The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient. In approximately 40 percent of the cases, the cancer originates from the rectum. The estimated annual incidence of rectal cancer is 43,000 and about 7,000 patients die each year from this malignancy. Examination Digital rectal exam and sigmoidoscopy allow for the assessment of tumor location, size, and fixation. Synchronous colon malignancies or coexisting adenomatous polyps should be identified preoperatively, if possible.
Colonoscopy is preferred over barium enema.
Imaging Studies Identifying the extent of local, regional, or distant metastasis may be useful if the findings would modify the approach to treatment. Laboratory Studies Laboratory studies should be obtained as indicated by the patients general condition and anesthetic requirements. Where possible the patient should participate in the treatment selection. This procedure is generally indicated for lesions of the lower one-third of the rectum or for higher lesions where tumor characteristics and anatomic factors favor such resection. Where possible, preoperative colostomy counseling is recommended.