Nodal staging in rectal cancer

Rectal cancer is common and nodal disease is an independent adverse prognostic factor for patient survival. Accurate demonstration of the presence and location of nodal disease preoperatively may influence management strategies. In this article we review the pathways of nodal spread in rectal cancer and assessment of nodal disease using sonography, CT, and MRI. The use of morphological criteria instead of size criteria has been shown to improve nodal staging by MRI. The potential role of magnetic resonance lymphography and PET imaging in further improving nodal staging accuracy is discussed.