Rectal cancer is one of the most common form of cancer in the industrialized countries and is associated with a high lethality. In the last decades a change has taken place in treatment options. Developments in surgery such as Healds introduction of TME as well as preoperative radiochemotherapy have led to a notable decrease of high local recurrence rate which is a major problem in rectal cancer. A preoperative radiochemotherapy is indicated when a T-stage ≥ 3 or a lymph node involvement

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... apparent. Thus a correct definition of tumor stage by means of endosonography or complementary MRI is essential to provide adequate treatment modalities and to diminish the risk of overtreatment. This retrospective study aims to evaluate the significance of endosonography and MRI in general practice with focus on effectiveness and efficiency. Therefore all patients with rectal cancer diagnosed in between the years 2005 and 2007 and internally performed local staging were included in this study. From a total of 127 patients endosonography failed in nearly every third case due to stenotic tumor growth. The availability of an experienced examiner posed another problem. Both led to delay in diagnosis and treatment. The use of MRI was necessary in every second case and failed in three cases. Correlation with histopathological findings was restricted to dominating tumor stages T2 and T3, whose differentiation is essential for adequate treatment modalities. Both MRI and endosonography were equal in detecting wall penetrating T3 lesions, but MRI was better in distinguishing between a T2- and a T3 lesion. Correct classification of nodal stage was a general problem and still poses a challenge for all participating disciplines. In general practice the use of MRI seems to be not only desirable but necessary and is characterized by high practicab [...]