CSS.47.AnalCarcinoma Flashcards Preview

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Flashcards in CSS.47.AnalCarcinoma Deck (37):

what procedure/evaluation is indicated in a patient with anal bleeding that does not respond to medical management?

anoscopy and/or colonoscopy


is the first-line treatment for nonmetastatic anal canal carcinoma surgical or nonsurgical?



how long should you wait after chemoradiation for anal carcinoma prior to proceeding to surgery and why?

allow up to 12 weeks for regression of lesion after chemoradiation prior to proceeding to surgery


what surgery is indicated if combined chemoradiation fails to treat anal carcinoma?

abdominoperineal resection


what is the primary presentation of anal fissure?

sharp pain with defecation, associated with bright red blood when wiping


what is the primary presentation of internal hemorrhoids?

painless rectal bleeding


what is the primary presentation of thrombosed external hemorrhoids?

constant pain that persists for days


what are three common causes of pruritus ani

rectal mucosal prolapse, irritation of hemorrhoidal skin tags, dietary irritants (citrus, caffeine, spicy food, tomatoes, dairy)


what are 5 risk factors for anal carcinoma (what makes a patient "high risk") and what evaluation should you perform for any anal complaints?

age > 50, HIV, HPV (anal/gyn), colorectal adenomas, and relevant family history - endoscopy


when evaluating for suspected anal carcinoma, which lymph node basin should you evaluate? how should you evaluate associated lymphadenopathy and why?

pay attention to inguinal nodes, evaluate LA with FNA to r/o regional LN involvement


when evaluating suspected anal carcinoma, what three imaging modalities can be used to assess for distant mets?

abdominal/pelvic CT; abdominal pelvic MRI; PET-CT


why should you perform a gynecologic evaluation in female patients with suspected anal carcinoma?

evaluate for gynecologic dysplasia b/c HPV is implicated in both neoplastic processes


Define T1 anal canal carcinoma

size < 2 cm


Define T2 anal canal carcinoma

size 2-4.9cm


Define T3 anal canal carcinoma

size >5 cm


Define T4 anal canal carcinoma

invades adjacent organs


Define N1 anal canal carcinoma

perirectal node involvement


Define N2 anal canal carcinoma

Unilateral internal iliac or inguinal LN involvement


Define N3 anal canal carcinoma

perirectal AND inguinal LN involvement or bilateral internal iliac / inguinal nodes


Define M0 anal canal carcinoma

no distant mets


Define M1 anal canal carcinoma

distant mets


What are the TNM stages (1) a/w Stage I anal canal carcinoma?



What are the TNM stages (2) a/w Stage II anal canal carcinoma?

T2-3, N0, M0


What are the TNM stages (3) a/w Stage IIIA anal canal carcinoma?

T1-3, N1, M0


What are the TNM stages (2) a/w Stage IIIB anal canal carcinoma?

T4, N1, M0 OR T-any, N2, M0


What are the TNM stages (1) a/w Stage I anal canal carcinoma?

T any, N any, M1


why is nonsurgical therapy the standard of care for initial treatment of anal canal carcinoma?

high response rate and high rate of sphincter preservation


what is the standard chemoradiation protocol to treat anal canal carcinoma

45 Gy in 25 fractions over 5 weeks to the primary cancer + 5-FU infused on days 1-4 & 29-32 + mitomycin C bolus days 1 & 29


what is the systemic therapy for metastatic anal canal carcinoma?

5-FU & cisplatin


how long does it take residual anal canal carcinoma to regress after chemoradiation?

up to 12 weeks


when should you perform repeat assessment of residual masses after chemoradiation for anal canal carcinoma and how should you evaluate?

biopsy mass at 12 weeks after completion of chemoradiation. If positive, proceed to surgery.


Name three preoperative considerations prior to APR for anal canal carcinoma

1) stoma site marking; 2) preop abx; 3) VTE ppx


what step should be considered to facilitate wound healing in patients undergoing APR after radiation therapy?

consider a myocutaneous flap


what are the basic steps of APR?

1) pt in lithotomy; 2) lap or open mobilization of distal colon and rectum; 3) divide mesentery at proximal SMA pedicle; 4) once dissected to pelvic floor, start dissection from perineal approach cephalad to meet intraabdominal portion while maintaining a wide dissection thru levator muscles; 5) resect specimen and send grossly close margins to frozen for eval; 5) place muscle flap in pelvis and close perineal defect in several layers with absorbable suture


how is an APR performed in the supine and prone positions?

perform abdominal portion of procedure in supine position, create colostomy, close abdominal incision, place patient prone to complete perineal portion of procedure


what is the postoperative follow up for anal canal carcinoma s/p APR?

follow up q3-6mo for 5 years with inguinal LN examination and anoscopy + topical acetic acid to survey for recurrent HPV dysplasia. If pt with T3 or greater disease or node posiitve disease, annual C/A/P imaging x 3 years


what should you do if you encounter metastatic disease at the time of APR?

continue to proceed with APR b/c this may be appropriate for palliation of symptoms from local dz