Colon Cancer: Preoperative Evaluation and Staging
The preoperative assessment of patients with colorectal cancer (CRC) often requires a multidisciplinary approach, involving a complete endoscopic evaluation as well as both clinical and radiographic staging. In addition to providing a concrete diagnosis,
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Key Concepts • Total colonic evaluation is recommended prior to surgical intervention to exclude synchronous tumors that may alter surgical plan. • Evaluation for metastatic disease by cross-sectional imaging is recommended prior to surgical intervention, as it may alter treatment decisions. • Preoperative carcinoembryonic antigen (CEA) level should be obtained, as changes in CEA may herald tumor recurrence. • Tumor location should be identified preoperatively. • Tumor grade, lymphovascular invasion, margin status, and immunohistochemical assessment of mismatch repair proteins may have prognostic significance and should be routinely reported.
colorectal cancer in the United States is approximately 5 % with a likelihood rising notably after 50 years of age. It is estimated that up to 90 % of cases occur in individuals over the age of 50 [11]. Once the diagnosis of colon cancer is made, the goal of preoperative evaluation is to establish the location of the tumor, assess for metastatic disease and adjacent organ invasion, and identify other patient and tumor factors that may affect outcome or alter the medical or surgical approach to treatment. The primary importance of staging in colon cancer is to rule out additional pathology and distant metastatic disease (stage IV), which can affect treatment approach. This differs from rectal cancer where estimates of locoregional tumor stage have a greater effect on treatment planning.
Clinical Presentation Background Colorectal cancer remains a challenging clinical entity worldwide—affecting more than one million individuals annually [1–3]. Marked geographic variations exist, with industrialized countries bearing significantly higher incidences that are believed to be attributed to a mix of diet and environment [2, 3]. In the United States, it is the third leading cause of cancerrelated deaths and is the third most common cancer following lung cancer and prostate and breast cancers in men and women, respectively [2–4]. In recent years, it has been estimated that annually there are roughly 100,000 new cases of colon cancer and more than 40,000 cases of rectal cancer [5–7]. Fortunately, both the incidence and mortality of colorectal cancer have declined steadily in the past three decades—largely due to more effective screening programs and improvements in treatment modalities [5–7]. However, despite these measurable gains, there remain significant disparities in incidence and mortality, particularly among African Americans [8–10]. Overall, the lifetime risk of developing
Colon cancer presents in three common ways: an asymptomatic lesion detected during routine screening examination; manifestation of vague but suspicious symptoms such as change in bowel habits, weight loss, and fatigue that lead to further investigation; and emergently, with perforation or obstruction. Early colon cancers are often asymptomatic, which underscores the importance of routine screening. Even so, it is estimated that about 30 % of all cancers are diagnosed by endoscopy in the absence of symptoms [
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