Workup/Staging Flashcards
What must the physical exam include for pts with suspected rectal cancer?
The physical must include DRE and pelvic exam for women.
How is the Dx of rectal cancer typically established?
Endoscopic Bx is a typical way of establishing the Dx. A full colonoscopy should be performed to r/o more proximal lesions.
What studies are performed in the workup of rectal cancer pts, and what is the purpose of each modality?
For staging purposes, EUS or pelvic MRI must be performed in rectal cancer pts for T and N staging. To r/o met Dz, CT C/A/P with IV and oral contrast is performed.
What labs are collected as part of the staging workup for colorectal cancers?
Labs for the workup of colorectal cancer: CBC, chem 7, LFTs, CEA
Is a PET scan routinely indicated for pts with rectal cancer?
No. A PET scan is not routinely indicated in pts with localized rectal cancer.
What is the AJCC 8th edition (2017) T staging for colorectal cancer?
The T staging for rectal cancer is based on the DOI:
Tis: CIS or invasion into lamina propria without extension to the muscularis mucosae
T1: invades submucosa (muscularis mucosae)
T2: invades muscularis propria
T3: invades through muscularis and into pericolorectal tissues
T4a: penetrates surface of visceral peritoneum (including gross bowel perforation)
T4b: invades or adheres to adjacent organs
What is the AJCC 8th edition (2017) N staging for colorectal cancer?
The updated 2017 edition of the AJCC did not alter the N staging for colorectal cancer:
N1a: 1 regional LN
N1b: 2–3 regional LNs
N1c: tumor deposits in subserosa, mesentery, or nonperitonealized pericolic or perirectal tissues without regional LN mets
N2a: 4–6 regional LNs
N2b: ≥7 regional LNs
How many regional nodes must be sampled for a dissection to be considered adequate?
At least 12 nodes should be sampled in curative cases. Notably, in pts with N0 Dz, the number of nodes examined is prognostic.
What is the AJCC 8th edition (2017) breakdown of M staging for colorectal cancer?
M1a: Mets to single organ/site (e.g., liver, lung, nonregional LNs) without peritoneal mets
M1b: Mets to ≥2 organs/sites without peritoneal mets
M1c: Mets to peritoneal surface with or without additional organ/site mets
What are the AJCC 8th edition (2017) TNM stage groupings for colorectal cancer?
Stage I: T1–2N0
Stage IIA: T3N0
Stage IIB: T4aN0
Stage IIC: T4bN0
Stage IIIA: T1–2N1 or N1c; T1N2a
Stage IIIB: T3–4aN1 or N1c; T2–3N2a; T1–2N2b
Stage IIIC: T4aN2a; T3–4aN2b; T4bN1–2
Stage IVA: any T or N; M1a
Stage IVB: any T or N; M1b
Stage IVC: any T or N; M1c
What is the AJCC 8th edition (2017) T staging for small intestine cancers?
Tis: high-grade dysplasia/CIS
T1a: invades lamina propria
T1b: invades through mucosa into submucosa
T2: invades into muscularis propria
T3: invades through muscularis propria into subserosa or into nonperitonealized perimuscular tissue (mesentery/retroperitoneum) without serosal penetration
T4: perforates visceral peritoneum or invades adjacent organs (e.g., other loops of small bowel, mesentery of adjacent bowel, and abdominal wall by way of serosa; for duodenum only invasion of pancreas or bile duct)
What are the AJCC 8th edition (2017) N and M staging for small intestine cancers?
N0: no regional LNs
N1: 1–2 LNs
N2: ≥3 LNs
M0: no DM
M1: DMs
What are the AJCC 8th edition (2017) stage groupings for small intestine cancers?
Stage 0: Tis
Stage I: T1–2N0
Stage IIA: T3N0
Stage IIB: T4N0
Stage IIIA: any T; N1
Stage IIIB: any T; N2
Stage IV: any T, any N; M1
Notably, only adenocarcinomas of the small intestine are eligible to rcv a stage group (other histologies rcv TNM staging, but should not be given a stage group).
What special lab test is routinely performed for colorectal cancer pts? Why?
CEA is routinely ordered for pts with colorectal cancer b/c it may help monitor response to therapy and Dz progression.
Describe the CEA trends for colorectal cancer pts after Sg and in the setting of a relapse.
Postresection for colorectal cancer, CEA levels should return to reference range in 4–6 wks. CEA increases 4–6 mos before a recurrence are clinically apparent (a rapid rise suggests hepatic or bony mets, while a slow rise suggests LR).
