Тerminology of rectal cancer: consensus agreement of the expert working group

Cover Image

Cite item

Full Text

Abstract

Unified terminology is a necessary condition for successful interdisciplinary communication within the field of oncology. The variety of anatomical, pathomorphological, and clinical terms used in rectal cancer is often accompanied by their ambiguous interpretation both in domestic and foreign scientific literature. This not only complicates the interaction between specialists, but also complicates the comparison of the results of rectal cancer treatment obtained in different medical institutions.

Based on the analysis of recent domestic and international scientific and methodological literature on rectal cancer, the key terms used in the diagnosis and treatment planning of rectal cancer were selected, followed by a two-time online discussion of their interpretations by experts from the Russian Society of Radiologists and Therapeutic Radiation Oncologists, the Association of Oncologists of Russia, and the Russian Association of Therapeutic Radiation Oncologists until reaching consensus (≥80%) of experts on all items. Terms that fail to attain consensus were excluded in the final list.

A list of anatomical, pathomorphological, and clinical terms used in the diagnosis, staging, and treatment planning of rectal cancer has been compiled and, based on expert consensus, their interpretation has been determined.

A lexicon recommended in the description and formulation of the conclusion of diagnostic studies in patients with rectal cancer is proposed.

About the authors

Tatiana P. Berezovskaya

A.F. Tsyba Medical Radiological Research Center ― branch National Medical Research Radiological Center

Email: tberezovska@yahoo.com
ORCID iD: 0000-0002-3549-4499
SPIN-code: 5837-3465

MD, Dr. Sci. (Med.), Professor

Russian Federation, Obninsk

Natalia A. Rubtsova

P.A. Herzen Moscow Research Oncological Institute ― branch National Medical Research Radiological Center

Email: rna17@ya.ru
ORCID iD: 0000-0001-8378-4338
SPIN-code: 9712-9091

MD, Dr. Sci. (Med.)

Russian Federation, Moscow

Valentin E. Sinitsyn

Lomonosov Moscow State University

Email: vsin@mail.ru
ORCID iD: 0000-0002-5649-2193
SPIN-code: 8449-6590

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Irina V. Zarodnyuk

State Scientific Centre of Coloproctology

Email: zarodnyuk_iv@gnck.ru
ORCID iD: 0000-0002-9442-7480
SPIN-code: 8310-8989

MD, Dr. Sci. (Med.)

Russian Federation, Moscow

Nicolai V. Nudnov

Russian Scientific Center of Roentgenoradiology

Email: nudnov@mrrc.ru
ORCID iD: 0000-0001-5994-0468
SPIN-code: 3018-2527

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Andrei V. Mishchenko

N.N. Petrov National Medical Research Centre of Oncology

Email: dr.mishchenko@mail.ru
ORCID iD: 0000-0001-7921-3487
SPIN-code: 8825-4704

MD, Dr. Sci. (Med.)

Russian Federation, Moscow

Yuliya L. Trubacheva

State Scientific Centre of Coloproctology

Email: trubacheva_ul@gnck.ru
ORCID iD: 0000-0002-8403-195X
SPIN-code: 3427-9074

MD, Dr. Sci. (Med.)

Russian Federation, Moscow

Tatiana A. Bergen

E. Meshalkin National Medical Research Center

Email: tbergen@yandex.ru
ORCID iD: 0000-0003-1530-1327
SPIN-code: 5467-7347

MD, Dr. Sci. (Med.)

Russian Federation, Moscow

Pavel Yu. Grishko

N.N. Petrov National Medical Research Centre of Oncology

Email: dr.grishko@mail.ru
ORCID iD: 0000-0003-4665-6999
SPIN-code: 3109-1583

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Svetlana S. Balyasnikova

N.N. Blokhin National Medical Research Center of Oncology

Email: Balyasnikova.Svetlana@gmail.com
ORCID iD: 0000-0002-9666-9301
SPIN-code: 3987-2336

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Yana A. Dayneko

A.F. Tsyba Medical Radiological Research Center ― branch National Medical Research Radiological Center

Email: vorobeyana@gmail.com
ORCID iD: 0000-0002-4524-0839

MD, Cand. Sci. (Med.)

Russian Federation, Obninsk

Darya V. Ryjkova

Almazov National Medical Research Centre

Email: d_ryjkova@mail.ru
ORCID iD: 0000-0002-7086-9153

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Malika M. Hodzhibekova

P.A. Herzen Moscow Research Oncological Institute ― branch National Medical Research Radiological Center

Email: malika_25@mail.ru
ORCID iD: 0000-0002-2172-5778
SPIN-code: 3999-7304

MD, Dr. Sci. (Med.)

