Staging Anal Cancer

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Q  ) In Anal Carcinoma  involvement of external iliac group of lymph nodes
a. Stage II
b. Stage III a
c. Stage III b

d) M1

Ans c, IIIb

Primary tumor (T)

  • TX: primary tumor cannot be assessed
  • T0: no evidence of primary tumor
  • Tis: carcinoma in situ (Bowen disease, high-grade squamous intraepithelial lesion [HSIL], anal intraepithelial neoplasia II-III (AIN II-III)
  • T1: tumor 2 cm or less in greatest dimension
  • T2: tumor >2 cm but <5 cm in greatest dimension
  • T3: tumor >5 cm in greatest dimension
  • T4: tumor of any size invades adjacent organ(s), e.g. vagina, urethra, bladder (note that direct invasion of the rectal wall, perirectal skin, subcutaneous tissue, or the sphincter muscle(s) is not classified as T4)
Regional lymph nodes (N)
  • Nx: regional lymph nodes cannot be assessed
  • N0: no regional lymph node metastasis
  • N1: metastasis in regional lymph nodes
  • N1a: metastases in inguinal, mesorectal, and/or internal iliac lymph nodes
  • N1b: metastases in external iliac lymph nodes
  • N1c: metastases in external iliac and in inguinal, mesorectal, and/or internal iliac lymph nodes
Distant metastasis (M)
  • Mx: distant metastasis cannot be assessed
  • M0: no distant metastasis
  • M1: distant metastasis

Involvement of para-aortic or more distant lymph nodes is considered M1

Stage 0 Tis N0 M0
Stage I T1 N0 M0
Stage II T2, T3 N0 M0
Stage IIIA T1, T2, T3 N1 M0
T4 N0 M0
Stage IIIB T4 N1 M0
Any      T N2, N3 M0
Stage IV Any T Any N M1

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Haemorrhoidectomy

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Q) Not an indiction of haemorrhoidectomy 

a) Persistent Second degree haemorrhoid 5 days after sclerotherapy

b) 3rd degree haemorrhoid

c) Fibrosed  haemorrhoid

d)  interno-external haemorrhoids when the external haemorrhoid is well defined.

Ans a

haemorrhoids can persist for 10 days after sclerotherapy

The indications for haemorrhoidectomy include:

● third- and fourth-degree haemorrhoids;

● second-degree haemorrhoids that have not been cured by non-operative treatments;

● fibrosed haemorrhoids;

● interno-external haemorrhoids when the external haemorrhoid is well defined.

Four degrees of haemorrhoids ●●

First degree – bleed only, no prolapse ●●

Second degree – prolapse but reduce spontaneously ●●

Third degree – prolapse and have to be manually reduced ●●

Fourth degree – permanently prolapsed

BAiley page 1357