Anal

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
 
 
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 are required.
 
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
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