Russian Federation, Moscow

Nataliya A. Rucheva

V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs

Email: rna1969@yandex.ru
ORCID iD: 0000-0002-8063-4462
SPIN-code: 2196-8300

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Igor E. Turin

N.N. Blokhin National Medical Research Center of Oncology

Email: igortyurin@gmail.com
ORCID iD: 0000-0002-8587-4422
SPIN-code: 6499-2398

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Sergey I. Achkasov

State Scientific Centre of Coloproctology

Email: achkasovy@mail.ru
ORCID iD: 0000-0001-9294-5447
SPIN-code: 5467-1062

MD, Dr. Sci. (Med.), Professor, Corresponding Member of the Academy of Sciences

Russian Federation, Moscow

Alexey A. Nevolskikh

A.F. Tsyba Medical Radiological Research Center ― branch National Medical Research Radiological Center

Email: alexey.nevol@gmail.com
ORCID iD: 0000-0001-5961-2958
SPIN-code: 3787-6139

MD, Dr. Sci. (Med.)

Russian Federation, Obninsk

Sergey S. Gordeev

N.N. Blokhin National Medical Research Center of Oncology

Email: ss.netoncology@gmail.com
ORCID iD: 0000-0002-9303-8379
SPIN-code: 6577-5540

MD, Dr. Sci. (Med.)

Russian Federation, Moscow

Inna V. Droshneva

P.A. Herzen Moscow Research Oncological Institute ― branch National Medical Research Radiological Center

