Rectal cancer

Question 1

What is the rectal ampulla? Remember it is the ___ frequent area for rectal cancer

Answer 1

the bottom 2/3 of the rectum

most

Question 2

Name 4 clinical presentations of rectal cancer:

1. rectal ___ = ___
2. ___
3. ___
4. ___ discharge

Answer 2

bleeding=hematochezia
constipation
tenesmus
mucus

Question 3

Tumor in the ___ lower part of the rectum will require ___ resection (including the ___ canal) and the sphincters

Answer 3

1/3
full
anal

Question 4

In order to determine pre surgical staging we use ___/___for the N and T, and ___ for the M

Answer 4

TRUS (Transrectal ultrasonography)
MRI
CXR

Question 5

Pre surgical assessment involves:

1) Rigid ___ to assess the size/location of the tumor
2) ___ of the entire colon to rule out meta synchronic tumor
3) pre surgical ____
4) ___

Answer 5

proctosigmoidoscopy
colonoscopy
staging (TRUS/MRI + CXR)
cystography

Question 6

Urgent rectal surgery due to complete obstruction will be one of the following: (4)

Answer 6

Hartman
sub total colectomy
transverse loop colostomy
stent

Question 7

Rectal tumor metastatic spread:
upper part-> __ and __ through the porta and iliac veins
classic spread->___ through the Boston plexus

Answer 7

lungs
liver
spine

Question 8

What are the 3 elective surgeries for rectal cancer:

Answer 8

local excision
LAR (low anterior resection)
APR (abdominal perineal resection) = MILES

Question 9

LAR and APR are both TME (___) where we remove the ____ and regional __

Answer 9

total mesolectal excision
mesorectum
LN

Question 10

LAR is for when the tumor is far enough from the ____, and the involved rectal segment + primary ___ of the __. We usually remove the ___ because it tends to bleed due to diverticula

Answer 10

sphincters
anastomosis
colon
sigma

Question 11

In LAR there is a high percentage of __, so we will usually opt for protective ___ for ___ weeks.

Answer 11

leakage
ileostomy
10

Question 12

After LAR, how will you assist against incontinence?

Answer 12

J pouch anastomosis

Question 13

When performing APR (MILES) we do an En block= ___, therefor the patient will need to use __ for life

Answer 13

total removal of the tissue

stoma

Question 14

What are the indications for APR? (5)

1) Direct involvement of the __
2) __ tumor
3) decreased ___ function
4) problematic ___
5) RUSH ___

Answer 14

sphincters
low (we need 2 cm of clean margins from the sphincters)
sphincter 
anatomy
0-5 cm from the anal verge

Question 15

What are the main complications of rectum surgery?

Answer 15

impotence
leakage
venous bleeding

Question 16

Which nerve are damaged when impotence is caused by rectum surgery?

Answer 16

hypogastric nerve (sympathetic) causing retrograde ejaculation

Question 17

Post surgery leakage will show ___ POD , and the patient will show: (5)

Answer 17

5-7
tachycardia 
tachypnea
fever 
pain
leukocytosis

Question 18

How do you treat anastomosis leakage? (4)

Answer 18

laparotomy
tube
protective ileostomy
do not touch the anastomosis