Transcript Anal Disease/Neoplasms

Anal Disease/Neoplasms
5 October 2005
Which of the following is not true about a
rectovaginal fistula
A. Can result from obstetric or operative injury
B. Is an abnormal communication between the
anterior wall of the anal canal or rectum and
the posterior wall of the vagina
C. Inflammatory bowel disease can be a cause
of simple rectovaginal fistulae
D. About 50% of small rectovaginal fistuale
secondary to obstetric trauma will heal
spontaneously
E. Endovascular advancement of an anorectal
flap can be created to repair a low, simple
fistula.
A. True.
B. True.
C. False. Inflammatory bowel disease can be a
cause of complex rectovaginal fistulae.
Simple RV fistulae are generally due to
traumatic or infectious causes. Complex fistuale
are caused by inflammatory bowel disease,
irradiation or neoplasm
D. True.
E. True.
Anal Condylomata acuminata
A. Have a characteristic papillary
appearance that can involve the
perianal skin, anal verge, and
anoderm
B. Are caused by HPV-16 and HPV-18
C. Up to 65% recur after excision
D. Malignant transformation is common
and should be treated in the same
manner as squamous cell carcinoma
of the anus
A. True.
Have a characteristic papillary appearance that
can involve the perianal skin, anal verge, and
anoderm
B. False
Most warts are caused by HPV-6 and HPV-11
C. True
Up to 65% recur after excision
D. False
Malignant transformation is RARE. However, if it
does occur, it should be treated in the same
manner as squamous cell carcinoma of the anus
Kaposi’s Sarcoma - True or False
A. Kaposi’s sarcoma of the colon and rectum
is generally asymptomatic
B. Kaposi’s sarcoma of the colon and rectum
most often presents with bleeding, diarrhea,
and obstruction
C. The characteristic lesion is a red, round,
submucosal nodule with central umbilication
D. A superficial biopsy is sufficient to make the
diagnosis
E. Surgical therapy is only indicated with
failure of medical management
A. TRUE
Kaposi’s sarcoma of the colon and rectum is generally
asymptomatic
B. FALSE
While KS of the colon/rectums is generally
asymptomatic, it can present with bleeding, diarrhea,
and obstruction
C. TRUE
The characteristic lesion is a red, round, submucosal
nodule with central umbilication
D. FALSE
A DEEP biopsy is required to yield an accurate result
E. FALSE
There is no effective medical treatment. Surgery is
indicated only to control massive bleeding, perforation
or obstruction.
Which of the following are true about perianal
neoplasms
A. Squamous Cell Carcinomas grow slowly and
lesions are characterized by central ulcers with
irregular, raised edges.
B. Basal Cell Carcinoma is more common in men
than women and rarely metastasize.
C. Similar to Paget’s disease of the nipple,
Paget’s disease of the perianal area is
associated with an invasive or in situ
adenocarcinoma.
Which of the following are true about perianal neoplasms
A. FALSE.
Squamous Cell Carcinomas grow slowly and
lesions are characterized by rolled, everted edges
with central ulceration.
B. TRUE.
Basal Cell Carcinoma is more common in men,
usually occur in the 6th decade, and rarely
metastasize.
C. FALSE.
Paget’s disease of the perianal area is generally a
benign neoplasm, but in some cases can become
invasive and become adenocarcinoma.
Squamous cell carcinoma of the anal canal
SCC above the dentate line metastasizes to the
_______ (superior/inferior) rectal vessels.
Lesions below the dentate line metastasize to
the ______ (obturator/inguinal) nodes.
SCC above the dentate line metastasizes to
the superior rectal vessels. Lesions below
the dentate line metastasize to the inguinal
nodes.
A.
B.
C.
D.
Which of the following are used for the
treatment of squamous cell carcinoma of
the anal canal?
Local excision
Abdominoperineal resection
Chemotherapy with 5-FU, mitomycin C
Pelvic radiation
A.
Local excision
The treatment of choice for carcinoma in situ or microscopic
invasive carcinoma of the anal canal. However, at the time of
diagnosis, many tumors are too large or advanced for local
excision
B.
Abdominoperineal resection
Not routinely performed as the primary treatment. It is
associated with a high rate of recurrence. This modality is
reserved for patient who have failed local treatment after
chemoradiation, those with complications for treatment (such
as fecal incontinence) and those unable to tolerate
chemoradiation
C.
Chemotherapy with 5-FU, mitomycin C
The standard treatment for SCC of anus. Used in association
with pelvic radiation. Chemoradiation is associated with
complete regression in 90% of patients and 5 year survival
rates of 76-90%.
D.
Pelvic radiation
Which of the following are true in regards to anal
melanoma?
A. Anal Melanoma is the third most common site for
melanoma following skin and eyes.
B. The most common symptom is rectal bleeding
C. Lesions are radioresistant but chemosensitive
D. Treatment with abdominoperineal resection shows a
survival advantage over wide local resection.
A.
TRUE.
Anal Melanoma is the third most common site for melanoma
following skin and eye.
B.
TRUE.
The most common symptom is rectal bleeding
C.
FALSE
Lesions are radioresistant and not sensitive to chemotherapy
or immunotherapy.
D.
FALSE.
There is no difference in survival between APR and wide local
resection. Both have survival rates of 15-17%