Learning objectives
Identify in the Magnetic Resonance Imaging (MRI) standardized protocol for rectal lesions presentations in colorectal cancer, mostly with extramural venous invasion (EMVI);
Present a brief review of colorectal anatomy emphasizing venous drainage system;
Demonstrate the prognostic importance of EMVI in patients with colorectal cancer and its impact on management.
Background
Epidemiology of rectal cancer:
Colorectal cancer is the third most prevalent cancer in men and the second most prevalent in women[1]. The incidence is higher in developed countries. Meantime, the mortality percentage in developed countries is lower, reflecting increased screening and improvements in rectal cancer diagnostic, staging, and therapy[2]. (Fig. 2).
Importance of MRI in rectal cancer:
In primary rectal cancer, MRI imaging plays a role in staging and treatment proposals[3,4,5]. (Fig 3).
Currently, surgical resection with appropriate neoadjuvant combined therapy is the mainstay in...
Findings and procedure details
Importance of EMVI in prognosis:
The prognosis in colorectal cancer is predicted by the extent of the local tumor spread (T), the involvement of the lymphatic system (N), and/or metastasis to other organs (M) that are incorporated in TNM staging [13].
(Fig 6).
The survival rate of rectal cancer patients depends on the disease stage and the status of surgical margins, nevertheless, new features, such as venous invasion, perineural invasion and tumor grade also have prognostic value. Currently, great importance has been given to EMVI....
Conclusion
Extramural venous invasion (EMVI) detected by MRI is a poor prognostic factor for colorectal cancer patients.
It is estimated that there is a five times increase in synchronous metastasis rates and four times the risk of developing metastasis after surgery in follow-uppatients.
Its identification through preoperative resonance may lead to a better condition of patients classified as high risk, with consequent future improvements in therapeutic strategies.
Personal information and conflict of interest
I. R. Cruz; SÃO PAULO/BR - nothing to disclose T. Silva; SÃO PAULO/BR - nothing to disclose C. Abud; São Paulo/BR - nothing to disclose D. J. J. Racy; São Paulo/BR - nothing to disclose K. Albuquerque; SÃO PAULO/BR - nothing to disclose G. Castro; SÃO PAULO/BR - nothing to disclose L. R. Torres; São Paulo/SP, SP/BR - nothing to disclose M. Ferreira; São Paulo/BR - nothing to disclose M. Pedroso; SÃO PAULO/BR - nothing to disclose
References
Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer2015;136(5):e359–e386.
American Cancer Society. Cancer facts and figures: 2018. https://www.cancer.org/content/dam/cancerorg/research/cancer-facts-and-statistics/annual-cancer-factsand- figures/2018/cancer-facts-andfigures-2018.pdf. Accessed May 1, 2018.
Glynne-Jones R, Tan D, Goh V. Pelvic MRI for guiding treatment decisions in rectal cancer. Oncology (Williston Park) 2014;28(8):667–677.
Glimelius B, Tiret E, Cervantes A, Arnold D; ESMO Guidelines Working Group. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013;24(Suppl 6):vi81–vi88.
Natally...
