Rectal cancer Flashcards
What is the rectal ampulla? Remember it is the ___ frequent area for rectal cancer
the bottom 2/3 of the rectum
most
Name 4 clinical presentations of rectal cancer:
- rectal ___ = ___
- ___
- ___
- ___ discharge
bleeding=hematochezia
constipation
tenesmus
mucus
Tumor in the ___ lower part of the rectum will require ___ resection (including the ___ canal) and the sphincters
1/3
full
anal
In order to determine pre surgical staging we use ___/___for the N and T, and ___ for the M
TRUS (Transrectal ultrasonography)
MRI
CXR
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) ___
proctosigmoidoscopy
colonoscopy
staging (TRUS/MRI + CXR)
cystography
Urgent rectal surgery due to complete obstruction will be one of the following: (4)
Hartman
sub total colectomy
transverse loop colostomy
stent
Rectal tumor metastatic spread:
upper part-> __ and __ through the porta and iliac veins
classic spread->___ through the Boston plexus
lungs
liver
spine
What are the 3 elective surgeries for rectal cancer:
local excision
LAR (low anterior resection)
APR (abdominal perineal resection) = MILES
LAR and APR are both TME (___) where we remove the ____ and regional __
total mesolectal excision
mesorectum
LN
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
sphincters
anastomosis
colon
sigma
In LAR there is a high percentage of __, so we will usually opt for protective ___ for ___ weeks.
leakage
ileostomy
10
After LAR, how will you assist against incontinence?
J pouch anastomosis
When performing APR (MILES) we do an En block= ___, therefor the patient will need to use __ for life
total removal of the tissue
stoma
What are the indications for APR? (5)
1) Direct involvement of the __
2) __ tumor
3) decreased ___ function
4) problematic ___
5) RUSH ___
sphincters low (we need 2 cm of clean margins from the sphincters) sphincter anatomy 0-5 cm from the anal verge
What are the main complications of rectum surgery?
impotence
leakage
venous bleeding
Which nerve are damaged when impotence is caused by rectum surgery?
hypogastric nerve (sympathetic) causing retrograde ejaculation
Post surgery leakage will show ___ POD , and the patient will show: (5)
5-7 tachycardia tachypnea fever pain leukocytosis
How do you treat anastomosis leakage? (4)
laparotomy
tube
protective ileostomy
do not touch the anastomosis