Author for correspondence.
Email: droshnevainna@mail.ru
SPIN-code: 1908-2624

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

References

  1. Rectal cancer. Clinical recommendations. Approved at the meeting of the Scientific and Practical Council of the Ministry of Health of the Russian Federation. Moscow; 2022.(In Russ). Available from: https://cr.minzdrav.gov.ru/recomend/554_3. Accessed: 15.08.2023.
  2. Bogveradze N, Snaebjornsson P, Grotenhuis BA, et al. MRI anatomy of the rectum: Key concepts important for rectal cancer staging and treatment planning. Insights Imaging. 2023;14(1):13. doi: 10.1186/s13244-022-01348-8
  3. Gollub MJ, Arya S, Beets-Tan RG, et al. Use of magnetic resonance imaging in rectal cancer patients: Society of Abdominal Radiology (SAR) rectal cancer disease-focused panel (DFP) recommendations 2017. Abdom Radiol. 2018;43(11):2893–2902. doi: 10.1007/s00261-018-1642-9
  4. Nougaret S, Rousset P, Gormly K, et al. Structured and shared MRI staging lexicon and report of rectal cancer: A consensus proposal by the French Radiology Group (GRERCAR) and Surgical Group (GRECCAR) for rectal cancer. Diagn Interv Imaging. 2022;103(3):127–141. doi: 10.1016/j.diii.2021.08.003
  5. Grishko PY, Balyasnikova SS, Samsonov DV, et al. A modern view on the principles of diagnosis and treatment of rectal cancer according to MRI data (literature review). Medical Visualization. 2019;23(2):7–26.(In Russ). doi: 10.24835/1607-0763-2019-2-7-26
  6. Fernandes MC, Gollub MJ, Brown G. The importance of MRI for rectal cancer evaluation. Surg Oncol. 2022;(43):101739. doi: 10.1016/j.suronc.2022.101739
  7. Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28(Suppl 4):22–40. doi: 10.1093/anonc/mdx22 4
  8. Beets-Tan R, Lambregts D, Maas M, et al. Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol. 2018;28(4):1465–1475. doi: 10.1007/s0033 0-017-5026-2
  9. Oien K, Forsmo HM, Rösler C, et al. Endorectal ultrasound and magnetic resonance imaging for staging of early rectal cancers: How well does it work in practice? Acta Oncol. 2019;58(Sup1):49–54. doi: 10.1080/0284186X.2019.1569259
  10. Brierley JD, Gospodarowicz MK, Wittekind C. TNM Classification of Malignant Tumours. 8th ed. Wiley-Blackwell; 2017. 272 р.
  11. Kikuchi R, Takano M, Takagi K, et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum. 1995;38(12):1286–1295. doi: 10.1007/BF02049154
  12. Boot J, Gomez-Munoz F, Beets-Tan R. Imaging of rectal cancer. Radiologe. 2019;59(Suppl 1):46–50٠. doi: 10.1007/s00117-019-0579-5
  13. Lambregts D, Bogveradze N, Blomqvist L, et al. Current controversies in TNM for the radiological staging of rectal cancer and how to deal with them: Results of a global online survey and multidisciplinary expert consensus. Eur Radiol. 2022;32(7):4991–5003. doi: 10.1007/s00330-022-08591-z
  14. Mainovskaya OA, Rybakov EG, Chernyshov SV, et al. New morphological risk factors for metastasis to regional lymph nodes in rectal cancer with invasion of the submucosal base. Coloproctology. 2021;20(4):22–33. (In Russ). doi: 10.33878/2073-7556-2021-20-4-22-33
  15. Volkova SN, Stashuk GA, Chermensky GV, Naumov EK. The role of MRI in the detection of extramural vascular invasion as an indicator of the presence of regional and distant metastases of cancer of the lower ampullary rectum. Experimental Clin Gastroenterol. 2019;164(4):66–71. (In Russ). doi: 10.31146/1682-8658-ecg-164-4-66-71
  16. Lord AC, D’Souza N, Shaw A, et al. MRI-diagnosed tumor deposits and EMVI status have superior prognostic accuracy to current clinical TNM staging in rectal cancer. Ann Surg. 2022;276(2):334–344. doi: 10.1097/SLA.0000000000004499
  17. Rokan Z, Simillis C, Kontovounisios C, et al. Locally recurrent rectal cancer according to a standardized MRI classification system: A systematic review of the literature. J Clin Med. 2022;11(12):3511. doi: 10.3390/jcm11123511
  18. Grishko PY, Mishchenko AV, Ivko OV, et al. The possibilities of multiparametric magnetic resonance imaging in assessing the effectiveness of neoadjuvant treatment of rectal cancer. Radiation Diagnostics Therapy. 2019;10(4):49–56.(In Russ).
  19. Inoue A, Sheedy SP, Heiken JP, et al. MRI-detected extramural venous invasion of rectal cancer: Multimodality performance and implications at baseline imaging and after neoadjuvant therapy. Insights Imaging. 2021;(2):110. doi: 10.1186/s13244-021-01023-4
  20. Al-Sukhni E, Milot L, Fruitman M, et al. Diagnostic Accuracy of MRI for assessment of t category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: A systematic review and meta-analysis. Ann Sur Oncol. 2012;19(7):2212–2222. doi: 10.1245/s10434-011-2210-5
  21. Borgheresi A, De Muzio F, Agostini A, et al. Lymph nodes evaluation in rectal cancer: Where do we stand and future perspective. J Clin Med. 2022;11(9):2599. doi: 10.3390/jcm11092599
  22. Zhuang Z, Zhang Y, Wei M, et al. Magnetic resonance imaging evaluation of the accuracy of various lymph node staging criteria in rectal cancer: A systematic review and meta-analysis. Front Oncol. 2021;(11):709070. doi: 10.3389/fonc.2021.709070
  23. Li X, Sun Y, Tang L, et al. Evaluating local lymph node metastasis with magnetic resonance imaging, endoluminal ultrasound and computed tomography in rectal cancer: A meta-analysis. Color Dis. 2015;17(6):129–135. doi: 10.1111/codi.12909
  24. Weiser MR. AJCC 8th ed. Colorectal cancer. Ann Surg Oncol. 2018;25(6):1454–1455. doi: 10.1245/s10434-018-6462-1
  25. Ueno H, Nagtegaal ID, Quirke P, et al. Tumor deposits in colorectal cancer: Refining their definition in the TNM system. A G Surg. 2023;7(2):225–235. doi: 10.1002/ags3.12652
  26. Santiago I, Figueiredo N, Parés O, et al. MRI of rectal cancer: Relevant anatomy and staging key points. Insights Imaging. 2020;11(1):100. doi: 10.1186/s13244-020-00890-7
  27. Ogura A, Konishi T, Cunningham C, et al. Neoadjuvant (chemo)radiotherapy with total mesorectal excision only is not sufficient to prevent lateral local recurrence in enlarged nodes: Results of the multicenter lateral node study of patients with low cT3/4 rectal cancer. J Clin Oncol. 2019;37(1):33–43. doi: 10.1200/JCO.18.00032
  28. Gollub MJ, Costello JR, Ernst RD, et al. A primer on rectal MRI in patients on watch-and-wait treatment for rectal cancer. Abdom Radiol. 2023. doi: 10.1007/s00261-023-03900-6
  29. Berezovskaya TP, Daineko YA, Nevolskikh AA, et al. Prospective evaluation of the use of the MRTG system in determining the effectiveness of neoadjuvant chemoradiotherapy in patients with rectal cancer. Bulletin Radiol Radiol. 2021;102(1):6–17. (In Russ). doi: 10.20862/0042-4676-2021-102-1-6-17
  30. Almeida RR, Souza D, Matalon SA, et al. Rectal MRI after neoadjuvant chemoradiation therapy: A pictorial guide to interpretation. Abdom Radiol. 2021;46(7):3044–3057. doi: 10.1007/s00261-021-03007-w
  31. Shelygin YA, Chernyshov SV, Kazieva LY, et al. Comparative analysis of open and transanal total mesorectumectomy in rectal cancer. Coloproctology. 2018;(4):67–73. (In Russ).
  32. Maistrenko NA, Khvatov AA, Sazonov AA. Pelvic exenterations in the treatment of locally advanced tumors. Bulletin Surnamed after Grekov. 2014;173(6):37–43. (In Russ).
  33. Sidorov DV, Alekseev BY, Grishin NA, et al. Variants of pelvic exenteration in locally advanced primary and recurrent rectal cancer. Oncology J named after P.A. Herzen. 2013;(6):7–13. (In Russ).

