EUS for Staging of Rectal Cancer
Comments: A 72 year-old man is found to have a rectal adenocarcinoma on screening colonoscopy. CT scan of the abdomen and pelvis is performed and shows evidence of rectal wall thickening without associated lymphadenopathy. Subsequent PET scan shows increased activity in the rectum only. Staging pull-through EUS examination is then performed. Radial imaging at 7.5 MHz shows clear identification of the bladder. Upon pull-through with the EUS scope, the rectal wall is identified showing the muscularis propria and a thickened submucosal space suggesting tumor involvement. The tumor appears to extend through the muscularis propria, shown here at the 6 o'clock position. As the probe is withdrawn further, there is easy identification of the seminal vesicles. Upon withdrawal of the EUS scope towards the anal verge, the prostate gland is identified at the 11 o'clock position. There is a clear interface between the rectal wall and the prostate gland. No lymphadenopathy is seen as the scope is finally pulled through the anus. An upper endoscope is then introduced through the tumor to the proximal tumor border. A 22-gauge sclerotherapy needle is then used to inject a total of 3 cc's of India Ink, or tattoo agent, in a submucosal bleb-like fashion in order to mark the proximal tumor border for possible surgical resection of this lesion. Final tumor stage: T3N0Mx.
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Jonathan M Buscaglia, MD Instructor of Medicine Johns Hopkins Medical Center |
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Citation: Buscaglia, JM (Nov 09 2009). EUS for Staging of Rectal Cancer. The DAVE Project. Retrieved Jul, 30, 2010, from http://daveproject.org/viewfilms.cfm?film_id=884 Times viewed since Feb 2006: 2367 |
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