Anal Disease/Neoplasms

5 October 2005

Which of the following is not true about a rectovaginal fistula

A. Can result from obstetric or operative injuryB. Is an abnormal communication between the

anterior wall of the anal canal or rectum and the posterior wall of the vagina

C. Inflammatory bowel disease can be a cause of simple rectovaginal fistulae

D. About 50% of small rectovaginal fistuale secondary to obstetric trauma will heal spontaneously

E. Endovascular advancement of an anorectal flap can be created to repair a low, simple fistula.

A. True.

B. True.

C. False. Inflammatory bowel disease can be a cause of complex rectovaginal fistulae.

Simple RV fistulae are generally due to traumatic or infectious causes. Complex fistuale are caused by inflammatory bowel disease, irradiation or neoplasm

D. True.

E. True.

Anal Condylomata acuminataA. Have a characteristic papillary

appearance that can involve the perianal skin, anal verge, and anoderm

B. Are caused by HPV-16 and HPV-18C. Up to 65% recur after excisionD. Malignant transformation is common

and should be treated in the same manner as squamous cell carcinoma of the anus

A. True. Have a characteristic papillary appearance that can involve the perianal skin, anal verge, and anoderm

B. FalseMost warts are caused by HPV-6 and HPV-11

C. TrueUp to 65% recur after excision

D. FalseMalignant transformation is RARE. However, if it does occur, it should be treated in the same manner as squamous cell carcinoma of the anus

Kaposi’s Sarcoma - True or False

A. Kaposi’s sarcoma of the colon and rectum is generally asymptomatic

B. Kaposi’s sarcoma of the colon and rectum most often presents with bleeding, diarrhea, and obstruction

C. The characteristic lesion is a red, round, submucosal nodule with central umbilication

D. A superficial biopsy is sufficient to make the diagnosis

E. Surgical therapy is only indicated with failure of medical management

A. TRUEKaposi’s sarcoma of the colon and rectum is generally asymptomatic

B. FALSEWhile KS of the colon/rectums is generally asymptomatic, it can present with bleeding, diarrhea, and obstruction

C. TRUEThe characteristic lesion is a red, round, submucosal nodule with central umbilication

D. FALSEA DEEP biopsy is required to yield an accurate result

E. FALSEThere is no effective medical treatment. Surgery is indicated only to control massive bleeding, perforation or obstruction.

Which of the following are true about perianal neoplasms

A. Squamous Cell Carcinomas grow slowly and lesions are characterized by central ulcers with irregular, raised edges.

B. Basal Cell Carcinoma is more common in men than women and rarely metastasize.

C. Similar to Paget’s disease of the nipple, Paget’s disease of the perianal area is associated with an invasive or in situ adenocarcinoma.

Which of the following are true about perianal neoplasmsA. FALSE.

Squamous Cell Carcinomas grow slowly and lesions are characterized by rolled, everted edges with central ulceration.

B. TRUE.Basal Cell Carcinoma is more common in men, usually occur in the 6th decade, and rarely metastasize.

C. FALSE.Paget’s disease of the perianal area is generally a benign neoplasm, but in some cases can become invasive and become adenocarcinoma.

Squamous cell carcinoma of the anal canal

SCC above the dentate line metastasizes to the _______ (superior/inferior) rectal vessels. Lesions below the dentate line metastasize to the ______ (obturator/inguinal) nodes.

SCC above the dentate line metastasizes to the superior rectal vessels. Lesions below the dentate line metastasize to the inguinal nodes.

Which of the following are used for the treatment of squamous cell carcinoma of the anal canal?

A. Local excision

B. Abdominoperineal resection

C. Chemotherapy with 5-FU, mitomycin C

D. Pelvic radiation

A. Local excisionThe treatment of choice for carcinoma in situ or microscopic invasive carcinoma of the anal canal. However, at the time of diagnosis, many tumors are too large or advanced for local excision

B. Abdominoperineal resectionNot routinely performed as the primary treatment. It is associated with a high rate of recurrence. This modality is reserved for patient who have failed local treatment after chemoradiation, those with complications for treatment (such as fecal incontinence) and those unable to tolerate chemoradiation

C. Chemotherapy with 5-FU, mitomycin CThe standard treatment for SCC of anus. Used in association with pelvic radiation. Chemoradiation is associated with complete regression in 90% of patients and 5 year survival rates of 76-90%.

D. Pelvic radiation

Which of the following are true in regards to anal melanoma?

A. Anal Melanoma is the third most common site for melanoma following skin and eyes.

B. The most common symptom is rectal bleeding

C. Lesions are radioresistant but chemosensitive

D. Treatment with abdominoperineal resection shows a survival advantage over wide local resection.

A. TRUE.Anal Melanoma is the third most common site for melanoma following skin and eye.

B. TRUE.The most common symptom is rectal bleeding

C. FALSELesions are radioresistant and not sensitive to chemotherapy or immunotherapy.

D. FALSE.There is no difference in survival between APR and wide local resection. Both have survival rates of 15-17%