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

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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

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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.

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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).

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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).

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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.

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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.

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