Computed Tomography

The pre-operative diagnosis and staging of rectal carcinoma represent in our country a problem of much social concern, considering the high incidence of mortality for this neoplasm (about 4 000 deaths/year in Italy) [15].

In recent years, the advances in surgical procedures and pre-, intra- and post-operative radiotherapy have enhanced the percentage of operability, while the risk of post-operative recurrence and the incidence of distant metastases are constant: this is partly due to the inadequacy of pre-operative staging. In fact the risk of recurrence is substantially related to two factors: (1) the extent of rectal wall infiltration; and (2) the presence of metastatic lym-phadenopathy [15,16]. These occurrences should be known to the clinician in order to plan the correct pre-operative adjuvant radiotherapy and, if necessary, to change the surgical approach. A correct pre-operative assessment of rectal carcinoma is thus necessary, taking into account the clinical evaluations (rectal exploration, rectoscopy, biopsy) and the use of combined diagnostic imaging (double contrast enema, transrectal sonography, computed tomography and magnetic resonance), where each procedure plays its own role in the identification and staging of the tumour [17].

The criteria used to define the stage of rectal carcinoma have been established by the NIH Consensus Conference of 1990, which indicates the EMU as the reference system of staging. The TNM classification has been used throughout this study (Table 1).

The present indications for computed tomography (CT) in rectal cancer are: the site of tumour, its infiltration in the perirectal fat or in the adjacent organs, the nodal spread and distant metastasis.

Table 1. TNM classification of rectal tumours

TNM

Dukes

Stage 0

Tis

N0

M0

Stage I

T1

N0

M0

A

T2

N0

M0

A

Stage II

T3

N0

M0

B

Stage III

Any T

N1

M0

C

Any T

N2-3

M0

C

Stage IV

Any T

Any N

M1

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