Questions on Rectal Surgery

Q1. Most common site of Colo Rectal cancer is

a) Hepatic Flexure b) Sigmoid colon

c) Anal canal d) Rectum

Q2. All are premalignant for carcinoma esophagus except

a) Diverticulum b) Caustic burn

c) Mediastinal fibrosis d) Human papillloma virus

Q3. Lipoma which undergo malignant degeneration is

a) Retroperitoneal b) Subserosal

c) subfascial d) Submucosal

Q4. Most important prognostic factor for carcinoma esophagus is

a) cellular differentiation b) Depth of esophagus involvement

c) length of esophagus involvement d) age of the patient

Q5 Contraindication to anterior resection of rectum is

a) Age more than 60 b) poorly differentiated carcinoma

c) Sigmoid lymph nodes d) single hepatic metastasis

Answers

1) d

Rectal Cancer is a common malignany of the lower GI tract and rectal pain is relatively a late feature. Rectum is the most common site of malignany in all colo rectal tumors. Other sites in order of decreasing frequency are

Rectum -38%, Sigmoid colon 21% Hepatic flexure of colon - 2%, Caecum 12%, Anal Canal 2%

2) c

Risk factors for carcinoma of esophagus are Alcohol, tobacco, beverages( low), nitrosamines, polycyclic aromatic hydrocarbons, croton flaveus, trace element deficiencies

Tylosis, achlasia (midesophagus), strictures due to lye ingestion, chronic esophagitis are other risk factors.

Barrets esophagus, congenital rests of columnar epithelium predispose to carcinoma esophagus and particularly adeno carcinoma.

Diverticula have a very small risk of carcinoma, HPV 16 and HPV 18 lead to carcinoma esophagus.

schakelford 5th editionpg 316

3) c

Lipoma of retroperitoneum and mediastinum are the most common to undergo malignant degeneration and change into carcinoma.

4) b

Most important is depth of involvement of wall of esophgus and lymph node involvement of the surrounding esophageal tissue.

Length of esophagus involvement is not that important because esophagus has extensive submucosal lymph supply and for complete cure 10 cm excision margin would mean removal of almost total esophagus.

5 b

APR (Abdomino perineal resection) is done if carcinoma Rectum or Anal Canal is poorly differentiated, sphincters cannot be preserved or there is no continence