA) with findings of anemia and a mildly elevated CEA level. What imaging is recommended for completion of the staging work-up in this patient?
- A 45-year-old patient undergoes emergent right hemicolectomy for an obstructing colon cancer with a small area of contained perforation. The patient recovers well and presents to your office for postoperative follow-up. Final pathology is T4aN0, with 0/13 nodes positive, margins negative, and mismatch repair intact. The best next step in this patient’s treatment plan is
- A 62-year-old woman is found to have a large near-obstructing sigmoid cancer on colonoscopy; biopsy returns as adenocarcinoma. Preoperative staging includes a carcinoembryonic antigen (CEA) level of 8 ng/mL, and imaging shows a few prominent lymph nodes near the sigmoid lesion. She is referred for surgical management. Frozen section on peritoneal nodules found near the lesion return as adenocarcinoma, and oncological resection is completed. Which of the following is the best determinant of the prognosis for this patient?
- Local Excision
- Indications for Preoperative Neoadjuvant Therapy
- Ulcerative Colitis: Surgical Management
Management of Rectal Cancer (2020)- Rectal Cancer: Neoadjuvant Therapy
- Preoperative Evaluation in Colorectal Patients
- Colonic Diverticular Disease
- Perioperative
- Colorectal Cancer: Postoperative Adjuvant Therapy and Surveillance
- Fundamentals of Rectal Cancer Surgery
- Minimally Invasive Complete Mesocolic Excision with Extended Lymphadenectomy for Colon Cancer
- Adjuvant Therapy for Rectal Adenocarcinoma
- Rationale for Multimodality Therapy
- Rectal Cancer Pathology Assessment
- Surgical Management of Ulcerative Colitis (2021)
- Benign Disease
- Management of Colon Cancer (2022)
- Surveillance and Survivorship Care of Patients After Curative Treatment of Colon and Rectal Cancer (2021)
- Rectal Cancer: Local Excision
- Colon and Rectal Surgery Educational Program (CARSEP)
- ASCRS Question Bank