Suspected Rectal Cancer - Investigations скачать в хорошем качестве

Suspected Rectal Cancer - Investigations

In patients with rectal cancer, Abdominal examination is normal in early detected cases. However, If large volume liver metastases are present, an enlarged liver may be palpable along with other signs, such as cachexia. Occasionally, it may be possible to elicit Ascites if there is widespread peritoneal dissemination. In many cases where the neoplasm is situated within 7 to 8 cm from anal verge, it can be felt on digital rectal examination as an elevated, irregular and hard endoluminal mass. An attempt should be made to determine whether the neoplasm is mobile, tethered or fixed, and to estimate the distance of the lower margin from the top of the anal sphincter complex. In females, a vaginal examination may be useful if involvement of the posterior vaginal wall is suspected. Digital rectal examination also offers the opportunity to evaluate the anal sphincter complex, which is important in cases where resection and low anastomosis is being considered. Rigid sigmoidoscopy can be performed in the outpatient clinic and is useful to identify the neoplasm and possibly obtain biopsies. A colonoscopy is required in most patients to exclude a synchronous tumor. If a proximal adenoma is found, it can be conveniently snared and removed via the colonoscope. If a synchronous carcinoma is present, the operative strategy is likely to change. If a full colonoscopy is not possible, for example when there is a stenosing cancer, a CT colonography or barium enema can be performed. Staging CT of the thorax, abdomen and pelvis is required to stage both local and metastatic disease. Positron emission tomography (PET) scanning can be helpful in identifying metastases. MRI is the best modality to assess soft tissue extent of the tumor for local staging of cancer and assess the circumferential resection margin, and to ascertain whether the mesorectal fascia is potentially involved. These determinations are of great importance in guiding both surgical and oncological management.