Gastric Surgery    MCQ Questions on Rectal cancer.

Almost in every examintaion there will be ten or twelve questions on rectal cancer. The important questions can be from TNM staging, symptoms, diagnosis and management. 
The role of radiotherapy, chemotherapy and surgery should be clear. Recent NCCN guidelines give a very good account of these.
Colon                 Anal Canal                Rectum Q11-
 Q1. Most common site of Colo Rectal cancer is
a) Hepatic Flexure                                          
b) Sigmoid colon
 c) Anal canal                                                  
 d) Rectum
Q2. Not a true statement regarding double contrast barium enema
a) Bowel preparation is not required                                         
b) Patient has to be rolled in various positions
 c) It is inferior to colonoscopy in detection of colon cancer and polyps                       
 d) Sensitivity in detecting polyps depend on the size of polyp       
Q3. Lipoma which undergo malignant degeneration is
a) Retroperitoneal                                     b) Subserosal
c) subfascial                                             d) Submucosal

Q4) True statement regarding Ripstein repair for Rectal prolapse is 

a) It is a procedure where a mesh is placed posterior to rectum and fixed to the lateral side walls.

b) Recurrence rate range from 15-20%

c) Constipation can be a significant side effect

d) Rectal mobilization is not needed

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
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) a
Bowel preparation is required in all cases before double contrast barium enema. A column of barium is given and colon is distended with air. The patient is rolled and moved in various position so that barium gets adherent to the wall of rectum and colon.
DCBE is inferior to colonoscopy in detection of small adenomas and tumor
 Shackelford's Surgery of the Alimentary Tract

Seventh Edition

Book Chapter

Diagnosis of Colon, Rectal, and Anal Disease 
3) c
Lipoma of retroperitoneum and mediastinum are the most common to undergo malignant degeneration and change into carcinoma.
4) c Constipation can be a significant side effect

Ripstein is an abdominal procedure where the mesh is placed anterior to the rectum. Extensive rectal mobilization is required upto the levels of both levators. The prosthetic mesh is placed anterior to the rectum and sutured to pre sacral fascia on both sides.

RECURRENCE RATE RANGE FROM 2-5%. Side effects of ripstein operation are mesh erosion, intestinal obstruction, constipation and ureteral fibrosis.

Sabiston 20th edition pdf book  page 1383

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
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