Preoperative approach to rectal carcinoma

The preoperative evaluation of patients with rectal carcinoma requires a careful medical history with close attention to symptoms. After a thorough physical examination including digital examination of the rectum, a proctoscopy reveals the size and localisation of the tumour. Even if a neoplasm has been documented by this procedure, total colonoscopy should be performed to detect synchronous neoplastic lesions at other sites in the colon which may affect the surgical resection. Endosonography is recommended as an additional diagnostic step because it allows a precise, preoperative staging of the tumour. Abdominal ultrasound or, alternatively, CT scan of the abdomen, is necessary to exclude hepatic metastases.