Medical Questions on Anal canal and Pelvic floor

Q1. Which is not a type of anal margin tumors?

a) Basal cell carcinoma

b) Epidermoid carcinoma

c) Paget's disease

d) Bowen's disease

Q2. False about the pelvic floor is

a) Anorectal ring is formed by Puborectalis and ext sphincter

b) Anorectal ring is 3cm above anal verge.

c) Pelvic Floor is supplied by S2,3,4

d) All are true

Q3 True about radiation proctitis is

a) Sucralfate enema is very effective.

b) Laser Abalation is efective in every case.

c) Local Metronidazole is effective

d) Resection and Anastomoses give best results.

Q4. Recurrence after resection for Ca rectum is related to all except

a) Tumor Grade

b) No. of lymph nodes

c) Lateral Margin Involvement

d) Inexperienced surgeon

e) None of the above

Q5. Contraindication for resection of locally recurent rectal cancer are all except

a) Extrapelvic disease

b)Sciatic pain

c) Bilateral ureteric obstruction

d) S1 or S2 nerve inolvement

e) Circumferential or extensive pelvic side wall involvement

f) None

Answers

1. b

Epidermoid carcinoma is a collective term used used for tumors from the epithelium

of anal canal. It includes squamous,clacogenic, transitional,basaloid, mucoepidermoid

and round cell carcinoma.

Most Common anal margin tumor is Squamous cell carcinoma. A preinvasive form of

squamous carcinoma, Anal Intraepithelial Neoplasia (AIN) was previosly known as Bowen

disease.

Basal Cell carcinoma occurs less frequently in anal margin than other parts of skin. A rare entity

is Paget disease or Intraepithelial adenocarcinoma.

2) d

Pelvic floor is formed by Levator Ani which has three parts

(i) Ileococcygeus

(ii) Pubococcygeus

(iii) Puborectalis

The fibres of puborectalis and external anal sphincter are continuous and form the Anorectal ring.

Anorectal ring is 3-4 cm above the anal verge. It can be palpated during the P/R examination and

this distance is known as surgical anal canal. Anatomical anal canal is from anal verge to dentate

line.

Ext anal sphincter is supplied by pudendal nerve S2-3

Levator Ani -- S2-3-4

Schakelford rectum pg 346.

3)b

Radiation Proctitis occurs due to radiotherapy to the pelvic organs. Rectum is fixed

and in proximity to the pelvic structures so it is more liable for injury.

The symptoms include tenesmus, discharge, bleeding etc.

Management of Acute radiation proctitis is

Stop Radiation, Fluid Rehydration, Dietary Modification, Antidiarrhoeals

Management of Chronic Prcotitis (Bleeding)

Oral Sucralfate (Not Enema)

Nd-YAG laser and Argon Laser Multiple sessions arerequired.

4% formalin instillation has shown good results .

Surgery is reserved for complications like Rectovaginal fistula and strictures

Schakelford 457.

4)e

It is related to all these factors.

The rate of recurrence is 25-50%. It is related to the following factors.

Tumor Related

High Grade, mucin producing, venous or lymphatic involvement,

Aneuploidy, mutant p53.

Extent of disease and stage is the single most important factor that predicts

relapse.

Technical factors

Tumors in the distal rectum, Techinque and experience of the surgeon.

5) f

Schakelford 283