Adjuvant radiotherapy and chemotherapy in the treatment of rectal cancer

The rectum is easily accessible by digital examination and other methods of investigation because of its position at the end of the gastrointestinal tract. This particularity of the rectum enables us, with relative accuracy, to define preoperatively, the stage of local invasion of carcinomas. PREOPERATIVE STAGING As regards the preoperative estimation of the bowel wall depth of invasion, digital examination accuracy is not more than 68% and the magnetic resonance imaging (MRI) reaches only 66%. The accuracy though of the endoluminal ultrasound (EUS) exceeds 88%. Those methods are less accurate when they are used to determine the regional lymph node status. The endoluminal ultrasound accuracy is not more than 71% and that of the magnetic resonance tomography is less than 72%. 1 Combining EUS and MRI helps us to select patients with advanced rectal cancer which are candidates for preoperative adjuvant treatment. None of these techniques, however, can reliably identify the extend of lymph node involvement.