Anal Cancer
38 results
1 - 38
Malignancy- A healthy 3-month-old infant is undergoing a routine well-baby examination at his pediatrician’s office. His parents are concerned about the strong familial history of colon cancer in most members of the father’s family diagnosed before age 35 years. Which finding on examination would alert the pediatrician to a possible diagnosis of familial adenomatous polyposis?
- A 25-year-old man with a known APC mutation undergoes a laparoscopic restorative total proctocolectomy/ileal pouch–anal anastomosis. Which of the following is the most common extracolonic manifestation?
- A 25-year-old patient presents to your office for surveillance of familial adenomatous polyposis. He has a history of proctocolectomy with ileal pouch–anal anastomosis. Esophagogastroduodenoscopy reveals 8 duodenal polyps that range from 6 to 8 mm. Pathology reveals tubulovillous histology with moderate dysplasia. How often should endoscopic surveillance be performed?
- A 25-year-old obese female patient with a known diagnosis of familial adenomatosis polyposis is preparing for prophylactic surgery. Colonoscopy reveals more than 200 small polyps in her colon with no significant polyps distal to the sigmoid. She desires to have children as soon as possible. Which surgical option will minimize her cancer risk while giving her the best chance of preserving fertility?
- A 64-year-old woman with a history of cervical intraepithelial neoplasia presents with a firm 3-cm mass protruding at the anal verge. Anoscopy shows a fixed mass just distal to the dentate line. A biopsy of the lesion is performed, which has the findings shown in the Figure. Colonoscopy findings are unremarkable and computed tomography of the chest, abdomen, and pelvis reveals no evidence of distant disease. Magnetic resonance imaging reveals no locoregional nodal or sphincter involvement. The next best step in management for this patient is:
- A 56-year-old man presents to the office with biopsy-proven midrectal adenocarcinoma on colonoscopy. Rigid sigmoidoscopy in the office shows a 5-cm circumferential mass 8 cm from the anal verge. Staging evaluation with computed tomography of the chest, abdomen, and pelvis and magnetic resonance imaging of the pelvis preoperatively demonstrates a T3N1M0 cancer. What is the next step in management for this patient?
- A 72-year-old patient with severe systolic congestive heart failure and oxygen-dependent chronic obstructive pulmonary disease completes chemoradiation for a locally advanced rectal adenocarcinoma 5-cm proximal to the anal verge. Reexamination of the rectum 8 weeks after chemoradiation reveals normal, intact mucosa, and magnetic resonance imaging of the pelvis reveals no visible cancer or suspicious mesorectal nodes. What is the most appropriate therapy for this patient?
- A 62-year-old man was found to have 1-cm posterior rectal lesion that is 3 cm from the anal verge. Histopathologic findings are consistent with a well-differentiated adenocarcinoma without lymphovascular or perineural invasion. Magnetic resonance imaging shows that the tumor is limited to the submucosa and there are no suspicious mesorectal lymph nodes. Metastatic workup uncovers no findings. What is the most appropriate management?
- A 63-year-old woman is diagnosed with a 1.5-cm, well-differentiated perianal squamous cell cancer that is 3.5 cm from the anal verge, with no involvement of the anal sphincter mechanism. There is no radiographic evidence of inguinal nodal or metastatic disease. The best treatment option for this patient is:
- A 54-year-old woman was referred to you with a newly diagnosed anal squamous cell carcinoma. Physical examination reveals a 1.2-cm distal anal canal lesion and no palpable inguinal lymphadenopathy. Magnetic resonance imaging of the pelvis shows no sphincter involvement and no regional lymphadenopathy. What is the most appropriate next step?
- A 70-year-old woman presents with a 3-cm lesion at the anal verge extending into the anal canal. Biopsies show a squamous cell carcinoma. Staging magnetic resonance imaging confirms a lesion 3.1 × 1.2 × 0.5 cm in size, possibly involving the internal sphincter muscle, without lymphadenopathy. What is the T stage in this patient?
- A 55-year-old man with HIV presents to your clinic complaining of severe itching around his anus that sometimes bleeds when he scratches. On physical examination, he has an excoriated and slightly raised area around the anus measuring about 50% of circumference on the right side. Biopsy shows confirmed high-grade squamous intraepithelial lesions. Which of the following is the best treatment option for this patient?
- A 52-year-old man is diagnosed with a 1.5-cm anal canal squamous cell cancer. He is HIV positive and has been taking highly active antiretroviral therapy for several years; his CD4 count is 225 while his viral load is undetectable. Which of the following is the most appropriate management for this patient?
- A 55-year-old man undergoes low anterior resection with primary anastomosis for a T2N0 rectal cancer located 9 cm from the anal verge. The splenic flexure was mobilized, the inferior mesenteric artery was divided distal to the take-off of the left colic artery, followed by total mesorectal excision. His recovery is uneventful. He returns to the clinic 3 months after surgery describing normal erections, but he is unable to ejaculate. At which step of the operation is nerve damage most likely to have occurred?
- A 53-year-old man is diagnosed with rectal adenocarcinoma 7 cm from the anal verge. Preoperative pelvic magnetic resonance imaging (MRI) demonstrates a threatened circumferential radial margin. After total neoadjuvant chemoradiation, a repeat MRI demonstrates a persistently threatened radial margin. Which of the following adjuncts should be considered in operative planning for this patient?
- A 68-year-old man with a history of a hemorrhoidectomy and fecal urgency presents with a T3n1m0 rectal cancer 5 cm from the anal verge. He has no family history of colorectal cancer. What is the most important consideration when counseling the patient about his surgical treatment options?
