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Rectal Cancer Symposium
Rectal cancer is a major health problem in Europe. Prognosis and treatment of the disease depend on stage at the time of diagnosis. Local recurrence, as well as liver metastases are significant causes of morbidity and mortality. The high mortality is presumably also caused by other factors: the examinations performed, the offered treatment including operative techniques, the possible combination of operation with radiotherapy and chemotherapy and post-treatment follow-up.
The treatment of rectal carcinoma has changed over the last years as far as surgical techniques (with introduction of total mesorectal excision) and radiotherapy is concerned. With the implementation of the new treatment options local recurrence rates have been considerably reduced and overall 5 year survival rates of 75% are being achieved. Accurate radiological evaluation of the extension of the tumour into the perirectal fat, distance to the mesorectal fascia, involvement of adjacent organs and lymph nodes are essential for best possible treatment planning. Accurate preoperative local staging of rectal cancer requires transrectal ultrasound (TRUS) and MR imaging of the rectum. TRUS is useful in the T-staging when early carcinoma of the rectum is clinically suspected. The use of 3 mm high resolution axial T2 weighted MRI can identify a number of poor prognostic features preoperatively, i.e. increasing depth of extramural spread, distance to the mesorectal fascia, N2 nodal disease, extramural venous invasion and peritoneal infiltration
Multidisciplinary teams and quality assurance are important for achievement of optimal treatment planning.