pUniversity of California San Francisco, San Francisco, California. qEmory University, Atlanta, Georgia, Primary care physician. rSpecialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Staging of Colorectal Cancer Colon Cancer The local treatment of colon cancer relies primarily on the section of involved colon (right versus left hemicolectomy), with removal of the associated mesentery and regional nodes. Use of selective adjuvant chemotherapy is dictated by lymph node positivity and extramural lymphovascular invasion on pathologic specimen. The role of preoperative imaging to predict T stage and N stage is an area of ongoing investigation, given that neoadjuvant therapy has not yet been shown to significantly improve survival over surgery alone (with postoperative adjuvant treatment) and the standard surgical approach is radical resection. Current ongoing trials including the large randomized controlled FOxTROT trial suggest that neoadjuvant treatment can preoperatively downstage colorectal cancer with better tolerated and more complete administration of chemotherapy before surgery rather than postoperative [15]. However, preoperative imaging of colon cancer appears to be of most benefit in identifying distant metastases, regardless of its ability to predict T stage and N stage. Given the limited role of locoregional staging, the imaging variant discussion for colon cancer will be limited to evaluation of distant metastases only.
Staging of Colorectal Cancer. pUniversity of California San Francisco, San Francisco, California. qEmory University, Atlanta, Georgia, Primary care physician. rSpecialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Staging of Colorectal Cancer Colon Cancer The local treatment of colon cancer relies primarily on the section of involved colon (right versus left hemicolectomy), with removal of the associated mesentery and regional nodes. Use of selective adjuvant chemotherapy is dictated by lymph node positivity and extramural lymphovascular invasion on pathologic specimen. The role of preoperative imaging to predict T stage and N stage is an area of ongoing investigation, given that neoadjuvant therapy has not yet been shown to significantly improve survival over surgery alone (with postoperative adjuvant treatment) and the standard surgical approach is radical resection. Current ongoing trials including the large randomized controlled FOxTROT trial suggest that neoadjuvant treatment can preoperatively downstage colorectal cancer with better tolerated and more complete administration of chemotherapy before surgery rather than postoperative [15]. However, preoperative imaging of colon cancer appears to be of most benefit in identifying distant metastases, regardless of its ability to predict T stage and N stage. Given the limited role of locoregional staging, the imaging variant discussion for colon cancer will be limited to evaluation of distant metastases only.