Table 2.

Suggested staging procedures

History including familial history of tumors and syndromes associated with hereditary disease

Physical examination must include the general condition (performance status, PS), and digital rectal exam

Laboratory tests including liver and renal function and prognostic markers (white blood cell count, alkaline phosphatase, lactate dehydrogenase (LDH), bilirubin, and albumin)

Carcinoembryonic antigen (CEA)

Pathological review of a tumor biopsy should at least provide histological subtype, tumor grade, and KRAS and NRAS mutational status. BRAF genotyping may be considered in RAS wild-type tumors for prognostic information

Computed tomography (CT) scan of the chest, abdomen and pelvis. Magnetic resonance imaging (MRI) of the liver could be considered in cases of hepatic metastases

Complete colonoscopy to locate the primary tumor, to obtain tissue for histological diagnosis, and to detect potential synchronous colorectal lesions. Virtual colonoscopy could be useful in case of tumors that impede the progression of the endoscopic tube

Other tests such as a bone scan or a brain CT scan should be performed only if clinically indicated

Additional examinations, as clinically needed, are recommended prior to major abdominal or thoracic surgery with potentially curative intent

Abdominal MRI with intravenous contrast may be considered in patients with potentially resectable liver metastases and for patients with iodine allergy

A fluorodeoxyglucose (FDG)-positron emission tomography (PET–CT) scan should be performed, if available, when metastatic disease is or may potentially become resectable

Needle biopsy of a patient with known histologic diagnosis is only recommended when it may change the therapeutic strategy