Multimodality imaging of usual and unusual sites of metastasis which occur after definitive therapy for rectal cancer

Rectal cancer is a common malignancy encountered largely after the fifth decade of life. Due to the recent advances in cancer therapy, which include chemoradiation therapy pre- and postoperatively, survival has improved. Radiologist has become an integral part of the patient management team to diagnose and localize the area of recurrent rectal cancer. Although typical pathways of rectal cancer spread have been described, recurrence may occur in unexpected locations due to the currently available aggressive therapy being able to control local disease. Imaging surveillance should include careful evaluation of expected and unexpected anatomic sites where tumor may recur. This paper will describe the common and uncommon locations of recurrent rectal cancer.