Optimization of Preoperative Assessment in Patients Diagnosed With Rectal Cancer

Guideline Objective

To provide the optimal strategy to assess patients diagnosed with rectal cancer prior to treatment. This includes:

1. Investigations [chest X-ray or computed tomography (CT) thorax/abdomen/pelvis, colonoscopy, serum carcinoembryonic antigen] to assess for distant metastases and synchronous lesions in patients with rectal cancer
2. Imaging [magnetic resonance imaging (MRI) pelvis, endoscopic ultrasound (EUS), transrectal ultrasound (TRUS), CT pelvis] for local staging of rectal cancer
3. The optimal MRI protocol to locally stage rectal cancerThe optimal MRI criteria to locally stage rectal cancerThe optimal MRI criteria to select patients for neoadjuvant therapy
4. The role of multidisciplinary cancer conferences (MCCs)The role of restaging MRI after neoadjuvant therapy

Patient Population

Newly diagnosed patients with rectal cancer undergoing elective treatment.

Intended Guideline Users

Radiologists, surgeons, radiation oncologists, medical oncologists, and pathologists.

Research Question(s)

1. What investigations (chest X-ray or CT thorax/abdomen/pelvis, colonoscopy, serum carcinoembryonic antigen) should be performed to assess for distant metastases and synchronous lesions in patients with rectal cancer?
2. What imaging (MRI pelvis, EUS, TRUS, CT pelvis) should be performed for local staging of rectal cancer?
3. What MRI protocol has been shown to have the best accuracy to locally stage rectal cancer?
4. What MRI criteria are necessary to locally stage rectal cancer preoperatively?
5. Which MRI criteria should be used to select patients for neoadjuvant therapy?
6. Does a pretreatment discussion at multidisciplinary cancer conference (MCC) improve patient outcome for patients with rectal cancer?
7. Does a restaging MRI after neoadjuvant therapy improve patient outcomes for patients with rectal cancer?