Staging Work up

Physical exam to assess for bone pain (bone scan if positive), mental status changes (CT of head). Chest x-ray is used to evaluate for evidence of lung metastasis. Most now advocate CT scans of the abdomen and pelvis to assess extent of the cancer. This can help to determine involvement of adjacent structures or evidence of distant metastasis such as liver. The presence of liver metastasis does not preclude resection and may provide an opportunity to do a single stage resection or ablation of the metastasis and primary (Table 12.3).

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