GI

Question 1

transanal excision of rectal cancer indications

Answer 1

The operation is indicated for

These tumors should be stage T1 (limited to the submucosa) or T2 (limited to the muscularis propria),

mobile tumors
smaller than 4 cm
involve less than 40% of the rectal wall circumference,
within 6 cm of the anal verge.

well or moderately differentiated histologically,
no vascular or lymphatic invasion.

associated with a three- to fivefold higher recurrence rate compared with similar stage cancers treated by radical surgical resection

close follow-up is mandatory, in that approximately 8% of T1 lesions recur and the recurrence rate for T2 lesions has been shown in some series to exceed 20%. As noted, most clinicians believe that local excision is not adequate treatment for a T2 rectal cancer and further treatment is required, adjuvant radiation plus chemotherapy or radical excision (low anterior resection or abdominal perineal resection).

Question 2

low anterior resection definition

Answer 2

below the peritoneal reflection through an abdominal approach

sigmoid colon is almost always included with the resected specimen because diverticulosis often involves the sigmoid, and the blood supply to the sigmoid is often not adequate to sustain an anastomosis if the IMA is transected.

total mesorectal excision, produces the complete resection of an intact package

Question 3

outcomes of total mesorectal excision regarding complication rates

Answer 3

decrease in the incidence of impotence and bladder dysfunction (85% to <15%).

Question 4

rectal cancer margins

Answer 4

1-2 cm for RECTAL

colon cancer 2-5 cm

Question 5

indication for neoadjuvant therapy for rectal cancer

Answer 5

stage II - III

new adjuvant

Surgery

Chemotherapy

Question 6

histology definition of T1 rectal cancer

Answer 6

limited to mucosa

Question 7

through indications for complete local excision of rectal mass

Answer 7

carcinoma in situ

formal resection needs to be performed for T1 rectal cancer

Question 8

histology definition of T2 rectal cancer

Answer 8

muscularis propria invasion

Question 9

how low kidney ago with low anterior resection

Answer 9

one-2 cm from upper portion of anal rectal ring - sphincter

Question 10

contraindications of low anterior resection

Answer 10

invasion:
Anal sphincter
The greater muscles

Question 11

T stage rectal cancer

Answer 11

Same as colon staging!

carcinoma in situ-invasion of lamina propria or intraepithelial layer

does NOT invade the submucosa and

T1-invade the mucosa
T2-invaded muscularis propria
T3-through muscularis propria into. Colorectal tissue
T4 A.-penetrates to the surface the visceral peritoneum
T4 B.-directly invades were as adherent to other organs

Question 12

N stage for rectal cancer

Answer 12

Same as colon staging!

N1 1-3 nodes
N1a one regional lymph node
N1b 2-3 regional nodes
N1c no regional nodes BUT deposits in the subserosa, mesentery, non-peritonealized pericolic or perirectal tissue

N2 4 or more nods
N2a 4-6 nodes
N2b 7 or more nodes

Question 13

colorectal staging

Answer 13

colon staged the same as rectum

I T1 or T2 (no neoadjuvant xrt for rectal)
IIa T3 ( through muscularis propria and into surrounding tissue)
IIb T4a ( and a up to but not into surrounding organs)
IIc T4b ( invades to the surrounding organs) - still stage II!
III Node positives
IV metastases

Question 14

treatment of stage I rectal cancer

Answer 14

surgery alone

T1-2
mucosa-into muscularis propria

Question 15

colon cancer margins

Answer 15

2-5 cm

Question 16

required nodes for adequate specimen colon cancer

Answer 16

12

Question 17

required nodes for adequate staging rectal cancer

Answer 17

12

Question 18

management of obstructing left colon cancer

Answer 18

subtotal colectomy

Segmental colectomy with on table lavage

With or without diverting loop ileostomy or Hartmn

Question 19

management of obstructing right-sided colon cancer

Answer 19

right hemi-with primary anastomosis

Question 20

Management of perforated colon cancer

Answer 20

small contained

Drainage

is not small and contained:
Diversion to protect anastomosis

Question 21

management of colon cancer with liver metastases order of operation

Answer 21

liver first

unless: Issues acute-perforation/obstruction

Question 22

management ovary lesions seen during surgery for colon cancer

Answer 22

bilateral nephrectomy

Question 23

adjuvant therapy for colon cancer

Answer 23

all node positive
stage III
no radiation

5-FU
leucovorin and oxaliplatin

possibly colon
stage II with T3 local perforation closer positive margins

Question 24

followup after her colon cancer surgery

Answer 24

first 2 years ( Then every 6 months for 2 more years)
every 4 months with history physical and CEA

Primarily for metachronous:
Annual CT scan chest x-ray colonoscope

after the first year, colonoscopy every 3 years

after 5 years:
Surveillance limited value to

Question 25

highest risk of colon cancer recurrence in what time.

Answer 25

2 years 60-80%

3 years 90%

Question 26

management of a synchronous lesion found in the separate area of the colon during surgery for cancer

Answer 26

subtotal colectomy

not to individual resections

Question 27

effect on cure rate with organ involvement

Answer 27

as long as en bloc resection R0 had been accomplished no change in survival

Survival based on node status

this includes the possibility of performing pancreatectomy, hysterectomy bilateral nephrectomy, partial nephrectomy total nephrectomy, duodenal resection…. the