EUS with high fequency probe detects sm1 tumours The Royal Marsdensuitable for local excision 1. Akasu T, Kondo H, Moriya Y, Sugihara K, Gotoda T, Fujita S, et al. Endorectal ultrasonography and treatment of early stage rectal cancer. World J Surg 2000;24(9):1061-8.
The Royal MarsdenKonishi, K., Y. Akita, et al. (2003). "Evaluation of endoscopic ultrasonographyin colorectal villous lesions." Int J Colorectal Dis– Large (>/=20 mm wide, >/=5 mm high) or rectal villous lesions were more likely than nonvillous lesions to be misjudged with regard to the differentiation between M/SM-s and non-M/SM-s.– It is difficult to determine the depth of invasion in villous lesions, especially large or rectal lesions, using only EUS.– EUS-based evaluation alone cannot determine the appropriate treatment for colorectal villous lesions.
The Royal MarsdenUK TEMS trial (NCRI)1. Biopsy proven adenocarcinoma2. MRI defined stage I rectal cancer (less than or equal to pT2 N0)3. Endorectal ultrasound defined rectal cancer less than or equal to uT24. Patients who have undergone submucosal excision for villous adenoma that on histopathological examination contains discrete invasion less than 3 cm diameter
The Royal MarsdenStaging of Early tumours MRI vsHistopathology
The Royal MarsdenMRI staging of early polyps disease– MRI T1/T2 – If local excision, should be deep submucosal excision and standard of care = Histological assessment, If deep T1 for primary completion TME surgery – May consider randomisation TME vs local excision + short course RT (NCRI TREC trial)
The Royal MarsdenConclusions– Early stage tumours can be usefully evaluated using MRI – Technique important – Options to consider especially for low lying early stage tumours – Follow up after less radical therapy: MRI is important