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. MRI anatomy of the rectum on T2-WI. (a) Sagittal plane: anal edge (intersphincteric groove; dotted line); anorectal junction (angle) at the level of the upper border of the internal sphincter of the anal canal (white arrows); transitional fold of the peritoneum at the lower point of attachment of the pelvic visceral peritoneum to the rectal wall (asterisk); peritonealized part of the rectum (black arrows). (b) Coronal plane: 1, internal sphincter of the anal canal; 2, intersphincteric space; 3, deep portion of the external sphincter; 4, superficial portion of the external sphincter; 5, subcutaneous portion of the external sphincter; 6, puborectalis muscle; 7, elevator muscle of anus (levator ani). (c) Axial plane: 1, intestinal lumen; 2, mucous membrane; 3, submucosal layer; 4, muscle layer; 5, mesorectal tissue; 6 mesorectal fascia.

Download (167KB)
Indexing metadata
3. Fig. 2. Circular border (edge) of rectal resection during total mesorectumectomy. (a) Diagram showing extramural growth of the tumor (green line); mesorectal fascia (yellow line); circular border (edge) of resection (red line); distance from the tumor to the mesorectal fascia (double black arrow); distance from the tumor to the circular border (edge) of resection (double red arrow). (b) T2-weighted images in the coronal plane of the tumor of the lower ampullary part of the rectum with extramural vascular invasion and deposit at the level of axial T2-weighted images. (c) Upper axial section corresponds to the level of the deposit involving the mesorectal fascia (black arrows), extramesorectal lymph node (dotted arrow). The lower axial section corresponds to the level of extramural vascular invasion. The depth of extramural invasion (a double white arrow). The distance from the tumor to the elevator muscle of anus (a double black arrow).

Download (250KB)
Indexing metadata
4. Fig. 3. Variants of tumor image on T2-WI. (a) Polypoid/exophytic tumor (arrow). (b) Semicircular tumor (T), extramural vascular invasion (arrows). (c) Mucinous tumor (arrows).

Download (187KB)
Indexing metadata
5. Fig. 4. Localization of the lateral pelvic lymph nodes (colored): external iliac lymph nodes are red; obturator lymph nodes are blue; and internal iliac lymph nodes are green. Shown in levels (a) proximal and (b) distal. EIA: external iliac artery; EIV: external iliac vein; IIV: internal iliac vein; IIA: internal iliac artery; Obt a/v/n: obturator artery/vein/nerve; OIM: obturator internus muscle.

Download (200KB)
Indexing metadata
6. Fig. 5. Assessment of tumor regression on high-resolution T2-WI using TRG. TRG١: (a) Tumor located at the 12–2 o’clock position before neoadjuvant chemoradiation therapy (arrow); (b) after treatment, the tumor is replaced by a linear area of submucosal fibrosis. TRG2: (c) Tumor in the lower ampullary rectum before chemoradiation therapy (arrow); (d) after treatment, the tumor is determined as an area of thick fibrosis (arrow), without macroscopic MR signs of tumor. TRG3: (e) Semicircular tumor in the lower ampullary rectum before chemoradiation therapy (arrow); (f) after treatment, the tumor has a mixed MR signal with a predominance of a low-intensity signal, characteristic of fibrosis, and preservation of macroscopic areas of a tumor MR signal of medium intensity (arrow). TRG4: (g) Tumor before chemoradiation therapy (arrow); (h) after treatment (arrow), there are no signs of response to treatment; the MR signal of the tumor tissue persists.

Download (468KB)
Indexing metadata

Copyright (c) 2023 Eco-Vector

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies