Many patients do not understand why so many tests have to be performed after hospitalization instead of early surgery, and some even suspect that hospitals are prescribing more tests in order to generate revenue.
Preoperative evaluation of colorectal cancer is crucial to decide the overall treatment plan, and preoperative staging is an important basis to guide the treatment strategy. To operate without accurate preoperative evaluation is irresponsible to patients.
For reference, these tests are necessary for colorectal cancer patients upon admission.
Systemic status: ECOG score, height, weight
Peripheral venous blood: Hb, RBC, WBC, LYM, NEU, NEU%, PLT
Blood biochemistry: albumin, pre-albumin, total bilirubin, AST, ALT, creatinine, urea nitrogen, fasting glucose, electrolytes
Serum tumor markers: CEA, CA19-9, CA72-4, CA12-5
Blood type, pre-transfusion examination, blood preparation.
Fiberoptic colonoscopy: It is the most effective, safe and reliable examination method to diagnose rectal cancer. Fiberscopic colonoscopy can directly observe the lesions while excluding the possibility of simultaneous cancer, and a few patients may have two or more cancerous lesions at the same time.
CT of the whole abdomen, enhanced CT is preferred, and only CT plain scan is allowed if the contrast agent is allergic. It is a more reliable basis for preoperative understanding of whether there is metastasis in the liver, whether the lymph nodes adjacent to the abdominal aorta are enlarged, whether there is infiltration of the cancer into the surrounding structures or organs, judging the possibility and risk of surgical resection and guiding the selection of reasonable treatment plan.
Pelvic CT or magnetic resonance imaging (MRI) examination can help to understand the infiltration of tumor and the presence of pelvic lymph node metastasis. In particular, MRI is advantageous for showing lesion infiltration and pelvic lymph nodes, which is meaningful for preoperative evaluation of rectal cancer patients.
Barium enema, which is optional, is performed to localize the lesion and to understand whether there are lesions in other parts of the colon.
Chest radiograph (front and side) or chest CT: cardiopulmonary condition and presence of metastases.
Calm 12-lead electrocardiogram
Respiratory function tests: FEV1, FVC, to be done in elderly patients and long-term smokers
Cardiac ultrasound for cardiac function, for elderly patients and high-risk patients
With the results of the preoperative evaluation, the correct staging is possible. There is a comprehensive staging of the lesion with T-stage of the primary lesion, N-stage of the lymph node metastasis, and M-stage of the distant metastasis
Stage 0: Tis N0 M0
Stage I: T1-2 N0 M0
Stage II: T3-4 N0 M0
Stage III: Any T N1-2 M0
Stage IV: Any T Any N M1