Anal and Rectal cancer

Question 1

Anal cancer with enlarged inguinal lymph nodes management?

Answer 1

fine needle aspiration and/or excisional lymph node biopsy to assess for nodal disease

Question 2

Patient population at increased risk of recurrent anal dysplasia and progression to anal squamous cell carcinoma:

Answer 2

HIV patients, immunosuppressed patients, men who have sex with men, anal intercourse, HPV

Question 3

What HPV subtypes are associated with the development of anal cancer?

Answer 3

HPV 16 & 18

Question 4

Imaging work up for anal squamous cell carcinoma?

Answer 4

CT chest/ab/pelvis +/-MRI pelvis

Question 5

Treatment of anal squamous cell carcinoma:

Answer 5

Nigro protocol: chemo (5FU + mitomycin C) and external beam radiation (45 Gy)

-surgery is reserved for patients with local regional recurrence or persistence of tumor after chemorads (APR)

Question 6

Lymphatic drainage of the anal canal -

Answer 6

inguinal lymph nodes

Question 7

What chemotherapy is indicated for metastatic anal SCC?

Answer 7

cisplatin-based chemo

Question 8

Management of anal LSIL & HSIL:

Answer 8

local surveillance every 3-6 months with or without high resolution anoscopy +/- topic or ablative therapies

Question 9

In female patients with anal cancer, what other surveillance should be performed?

Answer 9

pelvic exam and PAP smear bc HPV is a risk factor for both anal cancer and cervical cancer

Question 10

management of grade 1 anal epithelial neoplasia

Answer 10

observe with surveillance every 4-12 months

Question 11

Protocol after Nigro treatment for anal SCC:

Answer 11

reexamine at 8-12 weeks and repeat every 6-8 weeks until resolution

Question 12

Components of Nigro protocol:

Answer 12

5FU, mitomycin C, and pelvic radiation with pelvic inguinal radiation

Question 13

Treatment of anal margin cancer:

Answer 13

wide local excision with 1 cm margin for well differentiated lesions and less than 2 cm in size

Question 14

Treatment of anal melanoma:

Answer 14

wide local excision; does not respond to chemo or radiation

Question 15

Where does anal SCC usually spread first

Answer 15

inguinal lymph nodes

Question 16

Surveillance 1 year after treatment for rectal cancer:

Answer 16

CEA, colonoscopy, and CT chest/ab/pelvis

Question 17

True or False. SCC of the anal margin (hair-bearing perianal skin) without nodal involvement is treated like SCC of the skin.

Answer 17

true

Question 18

True or false. Sphincteroplasty is not contraindicated for fecal incontinence even if the sphincter mechanism is intact.

Answer 18

False