Imaging assessment of early rectal cancer

Early rectal cancer (ERC) is defined as invasive adenocarcinoma spreading into, but not beyond, the submucosa or muscularis propria-that is a Dukes'A: T1N0 or T2N0 tumour in the tumour node metastasis (TNM) classification (Taylor et al. 2008). Among these tumours it is suggested that the most superficial T1 tumours least likely to metastasize to local lymph nodes than adenocarcinoma invading deeper where the rich lymphatic and venous plexuses within the submucosa provide a mechanism for tumour spread beyond the rectum. Currently, only about 10 % of patients presenting symptomatically with rectal cancer are diagnosed with early disease; however, up to 30 % of screen detected cancers are being identified as Dukes'A. Thus, the overall detection of early stage tumours is likely to increase following greater implementation in screening programs. The goal of this invited review is to provide recommendations based on the consensus discussion on the information from preoperative imaging that is of relevance for clinical decision-making for patients with early rectal cancer.