Anal Cancer
283 results
37 - 136
Malignancy- A 58-year-old patient presents to the clinic reporting anal pain and bleeding with bowel movements. Examination shows an ulcer at the anal verge measuring 1.5 cm. Biopsy shows invasive squamous cell carcinoma. Pelvic magnetic resonance imaging (MRI) shows the lesion invades the external sphincter. What is the patient’s T stage?
- A 62-year-old woman presents to the office with a 1-month history of rectal pain, bleeding, and perianal mass. On digital rectal examination and anoscopy, a 3-cm firm mass is noted at the left lateral anal canal. Inguinal examination is unremarkable. Biopsy of the mass shows moderately differentiated squamous cell carcinoma. Staging computed tomography (CT) of the chest and abdomen and magnetic resonance imaging (MRI) of the pelvis demonstrate a T2N1M0 tumor. What is the best next step in her management?
- A 64-year-old man presents with a lesion on the perianal skin, as shown in the figure. Biopsy in the office demonstrates verrucous carcinoma. The most definitive management in this patient is
- A 47-year-old woman presents with rectal pain and feculent discharge from her vagina. A digital rectal exam (DRE) in the office reveals a 4-cm, firm, palpable mass starting just below the dentate line; it is immobile and contiguous with the posterior vaginal wall. You perform a biopsy that confirms squamous cell carcinoma. After completing the staging workup, you find she has T4N0, stage IIIB disease. The recommended treatment is
- A 61-year-old patient presents to clinic with a newly diagnosed rectal adenocarcinoma biopsy proven on colonoscopy. You perform a digital rectal examination (DRE) in the office and find a bulky circumferential tumor at approximately 6 cm from the anal verge that is not mobile. What is the best imaging modality to assess the local characteristics of the tumor?
- A 61-year-old man is found to have a 2-cm mass in the mid-rectum (8 cm from the anal verge) on diagnostic colonoscopy. Biopsy reveals moderately differentiated adenocarcinoma. Computed tomography (CT) reveals no evidence of metastatic disease, and magnetic resonance imaging (MRI) demonstrates a cT3, node-negative cancer. After presentation at a multidisciplinary tumor board, the patient agrees to total neoadjuvant therapy. The patient has a complete clinical response to treatment and opts for close radiologic and endoscopic surveillance in an effort to avoid surgery. On a surveillance proctoscopy 6 months after treatment, the patient is found to have a 7-mm recurrence at the original cancer site. Which of the following is the best next step in management?
- A 63-year-old otherwise healthy woman comes to see you for chafing and ulceration related to a perianal skin tag. It has been present ever since she was pregnant years ago; however, in the past 6 months, there is an area that has been bleeding persistently. On examination, she has a large 3-cm perianal skin tag, with a small area of ulceration at the base measuring about 1–2 mm. You take her for excision of this tag, and the pathology comes back as invasive, well-differentiated squamous cell carcinoma, 6 mm in width, with margins negative at least 1 cm from the edge of the specimen. Staging workup and imaging are negative. The recommended next step in treatment is
- A 63-year-old woman is diagnosed with a poorly differentiated microsatellite–stable rectal cancer 7 cm from the anal verge on screening colonoscopy. She denies trouble with continence. Staging computed tomography (CT) of the chest/abdomen/pelvis does not demonstrate distant disease; a mass is confirmed in the mid rectum with evidence of lymphadenopathy. Rectal magnetic resonance imaging (MRI) demonstrates this tumor is a T4aN2M0 with threatened circumferential radial margin. The multidisciplinary tumor board recommends total neoadjuvant chemotherapy with FOLFOX and long-course chemoradiation therapy. Six weeks after completing neoadjuvant therapy, flexible sigmoidoscopy demonstrates persistent tumor. Restaging MRI after total neoadjuvant therapy is consistent with persistently threatened posterior radial margin with tumor extending to the presacral fascia. The multidisciplinary tumor board’s best recommendation for her is
- A 47-year-old female patient presents 28 weeks after completing chemoradiation therapy for P16-positive HPV-associated squamous cell carcinoma of the anus. The patient continues to report intermittent bleeding and pain, which has continued to slowly improve. On physical examination, she has evidence of residual disease. The best next step in management for this patient is
Anal Squamous Cell Cancers (Revised 2018)
Anal Intraepithelial Neoplasia
Fundamentals of Rectal Cancer Surgery- Anorectal Disease
- A patient presents with persistent anal pain despite use of fiber and bowel regimen. On examination, the patient has a linear 2-cm tear in the right lateral position of the anal canal with exposure of the underlying internal sphincter. The most appropriate next step in the management of this patient is
- A 60-year-old male patient with a history of radiation for prostate cancer presents with pneumaturia and recurrent urinary tract infections. Workup reveals a 1-cm defect in the anterior rectum just above the dentate line, corresponding to a urethral defect on cystoscopy. There is evidence of radiation damage to the rectum but no active infection and no evidence of cancer recurrence. Which of the following is the most definitive management?
