Revised 05 Sept 2012

• In the absence of bowel obstruction at presentation, a complete colonoscopy to the cecum with adequate bowel preparation should be performed to identify and biopsy any suspicious intraluminal masses and to exclude any synchronous neoplastic polyps or cancers.
• Preoperative serum carcinoembryonic antigen (CEA) tumour marker is recommended to guide subsequent follow-up.
• Preoperative CT scan of the chest, abdomen and pelvis is recommended to exclude distant metastases and to provide a baseline for surveillance.
• PET scans are not recommended for staging purposes.
• In patients with unresectable distant metastases, core biopsy of accessible metastatic lesions (e.g. liver metastasis) is recommended if the primary tumour is inaccessible. Consider that predictive biomarker studies for newer targeted agents require a sufficient amount of tissue; fine needle aspirates are deemed to be insufficient in this setting.
• Although the role of this technique is still under study, computed tomography colonography (CTC) may be an option for patients unable to undergo a conventional colonoscopy. CTC, also known as Virtual Colonoscopy, is a total colonic imaging tool utilizing a specialized multislice CT scanner. This relatively brief procedure does require bowel preparation and insufflation of carbon dioxide gas. The examination occurs during a single breath hold of 10 seconds or less. Although CTG is minimally invasive and has low radiation exposure, availability of the procedure is limited. As well, the test does not permit concomitant biopsy or polyp removal.