- A 25-year-old woman is referred by her gastroenterologist with innumerable adenomatous polyps covering her entire colon and rectum after colonoscopy performed for anemia. Her father died of metastatic colon cancer at age 45 years; she has 1 sibling with a presentation similar to her own. The gene most likely responsible for these findings is:
- Anorectal Disease
- You are asked to evaluate a 73-year-old man with a rectourethral fistula confirmed on computed tomography cystogram. It is 2 years since he underwent radiation therapy for prostate cancer. What is the best approach for definitive fistula repair using a muscle flap?
- A 55-year-old woman with a history of high-risk cervical human papillomavirus presents with a 2.5 x 1 cm exophytic, firm lesion that extends from the anal verge to just below the dentate line. Biopsy was significant for squamous cell cancer. Which nodal basin would this lesion most likely drain?
- You evaluate a patient with a 3-month history of pruritis ani. Examination reveals perianal erythema and excoriation. You treat the patient with dietary modification and calamine-zinc barrier. The patient returns in 3 months reporting no symptomatic improvement. What is the next step in management?
- A 53-year-old woman presents with a 3×2–cm pruritic, well-circumscribed, eczematous, tender lesion that does not involve the anal verge. A punch biopsy notes intradermal infiltration of cells with large, round, eccentric nuclei, with pale vacuolated cytoplasm, which stain positive for cytokeratin 7. Workup is negative for malignancy. What is the best step in management?
- A 37-year-old patient undergoes excision and fulguration of perianal condyloma. Pathology demonstrated the presence of human papillomavirus (HPV) subtype 16. How would you best advise him of his disease progression?
- A 56-year-old HIV positive man with anal condyloma acuminata undergoes excision and fulguration of these lesions under general anesthesia. The pathology shows foci of high-grade dysplasia related to human papillomavirus. What is the next step in the management?
- A 53-year-old woman with a history of kidney transplantation 5 years ago presents with perianal itching and a painful lump. On examination, several perianal small cauliflowerlike lesions are noted. In addition to anoscopy what is the next step in management for this patient?
- A 69-year-old man presents for evaluation of rectal bleeding, incontinence, and tenesmus. One year ago, he underwent external beam radiation therapy for prostate cancer. On flexible sigmoidoscopy, friable mucosa with telangiectasias is observed in the rectum above the dentate line to 15 cm. What is the next treatment choice?
- Perioperative
- A 50-year-old man undergoes chemotherapy and radiation for a low T3N1 rectal cancer, followed by a robotic low anterior resection. After surgery, he is placed on an enhanced recovery protocol. When is the most appropriate time for Foley catheter removal from the bladder?
- A 56-year-old man undergoes a low anterior resection after neoadjuvant chemoradiation for a T3N0M0 rectal cancer located 9 cm from the anal verge. Eight days later, he presents to the emergency department with mild abdominal pain and a temperature of 102.2°F (39°C). Laboratory results are significant for a white blood cell count of 14,000/µL (14×109/L). Computed tomography of the abdomen and pelvis shows pneumoperitoneum with contrast extravasation into the pelvis. Abdominal examination shows focal peritonitis in the left lower quadrant. Intraoperative findings demonstrate a 3-mm anastomotic disruption anteriorly. In addition to abdominal washout, what is the best surgical option for this patient?
- Miscellaneous
- Benign Disease
- A 57-year-old woman with ulcerative colitis and symptoms of fecal incontinence caused by obstetrical trauma is referred for surgical evaluation for multifocal high-grade dysplasia noted on random endoscopic biopsies. The patient is interested in a continence-preserving procedure. What is the most appropriate surgical intervention for this patient?
- A 47-year-old male patient with a history of ulcerative colitis, who is currently taking vedolizumab, presents for routine screening colonoscopy. He has mild proctosigmoiditis, and a 5-mm semipedunculated polyp is noted in the sigmoid colon. What is the best management approach for this polyp?
- A 50-year-old man has longstanding ulcerative colitis diagnosed at age 20 years is presently asymptomatic and is receiving maintenance treatment with infliximab and 6-mercaptopurine. His bowel function is stable, at 6 nonbloody stools per day without any associated complaints. He undergoes colonoscopy which demonstrates minimal evidence of inflammation. Random biopsies reveal low-and high-grade dysplasia 2 cm, 30 cm, and 50 cm from the anal verge. The remainder of the biopsies reveal no dysplasia. What is the best next step in management?
- A 28-year-old man with a history of ulcerative colitis undergoes a total proctocolectomy with stapled ileal pouch–anal anastomosis. Six months after surgery, he presents with urgency, increased stool frequency, and bloody bowel movements. Endoscopic examination findings are shown (Figure A and B). What is the best next step in management?
- A 70-year-old man with history of perianal Crohn’s disease and 15-year history of an anal fistula presents to establish care. On examination, he has a right anterior anal fistula that appears chronic in nature. What is the best next step in management?
- A 58-year-old man with chronic ulcerative colitis is found to have a 3-cm mass approximately 5 cm from the anal verge on surveillance colonoscopy. Biopsies reveal moderately differentiated adenocarcinoma. On rectal examination, the mass is fixed and tethered. Staging reveals a T3N0 lesion, with no evidence of distant metastasis. The best next step in management is:
- A 55-year-old woman presents to your office for surgical consultation. Colonoscopy had demonstrated hundreds of adenomas carpeting the colon and 30 polyps in the rectum. She has never had a problem with fecal incontinence. What is the best next step in management?
- A 55-year-old man with a 20-year history of medically refractive ulcerative pancolitis and primary sclerosing cholangitis undergoes a 2-stage total proctocolectomy with ileal pouch–anal anastomosis. He underwent a mucosectomy and hand-sewn anastomosis. The final pathology report reveals multifocal low-grade dysplasia. When would you perform pouchoscopy?
- ASCRS Question Bank
- Pelvic Floor