- A 60-year-old patient is reevaluated for pruritus ani. Symptoms did not improve after topical steroid, barrier cream, and anal hygiene measures. Examination shows dry leathery scaly perianal skin without ulceration. The best next step is in her management is
- A 36-year-old man who is HIV-positive presents to your clinic with a 6-week history of perianal burning and itching. Rectal examination reveals multiple small condylomata within the anal canal. Intraoperative excisional biopsies of the condylomata confirm human papillomavirus (HPV). Which of the following HPV subtypes confers the highest risk of anal high-grade dysplasia and squamous cell carcinoma?
- A 45-year-old man, who reports sex only with men (MSM), has been referred to you for evaluation of a whitish anorectal lesion identified on initial screening colonoscopy. Biopsies confirmed high-grade squamous intraepithelial lesion (HSIL), for which he ultimately underwent excision and fulguration. What is the recommended surveillance?
- A screening anal pap was performed on a 33-year-old male patient with well-controlled human immunodeficiency virus (HIV). Cytology is consistent with high-grade squamous intraepithelial lesion (HSIL). The most appropriate next step in management is
- A 41-year-old patient presents to your clinic with anal pain for the past 2 months. On anoscopy and examination, a 1-cm ulcer is seen at the dentate line. The patient is sexually active with a single partner and received a kidney transplant 10 years ago. What is the most likely diagnosis of the anal lesion?
- You are performing a high-resolution anoscopy on a patient referred for high-grade squamous intraepithelial lesion (HSIL) seen on an anal pap. You identify two areas with high-grade dysplasia. What is the treatment of choice?
- A 56-year-old patient is diagnosed with rectal cancer just above the dentate line. What is the lymphatic drainage of this lesion?
- Pelvic Floor
- A 75-year-old man with a remote history of fistulotomy and radiation therapy for prostate cancer presents for evaluation of his worsening fecal incontinence. He has poor sphincter tone and a palpable muscular defect. Anal manometry confirms diminished resting and squeeze pressures that do not improve after pelvic floor physical therapy with biofeedback. His symptoms persist despite bowel habit optimization and sacral nerve stimulator implantation. The best next option for ths patient is
- A 38-year old woman presents to your clinic with chronic constipation and intermittent anal bleeding. During a rigid proctoscopy, a well-circumscribed ulcer is visualized on the anterior wall of the rectum, located at 8-cm from the anal verge. A biopsy is obtained, revealing minimal inflammation, with fibrosis of the lamina propria, and with a thickened muscularis mucosa. The most appropriate next step is
- Anorectal Crohn’s Disease
Malignancy- 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 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 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 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 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?
- About ASCRS Textbook of Colon and Rectal Surgery
- Preoperative Staging
- Benign Disease
- A 30-year-old female patient undergoes proctocolectomy and ileal pouch anal anastomosis (IPAA) for familial adenomatous polyposis. What surveillance is recommeded for her?
- A 65-year-old man with Crohn’s disease presents with intermittent bleeding from a long-standing anal fistula. He is on infliximab with good endoscopic control. On examination, there are large skin tags and an external fistula opening with irregular, heaped up, and friable edges. There is no evidence of abscess. Which of the following would be the most appropriate next step?
- Colorectal Cancer: Minimally Invasive Surgery
- 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?
- 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 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?
- Management of Rectal Cancer (2020)
Management and Longitudinal Surveillance of Anal Dysplasia in High- and Low-risk Patients- ASCRS Annual Meeting 2024
- Endoscopy
- Rectal Cancer: Nonoperative Management
- Anal Fissure and Anal Stenosis
- Dermatology and Pruritus Ani
- Colorectal Cancer: Preoperative Evaluation and Staging
- Rectal Anatomy
- Perioperative
- Rectal Cancer Biology and Hereditary Cancer Syndromes
- Anatomy and Embryology of the Colon, Rectum, and Anus
- Low Anterior Resection Syndrome (LARS)
- Miscellaneous
- Sexual Function After Colorectal Surgery in Women
- Complications of the Pelvic Pouch
- ASCRS Webinars
- Bowel Dysfunction Low Anterior Resection Syndrome
- Sporadic and Inherited Colorectal Cancer: How Epidemiology and Molecular Biology Guide Screening and Treatment
- Benign Disease
- 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 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?
- Long-term Complications of Abdominoperineal Resection: Strategies for Evaluation, Management, and Prevention
- Male Genitourinary Dysfunction as a Consequence of Colorectal Surgery
- Rectal Cancer: Local Excision
- Rectourethral and Complex Fistulas: Evaluation and Management
- Proctectomy for Rectal Cancer
- Management of Hemorrhoids (2024)
- Treatment of Difficult/Obstructive Defecation
- Rectovaginal Fistula
- Transanal Endoscopic Microsurgery for T1 Rectal Cancer in a High-Risk Patient
- Perioperative
- Intestinal Stomas