The document discusses staging and treatment of early stage rectal cancer. It provides details on MRI and endoscopic ultrasound for detecting early tumors, especially submucosal invasive tumors. It notes that MRI staging of early polyps can identify T1 or T2 tumors and guide decisions on local excision or total mesorectal excision surgery. The conclusion emphasizes that MRI is useful for evaluating and monitoring early stage rectal tumors, and helps determine appropriate treatment such as local excision or surgery.

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MRI staging of
early tumours
Gina Brown

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Lymph Node Metastases
KUDO classification: distance of SM invasion
SM1 superficial 1/3 0%
SM2 superficial 2/3 10%
SM3 deep 1/3 25%
Kikuchi R,
Dis Colon Rectum. 1995 Dec;38(12):1286-95

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4. EUS with high fequency probe detects sm1 tumours
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suitable 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.

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Konishi, K., Y. Akita, et al. (2003). "Evaluation of endoscopic ultrasonography
in 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.

6. Early stage disease
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UK TEMS trial (NCRI)
1. Biopsy proven adenocarcinoma
2. MRI defined stage I rectal cancer (less than
or equal to pT2 N0)
3. Endorectal ultrasound defined rectal cancer
less than or equal to uT2
4. Patients who have undergone submucosal
excision for villous adenoma that on
histopathological examination contains
discrete invasion less than 3 cm diameter

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Staging of Early tumours MRI vs
Histopathology

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MRI 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)

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Conclusions
– 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